DIVERSITY AND HEALTH ASSESSMENTS NURS 6512
DIVERSITY AND HEALTH ASSESSMENTS NURS 6512
Culture and socioeconomic factors influence the health outcomes for patients. Therefore, understanding the specific needs of the patients helps in developing appropriate intervention measures that guarantee better outcomes (Hu et al., 2019). In this case, JC is an at-risk 86-year-old Asian male who is financially and physically dependent on the daughter. The patient presents with hypertension, gastroesophageal reflux disease, chronic prostatitis, and b12 deficiency.
Socioeconomic, Spiritual, Lifestyle, and Other Cultural Factors Associated with the Patient
The patient is lonely considering that she depends on her daughter who is a single mother and has no time or money for the father’s health needs. In addition, the patient does not get spiritual support. Considering his age and physical instability, he cannot attend religious activities (Lee, 2017). The patient feels that he is already a burden to his daughter and feels sorry about it as evident in his conversation during his visit to the clinic. The reduced mobility and lack of social and spiritual support expose the patient to a sedentary lifestyle. Also, poor dietary intake could impact his health outcomes. Furthermore, understanding the Asian culture is necessary to interact appropriately with the patient.
Issues That You Would Need to Be Sensitive to When Interacting with the Patient
In interacting with the patient, one must be sensitive to avoid the possibility of conflict arising (Ball et al., 2019). In this case, it will be necessary to ask the patient whether he will be comfortable using the prescribed medications over the traditional medications (Xin et al., 2020). Besides, it is important to understand the additional medications that the client could be taking to avoid adverse medication interactions. The patient is physically inactive and this means that he may not engage appropriately in the activities of daily living. Therefore, asking the patient about his ability to bathe and feed will be important.
The targeted questions to ask will include:
- Do you have health insurance?
- How often do you check your blood pressure?
- How many meals do you take in a day?
- Do you always take medications as prescribed?
- Do you think your daughters offer you enough support?
The assessment aims at identifying the underlying factors that could affect the patient’s illnesses. The human healing processes depend on other factors such as spiritual and socioeconomic needs. In this case, the patient is lonely and requires enough social support.
NURS 6512 Week 2 discussion Discussion: Diversity and Health Assessments References
Ball, J., Dains, J., Flynn, J., Solomon, B., Stewart, R. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Hu, Y., Jiao, M., & Li, F. (2019). Effectiveness of spiritual care training to enhance spiritual health and spiritual care competency among oncology nurses. https://doi.org/10.21203/rs.2.16979/v2
Lee, R., Eun-Kyoung, O. (2017). Faith, spirituality, and values among Asian-American older adults: An exploratory factor analysis of the multidimensional measures of religion and spirituality. Mental Health, Religion & Culture, 19 (8), 920–931. doi:10.1080/13674676.2017.1290593
Xin, B., Mu, S., Tan, T., Yeung, A., Gu, D., Feng, Q. (2020). Belief in and use of traditional Chinese medicine in Shanghai older adults: A cross-sectional study. BMC Complement Medicine and Therapies 20 (128). https://doi.org/10.1186/s12906-020-02910-x. https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-020- 02910-x
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. 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.
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?
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NURS 6512 Week 2 discussion Discussion: Diversity and Health Assessments 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.
Sharifi, N., Adib-Hajbaghery, M., & Najafi, M. (2019). Cultural competence in nursing: A concept analysis. International journal of nursing studies, 99, 103386.
I enjoyed reading your post. It is important that providers know and understand different modes of communication, when, and how to use them with their various patients. In addition to communication, they should also know how health beliefs may vary from one culture to another, also how diet and nutritional practices may be different (Ball, et., 2019). Anticoagulants or blood thinners are a serious and important class of medication that prevent or reduce the risk of a blood clot. Patients should be educated on why they are on this medication, its use, and when and how to take the medication. They should be aware of labs and how often the lab should be monitoring and foods they needed to avoid while on this medication. As you mentioned in your discussion that the culture of the patient, therefore has an impact on his health because it dictates his willingness to adhere to the treatment (Collado, 2019). Some cultures or countries believe that they do not need medications for some illnesses because of not being aware of illness, resources, or how to treat them. Providers should educate, provide resources and allow patients to demonstrate what they learned or skills in order to make sure that they understand what was discussed.
