Diversity and Health Assessments

As a nurse practitioner, it is vital that health assessments are conducted with cultural competency and effective patient-centered communication. Being able to adapt the health assessment to each individual to include their personal beliefs and values will aid in forming a trusting patient-provider relationship (Ball et al., 2019). Having an awareness of different issues that can affect different patient populations will help the healthcare provider obtain the needed information to give the best possible care.

Patient Scenario

     TJ, a 32-year-old pregnant lesbian is experiencing vaginal discharge while she is at the clinic for her annual exam. She has had no complications thus far in this pregnancy that resulted from a sperm donor bank. She is receiving obstetrician care, taking her prenatal vitamins, and Tylenol for aches and pains when needed. There is a family history of diabetes. Gravida 1; Para 0; Abortions 0.

Socioeconomic, Spiritual, Lifestyle, & Cultural Factors

TJ being a member of the Lesbian, Gay, Bisexual, and Transgender (LGBT) is prone to more discrimination and disrespect in the healthcare setting (Ball et al., 2019). More time may be appropriate to help TJ feel comfortable during her clinic visit. Allowing her partner to be with her would help too. As the NP, we need to accept and appreciate the family unit and be supportive. One way to do this is to use neutral pronouns until TJ expresses what she prefers or ask TJ and her partner directly how to address their unborn baby. It will also be important to recognize that the LGBT group often experiences more poverty than typical heterosexual couples (Gonzales, Quinones, & Attanasio, 2019). TJ may receive government help with food and housing, etc. Their belief system may be different than anything the NP has ever heard of before. It would not be uncommon for them to be outcasted by family if they were raised in a religion that opposed same sex relationships. Their lifestyle will cause them to endure things a heterosexual couple typically would not. For instance, they have already used a sperm bank. They might also be facing legal issues in court, financial obligations, and unwanted discrimination from family and friends.

Sensitive Issues

     Issues that could be sensitive to TJ include lifestyle/sex partners. Since she is having vaginal discharge, the NP should ask about sexual partners and protection practices during sexual encounters. STDs must be ruled out along with gestational diabetes and bacterial vaginosis. The vaginal discharge may be unremarkable altogether, but it should be taken seriously.

Targeted Questions

     Five targeted questions to ask would include:

  1. How would you like me and the other healthcare providers to address you, your partner, and your baby?
  2. Are you currently sexually active?
  3. How long have you been experiencing this vaginal discharge and how would you describe it?
  4. When was your last prenatal visit?
  5. Do you have any questions for me at this time?

Conclusion

     NP’s will care for patients that belong to a different patient population than themselves. To do this well, a NP needs to be mindful of their own culture values and biases and be able to put them aside to understand their patient’s perspective. This type of civil humility will help the healthcare team offer appropriate care to provide the best possible health outcome for the patient. Optimal care is dependent on the provider obtaining full and accurate information from TJ and that will depend on the NP using a respectful nonjudgmental approach during the health assessment interview and ensuring the confidentiality of the information shared. To do this, the NP cannot afford to stereotype any patient into the LGBT group and think they are all alike: each individual is unique and that makes their healthcare needs unique as well (Griggs, Waddill, Bice, & Ward, 2021).

 

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.

Gonzales, G., Quinones, N., & Attanasio, L. (2019). Health and Access to Care among Reproductive-Age

Women by Sexual Orientation and Pregnancy Status. Women’s Health Issues, 29(1), 8–16.

https://doi-org.ezp.waldenulibrary.org/10.1016/j.whi.2018.10.006

Griggs, K. M., Waddill, C. B., Bice, A., & Ward, N. (2021). CARE DURING PREGNANCY, CHILDBIRTH,

POSTPARTUM, AND HUMAN MILK FEEDING for Individuals Who Identify as LGBTQ+. MCN: The

American Journal of Maternal Child Nursing, 46(1), 43–53. https://doi-

org.ezp.waldenulibrary.org/10.1097/nmc.0000000000000675

 

response

I enjoyed reading your post and the targeted questions. One of the questions that were asked included a partner. At this time, a partner  was not mentioned. One thing to consider is whether she will be raising this child alone and not with a partner. It is important for her to feel comfortable and not judged.  Raising a child and being a Lesbian can be difficult if not given the support she will need. However, if in fact she does have a partner, the partner would be considered a co-mother. According to an article  from “The Conversation”, A number of studies, while small scale and qualitative in nature, point to higher incidence of symptoms of postnatal depression among lesbian birth mothers. There are also similarly small scale and qualitative studies that suggest similarly heightened feelings of anxiety and depression among lesbian co-mothers” ( (Greenfield, 2019). Therefore, as a Health care provider we must educate  and show respect for both  partners to reduce any post partum depression.

Reference:

Greenfield, Mari. (2019, October 8). How pregnancy can be made more difficult by maternity care’s notions of ‘normal’ . https://theconversation.com/us. https://theconversation.com/how-pregnancy-can-be-made-more-difficult-by-maternity-cares.

 

 

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.

