Discussion: Diversity and Health Assessments

Discussion: Diversity and Health Assessments

Discussion 1. Initial Post.

It is very important that APRNs understand and be aware of the cultural differences we may encounter out in the field. “Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.” (CDC.2015.) Cultural competency is beneficial to treat and care for our patients. Cultural competency models have been created that help to understand different cultural better, respect individuals from other cultures, and develop skills to treat patients from other cultures. (Ball, J. 2019. Pg. 23.) This also helps to build a connection or bond with the patient when different cultural backgrounds create barriers. For this case study we are focusing on the following.  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.” When focusing on this patient one would as what cultural factors someone might face when treating a person from an Asian culture. Some challenges that one may be faced with when caring for someone from Asian culture would be communication styles, health beliefs/disease causation, family structure/support system, respect, and use of traditional traditions.  (Juckett, G. 2014.) The first thing to consider is any kind of communication barriers. Is an interpreter needed? When communicating with this patient it important to understand that Asian culture find it rude to make direct eye contact when having a conversation, in American culture we often hold direct eye content when discussing important information. (Bell, J. 2019. Pg. 27.) A socioeconomic factor to address would be the fact that this patient lives with his daughter. This patient most likely has to depend on his daughter financially, I would ask if he had any concerns paying for his medication. Health literacy is also an issue to focus on with this patient, does he understand the use of his medications. “Health care illiteracy leads to medication errors due to the inability to understand instructions.” (Juckett, G. 2014.) The questions I would try to focus when assessing this patient would be:

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  1. What are main concerns about your health?
  2. Do you have any concerns about your medications? Do you have any concerns about paying for your medicine?
  3. Who is your support system? How is your relationship with your daughter?
  4. Why do you feel like a burden to your daughter?
  5. Do you ever feel depressed?

Centers of Disease Control and Prevention. (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence

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.

Juckett, G., Nguyen, C., & Shahbodaghi, S. D. (2014). Caring for Asian immigrants: Tips on culture that can enhance patient care. Journal of Family Practice, 63(1), E1–E9.

Discussion: Diversity and Health Assessments Paper Details:

In 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 health care field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and health care professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.  Discussion: Diversity and Health Assessments

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.

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.”

Case 2- Discussion: Diversity and Health Assessments

TJ, a 32-year-old pregnant lesbian, is being seen for an annual physical exam and has been having vaginal discharge. Her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. She is currently taking prenatal vitamins and takes Tylenol over the counter for aches and pains on occasion. She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.

Week 2 Main Post

My case study covers a 32-year-old female TJ, being seen for an annual physical exam.  She is currently pregnant without complications from receiving sperm at a local sperm bank.  She has a family history of diabetes and is presently experiencing vaginal discharge. She has been currently being seen by an obstetrician for prenatal care.  Current medications include prenatal vitamins and occasional Tylenol for pain. Her sexual orientation is lesbian, and her pregnancy history is Gravida1; Para 0; Abortions 0.

Patients that identify as lesbian or bisexual tend to participate in more risky behaviors such as smoking or occasional alcohol use compared to heterosexual women (Gonzales, G., Quinones, N., & Attanasio, L., 2019). Lesbian and bisexual individuals experience discrimination and stigma and may delay care related to fear (Fagan, M. P., & Ireland, C. L., 2020). Mental health factors are a concern related to depression, suicide ideation, and self-harm (Fagan, M. P., & Ireland, C. L., 2020).  Sexual orientation may place the patient at a higher risk for sexually transmitted diseases and HIV, but testing should only be based on the level of risk, not orientation (Fagan, M. P., & Ireland, C. L., 2020).  Patients within the LBGT community have increased health disparities due to the lack of insurance and physician care due to fear of bias and discrimination (Anticuar, S., 2021).  Should a patient come out to disclose sexual orientation, it should be acknowledged, but sexual behavior should not be assumed (Fagan, M. P., & Ireland, C. L., 2020).

The following questions may be asked to develop a health history assessment without regard to sexual orientation.

“Currently, how many weeks pregnant are you? Or How many weeks along are you?”

“Current due date?” “When was your last Obstetrician appointment?”

“Is there a significant other involved with the pregnancy?”

“Can you tell me how long you have had vaginal discharge? Color? Consistency? Any Odor?”

“Have you had any other symptoms?” Burning with Urination? Vaginal pain or itching?”

“Do you smoke or drink?”

Anticuar, S. (2021). Examining Health Disparities Among Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning Adults in Davidson County, Tennessee.

Fagan, M. P., & Ireland, C. L. (2020). Guide for Providing Care for Lesbian, Gay and Bisexual Patients in Primary Care Quick Reference Guide.

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.

Case 3- Discussion: Diversity and Health Assessments

MR, a 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle. He is not taking any prescriptions medications and denies drug use. He has a positive family history of diabetes, hypertension, and alcoholism.

 

Case Study Assignments:  The following will be the assignments for this week’s Case Study:

Last Name A-M:

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 ahx 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”

Last Name N-Z:

TJ, a 32-year-old pregnant lesbian, is being seen for an annual physical exam and has been having vaginal discharge. Her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. She is currently taking prenatal vitamins and takes over the counter Tylenol for aches and pains on occasion. She has a strong family history of diabetes. Gravida 1; Para 0; Abortion 0

Shadow Health:  Please be sure to follow the course announcements to assist with your troubleshooting of this tool.  As I receive information, I will be posting it there.

I hope everyone has a great week!!!

 

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