NURS 6512 Diversity and Health Assessments Essay
NURS 6512 Diversity and Health Assessments Essay
NURS 6512 Diversity and Health Assessments Essay
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.
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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.
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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.
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.
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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.
Diversity and Health Assessments
The spiritual factor John represents is his full consideration of himself as a male, disregarding the natal sex of a woman. John undertook a complete transition of sex two years ago. I defined the identified perception of gender as a spiritual factor because the way John perceives himself internally motivates him to position himself in the external world. The socioeconomic status is complicated as John is unemployed after his transition and moves to reunite with his family, considering his weak health.
Additionally, John takes testosterone by himself. No medical appointments were prescribed after John’s transition. Finally, John takes Biktarvy daily, which comes from the mail for free. The overall lifestyle condition is that John consumed two packs of cigarettes daily for ten years and smoked 3-6 marijuana joints every weekend. The additional health info is that John is HIV-positive and applies 100 mg of Testosterone IM every seven days. Finally, John has not been married.
The primary issue I would be sensitive to when talking to John is his perception of gender. The reason is that people who commit gendered transition face difficulties in perceiving, responding to, and accepting the changes in their reproductive system, characterized by the misplacement of the “principle of totality” (Watt, 2020). In other words, I assume John might encounter difficulties in inseminating after the gender transition, which imposes obstacles for marriage or romantic relationships.
Another challenge I would encounter is preserving appropriateness in communicating with John on HIV and the overall feelings about their health condition through the prism of gender. From the Centers for Disease Control and Prevention resource, I clarified that minorities tend to receive less medical assistance than nonminorities (2020). The identified position matters as it imposes a challenge of bigotry in disguise.
The concept means that when communicating with John, my questions might be perceived as implicit discriminatory attitudes or behaviors (Casanova-Perez et al., 2021). John might misinterpret my questions because of the unintentional cognitive bias based on the cultural stereotypes regarding gender transition (Marcelin et al., 2019). John might consider I humiliate him. The strategy I would implement is an open-ended self-assessment questionnaire.
When developing patient history 5 target question I would like to ask:
- Did you feel any psychological difficulties in making attempts to apply for the job after a complete gender transition?
- How did your family members perceive your decision to gender transition?
- Have you had romantic relationships before and during the gender transition?
- Could you please describe your thoughts or episodes from your life that make you feel anxious, upset, and emotionally exhausted?
- What feelings do you experience when taking testosterone and Biktarvy? Pleasure, safety, comfort?
References
Casanova-Perez, R. et al. (2021). Broken down by bias: Healthcare biases experienced by BIPOC and LGBTQ+ patients. AMIA Annu Symp Proc., 275-284. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8861755/.
Centers for Disease Control and Prevention. (2020). Cultural competence in health and human services. https://npin.cdc.gov/pages/cultural-competence.
Marcelin, J. et al. (2019). The impact of unconscious bias in healthcare: How to recognize and mitigate it. J Infect Dis. 10.1093/infdis/jiz214.
Watt, H. (2020). Social and medical gender transition and acceptance of biological sex. Christian bioethics: Non-Ecumenical Studies in Medical Morality, 26(3). https://doi.org/10.1093/cb/cbaa015.
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.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 2 Discussion Rubric
Post by Day 3 of Week 2 and Respond by Day 6 of Week 2
To Participate in this Discussion:
Week 2 Discussion
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
Response #2
Great post I agree that sensitivity, cultural awareness, and a patient- centered approach are vital in providing adequate healthcare to many diverse populations. One diverse population that is often faced with discrimination and stigmatized is the LGBTQ+ population. Transgender and gender- diverse individuals experience many healthcare inequities, which include negative patient care outcomes and multiple barriers to accessing care (Hana, Butler, Young, Zamora, & Lam, 2021).
Being culturally competent requires that healthcare providers be sensitive to a patient’s heritage, sexual orientation, ethnicity, and cultural backgrounds. To be culturally competent one must gain knowledge, shape attitudes, and develop skills (Ball, Dains, Flynn, Solomon, & Stewart, 2019).
Cultural humility involves that a person be able to recognize their lack of knowledge in other cultures and their cultural perspectives and be open to gaining new perspectives of a different culture (Ball, Dains, Flynn, Solomon, & Stewart, 2019). Cultural humility is needed to be able to provide high quality patient care while being sensitive and respectful of a patient’s different cultural needs and desires (Ball, Dains, Flynn, Solomon, & Stewart, 2019).
When transgender or the LGBTQ+ population are faced with discrimination and disrespect in the healthcare system, it affects their social determinates of health and access to healthcare, which then leads to high rates unemployment, poverty, lack of education and social support systems, and housing instability (Hana, Butler, Young, Zamora, & Lam, 2021).
When the transgender or LGBTQ+ community does access care, they often have a wall up due to the fears of being judged, misunderstood, and/or not receiving adequate healthcare (Hana, Butler, Young, Zamora, & Lam, 2021). Being culturally competent is an ongoing learning process that should be made a top priority amongst healthcare professionals, and be able to adapt to your patients’ unique needs will help build rapport and lay the foundation of a great patient-provider relationship (Ball, Dains, Flynn, Solomon, & Stewart, 2019).
In this case study I can appreciate your involvement of the possible spiritual or religious aspects that maybe of importance to John. I also liked he way your worded your first question, asking John to provide information about his transition, which will hopefully lead into his health history, support systems, and family dynamics.
This allows John to be able to lead the conversation which is essentially a win -win for you both. This communication will allow John to start to trust you and begin to open- up about his life and health and you will be able to gain the knowledge about John (health history, surgical history, etc.) that you will need to adequately care for John.
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 (Vol. 9th Edition). St. Louis: Elsevier.
Hana, T., Butler, K., Young, L. T., Zamora, G., & Lam, J. S. (2021). Transgender Health in Medical Education. Bull World Health Organ, 296-303.
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/
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.