I was admitting Darlene Jenkins, a pregnant, unmarried,14-year-old to the prenatal clinic. This was her first visitand she was already in her third trimester. A quick historyrevealed multiple factors putting both her and her fetus at risk for health problems: lack of family (or other) support (home-less, occasionally staying with an older girlfriend), father of the baby unknown, multiple sexual partners, diet consistingmainly of fast food, no prenatal vitamins, little to no exercise,and history of smoking (2 packs of cigarettes per day) andalcohol consumption (“beer 4 to 5 times a week”). When shewas seen by the medical resident, he asked her quite curtly if she was trying to “kill your baby,” telling her that it was prob-ably too late for her to get the care she needed. “Why should we waste our time on you when other women here reallywant to be helped?” Although Darlene was acting “tough,” Icould tell from her expression that she was both angry andhurt. While I was upset by the choices that she had made sofar and shared some of the resident’s frustration, I knew wehad to give her a reason to trust us if we wanted her to starttaking better care of herself and her baby. I was also upsetby the resident’s lack of professionalism and wondered if Ishould say something to him. How do you think you would respond in a similar situa-tion? Why? What does this tell you about yourself and the adequacy of your skills for professional practice? Can youthink of other ways to respond? What knowledge, skills, andattitudes do you need to develop to continuously improvequality and safety when caring for patients like Darlene? Patient-Centered Care: What information should be com-municated to Darlene regarding concerns about her preg-nancy and the developing fetus? How could you involve the patient as a partner in coordinating her care to promote trust?How might you talk with Darlene about the various risk factorscontributing to her health and that of her baby? What is thebest way to communicate emotional support to Darlene?Teamwork and Collaboration/Quality Improvement:What communication skills do you need to continue to functionas a resource and advocate for Darlene? What if the nurse confronted the resident in front of the patient? Would you con-sider this professional behavior? Do you feel that the resident functioned in a professional manner? Do you agree with the nurse in her thinking that an apology from the resident wouldhelp encourage Darlene to trust health care professionals? Whyor why not? Are there other community resources that mighthelp Darlene in the care of her baby following the baby’s birth?Safety/Evidence-Based Practice: Is there anything more youcould have done to acknowledge you understand Darlene’sreasons for lack of trust and possible unwillingness to makechanges to promote a positive outcome? How might a nurse’sdevelopmental stage have affected the actions taken toward the resident and the patient? What evidence in nursing literature pro-vides guidance for decision-making regarding ensuring a safe environment and giving Darlene the support that she needs?Informatics: Can you identify essential information thatmust be documented in Darlene’s electronic record aboutefforts to communicate with her and the specific concernsthat she expressed? What other information must be available to support safe care for Darlene and her fetus and coordina-tion of her care? Can you think of other ways to respond or approach the situation?

Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
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I was admitting Darlene Jenkins, a pregnant, unmarried,
14-year-old to the prenatal clinic. This was her first visit
and she was already in her third trimester. A quick history
revealed multiple factors putting both her and her fetus at risk

for health problems: lack of family (or other) support (home-
less, occasionally staying with an older girlfriend), father of

the baby unknown, multiple sexual partners, diet consisting
mainly of fast food, no prenatal vitamins, little to no exercise,
and history of smoking (2 packs of cigarettes per day) and
alcohol consumption (“beer 4 to 5 times a week”). When she
was seen by the medical resident, he asked her quite curtly if

she was trying to “kill your baby,” telling her that it was prob-
ably too late for her to get the care she needed. “Why should

we waste our time on you when other women here really
want to be helped?” Although Darlene was acting “tough,” I
could tell from her expression that she was both angry and
hurt. While I was upset by the choices that she had made so
far and shared some of the resident’s frustration, I knew we
had to give her a reason to trust us if we wanted her to start
taking better care of herself and her baby. I was also upset
by the resident’s lack of professionalism and wondered if I
should say something to him.

How do you think you would respond in a similar situa-
tion? Why? What does this tell you about yourself and the

adequacy of your skills for professional practice? Can you
think of other ways to respond? What knowledge, skills, and
attitudes do you need to develop to continuously improve
quality and safety when caring for patients like Darlene?

Patient-Centered Care: What information should be com-
municated to Darlene regarding concerns about her preg-
nancy and the developing fetus? How could you involve the

patient as a partner in coordinating her care to promote trust?
How might you talk with Darlene about the various risk factors
contributing to her health and that of her baby? What is the
best way to communicate emotional support to Darlene?
Teamwork and Collaboration/Quality Improvement:
What communication skills do you need to continue to function
as a resource and advocate for Darlene? What if the nurse

confronted the resident in front of the patient? Would you con-
sider this professional behavior? Do you feel that the resident

functioned in a professional manner? Do you agree with the

nurse in her thinking that an apology from the resident would
help encourage Darlene to trust health care professionals? Why
or why not? Are there other community resources that might
help Darlene in the care of her baby following the baby’s birth?
Safety/Evidence-Based Practice: Is there anything more you
could have done to acknowledge you understand Darlene’s
reasons for lack of trust and possible unwillingness to make
changes to promote a positive outcome? How might a nurse’s
developmental stage have affected the actions taken toward the

resident and the patient? What evidence in nursing literature pro-
vides guidance for decision-making regarding ensuring a safe

environment and giving Darlene the support that she needs?
Informatics: Can you identify essential information that
must be documented in Darlene’s electronic record about
efforts to communicate with her and the specific concerns
that she expressed? What other information must be available

to support safe care for Darlene and her fetus and coordina-
tion of her care? Can you think of other ways to respond or

approach the situation?

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