NURS 6512 Discussion Diversity and Health Assessment

NURS 6512 Discussion Diversity and Health Assessment

NURS 6512 Discussion Diversity and Health Assessment

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.

May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Photo Credit: Getty Images
Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.
In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

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.
• By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
• Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
• 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?

By Day 3 of Week 2

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. 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 of Week 2

Respond on or before Day 6 on 2 different days to at least two of your colleagues who were assigned a different patient than you. 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.

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Discussion Week 2

Patient Scenario:

TJ, a 32-year-old pregnant lesbian, 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.

Specific Socioeconomic, Spiritual, Lifestyle, and other Cultural Factors

Despite impressive advances towards LGB equality in many countries, including the United States, research suggests that LGB persons continue to experience health disparities on almost every major US health indicator, including tobacco use, alcohol and drug use, depression, anxiety and suicidality, reproductive and sexual health, nutrition, physical activity and obesity (Dorsen & Van Devanter, 2017). While working with this patient, it is essential to be aware of the patients’ demands and provide non-judgmental care.

Identifying risk factors for sexually transmitted infections are a necessary part of the sexual history (Ball et al., 2019). For this patient focusing on the chief complaint, when discharge may have begun, and how long it has been happening. Lifestyle could be a focus to examine further due to the strong family history of diabetes; it would be essential to ask questions related to diet, unusual fatigue, or history of vaginal/bladder infections.

Culturally Sensitive Issues

Being competent in cross-cultural functioning means learning new behavior patterns and effectively applying them in the appropriate settings (Cultural Competence in Health and Human Services, 2020). Culturally competent suggestions would be understanding and showing interest in the patient as a unique person, exploring and respecting the patient, beliefs, values, and preferences for care (Ball et al., 2019). While interacting with this 32-year-old pregnant patient, who identifies themself as a lesbian, it would be vital to inquire how the patient would like to be identified throughout the plan of care. Also, particular attention should be paid to care for patients who self-identify as being lesbian, gay, bisexual, and transgender (LGBT) (Ball et al., 2019). As a healthcare provider, I would need to invest time studying and becoming culturally competent to provide efficient care.

Five Targeted questions to ask patient

1. How are you feeling today?
2. How would you like to be addressed?
3. How are you coping with pregnancy?
4. Do you want or expect emotional support from the healthcare team
5. Are there medical matters that you do not wish to disclose to others?
6. Is there a religion or faith in which you wish to follow?

References

Ball, J., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). In Seidel’s guide to
physical examination: an interprofessional approach (9th ed., pp. 28-93). essay, Mosby.
Centers for Disease Control and Prevention. (2020). Cultural Competence In Health and Human
Services. Centers for Disease Control and Prevention. https://npin.cdc.gov/pages/cultural-
competence.
Dorsen, C., & Van Devanter, N. (2017). Open arms, conflicted hearts: nurse-practitioner’s
attitudes towards working with lesbian, gay and bisexual patients. Journal of Clinical
Nursing, 25(23-24), 3716–3727. https://doi.org/10.1111/jocn.13464

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:

1. When did the discharge begin?
2. Color of discharge?
3. Is there any odor?
4. Do you have any vaginal pain?
5. 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 (9^th 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):

1. What surgical procedures have you had?
2. What additional symptoms are you having besides feeling weak?
3. How long have you been receiving hormone treatment?
4. How are you dealing with your recent depressive episode?
5. 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

In 2020, 10.6 percent of African American were uninsured compared with 5.9% non- Hispanic whites (Carratala, 2020). It’s important as a healthcare provider not to judge a patient who does not have medical insurance. As healthcare practitioners it is important to treat everyone equally, rather they have medical insurance or not. The majority of African American adults say they have less access to quality medical care where they live.

This is a major reason why African American people in the U.S. generally have worse health outcomes than other races of adults (Funk, 2022). When treating a patient, it’s important to gather as much information as possible from the patient’s medical history. Family history is also important to know. I suggest using open-ended questions to obtain our patient medical history. It’s important for the healthcare provider to have a good relationship with their patient. 

The Scenario

Shawn Billings, a 28-year-old African American patient comes into the clinic today. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and 4 days ago with a migraine, given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache. He is very agitated today. He is here with his father and worried that he will not get any medication.