Excellent Good Fair Poor
Main Posting
45 (45%) – 50 (50%)

“Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)

“Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)

“Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.
(0%) – 34 (34%)

“Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
10 (10%) – 10 (10%)

Posts main post by Day 3.
(0%) – 0 (0%)

N/A
(0%) – 0 (0%)

N/A
(0%) – 0 (0%)

Does not post main post by Day 3.
First Response
17 (17%) – 18 (18%)

“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)

“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)

“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
(0%) – 12 (12%)

“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response
16 (16%) – 17 (17%)

“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)

“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)

“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
(0%) – 11 (11%)

“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation
(5%) – 5 (5%)

Meets requirements for participation by posting on three different days.
(0%) – 0 (0%)

N/A
(0%) – 0 (0%)

N/A
(0%) – 0 (0%)

Does not meet requirements for participation by posting on three different days.
Total Points: 100
Main Post- JC, Asian Male

Case Study #1: 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 hx 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.”

 

I would introduce myself to Mr. JC and welcome him to the office. Based on the fact that he is able to understand me and able to reply in kind I would not be as concerned about getting an interpreter but would be sure to tell him that when we sit down to discuss his diagnoses and/or medications I would have the interpreter available in case we needed it. I would want to make sure that the information I give is being received and vice versa.

 

Question 1: What brings you to the office today, Mr. JC? I would be mindful of my use of eye contact as using hard eye contact might be thought rude or immodest in some Asian or Middle Eastern cultures (Ball et al., 2019). I would keep in mind that in the Asian culture they can be very stoic in the face of pain so if there is any pain it may be minimized or ignored (Coleman, 2019).

 

Question 2: What form of health insurance do you have? If he does not have insurance I would make sure I find the appropriate resources so he can apply for insurance if it’s needed. I would then start to find more cost-effective alternatives to save his daughter some money. For example, Question 3: Mr. JC, if I could save your daughter some money every month by prescribing you B-12 oral supplements instead of the injections, would you be interested? It would still be effective in improving your anemia (Wang et al., 2018). I would do the same if needed with any other medications and/or treatments as it would show that I am being sensitive to their needs as a family by considering the cost of every medication, test, or intervention.

 

Question 4: Did anyone tell you that you were a burden to your daughter? I would like to know if this is a self-imposed belief or had the daughter verbalized this in the past. In Asian cultures, it is well-known that seniors are respected and revered. It is also known that in the Asian culture they do not believe in nursing homes for their aging parents. The children take their parents in and take care of them. It is an expectation in many Asian families. If his daughter is a single mother struggling to raise her family and take care of her father as well, then perhaps some extended family needs to step in and help also.

 

Question 5: Do you take any other supplements, herbs, or remedies other than what I have prescribed to you? I know that in the Asian culture traditional Chinese medicine (TCM) is a very big part of their culture. And, since it is not FDA-regulated I would like to make sure that there are no drug interactions. TCM has treatments for hypertension, for example, that are not very well studied (Zhang et al., 2020). If cost is a factor it is also possible that a TCM treatment for an ailment might be less expensive than prescribed medications. I would want to make sure that Mr. JC is getting the best treatment for his ailments and not getting a poor substitute because of financial constraints.

 

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.

Coleman, D. E. (2019). Evidence based nursing practice: The challenges of health care and cultural diversity. Journal of Hospital Librarianship19(4), 330-338. https://doi.org/10.1080/15323269.2019.1661734

Wang, H., Li, L., Qin, L. L., Song, Y., Vidal-Alaball, J., & Liu, T. H. (2018). Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database of Systematic Reviews2018(3). https://doi.org/10.1002/14651858.cd004655.pub3

Zhang, Y., Wang, B., Ju, C., Liu, L., Zhu, Y., Mei, J., Liu, Y., & Xu, F. (2020). Traditional Chinese medicine for essential hypertension: A clinical evidence map. Evidence-Based Complementary and Alternative Medicine2020, 1-17. https://doi.org/10.1155/2020/5471931

 

response sample

The layout of the Health Assessment questions is adorable. Before western culture, many cultures in different countries used traditional medicines to cure specific ailments and promote health. These traditional medicines, now being referred to as alternative medicines, are now being used worldwide. However, there is no evidence-based research on the alternative drugs because of poor documentation, funding, and feared incompatibilities with western medicine (Veziari et al., 2021)

It is imperative to ask about alternative medicine and educate the patient on specific side effects of combining both alternative and western medicine. As a health provider, it is also necessary to ensure patients are compliant with their plan of care and address them to help manage their illnesses (Stewart, 2018). Factors affecting non-compliance come from experiencing side effects, inability to afford medications or care, and inability to adhere to a specific regimen. Non-compliance can lead to deaths or unplanned hospitalizations (Stewart, 2018).

References

Stewart David Spence. (2018). Approaches for the Management of Non-Compliance in Patients with Chronic Illness. University of Ottawa Journal of Medicine8(1). https://doi-org.ezp.waldenulibrary.org/10.18192/uojm.v8i1.2305

Veziari, Y., Kumar, S., & Leach, M. (2021). Barriers to the conduct and application of research among complementary and alternative medicine professions in Australia and New Zealand: A cross-sectional survey. Complementary Therapies in Medicine60. https://doi-org.ezp.waldenulibrary.org/10.1016/j.ctim.2021.102752

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