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NURS 6512N 32 Discussion Diversity and Health Assessment

NURS 6512N 32 Discussion: Diversity and Health Assessment

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.
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

What's Coming Up in Week 3?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you examine assessment techniques, health risks and concerns, and
recommendations for care related to patient growth, weight, and nutrition. You will also
begin your first DCE: Health History Assessment which will be due in Week 4. Plan your
time accordingly.
Overview of Digital Clinical Experiences (DCE) and Lab Components
Throughout this course, you are required to not only complete your standard course
assignments and discussions, but you will also complete DCE and Lab Components
that are either structured as optional or required assignment submissions. Please take
the time to review your DCEand Lab Components for this course that are required
submissions. See the table below and the attached table for specific DCE and Lab
Components for the course.
Note: Each Shadow Health Assessment may be attempted and reopened as many
times as necessary prior to the due date to achieve a total score of 80% or better, but
you must take all attempts by the Day 7 deadline. You must pass BOTH the Health
History and Comprehensive (head-to-toe) Physical Exam of at least a total score of 80%
in order to pass the course.

Week Digital Clinical

Experiences Lab Components

Module 1:  Comprehensive Health History

Week 1: Building a
Comprehensive Health
History

 

Module 2: Functional Assessments and Assessment Tools

Week 2: Functional
Assessments and Cultural
and Diversity Awareness in
Health Assessment

 

Week 3: Assessment Tools,
Diagnostics, Growth,
Measurement, and Nutrition
in Adults and Children

DCE: Health History
Assessment (assigned
in Week 3, due in
Week 4)

Case Study Assignment:
Assessment Tools and
Diagnostic Tests in Adults
and Children

Module 3: Approach to System Focused Advanced Health Assessments

Week 4: Assessment of the
Skin, Hair, and Nails

DCE: Health History
Assessment

Lab Assignment:
Differential Diagnosis for
Skin Conditions (SOAP
Note for differential
diagnosis)

Week 5: Assessment of
Head, Neck, Eyes, Ears,
Nose, and Throat

NURS 6512N 32 Discussion Diversity and Health Assessment

NURS 6512N 32 Discussion Diversity and Health Assessment

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DCE: Focused Exam:
Cough

Case Study Assignment:
Assessing the Head, Eyes,
Ears, Nose, and Throat
(Episodic SOAP Note)

Week 6: Assessment of the
Abdomen and
Gastrointestinal System

 

Lab Assignment: Assessing
the Abdomen (Analyze
SOAP Note)

Week 7: Assessment of the
Heart, Lungs, and Peripheral
Vascular System

DCE: Focused Exam:
Chest Pain

Week 8: Assessment of the
Musculoskeletal System

Discussion: Assessing
Musculoskeletal Pain
(Episodic SOAP Note)

Week 9: Assessment of
Cognition and the
Neurologic System

DCE: Comprehensive
(head-to-toe) Physical
Assessment

Case Study Assignment:
Assessing Neurological
Symptoms (Episodic SOAP
Note)

Week 10: Special
Examinations—Breast,
Genital, Prostate, and Rectal
Lab Assignment: Assessing
the Genitalia and Rectum
(analyze SOAP Note)

Module 4: Ethics in Assessment

Week 11: The Ethics Behind
Assessment   Lab Assignment: Ethical

Concerns

Next Week

To go to the next week:
Week 3

Week 3: Assessment Tools, Diagnostics,
Growth, Measurement, and Nutrition in

Adults and Children

Many experts predict that genetic testing for disease susceptibility is well on its way to
becoming a routine part of clinical care. Yet many of the genetic tests currently being
developed are, in the words of the World Health Organization (WHO), of “questionable

prognostic value.”
—Leslie Pray, PhD

Obesity remains one of the most common chronic diseases in the United States. As a
leading cause of United States mortality, morbidity, disability, healthcare utilization and
healthcare costs, the high prevalence of obesity continues to strain the United States
healthcare system (Obesity Society, 2016).  More than one-third (39.8%) of U.S. adults
have obesity (CDC, 2018). The estimated annual medical cost of obesity in the U.S.
was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were
$1,429 higher than those of normal weight (CDC, 2018).
According to the Centers for Disease Control and Prevention (CDC), the rate of
childhood obesity has tripled in the past 30 years, with an estimated 13.7 million
children and adolescents considered obese (CDC, 2018). When seeking insights about
a patient’s overall health and nutritional state, body measurements can provide a
valuable perspective. This is particularly important with pediatric patients.
Measurements such as height and weight can provide clues to potential health
problems and help predict how children will respond to illness. Nurses need to be
proficient at using assessment tools, such as the Body Mass Index (BMI) and growth
charts, in order to assess nutrition-related health risks and pediatric development while
being sensitive to other factors that may affect these measures. Body Mass Index is
also used as a predictor for measurement of adult weight and health.
Assessments are constantly being conducted on patients, but they may not provide
useful information. In order to ensure that health assessments provide relevant data,
nurses should familiarize themselves with test-specific factors that may affect the
validity, reliability, and value of these tools.
This week, you will explore various assessment tools and diagnostic tests that are used
to gather information about patients’ conditions. You will examine the validity and
reliability of these tests and tools. You will also examine assessment techniques, health
risks and concerns, and recommendations for care related to patient growth, weight,
and nutrition.
Learning Objectives
Students will:
 Evaluate validity and reliability of assessment tools and diagnostic tests
 Analyze diversity considerations in health assessments

 Apply concepts, theories, and principles related to examination techniques, functional
assessments, and cultural and diversity awareness in health assessment
 Apply assessment skills to collect patient health histories
Learning Resources

Required Readings (click to expand/reduce)
Note: To access this week's required library resources, please click on the
link to the Course Readings List, found in the Course Materials section of
your Syllabus.
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.
 Chapter 3, “Examination Techniques and Equipment”
This chapter explains the physical examination techniques of inspection,
palpation, percussion, and auscultation. This chapter also explores special
issues and equipment relevant to the physical exam process.

 Chapter 8, “Growth and Nutrition”
In this chapter, the authors explain examinations for growth, gestational
age, and pubertal development. The authors also differentiate growth
among the organ systems.

 Chapter 5, “Recording Information”  (Previously read in Week 1)
This chapter provides rationale and methods for maintaining clear and
accurate records. The text also explores the legal aspects of patient
records.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.
(2019). Student checklist: Health history guide. In Seidel's guide to
physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line:  Seidel's Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the
Copyright Clearance Center.
Centers for Disease Control and Prevention. (2018). Childhood overweight
and obesity. Retrieved from http://www.cdc.gov/obesity/childhood

This website provides information about overweight and obese children.
Additionally, the website provides basic facts about obesity and strategies
to counteracting obesity.

Chaudhry, M. A. I., & Nisar, A. (2017). Escalating health care cost due to
unnecessary diagnostic testing. Mehran University Research Journal of
Engineering and Technology, (3), 569.

This study explores the escalating healthcare cost due the
unnecessary use of diagnostic testing. Consider the impact of
health insurance coverage in each state and how nursing
professionals must be cognizant when ordering diagnostics for
different individuals.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health
assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO:
Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., &
Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

 Chapter 1, “Clinical Reasoning, Evidence-Based Practice, and Symptom
Analysis”

This chapter introduces the diagnostic process, which includes performing
an analysis of the symptoms and then formulating and testing a
hypothesis. The authors discuss how becoming an expert clinician takes
time and practice in developing clinical judgment.

Gibbs , H., & Chapman-Novakofski, K. (2012). Exploring nutrition literacy:
Attention to assessment and the skills clients need. Health, 4(3), 120–124.
This study explores nutrition literacy. The authors examine the
level of attention paid to health literacy among nutrition
professionals and the skills and knowledge needed to
understand nutrition education.

Martin, B. C., Dalton, W. T., Williams, S. L., Slawson, D. L., Dunn, M. S., &
Johns-Wommack, R. (2014). Weight status misperception as related to
selected health risk behaviors among middle school students. Journal of
School Health, 84(2), 116–123. doi:10.1111/josh.12128
Credit Line: Weight status misperception as related to selected health risk behaviors among middle school students by Martin,
B. C., Dalton, W. T., Williams, S. L., Slawson, D. L., Dunn, M. S., & Johns-Wommack, R., in Journal of School Health, Vol.
84/Issue 2. Copyright 2014 by Blackwell Publishing. Reprinted by permission of Blackwell Publishing via the Copyright
Clearance Center.

