Assignment: You are the midwife/WHNP, seeing a prenatal patient. In this simulation, you will focus ONLY on prenatal genetic screening/testing, vaccinations, and physical activity
Assignment: You are the midwife/WHNP, seeing a prenatal patient. In this simulation, you will focus ONLY on prenatal genetic screening/testing, vaccinations, and physical activity
Case scenario
You are the midwife/WHNP, seeing a prenatal patient. In this simulation, you will focus ONLY on prenatal genetic screening/testing, vaccinations, and physical activity.
Patient’s name: Valerie Saunders
Age, gender: 36 years old; cisgender woman
Race: Did not disclose
Reason for presenting to care: Prenatal visit at 11 weeks gestation. Established care at 7 weeks so this is her second visit. Clinicians/learners have met her before and established a caring relationship at the previous visit.
ORDER A CUSTOMIZED, PLAGIARISM-FREE PAPER HERE
Good News For Our New customers . We can write this assignment for you and pay after Delivery. Our Top -rated medical writers will comprehensively review instructions , synthesis external evidence sources(Scholarly) and customize a quality assignment for you. We will also attach a copy of plagiarism report alongside and AI report. Feel free to chat Us
Current medications: prenatal vitamins, occasional Tums
Past Medical and Surgical History: None significant. Had all childhood vaccinations. Had two doses of Pfizer covid-19 vaccine (last dose 6-7 months ago.) Has not had a COVID-19 booster. NKDA
Past OB/GYN History: This is Valerie’s first pregnancy. Planned pregnancy. No significant gynecologic history
Family History: No known genetic disorders in the patient’s family or the partner’s family
Social History: Married, grocery store manager, does not use tobacco, alcohol, or illegal substances. Does not have a specific exercise routine.
OB chart review for previous visit at 7 weeks: Dates set by Naegele’s Rule (sure, normal LMP and regular cycles). Pt reported fatigue and significant nausea/vomiting at that visit and so she did not want to discuss genetic screening/testing options, vaccinations, or physical activity. BP 108/68. Wt 169. BMI 28. Uterine size consistent with 7 weeks gestation. All first trimester labs done at that visit and all results normal. Has not had carrier screening for inherited gene mutations. Edinburgh perinatal depression screen negative for depression. Patient has indicated that she is NOT interested in considering terminating the pregnancy, regardless of results of any screening or testing.
Today’s ROS: No bleeding or cramping. Nausea/vomiting and fatigue are getting much better. Feels generally well today.
Today’s physical exam results:
● BP 110/72
● Wt 171 (2 lbs. total weight gain so far), BMI 28 at initial OB visit
● Uterine fundus just below the level of the symphysis
● After SDM discussion with patient about risks and benefits of attempting to auscultate fetal heart tones with Doppler today, decision made to auscultate with Doppler and FHTs heard at 168 bpm
What questions would help the patient articulate her screening/testing preferences and values?
What are the screening/testing options that align with common pathways of discussion and how will you develop a plan with the patient?
The focus points
Topic 1/Shared decision-making/prenatal genetic screening/testing options conversation
- Faculty will indicate that the simulation should begin and the first clinician pair will greet the patient and begin.
- The student clinician assigned to the patient-information gathering portion should ask the necessary questions to determine the patient’s values, preferences, experiences, etc. that would be needed to determine which options to present. Don’t forget all three types of screening: (1) carrier screening for gene variants in the parents, (2) screening for fetal aneuploidies/chromosomal differences, (3) screening for fetal anatomic differences like neural tube defects.
- The student clinician assigned to discuss options should use the information that the first student gathered to present options that align with the needs and values that the patient expressed, come to a decision, and name the decision.
- Although we’ve separated the two roles, we recognize that the dividing line between asking questions and presenting options can be fluid and blurry. Please just remain flexible and we promise that it works out OK!
- For students who are observing this portion (rather than acting as the clinician), consider the following. Did the student clinicians: ask about the patient’s values, beliefs, and concerns about prenatal genetic screening/testing options; present prenatal genetic screening/testing information accurately, based on what the patient said, and without medical jargon; and name the decision that the patient made and summarize next steps? What did you notice about the way those parts of the conversation flowed or how the patient reacted?
Topic 2/Motivational interviewing/health behaviors conversation
- Faculty will signal the switch of topics and clinicians/observers. The observers for the genetic testing portion will now be in the clinician role and begin with the motivational interviewing/health behaviors portion.
- The student clinician assigned to the vaccinations portion should focus on all relevant aspects of the motivational interviewing process for influenza and COVID-19 vaccinations. Use the patient’s responses, prioritization, and MI to guide you, rather than giving a lecture. For the influenza vaccination, imagine that it’s early in flu season, rather than the time of year we’re actually in. Don’t forget to consider the COVID-19 booster.
- The student clinician assigned to the physical activity portion should focus on all relevant aspects of the motivational interviewing process for physical activity. Use the patient’s responses, prioritization, and MI to guide you, rather than giving a lecture.
- The most common area of motivational interviewing skills that students identify they plan to improve in the future is jumping in quickly with advice and teaching. Try to resist this.
- For students who are observing this portion (rather than acting as the clinician), consider the following. Did the student clinicians assess the patient’s priorities, motivations, desires, barriers, concerns, and goals for vaccination and physical activity during pregnancy; present information based on what the patient conveyed; and name the decision that the patient made and summarize next steps? What did you notice about the way those parts of the conversation flowed or how the patient reacted?