Discussion: NURS 6512 Diversity and Health Assessments
Discussion: NURS 6512 Diversity and Health Assessments
Discussion NURS 6512 Diversity and Health Assessments
You submitted a very thoughtful and thorough approach to this patient’s assessment. There are many factors that needed to be addressed considering the patient’s sexuality, socioeconomic, and mental health state. As you stated creating a safe and secure environment is essential to building trust with the patient to best identify the needs and resources available (Ball et al., 2019). I found it interesting that the patient has an active green card. Using the RESPECT model would allow the patient to feel at ease discussing his cultural beliefs and values (Ball et al., 2019). This allows the provider to connect on a social level even if the provider is not on the same level-Rapport.
The patient has multiple issues that need assistance and has been brave enough to come to the clinic, so providing help and empathy creates security and safety in the patient-provider relationship-Empathy. Understanding the patient’s preference for pronouns, as you stated, is important to acknowledge how the patient identifies and shows respect (Ball et al., 2019). Identifying the patient’s barriers are necessary to also discover his support (Ball et al., 2019). Since the patient is unemployed, it would be beneficial to determine if he has insurance (Schembri & Ghaddar,2017). Referring the patient to a financial counselor would benefit him in discovering resources available to help with medication assistance and regular provider visits (Ball et al., 2019).
Understanding the country of origin will help the provider understand if the patient is battling cultural beliefs and values with his decision to transition from his natural gender assignment (Young & Guo 2016). This may be a factor contributing to his depression. As you reported, it is important to discover his support system as being a green card holder and transgender patient raises concern for the need for a good support system so the patient does not feel alone (Pankaew & Nuchanad, 2022). Depression is ranked high in the transgender population, therefore finding appropriate resources for counseling and medications is essential for the holistic health of the patient (Pankaew & Nuchanad, 2022). With the prescribing of gender-altering hormones, anxiety and depression are higher among the transgender population (Aldridge, et al., 2022).
As the provider, it is important to communicate to the patient that you are a team and working toward the same goal (Ball et al., 2019). Continually assessing if the patient is understanding your communication is key as he is not from this country. Explaining the rationale for questions and treatment is essential to determine mutual goals and understanding (Coleman, 2019). Respecting the patient’s decision is essential for gaining trust (Ball et al., 2019). This is a sensitive subject so the patient needs to feel confident in trusting the provider to disclose inhibitions, lifestyle, and limitations (Ball et al., 2019).
I agree with the open-ended questions, but see the importance of specific questions to target specific needs for medication assistance as having a provider to follow medication administration and socioeconomic factors is essential (Ball et al., 2019).
With the patient’s history of HIV, addressing The Five P’s of Sexual History is essential as the transition completion does not negate safe sex (Ball et al., 2019). The Five P’s include partners, practices, protection of STIs, past history of STIs, and prevention of pregnancy for the patient.
I appreciate your thorough assessment approach and wish you continued success in the program!
References
Aldridge, Z., Patel, S., Guo, B., Nixon, E., Pierre Bouman, W., Witcomb, G. L., & Arcelus, J.
(2021). Long-term effect of gender-affirming hormone treatment on depression and anxiety symptoms in transgender people: A prospective cohort study. Andrology, 9(6), 1808–1816. https://doi.org/10.1111/andr.
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.
Coleman, D. E. (2019). Evidence based nursing practice: The challenges of health care and cultural diversity Links to an external site.
Links to an external site.. Journal of Hospital Librarianship, 19(4), 330–338. https://doi.org/10.1080/
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Pankaew Tantirattanakulchai, & Nuchanad Hounnaklang. (2022). Perceived social support and its relationship with depression among Bangkok’s trans women. Journal of Health Research, 36(2), 365–375. https://doi.org/10.1108/JHR-
Schembri, S., & Ghaddar, S. (2017). A Cultural View on Healthcare Access: Considering the
Hispanic Perspective. Advances in Consumer Research, 45, 469–473.
Young, S., & Guo, K. L. (2016). Cultural diversity training Links to an external site.
Links to an external site.. The Health Care Manager, 35(2), 94–102. https://doi.org/10.1097/hcm.
In May 2012, Alice Randall wrote for The New York Times about the cultural forces that led black women to maintain weights over what was considered healthy. According to Randall’s observations and personal experience as a black woman, many African-American communities and cultures regard fat women as more attractive and desirable than healthy-weight women. As she noted, many black women are heavy because we want to be (Randall, 2012).
Although Randall’s remarks sparked much debate and controversy, they illustrate a fundamental truth in the medical industry: different people, races, and groups have distinct beliefs and behaviors that affect their health. Nurses and other healthcare providers should be aware of this fact and adjust their recommendations and health-evaluation methods to accommodate for variation.
You will examine different social, spiritual, behavioral, and other cultural variables that should be taken into account while constructing a health history for individuals from varied backgrounds in this topic.
The population in the united states is composed of people from diverse cultural backgrounds and this aspect is also duplicated in the healthcare system. To ensure the provision of quality and effective healthcare services to the diverse population, the healthcare providers must be competent, sensitive, and also be aware of the diversity of the patient cultures and other essential beliefs as well as avoid stigmatizing patients based on their cultural differences.
When a healthcare provider is culturally competent, he or she accepts the diverse needs of their patients even though the diverse needs may be different from those of theirs. To ensure culturally competent healthcare services, the healthcare providers must be sensitive to the patient’s socioeconomic status, heritage and ethnicity. Distinct from cultural awareness and cultural sensitivity, cultural competence is the ability of healthcare providers to modify their practices such that they effectively meet the needs of the different cultural groups (Sharifi, Adib-Hajbaghery, & Najafi, 2019). On the contrary, cultural awareness and sensitivity highlight the ability to recognize the differences without necessarily modifying practices to meet the various needs of different patients.
Case scenario
The case study presents Mono Nu, who is a 44- year old Filipino patient who
started blood thinner medications a period of two weeks ago. The patient is from a low-income household and hence does not afford the prescribed medication. Besides, he has no adequate understanding on the working mechanism of the medications or why they are necessary. In addition, the patient lacks a social support network so that he can maintain his medications. His main diet is fish and tofu, which may lack in some essential nutritional components hence affecting the mode of action of the blood thinner medications.
Cultural Factors
Mono Nu is from the Philippines which makes him have a different understanding of health and wellness contrary to people from the western culture. The culture in the Philippines is such that they rely on family, friends, and faith in God for healing (Cacho & del Castillo, 2022). This culture of health and wellness prevents the Philippines from access to healthcare.
The culture of the patient, therefore, has an impact on his health because it can dictate his willingness to adhere to the prescribed medications (Collado, 2019). In addition, the patient does not understand why his medications are producing the anticipated results meaning that the patient might be frustrated or, might be in a state where he feels helpless. His choice of diet however indicates that he appreciates specific diet which is essential to healthy eating.
As a health practitioner, some of the most sensitive issues to take into account while interacting with this particular patient include their age, cultural differences in terms of health beliefs, the likelihood of frustrations with the medications, and some potential side effects of medications.
Targeted Questions
- What is your level of income? Do you have financial challenges in obtaining your prescribed medications?
- Do you understand the mode of action of your blood thinner medications and why they are necessary for your current state?
- Are there some cultural beliefs that may negatively influence your willingness to take the prescribed medications?
- Do you have any social program that can assist you in obtaining your medications as prescribed?
- Are there any other health concerns that you feel that I should be aware of?
References
Cacho, R., & del Castillo, F. (2022). God’s Benevolent Love in the Time of COVID-19 Pandemic: Articulations and Experiences of Select Filipino Youth. Religions, 13(2), 162.
Collado, Z. C. (2019). Challenges in public health facilities and services: evidence from a geographically isolated and disadvantaged area in the Philippines. Journal of Global Health Reports, 3.
Sharifi, N., Adib-Hajbaghery, M., & Najafi, M. (2019). Cultural competence in nursing: A concept analysis. International journal of nursing studies, 99, 103386.
Case 1
JC, an 86-year-old Asian male in need, is physically and financially dependent on his daughter, a single mother with little time or money to devote to her father’s medical requirements. He has high blood pressure (HTN), gastroesophageal reflux disease (GERD), a vitamin B12 deficiency, and chronic prostatitis. He is currently taking Lisinopril 10mg QD, Prilosec 20mg QD, monthly B12 injections, and Cipro 100mg QD. He walks in for his yearly physical and says, “I came for my annual physical, but I don’t want to be a burden to my daughter.”
Case 2
TJ, a 32-year-old pregnant lesbian, is getting a physical exam and has been experiencing vaginal discharge. So far, her pregnancy has been trouble-free. She has been seeing an obstetrician for prenatal care. She obtained sperm from a nearby sperm bank. She is now taking prenatal vitamins and occasionally takes Tylenol over the counter for aches and pains. She comes from a long line of diabetics. Abortions 0; Gravida 1; Para 0;
Case 3
MR, a 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle. He is not taking any prescriptions medications and denies drug use. He has a positive family history of diabetes, hypertension, and alcoholism.
To prepare:
Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
Select one of the three case studies. Reflect on the provided patient information.
Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?
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By Day 3
Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Read a selection of your colleagues’ responses
By Day 6
Respond on or before Day 6 to at least two of your colleagues who selected a different patient than you, using one or more of the following approaches:
Suggest additional socioeconomic, spiritual, lifestyle, and other cultural factors related to the patient.
Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.
My patient is TJ, a 32-year-old pregnant lesbian, who is being seen for an annual physical exam and has been having vaginal discharge. Her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. She is currently taking prenatal vitamins and takes over the counter Tylenol for aches and pains on occasion. She has a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.
It is important for the provider to be aware of the sexual orientation of a patient. When working with a patient who is of a sexual minority it becomes equally important for the provider to know of any potential feelings regarding heterosexism and homophobia within themselves. Feelings of apprehension or reluctance to discuss preferences can be assuaged by using nonjudgmental words, tone, posture, and approach to examining the patient (Ball, et al 2019).
In order to build a health history for my patient, trust and honesty can be initially instilled by offering informational pamphlets and resources in the office and waiting areas. Then a supportive relationship can be best developed by asking gender neutral questions and then building upon the initial interaction with more direct and open questions.
Questions that are open-ended versus simple yes or no responses would be more likely to create a discussion rather than close down the discussion. For example, asking about the patient’s living situation rather than whether they are married or if the patient has a boyfriend/girlfriend would be a nonjudgmental approach to any circumstances.
To start the patient assessment, general questions such as establishing why the patient has made the appointment with the provider; when the health problem started; and the length of time for symptoms. The patient’s age, marital status, gender, occupation, previous hospital/medical concerns/medications prescribed; over the counter/natural supplements used; pregnancy insemination date; and last lab draw date can be noted in the patient’s record.
A completed patient history would include a timeline of the symptoms and what the patient status was prior to the symptoms starting; female productive history, sexual history, aggravating factors; and alleviating techniques. This is also a good time to be alert for a secondary health concern that the patient may want to discuss and determining the patient’s support system that is available over the next few months.
Vaginal discharge in pregnant women is common and may be normal or abnormal. Physiological vaginal discharge in pregnancy is colorless or white, non-irritating, and odorless with no sequelae. It is important to ask the patient:
- When did the discharge begin?
- Color of discharge?
- Is there any odor?
- Do you have any vaginal pain?
- Any symptoms of urinary tract infection?
Once these questions are answered, it would also be important to complete a vaginal exam with swabs taken to determine if there is any infection in the discharge and obtain a urine sample to test for a urinary tract infection. This is also an opportune time to complete patient education on some of the reasons why a female can have a discharge during pregnancy (Ball, et al 2019).
Resources
Ball. J. W., Dains. J. E., Flynn. J. A., Solomon. B. S. & Steward. R. W. (2019). Seidel’s guide to
physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier
Mosby. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883588/
Prasad. D., Parween. S., Kumari. K. & Singh. N (2021). Prevalence, etiology, and associated
symptoms of vaginal discharge during pregnancy in women seen in a tertiary care
hospital in bihar. Cureus. Jan 14;13(1): e12700. doi: 10.7759/cureus.12700. PMID:
33614308; PMCID: PMC7883588. Retrieved from: https://www.ncbi.nlm.nih.
gov/pmc/articles/PMC7883588/
The assigned case study features a White young adult male patient who underwent a gender transition two years ago. Numerous socioeconomic, spiritual, lifestyle and other cultural factors have an impact on the patient’s health and well-being. The patient’s socioeconomic situation prevents him from affording to seek proper medical care services because he is currently unemployed and has no health insurance (Bringedal & Isaksson R, 2021).
His lifestyle, which includes marijuana and tobacco use, is detrimental to his physical and emotional well-being. In terms of his spirituality, the patient would find it challenging to join a faith that endorses gender transition without risking his mental health. As a Caucasian, the client may face discrimination for being transsexual.
It will be necessary for the Nurse Practitioner to utilize tact when speaking with the patient about several topics about his health and way of life (Safer & Tangpricha, 2019). For instance, it’s vital to use inclusive language and ask open-ended inquiries that let patients describe their gender identity and sexuality in their own words. It’s crucial to inquire about the patient with care and consideration about his HIV diagnosis and depressive episodes.
When it will be required to disclose information about a patient’s body to other healthcare practitioners for medical purposes, the nurse practitioner should presume that this information is very confidential and should notify patients in advance (López et al., 2020). Frequently, more pertinent, direct queries are preferable.
The following five inquiries will be made to further evaluate the patient’s health (Ball et al., 2019):
- What surgical procedures have you had?
- What additional symptoms are you having besides feeling weak?
- How long have you been receiving hormone treatment?
- How are you dealing with your recent depressive episode?
- What kind of health promotion do you perform?
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.
Bringedal, B., & Isaksson RØ, K. (2021). Should a patient’s socioeconomic status count in decisions about treatment in medical care? A longitudinal study of Norwegian doctors. Scandinavian Journal of Public Health, 140349482110336. https://doi.org/10.1177/14034948211033685
López, S. R., Ribas, A. C., Sheinbaum, T., Santos, M. M., Benalcázar, A., Garro, L., & Kopelowicz, A. (2020). Defining and assessing key behavioral indicators of the Shifting Cultural Lenses model of cultural competence. Transcultural Psychiatry, 57(4), 594–609. https://doi.org/10.1177/1363461520909599
Safer, J. D., & Tangpricha, V. (2019). Care of Transgender Persons. New England Journal of Medicine, 381(25), 2451–2460. https://doi.org/10.1056/nejmcp19036
Thank you, Lainey, for your thoughtful response. The influence of various factors such as age, gender, race, ethnic group, cultural attitudes, regional differences, and socioeconomic status on both patient-seeking behavior and clinician care provision has been acknowledged by Ball et al. (2019). In the case of the African American patient described, who is labeled as a “frequent flyer,” it is important to consider the unique factors that may contribute to his attitudes and health-seeking behaviors.
Access to quality medical care, or the lack thereof, is a signifi