NURS 6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION PAPER
NURS 6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION PAPER
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
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CASE STUDY 1
John Green, 33 year-old Caucasian male, presents to the office to establish as a new patient. John’s natal sex is female but he identifies as a male. He transitioned from female to male 2 years ago. He has made a full transition with family and socially last year. He just moved back home and is unemployed at this time. He has been obtaining testosterone from the internet to give to himself. He has not had any health care since he decided to change other than getting his suppression medications through Telehealth 3 months ago. His past medical history includes smoking 2 packages of cigarettes per day for the last 10 years, smokes 3-6 marijuana joints every weekend (has an active green card), and does suffer from depression episodes. He is HIV positive for the last 3 years but remains virally suppressed at his last blood draw 6 months ago. He has been feeling very weak over the last few weeks which prompted him to move back home with his parents. He takes Biktarvy once daily that comes in the mail for free, tolerates it well, and 100 mg Testosterone IM every 7 days. His PMH is non-contributory. No past medical history. He has never been married. No significant family history. He is worried since moving back home and unemployed he will be a burden on his family, and he thinks his health may be declining.
CASE STUDY 2
Shawn Billings, a 28 year-old African American patient comes in to 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.
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.
NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION Case Study #1: 33-year-old Caucasian male
Introduction
For health assessments to be productive and support the health of the patient, advanced practice registered nurses (APRNs) must consider the impact of factors such as cultures and developmental circumstances. It is also important to note that different populations, cultures, and groups have a variety of beliefs and practices that impact their health in a diverse arena. With that said, APRNs must gain the skill of adapting their health assessment methods and techniques to support the diversity they will encounter. The purpose of this discussion is to explain the socioeconomic, spiritual, lifestyle, and other cultural factors associated with the assigned patient case study, the issues that the APRN would need to be sensitive to when interacting the patient and providing target questions to build a health history and assess the patient’s health risks.
Socioeconomic, Spiritual, Lifestyle & Cultural Factors
The patient is a 33-year-old single Caucasian who identifies as male, although female at birth. The patient made his transition roughly two years ago and has announced this change with his family and friends. He is currently unemployed and is planning to move back home with his parents. He is a known heavy smoker – tobacco and marijuana – over the past several years, suffers from depression, and has a history of Human Immunodeficiency Virus (HIV). Although diagnosed with HIV three years ago, the patient has remained virally suppressed for six months according to his last blood draw. He currently takes testosterone every seven days, in which he is getting from the internet, and Biktarvy once daily that has been free of cost to the patient. The patient has not had any health care in the past, other than his telehealth visit three months ago to obtain his suppression medications. The patient presents to the office to establish as new patient as well as address his symptom of feeling very weak over the last few weeks, which essentially prompted him to move back home with his parents. The patient does not have any contributory past medical history or family history. The patient remains worried about his declining health, unemployment, and dependence on his family for support.
Sensitive Issues
Under these known circumstances, the APRN would need to be sensitive to various factors while gathering the patient’s health history. First, the APRN must approach the initial interview in a non-judgmental fashion to ensure the patient feels comfortable and is able to establish rapport to ensure as much information is gathered as possible. It is important the APRN does not classify the patient in a stereotypical fashion as those pre-conceived thoughts could hinder cultural competence. The APRN could classify this patient as a minority due to his sexual identification, therefore the APRN would need to acknowledge her implicit biases towards the patient’s physical preferences. If not, there could be a large divide in the APRNs ability to connect with the patient and gather pertinent information to the patient’s health history. Secondly, the APRN must be mindful of conversation surrounding the patient’s choice of testosterone purchasing in relation to possible drug interactions and safety concerns. Although the patient’s choice of hormone-therapy purchasing is not suggested, he does remain dedicated to his transition with his commitment to administering weekly self-injections. Giving credit where credit is due is important, however, in this situation the APRN also needs to be careful how she educates the patient but also ensures the patient understands the safety risks. Perhaps providing the patient with resources that allow him to purchase testosterone from a reputable and regulated source would be best. Next, in knowing the patient has not received health care prior to his telehealth visit three months ago, the APRN must gently ask questions to better understand why the patient has neglected to see a health care provider. Education on consistent healthcare guidance could also be discussed here. It is important for the APRN to get a better understanding of where the patient is as far as being open to healthcare. Furthermore, the APRN could educate herself on gender, transgender, and sexuality terminology prior to the patient interview. This will allow the practitioner to be more fluid in conversation and ensure the patient is addressed appropriately. Moreover, the APRN should also be sensitive to the patient’s emotional status and address his depressive episodes as a priority. According to Kirubarajan et al. (2021), the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community in the United States is at risk for numerous adverse health outcomes with various disparities including an increased risk for suicide, HIV, sexually transmitted infections (STIs), and mental health issues, which is likely due to a lack of provider education on LGBTQ needs. Understanding where the patient’s stresses lie and empathizing with him of why he feels the way he does will be crucial in connecting with the patient to better comprehend his needs. Additionally, this gives the APRN the ability to deliver optimal care and reduce negative outcomes among the LGBTQ community NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION . The APRN could also provide the patient with various resources and recommendations to help support his mental and emotional needs, such as seeing a counselor if pharmacological support is not necessarily warranted. Finally, to reduce disparities in healthcare, the APRN could focus on achieving cultural humility by striving to incorporate ways to respond thoughtfully to the patient’s concerns and complaints while considering the health literacy of the patient (Ball et al., 2019). In combination, these efforts will allow the patient to feel vulnerable without being judged, humiliated, or taken less seriously for his current condition and situation. This way, the APRN will be better able to build the patient’s health history and gather the patient’s health risks to best care for the patient.
