Posted: December 20th, 2021

Discussion – Main post week 2, Advanced Health Assessment & Diagnostic Reasoning

Discussion: Diversity and Health Assessments
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).

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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.

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.

Sample Essay Solution
Discussion – Main post week 2

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 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.

The population in the US is made up of people with varying backgrounds and cultures. A practitioner must be aware of this state of affairs when providing health care services for this population. It is important that the practitioner be sensitive and competent when dealing with the different cultures and must avoid using stereotypes even as they acknowledge the unique patient individualities. A healthcare provider who is culturally competent adapts his approach and practice to a patient’s unique needs taking into consideration, the patient’s culture and background especially when the patients background and culture differs to his (Ball et al, 2019). To achieve culturally competent care, sensitivity to patient’s sexual orientation, socioeconomic status, heritage, ethnicity and cultural background is essential (Ball et al, 2019). There is a major difference between cultural awareness, sensitivity and cultural competence. While cultural competence stresses the notion of effectively working in different cultural contexts and altering one’s way of operation to effectively meet the needs of different cultures, cultural sensitivity and awareness stresses on understanding cultural differences and similarities and does not include structural change or action.

Explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with my patient.

An analysis of the provided data shows that the patient’s family has a poor socio-economic status. The patient background is of an ethnic minority group. (Lipson, & Meleis, 2016)

opines that socioeconomic disparity affects the medical care and health of people belonging to these groups. This context will call for the use of a cultural assessment guide so as to find out more about the patient’s health practices and beliefs, special rituals and faith-based beliefs, dietary practices, languages spoken, and source of support beyond the family.

Explanation of issues that I would need to be sensitive to when interacting with the patient, and why.

To be culturally competent with my patient, I will need to control my body language while communicating with him. Some cultures consider firm gazes as rude or immodest so I will avoid gazing at my patient in that way. My emphasis will be more on feelings and attitude rather than on coming to the point and being direct. I will find out of the patient has the ability to speak in English and if there are any other methods of showing respect in his culture. To assess the (Lipson, & Meleis, 2016)

patient’s social context, I would Question Assignment the patient on his support networks, literacy, sense of life control and stressors. I will practice cultural humility so as to recognize the patient’s cultural perspective and limitations (Choudhry, Mani, Ming, & Khan, 2016).

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.

Some of the targeted questions I would ask the patient include the following:

What medication do you take including vitamins and over the counter drugs?
Do you feel depressed or sad often?
Is there anyone who threatens or physically hurts you?
How do you take your medications? Is there a system?
How is your food prepared and eaten?
Challenges associated with communicating with patients from a variety of specific populations.

Communication challenges are a constant concern in the MCO’s. Significant communication challenges in MCO’s include: stereotyping, la(nguage barriers, ethnocentrism, cultural shock, task completion, cultural relativism, privacy, non-verbal language and trust building. (Choudhry, Mani, Ming, & Khan, 2016).

What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

Introduce oneself appropriately, respectfully and professionally.
If you happen to notice that there is a language barrier, avoid using the patient’s family or friends as interpreters
Find and work closely with a professional interpreter who is both knowledgeable and linguistically aware of the patient population
API cultures consider direct eye contact rude and this might elicit discomfort in the patient. There will be need to reduce the amount of eye contact.
Speak plainly and enunciate clearly while avoiding the use of medical jargon. Do this respectfully to avoid coming out like you are talking down to the patient.
Take your time and treat every patient as if they are the only person that matters during the consultation.
API’s see health professionals as authority figures, one can use the initial interaction to establish trust and build a positive relationship which will impact outcomes and treatment adherence.
The patient needs to be assured of confidentiality and one’s commitment to helping them access the best care there is.
Reference

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.

Cultural Competence. (n.d.). Retrieved from https://npin.cdc.gov/pages/cultural-competence.

Lipson, J. G., & Meleis, A. I. (2016). Issues in Health Care of Middle Eastern Patients. THE WESTERN JOURNAL OF MEDICINE, 139(6). doi:10.1037/e596762011-012

Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A.

Davis.

Choudhry, F. R., Mani, V., Ming, L., & Khan, T. M. (2016). Beliefs and perception about mental health issues: a meta-synthesis. Neuropsychiatric Disease and Treatment, Volume 12, 2807-2818. doi:10.2147/ndt.s111543

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9. Journal of General Internal Medicine, 16(9), 606-613. doi:10.1046/j.1525-1497.2001.016009606.x

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