Data on Socioeconomic and Education Status for Black Males

Black men are the least likely, when compared to black women, white men, and white women, to have an advanced degree (Eggly et al., 2017). 4% of black men in America have a master’s degree, 9% of black women have a master’s degree, 8% of white men have a master’s degree, and 13% of white women have a master’s degree (Nzau et al., 2020). Black men are much more likely to be born into poverty and much less likely to get out of it compared to these same groups (Eggly et al., 2017). Black men make up about 6% of the population but account for over 30% of the prison population (Nzau et al., 2020). Black men have a shorter life expectancy than white men by about 4 years (Nzau et al., 2020).

Black men are perceived as the most violent group of individuals, based on studies conducted to measure implicit bias (Nzau et al., 2020). More than 40% of white respondents ranked almost all or all black men as violent (Nzau et al., 2020). White males and black females were perceived as similarly violent, and white women were perceived as the least violent (Nzau et al., 2020).  Black men earn more than black women, but less than white women and white men (Nzau et al., 2020). Black men are twice as likely to be unemployed than white men (Nzau et al., 2020).

Other Statistics to Consider

Statistics can sometimes be a blunt object to use when thinking of groups of people. For example, it is important to observe that the black population is diverse with people of various ethnic backgrounds and immigrants. Why does this matter? It is estimated that about 59% to over 70% of Nigerians hold a bachelor’s degree or higher (Ajobaju, 2021). The number varies in percentage levels for Nigerians because the number of Nigerians who took the survey, are estimated from the U.S. Census Bureau and is thought to have been grossly underestimated (Muri, 2012). About 31% of black immigrants have at least a bachelor’s degree while 33% of U.S. population has a bachelor’s degree or higher (Pew Research Center, 2022).

About 1 in 10 blacks are immigrants (Pew Research Center, 2022). About 25 % of black immigrants make $100,000 yearly or higher compared to 17% of black born Americans (Pew Research Center, 2022). The average median income for immigrants is $63,000 and for black immigrants is $56,000 (Pew Research Center, 2022). Less than 1 out of 5 black immigrants lived below the poverty line in 2019 when about 1 in 5 black Americans lived below the poverty line in 2019 (Pew Research Center, 2022). On certain levels, black immigrants have a different experience in America than black Americans.

Blacks and Religion

U.S. born blacks are much more likely to be protestant than any other religion when compared to immigrant blacks (Pew Research Center, 2022). Immigrant blacks are more likely to claim to be Catholic and non-Christian (Pew Research Center, 2022). African blacks are the least likely to say they are unaffiliated to any religious groups (Pew Research Center, 2022). Overall, most black people in America seem to derive their sense of spirituality from religion (Pew Research Center, 2022).

Males

Generally speaking, men seem to be suffering within today’s culture (Reeves, 2022). The factors that are contributing to this are multifactorial. In some corners of pop culture, feminism is often deemed the primary culprit. However, there are many other factors that seem to play a significant role in why men are falling behind (Reeves, 2022). Traditionally male dominated jobs, which include construction workers, automotive jobs, truck drivers, farmers, pilots, and other male dominated sectors, have been areas where technology has dominated (Casey & Nzau, 2019).

It should also be noted that male dominated sectors are also at the highest risk for death and fatal injuries (Industrial Safety & Hygiene News, 2020). The jobs with the highest risk for on-the-job deaths, include roofers, oil miners, firefighter supervisors, lineman, garbage collectors, iron workers, and power liners which all made the top 10 for the most dangerous jobs in America list (Industrial Safety & Hygiene News, 2020). Jobs that are traditionally dominated by women, like nurses and teachers, have been impacted by automation to a much lesser extent (Casey & Nzau, 2017).

Studies are showing that men, on average, tend to be better risk takers than women and have poorer impulse control when compared to women (Reeves, 2022). To some degree, this explains some of why more men than women, on average, tend to gravitate to jobs that are physically more dangerous, in free societies where women can choose to work these same jobs (Peterson, 2018). Today’s economy requires impulse control and long-term planning as humans continue to increase lifespan (Reeves, 2022). With the economy also demanding less labor-intensive jobs, like farming or factorial work, and instead prefer people with a psychological make-up that is less impulsive, and more prone to long term planning, the gap in education makes more sense and the problem for those who are less risk averse and wise in short sightedness, compounds (Reeves, 2022).

5 questions

With all of this in mind, it is important to understand my clients social and economic situation and temperamental make up. My questions would be holistic in approach. I would keep in mind, that as an ethnic woman, there will be men who are uncomfortable with being completely honest with me. I grew up in several places as a kid. I’ve grown up in small southern towns, I’ve grown up in northern cities, and I’ve grown up around a plethora of different ethnic cultures. Amongst every group, there’s always several things that most of the people in a culture love.