Target Questions: Health History & Health Risks
In preparing to ask the patient questions to build a health history and address health risks, the APRN should ensure patient-centered care, cultural competence, and cultural humility are kept at the forefront and overlap at best. Patient-centered care allows practitioners to curb hindering behavior, understand the stages of the medical interview, and attend to health promotion and disease prevention (Ball et al., 2019). Cultural competence requires healthcare providers to remain sensitive to patient’s heritage, sexual orientation, socioeconomic status, ethnicity, and cultural beliefs (Ball et al., 2019). Cultural humility is the ability of practitioners to recognize their limitations surrounding knowledge and cultural perspective while being open to new perspectives (Ball et al., 2019). Viewing the patient as an individual rather than in a group allows the practitioner to develop a more solid and productive patient-practitioner relationship. Together, these three concepts ensure the APRN is interested in the patient as their own unique person, respects patient values, beliefs, and preferences, conveys unconditional positive regard, and provides education tailored to the patient’s needs and level of understanding (Ball et al., 2019). The APRN could also utilize the RESPECT model – rapport, empathy, support, partnership, explanations, cultural competence, and trust (Ball et al., 2019) – to assist in building the patient’s health history. This model is an excellent tool for cross-cultural communication and patient-centered care, therefore creating respect for patients in diverse cultures. To start, the APRN could ask the below target questions to create a foundation in building the patient’s health history and identifying his health risks:
- What are your healthcare goals? What are you hoping to achieve today?
- How is your transition is going so far? Are there any challenges you’ve struggled with? What is going well?
- How are you feeling today? Can you describe your lows, highs, and moments of comfort?
- How long have you experienced your current symptoms?
- How often are you taking your medications? Do you have a routine or schedule with your medications?
- Can you demonstrate how you administer your testosterone intramuscular (IM) injections? I want to be sure you can receive safe-needle handling education if you are interested or there is a need for it.
- How many sexual partners have you had in the last six months?
Conclusion
“A culturally competent healthcare provider adapts to the unique needs of patients of backgrounds and cultures that differ from his or her own” (Ball et al., 2019, p. 22). Crossing the cultural divide allows APRNs to open their minds and be more mindful of how they can best treat and support their patients while respecting their cultural differences. Being fluid in cultural diversity and working towards becoming culturally competent evolves over time as “individuals and organization are at various levels of awareness, knowledge, and skills along the culture competence continuum” (Centers for Disease Control and Prevention, 2020, para. 5). To build a strong health history, APRNs must understand themselves well enough where they are able to use probing questions to avoid viewing the patient as a stereotype. Overall, prejudices and attitudes are often generated from cultural perspectives, so it is important for practitioners to understand themselves to better understand their patients. Being able to adapt to each patient and their individual needs allows the APRN to have genuine intentions to make strides toward cultural competence.
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.
Centers for Disease Control and Prevention. (2020). Cultural competence in health and human
services. https://npin.cdc.gov/pages/cultural-competence.
Kirubarajan, A., Patel, P., Leung, S., Park, B., & Sierra, S. (2021). Cultural competence in fertility care for
lesbian, gay, bisexual, transgender, and queer people: a systematic review of patient and provider
perspectives. Fertility and Sterility, 115(5), 1294–1301. https://doi.org/10.1016/j.fertnstert.2020.12.002.
NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION response
Initial Post
Diversity and Health Assessments
Description of Case Scenario and cultural and socioeconomic factors associated with this patient.
In the given scenario, the patient is a 33-year-old unmarried Caucasian male, who transitioned from his natal female sex to male, presenting to the office to establish as a new patient. He smokes 2 packs of cigarettes per day for the last 10 years, smokes 3-6 marijuana joints every weekend, suffers from depression, is unemployed, and is HIV positive, but virally suppressed. He takes Biktarvy once a day and injection testosterone 100mg weekly. No past medical history and family history of any diseases. He lives with his family and thinks that he would be a burden to his family.
In this scenario, the patient is seeking establishment of care. The factors that can be affected are his race/ ethnicity, transition from female to male, unemployment and staying with family, smoking and drug use, history of HIV, and depression episodes. In any case, in the first visit, a thorough history collection and detailed physical examination is important. It includes identification, chief complaint, history of present illness, past medical history, family history, social history, review of systems, physical examination, lab data, problem list from most severe to least severe, assessments, differential diagnoses, and a treatment plan. (Sullivan, 2019). The information should be asked of patients or their caretakers and should never be gathered by observation alone. It should be collected upon patient registration to ensure that appropriate fields are completed when patient begins treatment. Questions about race and ethnicity, English language proficiency, language preferences are needed for effective communication. Patient’s concerns should be addressed when the information is being obtained. (Ulmer et al.)
The issues need to be sensitive when interacting with the patient.
Age, gender, race, ethnicity, cultural attitudes, regional difference, and socioeconomic status influence the way patients seek medical care and the way health care providers collect history from. For example, the black and Latino patients are less likely to receive treatment for depression. (Ball et al.) Caucasians are less likely to believe that mental health professionals can help individuals with schizophrenia, and depression. (Anglin et al). This may be due to the inequalities in the quality of care received, socioeconomic status, psychosocial explanations of cultural mistrust and stigma. (Anglin et al.). Here, the patient has depression, so care should be taken when collecting history about depression. Particular attention should also be given to patients who self-identify as being lesbian, gay, transgender or bisexual. (Ball et al.) In this case, the patient transitioned from female to male. So, special responsibilities include providing a welcoming and safe environment, gathering a history with sensitivity and compassion, and performing a physical examination using ‘gender-affirming’ approach. Also, the provider should identify the other health topics that the patient may be sensitive to such as HIV, and unemployment in this case, any restrictions to exposure of body parts, and discussion of sexual health, and the attitude towards mental illness. (Ball et al.). The provider should keep in mind that compliance with complicated therapies such as those for HIV, can be differed in various ethnicity, but can be better with education.
The RESPECT model can help in effective, patient-centered, Cross-cultural communication which include Rapport, Empathy, Support, Partnership, Explanations, Cultural competence, and Trust.
Targeted questions
In this case, the patient suffers from depressive episodes, and is worried that he will be a burden to his family and thinks that his health is declining. So, suicide and depression screening are important. Questions can be asked include,
Do you feel sad or down more than usual?
Are you bored all the time?
Are you having trouble getting sleep?
Have you thought about hurting yourself or someone else?
Does it seem that you have lost interest in things that you used to really enjoy?
Would you rather just be by yourself most of the time?
Have you ever tried to kill yourself?
Have you ever had to hurt yourself?
Since this patient has a history of smoking and drug use, this history can be obtained by using National Institute on Drug Abuse Modified Alcohol, Smoking and Substance Involvement Screening Test (NIDA Modified ASSIST). The questions can include,
Do any of your friends use tobacco? Alcohol? other drugs?
Do you use tobacco? Alcohol? Other drugs?
How many packs of cigarettes do you smoke?
Have you ever thought of cutting down the number of cigarettes you smoke?
Are you unable to stop smoking or using drugs when you want to?
Have you ever experienced withdrawal symptoms?
Do you ever feel guilty or bad about your drug use?
Since this patient is suffering from HIV, sexual history should be collected and it can be obtained by using 5 Ps, partners, practices, protection from STDs, past history of STDs, and prevention of pregnancy.
Tell me about the people you have dated?
What does the term safe sex mean to you?
Are you interested in boys? Girls? Both?
How many sexual partners you had altogether?
The employment history can be collected by asking, what are your employment plans?
Have you ever been suspended? Terminated?
How well do you get along with the people at work?
Do you feel as if you belong at your workplace?
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
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia. PA: F.A. Davis.