Noble, H., & Smith, J. (2015) Issues of validity and reliability in qualitative
research . Evidence Based Nursing, 18(2), pp. 34–35.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. (2011). History subjective data checklist. In Mosby’s guide
to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Mosby’s Guide to Physical Examination, 7th Edition by Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A.,
Solomon, B. S., & Stewart, R. W. Copyright 2011 by Elsevier. Reprinted by permission of Elsevier via the Copyright Clearance
Center.

This History Subjective Data Checklist was published as a companion to
Seidel’s Guide to Physical Examination (8th ed.) by Ball, J. W., Dains, J.
E., & Flynn, J.A. Copyright Elsevier (2015). From
https://evolve.elsevier.com
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.).
Philadelphia, PA: F. A. Davis.
 Chapter 2, "The Comprehensive History and Physical Exam" (Previously
read in Week 1)
 Chapter 5, "Pediatric Preventative Care Visits" (pp. 91 101)
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation
as well as other support resources:
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file].
Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Shadow Health. (n.d.). Shadow Health help desk. Retrieved
from https://support.shadowhealth.com/hc/en-us
Document: Shadow Health. (2014). Useful tips and tricks (Version 2)
(PDF)
Document: Shadow Health Nursing Documentation Tutorial (Word
document)
Document: Student Acknowledgement Form (Word document)
Note: You will sign and date this form each time you complete your DCE
Assignment in Shadow Health to acknowledge your commitment to
Walden University’s Code of Conduct.
Optional Resource
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s
diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

 Chapter 3, "The Physical Screening Examination"

 Chapter 17, "Principles of Diagnostic Testing"
 Chapter 18, "Common Laboratory Tests"
Required Media (click to expand/reduce)

Taking a Health History

How do nurses gather information and assess a patient’s health?
Consider the importance of conducting an in-depth health assessment
interview and the strategies you might use as you watch. (16m)
Accessible player

Name:  Discussion Rubric

  Excellent

90–100

Good

80–89

Fair

70–79

Poor

0–69

Main Posting:

Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

40 (40%) – 44 (44%)

Thoroughly responds to the Discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least three current credible sources.

35 (35%) – 39 (39%)

Responds to most of the Discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least three credible references.

31 (31%) – 34 (34%)

Responds to some of the Discussion question(s).

One to 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.

Cited with fewer than two credible references.

0 (0%) – 30 (30%)

Does not respond to the Discussion question(s).

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 references.

Main Posting:

Writing

6 (6%) – 6 (6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

5 (5%) – 5 (5%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

4 (4%) – 4 (4%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

0 (0%) – 3 (3%)

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 Posting:

Timely and full participation

9 (9%) – 10 (10%)

Meets requirements for timely, full, and active participation.

Posts main Discussion by due date.

8 (8%) – 8 (8%)

Meets requirements for full participation.

Posts main Discussion by due date.

7 (7%) – 7 (7%)

Posts main Discussion by due date.

0 (0%) – 6 (6%)

Does not meet requirements for full participation.

Does not post main Discussion by due date.

First Response:

Post to colleague’s main post that is reflective and justified with credible sources.

9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 (7%) – 7 (7%)

Response is on topic and may have some depth.

0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

First Response:

Writing

6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully 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.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

First Response:

Timely and full participation

5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

3 (3%) – 3 (3%)

Posts by due date.

0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.
9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 (8%) – 8 (8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 (7%) – 7 (7%)

Response is on topic and may have some depth.

0 (0%) – 6 (6%)

Response may not be on topic and lacks depth.

Second Response:
Writing
6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully 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.

5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

4 (4%) – 4 (4%)

Response posed in the Discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

0 (0%) – 3 (3%)

Responses posted in the Discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

Second Response:
Timely and full participation
5 (5%) – 5 (5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 (4%) – 4 (4%)

Meets requirements for full participation.

Posts by due date.

3 (3%) – 3 (3%)

Posts by due date.

0 (0%) – 2 (2%)

Does not meet requirements for full participation.

Does not post by due date.

Total Points: 100

Name:  Discussion Rubric

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