aving great clinical knowledge about the disease processes and medications to treat is only a part of what it takes to be an effective advanced practice nurse. In order for the advanced practice nurse to apply these skills, they need to have effective communications skills that allow them to gather the needed information pertaining to their current condition. When establishing the clinician and patient relationship it is important to explore the patient’s past medical history, assess current health practices, identify potential risk factors, and assessment of knowledge, expectations, and perceptions of pregnancy (Ball et al, 2019). Depending on the client in question there are several concepts and practices that can be applied to create a situation that is comfortable to the patient in order to help ensure they are confident in your ability as an advanced nurse practitioner to provide competent care in treating their problem. According to Ball et al, (2019), the skills of listening and the use of non-verbal cues are both of the utmost importance when interacting with a client.
When building a health history for a 16-year-old white pregnant teenager that lives in an inner-city neighborhood it is important to understand several things in order to communicate effectively without seeming biased or judgmental. Knowing that she is a high-risk pregnancy, at an age where drug use is common, the potential for social isolation, and the possibility of being subject to a low socioeconomic living will all have to be addressed in a manner that builds a trusting nonjudgmental relationship in order to ensure she is being completely honest with you during the interview. Parra-Pingel et al, (2017) point out that teenage patients are at high risk for preeclampsia at two times the rate as women of adult age.
When trying to establish a relationship with a teenage client there are a few things I would do. First off I would position myself at an eye level in order imply that we are equal. The next thing I would do is to attempt to use age-appropriate language, this will help make me seem relatable to her. I would be sure to use open-ended questions and allow her ample time to respond and at the same time write down any area that allowed for further explanation or education that I can address at the appropriate times. According to Ball et al, (2019) because of her age, it would be appropriate to use the CRAFFT questionnaire, the HITS screening tool, and the 5 p’s of sexual activity as risk assessment tools. Evaluating an adolescent’s social history through a substance screening tool such as CRAFFT is pertinent to determine their potential involvement with alcohol and other drugs that would have a harmful effect on the teen mother or baby (Ecker et al, 2019). Ball et al, (2019), imply that the HITS tool is used to assess the girl for abuse from her partner and in her home for both verbal and physical violence. The 5 P’s of sexuality involve questions regarding sexual partners, sexual practices, sexual protection for STDs, prevention of pregnancies, and any past history of STDs. Before I implemented this particular assessment tool I would make sure the patient understood the importance of these questions and ensure her that they were routinely asked of all patients in her situation.
When thinking of questions to ask a 16-year-old pregnant girl it would be pertinent to ask questions that assess age-related risks, her expectations of pregnancy, and her current living situation. These questions can help to establish if she has the proper support systems, such as family, financial, mental health, and nutrition. They should also help to address her current medications and how they could affect her current situation. Here are five questions that could be asked to help gather this information.
1. Are you on any medications currently, including any over-the-counter vitamins and supplements?
2. How many people live in your household? Do you live with your parents or another family member?
3. Are you in school? What grade are you in?
4. Has anyone talked to you about resources that are available to help alleviate some of the financial burdens as well as nutritional needs such as food stamps. WIC, and potential cash assistance?
5. Were you happy to find out you were pregnant?
References
Ball, J., Dains, J., Solomon, B., & Stewart, R. (2019). Seidel’s Guide to physical examination. Seidel’s Guide to Physical Examination – 9th Edition.
Ecker , J., Abuhamad, A., Hill, W., Bailit, J., Bateman, B. T., Berghella, V., & Blake-Lamb, T. (2019, March 17). Substance use disorders in pregnancy: Clinical, ethical, and research imperatives of the opioid epidemic: A report of a joint workshop of the society for maternal-fetal medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine. American journal of obstetrics and gynecology. https://doi.org/10.1016/j.ajog.2019.03.022
Parra-Pingel, P. E., Quisiguia-Avelln, L. A., Hidalgo, L., Chedraui, P., & Prez-Lpez, F. R. (2017, June 6). Pregnancy outcomes in younger and older adolescent mothers with severe: AHMT. Adolescent Health, Medicine and Therapeutics. 8, 81-86. doi:10.2147/AHMT.S131050
