NURS 6512 Diversity and Health Assessments Discussion

case study

JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. He has ahx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter”

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Discussion post

Case Study

JC, an at-risk 86-year-old Asian male, is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. He has a history of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and states, “I came for my annual physical exam, but do not want to be a burden to my daughter.”

Introduction

Cultural competency is essential in healthcare as it will help develop a relationship of trust with the patient. Being a culturally competent provider means that you have a curiosity and respect for a patient’s beliefs and values and includes being reflective and aware of your feelings, biases, experiences, and lack of knowledge. The healthcare provider must be mindful of their cultural background and the cultural background of their patients. According to Ball, Dains, Flynn, Solomon, and Stewart (2015), culturally competent healthcare providers can adapt to patients’ unique needs from different cultural backgrounds, building a trusting relationship between providers and patients. For this purpose of this discussion, the first case study’s cultural factors will be discussed, and sensitive issues and appropriate targeted questions to ask this patient. NURS 6512 Diversity and Health Assessments Discussion

Factors

There are concerns with the overall healthcare of these patients when assessing this patient’s cultural factors. The socioeconomic factor related to this patient is that the patient lives with and relies on his daughter, a single mother, for physical and financial support. The patient is 86 years old and is likely unable to contribute to the household financially or physically. It is also unclear if the daughter can support the patient beyond his medical needs. In the Asian culture, it is expected that adult children care for their aging parents; this includes providing financial support. However, younger generations interpret the expectation of caring for the elderly differently, and many have a difficult time financially supporting their aging parents (Yan, Chan, & Tiwari, 2014). According to Vega (2014), 12.3 percent of Asian-Americans over 65 years of age live in poverty, compared to 9.1 percent of all Americans over 65 years of age. The suicide rate for Asians over 75 years of age is almost twice that of others the same age.

Sensitive Issues

The fact that the patient relies on his daughter for support and the patient’s statement about not wanting to be a burden is concerning, and the topic should be discussed with the patient sensitively. According to Carteret (2010), Asians place a strong emphasis on family, and family loyalty is expected. Therefore, the father may not be open about his home situation and relationship with his daughter out of fear of shame, dishonor, or disgrace to himself or his family. The APRN should be aware of this cultural factor when discussing why the patient feels that he is a burden to his daughter. Additionally, it would be appropriate to speak with the patient about in-home services to help care for him and address any financial concerns that the patient may have regarding his medications and managing his comorbidities. The APRN would need to be culturally sensitive not offend the patient due to the strong family beliefs and fear of shaming the family.

Targeted Questions

When asking targeted questions to the Asian patient, it is crucial that the APRN recognize and understand that particular culture and how they communicate. When conversing with Asian cultures, preserving harmony is as important as how questions are asked and the body language being used (Carteret, 2010). Direct questions may not be the most appropriate, especially when addressing sensitive issues such as the patient’s home life. The following questions would be asked.

Can you tell me about your current health problems?
Do you ever feel sad or depressed?

You mentioned that you don’t want to be a burden to your daughter, can you tell me about your relationship with your daughter?
Do you feel safe at home?
Would you be open to exploring resources to help you at home?

Conclusion

Healthcare providers must be aware of the different cultural factors that influence patient care. Providers must be open to different cultures and sensitive to the patients’ cultural beliefs and norms. A culturally competent provider can adapt to the patient’s needs, therefore, building a foundation of trust (Ball, Dains, Flynn, Solomon, & Stewart, 2015). When concerns arise when caring for patients from different cultures, the provider should address those concerns in a culturally sensitive way so as not to offend the patient or family and provide the patient with the care they need.

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References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Carteret, M. M. (2010). Cultural values of Asian patients and families. Retrieved from http://www.dimensionsofculture.com/2010/10/cultural-values-of-asian-patients-and-families/

Vega, T. (2014). As parents age, Asian-Americans struggle to obey a cultural code. The New York Times.

Yan, E., Chan, K.-L., & Tiwari, A. (2014). A systematic review of prevelance and risk factors for elder abuse in asia. Trauma, Violence, & Abuse, 16(2), 199-219.

Discussion: Diversity and Health Assessments

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. NURS 6512 Diversity and Health Assessments Discussion
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. NURS 6512 Diversity and Health Assessments Discussion

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Functional Assessments and Cultural and Diversity Awareness in Health Assessment

Xiaodong et al. (2017), in an issue of Healthy China 2030, “the focus should be on disease prevention and encouraging people to adopt healthy lifestyles. Simultaneously, the public health service system and the health services industry should be improved to facilitate early detection, early diagnosis, and early treatment of diseases, as these are of great significance to reduce the mortality rate”(p. 112). The essentials of nursing is having compassion and autonomy. To immediately identify cultural diversity as patient status is of major importance in the development of an efficient risk assessment. Patient care should be holistic and patient-centered regardless of cultural factors, spirituality, ethnicity, demographics, or socioeconomic status. Active-listen, allowing time for responses promotes a trusting environment that sets the mode of building an interactive nurse-patient relationship. Good rapport with the patient will promote comfort to make information easy and forthcoming. Trust allows the nurse to adequately determine the patient’s needs to develop a focused health assessment effectively.

Cultural Sensitivity

The patient is an at-risk 86-year-old male, physically and financially dependent on his daughter, a single mother with little time for all his health needs. Patient families are significant in implementing the patient’s beliefs and values into their treatment plan. In some cases, the family can make adjustments related to patient beliefs on health promotion to comply with the care regimen, and cultural diversity should always be considered. Nursing has evolved throughout the years, focusing on essential patient care theories and philosophies (Andersson, Willman, Sjostrom-Strand, & Borglin, 2015). Some theories and philosophies focus on understanding and analyzing your cultural competence related to patient and caregiver family cultures. Cultural diversity is about respecting and appreciating an individual’s society, interests, skills, and talents; culture sensitivity is about being aware of one’s cultural differences, according to (Brown, 2020). To establish a professional understanding of cultural diversity/sensitivity, it is important to maintain competences, a set of functional capabilities to effectively as an individual and an organization to efficiently work within the context of the cultural beliefs, behaviors, and needs presented by customers and their communities (CDC, 2015). Another issue to address with this scenario is caregiver strain. According to Menon et al. (2017), “the lack of support system in various countries makes the burden of caregiving to fall on the family members, a single individual in most cases. The sudden nature of the disease leaves the family unprepared to deal with consequences which include psychological and financial burden”(p. 418). Single home caregivers can be stressful for the individual as well as the patient. Patient concerns with overwhelming ad becoming a burden on a loved one can cause underlying issues of mental strain and distress in the home that can alter patient outcomes. NURS 6512 Diversity and Health Assessments Discussion

Target Question

Are there any changes or symptoms related to your health?

What are your concerns about becoming a burden to your daughter?

Do you feel safe in your home environment?

Who all lives in the home?

Are there any concerns about your health needs being met?

References

Andersson, E. K., Willman, A., Sjöström-Strand, A., & Borglin, G. (2015). Registered nurses’ descriptions of caring:

a phenomenographic interview study. BMC Nursing, 14(1), 1–10. https://doi.org/doi:10.1186/s12912-015-

0067-9

Brown, L. (2020). Assessment Tools, Diagnostics, Growth, Measurements, and Nutrition in Adults and Children Program

Transcript [Speech audio recording]. Walden University.

Centers for Disease Control and Prevention. (2015). Cultural competence.

https://doi.org/npin.cdc.gov/pages/cultural-competences

Menon, B., Salini, P., Habeeba, K., Conjeevaram, J., & Munisusmitha, K. (2017). Female caregivers and stroke

severity determine caregiver stress in stroke patients. Annals of Indian Academy of Neurology, 20(4), 418–424.

https://doi.org/10.4103/aian.AIAN_203_17

Xiaodong, T., PhD, Xiangxiang, L., MD, & Haiyan, S., MD. (2017). Healthy China 2030: A Vision for Health Care.

School of Health Sciences, (12), 112–114. https://doi.org/www.elsevier.com NURS 6512 Diversity and Health Assessments Discussion