NURS 6512 Week 2 discussion Discussion: Diversity and Health Assessments 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.
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.
I agree with you, the emphasis should be more on the patient cultural background. Generally, when interacting with this patient, the patient’s condition, race, culture, life experiences, and beliefs; should be put into consideration (Ball, Dains, Flynn, Solomon, & Stewart, 2019). Cultural beliefs played a key role in patient health. In this case study, Mono Nu is from the Philippines and has a culture that has been known for the traditional use of plant medicines. There are several factors that the healthcare professional should consider when assessing patients with different cultural backgrounds. First, this professional should consider the patient’s socioeconomic status since they are likely to affect the patient’s health literacy, perception of healthcare, health-seeking behavior, ability to afford medical services, and the risk factors that patients face (Arpey et al., 2017; McMaughan et al., 2020).
with this, in mind, the health care professional will assess the patient’s drug history and make sure to ask about herbal supplements. Many herbal plant decreased the effectiveness of the medicine and block the action of blood thinners. Warfarin for instance role is to prevent clot formation, a diet rich in VitK decreased the effectiveness of the medication and may lead to severe health consequences (Rosenthal and Burchum, 2018). Also, it’s important that the healthcare professional educate patient Mono Nu about the importance of blood thinners and emphasize more the diet low with vitk.
NURS 6512 Week 2 discussion Discussion: Diversity and Health Assessments References
Arpey, N. C., Gaglioti, A. H., & Rosenbaum, M. E. (2017). How socioeconomic status affects patient perceptions of health care: A qualitative study. Journal of Primary Care & Community Health, 8(3), 169–175. https://doi.org/10.1177/2150131917697439
Ball, J.W., Dains, J.E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s Guide to Physical Examination. (9th ed.). St. Louis, MO: Elsevie Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice nurse and physicians assistant. St. Louis, MO: Elsevier.
I enjoyed reading your entry. The targeted questions you suggested would help you gather more information about the patient. On a scale of 0-10, 0 being no pain and 10 being the worst pain, how can you rate your headache? The patients’ pain level can help you understand how critical the pain may be effecting the patient. Depending on the severity of the headache you have to monitor for other healthcare issues he could possibly be facing. The patient would most likely be open to explain how bad the headache is hurting him. Do you smoke cigarettes, drink alcohol, or use any recreational drugs? This question is a good question because some of these things aggravate a headache even more and some recreational drugs can enhance a headache. Recreational drugs cause a risk to a patients’ health and may enhance a patients want to self harm. Also there are negative impacts of cigarettes, alcohol, and drugs on the patients’ health. Smoking cigarettes increases the risk for heart disease, stroke, and cancer (Health effects of cigarette smoking, 2021). Do you feel safe at home? How much sleep do you get? Do you feel depressed? Do you feel like hurting yourself? These four questions help the provider understand the patient’s mental health level. The patient safety and mental health is important to address when addressing medical issues. The patients’ frequent flyer status at the hospital may be a indicator of situations sometimes characterized by physical, mental, spiritual, and social deprivation of their home situations (Huang, van der Borght, Leithaus, Flamaing, and Goderis, 2020). The patient may no be that open to answering these questions because they may seem invasive to him. I would try to make the patient feel comfortable and safe before assessing him. What coping skills/mechanism works for you when you are stressed? The patients coping skills is important to address because the patient is a frequent flyer to the hopital. The patient may be lacking coping skills and may be reluctant to open up about his coping mechanisms. Patients with maladaptive coping mechanisms are more likely to engage in health risk behaviors (Algorani & Gupta, 2022). What do you do for a living? Although this is a good question, I don’t believe this would help you gather information about the patients chief complaint.
The questions that would apply to my patients is the questions about coping mechanisms, safety, depression, and self harm. My patient is a transgender male that recently came out so his mental health status may be a risk for depression and possible self harm. My patient has also had losses in employment and had to move back home with his parents so his coping skills may be questioned on how he is dealing with the recent transitions in his life. My patient also may face a lot of bias, discrimination, and stigmas with his recent transition to male which could place him in harms way. The question about smoking, alcohol, and drugs would also apply to my patient because he smokes cigarettes and marijuana.
Algorani EB, Gupta V. Coping Mechanisms. [Updated 2022 Apr 28]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559031/
Centers for Disease Control and Prevention. (2021, October 29). Health effects of cigarette smoking. Centers for Disease Control and Prevention. Retrieved March 10, 2023, from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/#health-risks
Huang, M., van der Borght, C., Leithaus, M., Flamaing, J., & Goderis, G. (2020). Patients’ perceptions of frequent hospital admissions: a qualitative interview study with older people above 65 years of age. BMC geriatrics, 20(1), 332. https://doi.org/10.1186/s12877-020-01748-9Links to an external site.
The patient selected is John, a 33-year-old male that has been transitioning from a female for the last two years and made a full transition with family and socially last year. He has been administering testosterone obtained via telehealth (he was previously receiving medication from the internet). He also takes Biktarvy as he tested positive for HIV 3 years ago but virally suppressed as of his blood draw six months ago. His medical history includes depression, smoking two packs of cigarettes daily, and smoking 3-6 marijuana joints on the weekend (he has an active green card). He is currently unemployed and has been feeling very weak over the last few weeks, which prompted him to move back into his parent’s house.
Factors Affecting The Patient
This patient has a multitude of factors that could lead to isolation or worsening of his depression if he does not have a proper outlet or trusted healthcare provider. Socioeconomic factors affecting this patient include his unemployment status and moving back in with his parents. A patient’s socioeconomic status can influence how they seek medical care and the type of care they receive from providers (Ball et al., 2019, p. 24). Spirituality wasn’t mentioned in the summary, but it is helpful to understand the patient’s beliefs in order to tailor their care and offer resources if they haven’t been able to attain them (Ball et al., 2019, p. 10). The patient’s lifestyle has probably changed since he has been feeling weaker, and this could take a toll on his mental health. Changes to his lifestyle could include leisure activity, sexual experiences, and diet or exercise habits. Cultural factors for this patient include his beliefs, sexual orientation, the people he surrounds himself with, heritage, ethnicity, and socioeconomic status (Ball et al., 2019, p. 23). All of these factors together make each individual unique and should be considered when having discussions about their health, as they might impact how a patient feels about medication or treatment.
Building a Health History & Targeted Questions
Building a trusting relationship with this patient is the initial priority because it seems his healthcare recently has been solely online, which may indicate he has apprehension about an in-person visit. Patients of the LGBTI community have faced bias and undesired interactions with healthcare providers, which has steered many away from seeking care (Coleman et al., 2022). The goal is to make sure this patient is comfortable throughout the visit so he can openly communicate and return for follow-up appointments.
The first question would be asking the patient about his identity. The summary did indicate that he transitioned two years ago, but it is important to hear from the patient how they want to be addressed, and this is a great opportunity to be open and supportive while building rapport. If the patient is comfortable, asking about their medical journey with transitioning is important because this will help understand why he has been seeking most of his care online.
The second question would be directed toward his chief complaint. The patient mentioned feeling weaker in the last few weeks. I would ask the patient about specific symptoms because often, weakness and fatigue are mixed up and can mean different things. Weakness could indicate overall muscle weakness from an electrolyte imbalance, thyroid issues, or an overall new development of a disease (HealthLink BC, 2020). Fatigue is the feeling of exhaustion, and this could be attributed to the patient’s HIV, depression, or marijuana usage (Ethan et al., 2020; HealthLink BC, 2020). Once established with exactly what he is feeling, I would ask how often he feels this way or if it is consistent, if there are other symptoms associated, and how it affects his daily life.
The third question would address his mental health status because he feels his health is declining, he is unemployed, he had to move in with his parents, and he has had episodes of depression. This can all weigh heavy on a person that does not have the right support system. I would also want to address how his depression has been, if he has had any recent episodes, what he does to help them, and if he feels he is ready to start on an antidepressant. It would also be appropriate to perform the PHQ-9, which helps identify major depressive disorder, and the Columbia-Suicide Severity Risk Screener to identify suicide risk (Ball et al., 2019, p. 94).
The fourth question will be related to the last, asking if he does feel like he has a support system. This patient is going through a lot, and a strong support system is vital. I would ask the patient about his relationship with his parents, friends, and community. Offering resources where he lacks support, whether that be his mental health, personal relationships, or medical condition, will help him find people who are going through similar issues and form a trusting community (White & Fontenot, 2019).
The fifth question would be if he would want to start getting his medications (testosterone and Biktarvy) through me instead of online. Offering this service to the patient will let him feel he is receiving thorough care without judgment. This will hopefully be a gateway into a long-term relationship with the patient and help him create a healthier future for himself. In future visits, addressing smoking cessation and other healthy lifestyle habits will be addressed.
Strategies
All of these questions are very personal, and as the patient’s provider, it is our job to create a trusting environment. One strategy to use while performing his examination would be incorporating patient-centered care in which the provider asks the patient their preferences and their needs to ensure a care plan can be developed that will properly suit them (Ball et al., 2019, p. 2). Another strategy includes asking open-ended questions, as this will allow the patient to answer with as much or as little information but never try and force answers from the patient (Ball et al., 2019, p. 4). When confronted with a patient that has different ideals, cultural beliefs, or any other significant differences, it is important to keep an open mind and never pass judgment. This will allow for the smoothest conversation and keep the patient at ease throughout their visit.
References
Ball, J. W., Dains, J. E., & Flynn, J. A. (2018). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). Mosby.
Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., . . . Arcelus, J. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(sup1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644
Ethan, X., Logan, A., Liam, M., & Leonard, J. (2020). Impact of Marijuana (Cannabis) on Health, Safety and Economy. Int. Digit. Organ. Sci. Res, 5, 43-52.
HealthLink BC. (2022). Weakness and Fatigue. https://www.healthlinkbc.ca/illnesses-conditions/fatigue-and-sleep/weakness-and-fatigue
White, B. P., & Fontenot, H. B. (2019). Transgender and non-conforming persons’ mental healthcare experiences: An integrative review. Archives of Psychiatric Nursing, 33(2), 203–210. https://doi.org/10.1016/j.apnu.2019.01.005
NURS 6512 Week 2 discussion Discussion: Diversity and Health Assessments Grading Rubric
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
Acceptable level of performance
81% 13 points |
Inadequate demonstration of expectations
68% 11 points |
Deficient level of performance
56% 9 points
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Failing level
of performance 55% or less 0 points |
| Total Points Possible= 50 | 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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Presentation of information is unsatisfactory in three or more of the following elements
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| 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points | |
| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
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Presentation of information was minimally demonstrated in the all of the following elements:
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Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
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| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic. |
Demonstrated all of the following:
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Demonstrated 3 of the following:
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Demonstrated 2 of the following:
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Demonstrated 1 or less of the following:
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| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error. |
The following was present:
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The following was present:
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The following was present:
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| 0 Points Deducted | 5 Points Lost | |||||
| Participation
Requirements |
Demonstrated the following:
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| Due Date Requirements | Demonstrated all of the following:
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Demonstrates one or less of the following.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |