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The patient being assessed is a 38-year-old Native American who is pregnant and living on a
reservation. The first step in building a medical history is to create a relationship with the patient. Ball et
al. (2019) states that each person is unique and to prevent misinterpretations or misperceptions, the
provider must grasp the patient’s personal sense to the world. Personal experience from a situation can
be interpreted differently from a patient with a different background, although the experience is the
same (Ball et al., 2019). Honesty and candor can create a trusting partnership that is needed to be
successful. To provide high-quality care, the care provided must be patient-centered care. Individuals
can make choices related to their health if the provider respects their wants, needs, and preferences
(Ball et al., 2019).   

Native Americans have unique social determinants of health including poverty, federal food programs,
food deserts, adverse childhood experiences, and trauma (Warne & Wescott, 2019). Open-ended
questions without interruption are important when a provider is seeking a connection and learning the
patient’s health history. Creating physical and emotional comfort for this patient is very important
when attempting to create trust. Communication is key in creating such an environment.  

The patient must be questioned about their history to determine if it threatens their well-being or
that of the fetus. Preterm labor, pre-eclampsia, malnutrition or vitamin deficiency, and drugs such as
lithium valproic acid or angiotensin-converting enzyme inhibitors should be questioned because they
can put the patient and the fetus at high risk. One tool that can be provided for this patient is called the
Pregnancy Risk Assessment Monitoring System (PRAMS). The Centers for Disease Control and
Prevention (n.d.) states that this program is developed to reduce morbidity and mortality of infants
influenced by maternal behaviors that happen before, during, and after pregnancy. It is designed to
improve the health of mothers and infants by determining those who are at high risk of health issues,
monitoring health status changes, and measuring progress (Centers for Disease Control and Prevention,
n.d.).  

There are many factors that can contribute to an increased risk of health. A factor that increases health
related risk for a pregnant 38-year-old is her age. Pregnancy after the age of 35 increases her risk of
gestational diabetes, high blood pressure during her pregnancy, premature birth with a low birth
weight, cesarean section, chromosomal conditions, and miscarriage.  

There are a few targeted questions that need to be asked of this pregnant 38-year-old Native
American patient including: 

 Have you had any previous pregnancies? If so, did you have any complications with the
pregnancy or delivery? 

 Are there special beliefs and practices surrounding pregnancy, childbirth, lactation and
childrearing? 

 What is your current prenatal care?  

 Who is ultimately responsible for maintaining your health?  

 Who makes the decisions in the family? 

References 

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel's guide to physical
examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby. 

Centers for Disease Control and Prevention. (n.d.). About

PRAMS. https://www.cdc.gov/prams/about/prams-faq.htm  

Mayo Clinic. (2022). Pregnancy after 35: Healthy pregnancies, healthy

babies.  https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy/art-
20045756  

Warne, D., & Wescott, S. (2019). Social Determinants of American Indian Nutritional Health. Current
Developments in Nutrition, 3(2), 12-18.  https://doi.org/10.1093/cdn/nzz054

AXA POST

 According to Ball et al. (2019), building a health history is vital to diagnosing

patients appropriately. To make this process comfortable and trustful, healthcare
providers should acknowledge patient differences and beliefs. Moreover, a unique
technique is essential to individualized patient care according to the patient
background. The communication techniques used in the case of an immigrant will
focus on chronic illness, migration trauma, and socioeconomics.

My patient is a 40-year-old black recent immigrant from Africa without health

insurance. The challenge here is that this patient’s English fluency is not indicated. I
would begin my interview by offering a friendly smile to make the patient feel
comfortable and introduce myself.  I would then ask basic questions such as name,
age, and where the patient resides to assess the patient’s language competency.  If
necessary, I may require the assistance of an interpreter, perhaps a software tool to
help with translating, if an interpreter is unavailable. Thus, a language assessment
is imperative in obtaining this patient’s comprehensive health history.

After addressing any communication challenges, focus on obtaining basic

information such as age, gender, marital status, and occupation.  After that,
proceed towards getting a thorough health assessment by asking specific
questions.  The aim of obtaining a high-quality, comprehensive patient health
history is to identify symptoms that represent a range of pathologies; even by itself,
the assessment is a powerful instrument (Diamond-Fox, 2021).

Advanced practice providers have several risk assessment tools at their disposal,
and according to Wu and Orlando, “Health risk assessments (HRAs) are an
important element of the healthy stage” (2015, p. 508.)  One of the appropriate
Health Risk Assessment tools to consider in this clinical scenario is an assessment
of cultural needs. Research provides a proliferative set of questions to aid cultural
assessment (Ball et al., 2019). The patient is an immigrant, which places him at a
greater risk of psychological health problems such as culture shock, low
socioeconomic status, and a possible void in the emotional family/support system
(Adu-Boahene et al., 2017). And for this reason, add a mental health component in
my interview to check for any signs of depression, anxiety, trauma, sleep
disturbance, eating disorder, substance abuse, or violence. Many adult immigrants
feel depressed about being in a new place and worry about restarting their life. The
patient health questionnaire nine tools for depression could be helpful in this
patient because of a change of lifestyle, stressful life events, possible chronic illness,
and no insurance.

Five targeted questions

 What is the reason for your visit today?

 When did you first begin to feel your symptoms?
 Can you describe your symptoms, giving the location, duration, aggravating and alleviating factors, onset,
and duration?
 Do you have any medical conditions, or are you taking medications for any condition? Are there any
childhood illnesses or injuries pertinent to the patient’s chief complaint?
 Lastly, “Why are you seeking medical help right now, and what can I do to help you?” I would like to
summarize by asking, “Am I missing anything? or “Is this information correct?
 

Advanced practice providers must consider all aspects of a person’s health: their
cultural expectations and beliefs, their environmental surroundings, their current
complaints, their family history, their understanding of health, both ill and well, and
their expectations of what health care looks like and how it should serve them best.
Advanced practice providers need to carefully consider the unique descriptors of
each patient to allow them to develop the most effective assessments to accurate
health history.

References

Adu-Boahene, A. B., Laws, M. B., & Dapaah-Afriyie, K. (2017). Health-Needs

Assessment for West African Immigrants in Greater Providence, RI. Rhode Island
Medical Journal, 100(1), 47–50. Retrieved November 29, 2020, from https://doi.org/PMID:
28060966
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s
guide to physical examination: An interprofessional approach (9th ed.). Mosby.

Diamond-Fox, S. (2021). Undertaking consultations and clinical assessments at

advanced level. British Journal of Nursing, 30(4), 238-243. https://doi.org/10.12968/bjon.2021.30.4.238