DIVERSITY AND HEALTH ASSESSMENTS NURS 6512
Sample Answer for DIVERSITY AND HEALTH ASSESSMENTS NURS 6512 Included After Question
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).
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
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.
A Sample Answer For the Assignment: DIVERSITY AND HEALTH ASSESSMENTS NURS 6512
Title: DIVERSITY AND HEALTH ASSESSMENTS NURS 6512
Patient Summary
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 Links to an external site.
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.2019.01.005Links to an external site.
A Sample Answer 2 For the Assignment: DIVERSITY AND HEALTH ASSESSMENTS NURS 6512
Title: DIVERSITY AND HEALTH ASSESSMENTS NURS 6512
Calling a transgender person by their pronouns can decrease suicidal ideations, suicidal behaviors, and depressive symptoms (Grossman, 2018). Your questions are great which can bring forth honest answers. I think I would question if he a psychologist or psychiatrist that he thinks is helpful and how long has he been seeing them. If his mental health is deteriorating and his been going for a while, I think that is a clear sign that there might be a better mental health practitioner for him.
Dealing with depression can be challenging. Many elite psychologists and psychiatrists recommend however, that at some point, in order to get better, a person has to begin to have healthy exposure to the stimulation that is causing or contributing to their distress (Lembke, 2022). For example, a person who wants to overcome their fear of spiders would need counseling and at some point, a healthy amount of exposure to spiders possibly(Lembke, 2022). Even if it starts with pictures of the spider at first. At some point, John needs to integrate better into society if he wants to get to a healthier headspace (Peterson, 2018). John has taken some steps to do this by looking more like the gender he prefers to be called. People will call John by his preferred pronouns because it’s easier to do and this makes it easier for John to integrate into society. Thie fact that John is trying to look like the gender pronouns he wants to be called, I think should be acknowledged, it will help with his confidence and helps with his integration process. Overall, isolation and avoidance will not make John mentally healthier but instead more neurotic (Peterson, 2018).
References
Grossman, A. H., Pollitt, A. M., & Russell, S. T. (2018). Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth. The Journal of adolescent health: official publication of the Society for Adolescent Medicine, 63(4), 503–505. https://doi.org/10.1016/j.jadohealth.2018.02.003
Lembke, A. (2022). Dopamine nation: Finding balance in the age of indulgence. Dutton.
Peterson, J. B. (2018). 12 Rules for Life: An antidote to chaos. Vintage Canada.
A Sample Answer 3 For the Assignment: DIVERSITY AND HEALTH ASSESSMENTS NURS 6512
Title: DIVERSITY AND HEALTH ASSESSMENTS NURS 6512
Hello Alysa! Thank you for this great post. Indeed, this patient has many factors that could worsen his depression including unemployment, which forced him to move in with his parents. These socioeconomic factors could impact how he seeks medical care and the kind of care he can receive. There are also other factors including lifestyle changes, mental health, and cultural factors which may significantly impact the healthcare of patients and should be considered as part of healthcare delivery. As you have noted, these factors can be considered through the establishment of health history and targeted questions (Seitz et al., 2019). Obtaining accurate health history and asking patients targeted questions requires a relationship of trust between the healthcare provider and the patient. Trust is critical in influencing the outcomes of patient management, especially in the management of long-term conditions such as the one presented in the case scenario at hand (Montgomery et al., 2020). It also influences the outcomes of prevention and health promotion programs. A relationship of trust between the clinician and the patient is associated with a direct therapeutic effect.
References
Montgomery, T., Berns, J. S., & Braddock, C. H. (2020). Transparency as a trust-building practice in physician relationships with patients. JAMA, 324(23), 2365-2366. Doi:10.1001/jama.2020.18368
Seitz, T., Raschauer, B., Längle, A. S., & Löffler-Stastka, H. (2019). Competency in medical history taking—the training physicians’ view. Wiener klinische Wochenschrift, 131(1), 17-22. https://doi.org/10.1007/s00508-018-1431-z
A Sample Answer 4 For the Assignment: DIVERSITY AND HEALTH ASSESSMENTS NURS 6512
Title: DIVERSITY AND HEALTH ASSESSMENTS NURS 6512
Alyssa, wonderful thoughts in your discussion. A physician has a role beyond providing professsional healthcare to the patients. Jill Day et al. (2018) refers to this principle as beneficence, which entails demonstrating acts of compassion to the patient. My observation of your approach to John demonstrates a lot of beneficence. Beyond promoting trust through your questions, there is also the aspect of empathy where a physician tries to feel alongside the patient so that they understand their true feelings and help them deal with their traumas (Moudatsou et al., 2020). Besides empathy, being non-judgmental is critical for the health assessment. Sometimes physicians may have in-built beliefs that are biased, for instance towards transgender persons. In asking the questions, it is important to ensure that there is no form of bias since this would ruin the positive working environment you are trying to create with John.
References
Jill Day, B. G. S., LDA, R., & Sarah Stream, B. A. (2018). Ethics in the Dental Office: Autonomy, beneficence, non-maleficence, and justice should guide your decisions. Dental Assistant, 87(4), 8-9.
Moudatsou, M., Stavropoulou, A., Philalithis, A., & Koukouli, S. (2020, January). The role of empathy in health and social care professionals. In Healthcare (Vol. 8, No. 1, p. 26). MDPI.
A Sample Answer 4 For the Assignment: DIVERSITY AND HEALTH ASSESSMENTS NURS 6512
Title: DIVERSITY AND HEALTH ASSESSMENTS NURS 6512
“Can you describe your typical daily routine, including your work and any sources of stress? We want to understand if lifestyle factors could be contributing to your frequent headaches.” This question is a good starting point to assess lifestyle factors but could be more specific. It might be beneficial to ask for details about sleep patterns, dietary habits, and physical activity, which can all contribute to headaches. Additionally, it would be helpful to explore the timing of headaches in relation to the patient’s daily routine (Gentile, 2005).
“Are there any specific triggers or patterns you’ve noticed with your headaches? This information can help us tailor a more effective treatment plan.” This question is well-phrased and essential for tailoring a treatment plan. However, it may be beneficial to prompt the patient with examples of common headache triggers (e.g., certain foods, stress, weather changes) to help them recall and report potential triggers.
“Could you share any spiritual or cultural beliefs that influence your health decisions or perceptions of medical treatment?” This question is valuable in understanding the patient’s cultural background and beliefs, but it may benefit from being more open-ended. Instead of directly asking about beliefs influencing health decisions, it might be better to ask the patient to share any cultural or spiritual practices related to health or healing, allowing for a more comprehensive response.
“Have you encountered any challenges related to healthcare access or experiences that have shaped your trust in medical professionals?” This question is important for understanding the patient’s past experiences and potential barriers to care. However, it could be made more open-ended by asking the patient to describe their experiences rather than assuming that they have encountered challenges. This would encourage patients to share their perspectives more freely (Rowe & Knox, 2023).
“Are there particular medications or treatments that have worked well for you in managing your headaches, and have you experienced any adverse reactions to medications?” This question is crucial for assessing the patient’s history of headache management. However, it could be expanded by asking the patient to describe their experiences with medications and treatments in more detail. For example, asking about the effectiveness of specific medications, dosages, and the frequency of use could provide a more comprehensive understanding.
References
Gentile, S. (2005). Indications for the diagnosis and treatment of acute headaches correlated with neurological pathologies. The Journal of
Headache and Pain, 6(4), 290–293. https://doi.org/10.1007/s10194-005-0211-0 Links to an external site.
Rowe, A., & Knox, M. (2023). The Impact of the Healthcare Environment on Patient Experience in the Emergency Department: A Systematic
Review to Understand the Implications for Patient-Centered Design. HERD, 16(2), 310–329. https://doi.org/10.1177/19375867221137097