Ulmer, C., McFadden, B., & Nerenz, D. R. (2009). Improving data collection across the health
care system-race, ethnicity, and language data. National academic press.
https://www.ncbi.nlm.nih.gov/books/NBK219747Links to an external site.
NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION case study 2 post
Discussion
The post explore the specific socioeconomic, spiritual, lifestyle, and cultural factors associated with Shawn Billings, a 28-year-old African American patient who frequently visits the clinic with migraines. Shawn Billings is an African American patient who is likely to experience socioeconomic disparities, given the historical and current systemic racism and discrimination faced by African Americans in the United States. According to the U.S. Census Bureau (2019), African Americans have a poverty rate of 18.8%, compared to the national average of 10.5%. This may impact Shawn’s ability to access healthcare, obtain medication, and follow recommended treatment plans.
Shawn’s spiritual beliefs and practices may also play a significant role in his healthcare decisions and outcomes. African American patients are more likely to value religion and spirituality as a coping mechanism for stress and illness (Holt et al., 2019). Therefore, healthcare providers need to consider and respect Shawn’s spiritual beliefs when interacting with him and providing care. Several lifestyle factors may contribute to Shawn’s recurring migraines, including stress, diet, and sleep patterns. It is crucial for healthcare providers to ask Shawn about his daily routines and habits to gain a better understanding of his lifestyle and potential triggers for his migraines. As an African American patient, Shawn may have cultural beliefs and practices that impact his healthcare experiences and decisions. For example, African Americans have a higher prevalence of hypertension and diabetes, which may be attributed to cultural dietary practices and limited access to healthy foods (Crawley et al., 2020). Therefore, healthcare providers need to be aware of and respect Shawn’s cultural beliefs when providing care.
When interacting with Shawn, healthcare providers need to be sensitive to the potential biases and stigmatization associated with labeling him as a “frequent flyer.” This label may create assumptions and judgments about Shawn’s behavior and medical history, leading to suboptimal care. Healthcare providers also need to be mindful of any potential racial bias or discrimination and provide equitable care. Targeted questions for health history and risk assessment include:
- Can you describe your typical daily routine and habits, including your sleep patterns, dietary practices, and physical activity levels?
- Have you noticed any specific triggers for your migraines, such as stress or certain foods?
- How do you typically manage your migraines, and have you noticed any patterns in your response to medication?
- Do you have any spiritual beliefs or practices that impact your healthcare decisions or preferences?
- Have you experienced any difficulties accessing healthcare or medication in the past, and if so, how did you address these challenges? NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION
Thus, healthcare providers need to consider several socioeconomic, spiritual, lifestyle, and cultural factors when providing care to Shawn Billings, an African American patient with recurring migraines. By understanding and addressing these factors, healthcare providers can provide equitable and effective care to Shawn and improve his healthcare outcomes.
References
Crawley, L. M., Ahn, D. K., & Winkleby, M. A. (2020). Perceptions of a healthy diet are associated with major food group consumption in African American women. Journal of Racial and Ethnic Health Disparities, 7(6), 1057-1068. https://doi.org/10.1093/jc/dks199Links to an external site.
Holt, C. L., Caplan, L., Schulz, E., Blake, V., Southward, V. L., & Buckner, A. V. (2019). Role of religion in cancer coping among African Americans: A qualitative examination. Journal of Psychosocial Oncology, 34(3), 179-199. https://doi.org/10.1097/01.NAQ.0000305946.31193.61
U.S. Census Bureau. (2019). Income and Poverty in the United States: 2018. https://www.census.gov/library/publications/2019/demo/p60-266.htmlLinks to an external site.
NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION response
Thank you for the informative post. The health disparities faced by the African American population are at the forefront of this case study. In addition to the disparities you mentioned, there is evidence that Black Americans with darker skin tones have poorer physical and mental health than Black Americans with lighter skin tones (Dent et al., 2020). Black Americans with darker skin tones are more likely to be diagnosed with hypertension and to have higher blood pressure, greater body mass index, and a greater smoking prevalence (Dent et al., 2020). Though the patient’s skin tone is not mentioned, if he is a darker-toned Black American, the migraines could be caused by undiagnosed hypertension and risk factors for migraines, such as smoking and alcohol intake. Instead of the healthcare providers calling the patient a “frequent flyer,” they should explore the patient’s health further rather than giving him a temporary solution to a recurring problem.
Another important aspect of this case is that the patient continually seeks treatment via clinic care and not primary care. The healthcare providers, in this case, should inquire whether the patient has a primary care provider and, if not, provide a referral to the patient. One study found that only 62% of Black American adults have regular primary care providers compared with 77% of White Non-Hispanic American adults (Ahad et al., 2019). The providers in this scenario should have asked the patient at the first visit whether he had a primary care provider. Further visits to the clinic could have been prevented if the patient had a primary care provider managing his health.
Thank you,
References
Ahad, F. B., Zick, C. D., Simonsen, S. E., Mukundente, V., Davis, F. A., & Digre, K. (2019). Assessing the likelihood of having a regular health care provider among African American and African immigrant women. Ethnicity & Disease, 29(2), 253–260. https://doi.org/10.18865/ed.29.2.253Links to an external site.
Dent, R. B., Hagiwara, N., Stepanova, E. V., & Green, T. L. (2020). The role of feature-based discrimination in driving health disparities among Black Americans. Ethnicity & Health, 25(2), 161–176. https://doi.org/10.1080/13557858.2017.1398314Links to an external site.
NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION response 2
Thank you for your discussion post regarding your assigned case study. It is alarming how much of the African American population struggle with access to healthcare in the United States. It would make sense that there would be a lack of consistent healthcare and patient compliance associated with this racial group due to the known challenges that come with poverty. You make a valid point about the spirituality factors in this situation. It is very interesting the information you found surrounding spirituality beliefs and practices in relation to seeking healthcare. Although these values and beliefs need to be respected and understood, at the same time this is where the APRN can be of great assistance by providing education surrounding ways to seek medical care and explain the risks if medical care is delayed. I agree with you that the patient’s triggers with his migraines remain important details to note as this may drive home a root cause of why the patient is presenting in this much pain as often as he is. Regardless of the patient’s decisions, it is crucial the APRN remains non-judgmental and does not let her biases get in the way of being able to establish a rapport with the patient to build a thorough health history. Understanding the patient’s health risks will also be important to identify to help prevent further complications or health concerns in the future. This patient should be viewed as a unique being who is seeking assistance for true symptoms rather than manipulative or drug-seeking behaviors. Even labeling the patient as a “frequent flyer” could create unrealistic or minimized provider efforts, which could in turn harm the patient or cause a delay in care. According to Osmancevic, Großschädl, and Lohrmann (2023), “Effective interventions, such as educational training, need to be implemented in order to deliver culturally competent care and potentially reduce disparities in healthcare and improve patient outcomes” (p. 1).
I appreciate your target questions as they are significantly important. I like that you are asking questions in relation to sleep. Getting appropriate rest is so vital to proper healing, disease management, illness prevention, and optimal systemic functioning. Rest is often undervalued and overlooked in Western medicine in my experience, so I was thrilled to see that you incorporated that into your questions. Also, I appreciate your interest in the patient’s culture and how his beliefs tie into his current healthcare efforts and decision making. From the information you provided in your discussion post, it is known that this racial group often delays seeking treatment for illness due to their cultural practices. With that said, it is important for the APRN to empathize with the patient, but also could be an eye opener for the practitioner, especially if the patient is presenting to the office so frequently. With his symptoms being this severe, a comprehensive workup would be warranted if nothing else could explain the severity and frequency.
Depending on how severe the patient’s pain is, it would be important for the APRN to gauge how engaging the patient would be during the health history interview. This may prompt the APRN to ask the target questions in order from most important to least important. This way, the APRN gathers the most pertinent information before the patient feels too overwhelmed or stimulated. Target questions one, four, and five would be most appropriate in my assigned case study as the patient’s routine, health habits, and cultural and spiritual practices are equally as important in the case of a transgender male. Just like the African American culture having their own practices and beliefs as to why they do not always seek medical care, the LGBTQ community has been known to “not seek medical attention because of fear of discrimination and a history of previous negative experiences with medical professionals” (Marchand & Selter, 2022, p. 1). As APRNs, it is our duty to break that cycle and provide the best patient-centered care possible, allowing all cultures to feel confident and comfortable that they will not be judged but only cared for with equality and respect.
References
Marchand, K., & Selter, S. (2022). LGBTQ+ ALLY FOR COMPASSIONATE CARE…47th Annual Oncology
Nursing Society Congress, April 27-May 1, 2022, Anaheim, CA. Oncology Nursing Forum, 49(2), E35.
https://doi.org/10.1188/22.ONF.E2.
Osmancevic, S., Großschädl, F., & Lohrmann, C. (2023). Cultural competence among
nursing students and nurses working in acute care settings: a cross-sectional study. BMC Health Services
Research, 23(1), 1–7. https://doi.org/10.1186/s12913-023-09103-5.NURS-6512N DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION