Cultural Competence Case Study group B
Culture generally is about entire human behaviors, attitudes and ideas, speech patterns, imaginations, language, beliefs, and etiquette; basically, it is features that distinguish one group entity from other groups of human entities (Ball, Dains, Flynn, Solomon, & Stewart, 2019).
Healthcare professionals should demonstrate competence when dealing with diverse patients. According to Nair and Adetayo (2019), cultural competence is beneficial for both patients and healthcare providers since it encourages patient engagement/participation, promotes respect, enhances understanding between persons, and promotes better health outcomes. This competence is particularly vital when dealing with patients in multicultural societies like the US that are characterized by cultural diversity. In the assigned case study, for instance, the language barrier inhibits communication between a healthcare professional and Paloma Hernandez and may have led to poor health outcomes for the patient.
There are several factors that the healthcare professional should consider when working with the patient. 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). Socioeconomic factors are of great significance when serving patients like Paloma whose communities have higher rates of poverty. Other factors like spirituality may also affect health-seeking behavior, perception towards treatment, medication adherence, and medication refusal. For instance, some patients could refuse medication on a religious basis or their belief that healing comes from God. Precisely, Latinos have tight religious ties and view the church as a major spiritual, social, and educational resource for the people and a significant determinant of medication compliance (Caplan, 2020; Gast et al., 2020). Although healthcare professionals should help patients to overcome their health problems, they must always respect the patients’ views and interests. Lifestyle factors should also be considered when dealing with patients like Paloma due to their impact on risk factors, treatment, and health outcomes. For instance, lifestyles like smoking, alcohol consumption, and the diet (foods that the patient consumes) could affect their likelihood of developing gastrointestinal complications (Capurso & Lahner, 2017; Livovsky et al., 2020). Other important cultural factors include language, beliefs, and values. For instance, close family and social ties among Latinos could be a good facilitator for accessing health support, although the language barrier could interfere with communication and involvement in clinical decisions. For instance, miscommunication due to a language barrier between the healthcare professional and the patient created confusion, poor medication adherence, or the consumption of dosage, which could in turn have led to the re-hospitalization of the patient.
There are many reasons why healthcare professionals should be sensitive when dealing with patients like Paloma. Cultural competence, awareness, and sensitivity reduce the risk of misunderstanding/misjudging patients from other cultures, reduces the risk of bias, guide healthcare professionals to select the right words, promote respect between patients and healthcare professionals, and help healthcare professionals to involve patients in clinical decision-making. In other words, cultural competence is critical to care coordination and patient-centered care as it encourages patient engagement and ensures that their health needs are met. Cultural insensitivity could lead to communication barriers, conflicts, lack of respect, and lack of collaboration.
Creating a health history for Paloma can significantly help in assessing the patient, tracking her progress, and making informed clinical decisions. Below are some important questions that are relevant to Paloma.
- When did your pain start?
- Where is the location of your pain?
- How would you rate your pain on a scale of 1-10?
- Do you smoke or drink?
- Do you always take Omeprazole as instructed, and how does this medication affect your pain?
- Are there any foods on your diet that you believe could be worsening your abdominal pain?
- Do you eat a lot of spicy food?
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. (8th ed.). St. Louis, MO: Elsevier
Caplan, S. (2019). Intersection of cultural and religious beliefs about mental health: Latinos in the faith-based setting. Hispanic Health Care International, 17(1), 4–10. https://doi.org/10.1177/1540415319828265
Capurso, G., & Lahner, E. (2017). The interaction between smoking, alcohol and the gut microbiome. Best Practice & Research Clinical Gastroenterology, 31(5), 579–588. https://doi.org/10.1016/j.bpg.2017.10.006
Gast, J., Peak, T., & Hunt, A. (2017). Latino health behavior: An exploratory analysis of health risk and health-protective factors in a community sample. American Journal of Lifestyle Medicine, 14(1), 97–106. https://doi.org/10.1177/1559827617716613
Livovsky, D. M., Pribic, T., & Azpiroz, F. (2020). Food, eating, and the gastrointestinal tract. Nutrients, 12(4), 986. https://doi.org/10.3390/nu12040986
McMaughan, D. J., Oloruntoba, O., & Smith, M. L. (2020). Socioeconomic status and access to healthcare: Interrelated drivers for healthy aging. Frontiers in Public Health, 8(231), 231. https://doi.org/10.3389/fpubh.2020.00231
Nair, L., & Adetayo, O. A. (2019). Cultural competence and ethnic diversity in healthcare. Plastic and Reconstructive Surgery – Global Open, 7(5), e2219. https://doi.org/10.1097/gox.0000000000002219
Sample Answer 3 for NURS 6512 Discussion: Diversity and Health Assessments
John Green, 33-year-old Caucasian male, presents to the office to establish as a new patient. John’s natal sex is female, but he identifies as a male. He transitioned from female to male 2 years ago. He has made a full transition with family and socially last year. He just moved back home and is unemployed at this time. He has been obtaining testosterone from the internet to give to himself. He has not had any health care since he decided to change other than getting his suppression medications through Telehealth 3 months ago. His past medical history includes smoking 2 packages of cigarettes per day for the last 10 years, smokes 3-6 marijuana joints every weekend (has an active green card) and does suffer from depression episodes. He is HIV positive for the last 3 years but remains virally suppressed at his last blood draw 6 months ago. He has been feeling very weak over the last few weeks which prompted him to move back home with his parents. He takes Biktarvy once daily that comes in the mail for free, tolerates it well, and 100 mg Testosterone IM every 7 days. His PMH is non-contributory. No past medical history. He has never been married. No significant family history. He is worried since moving back home and unemployed he will be a burden on his family, and he thinks his health may be declining.
There are several John Green’s economical, spiritual, behavioral, and cultural characteristics that I must consider as a nurse practitioner.
Socioeconomic Factors
Due to financial constraints, John may not be able to continue receiving medical care and taking his prescribed medications. John’s experience is only one example of the many obstacles transgender persons face when trying to make ends meet. There is a higher rate of homelessness, poverty, and unemployment among transgender people compared to the general population. This may be due to the multiple challenges that transgender people face in the workplace and in society as large. Due to financial constraints, he must rely on buying testosterone from the internet, which may expose him to the risk of utilizing harmful and inefficient drugs. As he is HIV + and a smoker, he may end up costing his family more money for medical care than they can afford.
Spiritual Factors
John’s spirituality and sense of self-worth may undergo profound changes because of his gender transition. The place of transgender individuals, defined by the religious and socio-cultural values especially of Muslim society. the sacred faith (Islam – as experienced in Pakistan and Bangladesh) does not accept other options outside the male and female gender norms; however, any notion that is not translated by the Holy Quran, for example living outside the male-female range, is anti-Islamic and is dealt with by dangerous means of violence (Yasser et al. 2021). Thus, respect for his religious or spiritual practices is warranted because they may play a significant impact in his propensity to seek medical care and adhere to treatments.
Lifestyle Factors
As a result of his smoking and marijuana use, John may be at an increased risk for developing lung cancer and other respiratory diseases. Therefore, it is crucial to inform him about the dangers that such behaviors may pose to his health. Medical schools, mental health counseling training programs, recovery and behavioral health services, and healthcare insurance companies need to be aware that the relationship between experiences with medical transition, age, and personal gender identity may impact rates of substance use within the transgender community (Redcay et al., 2022). It’s important to evaluate his mental health and provide the care he needs because his depressive episodes may have a wider influence on his welfare and quality of life. Transgender individuals experience, in addition to higher levels of anxiety and depression, increased suicidal behaviors when social supports are not in place. Research suggests that they do not attempt suicide because of their gender identity, but because of a lack of support (Jacob et al., 2017). Finally, John’s way of life is illustrative of the challenges transgender persons face. John is currently childless and does not have a partner. Finding a loving, supportive relationship can be difficult for transgender persons.
Cultural Factors
John may face discrimination and stigma due to his HIV-positive diagnosis and his gender transition. There are many cultural challenges he faces that the rest of us don’t face. In some societies, men enjoy greater social status and political influence simply by virtue of their gender. This trend of health care discrimination coupled with avoidance of seeking care leads to poorer health for transgender people (Jacob et al., 2017). As his healthcare practitioner, it is my responsibility to foster an accepting and non-judgmental atmosphere, one that considers his individual values and cultural norms.
Sensitive Issues During Provider – Patient interaction
Being mindful of John’s transition and the specific health concerns he may be experiencing as a result is essential while communicating with him. John may encounter stigma and discrimination because of his transgender status, and it’s crucial to be aware of this. Treating his medical history with dignity and inviting his queries is essential. Transgender individuals experience discrimination, stigmatization, and unethical and insensitive attitudes in healthcare settings. Therefore, healthcare professionals must be knowledgeable about the ways to deliver ethical and culturally competent care (Sundus et al., 2021).
Targeted Questions to Build Patient Health History and Assess Health Risks
- Can you tell me more about your gender transition journey, including when you first realized your gender identity and the steps you took to transition?
- How long have you been smoking, and have you tried to quit in the past?
- How often do you use marijuana, and have you ever experienced any negative effects of using it?
- Can you describe your experience with depression, including how often you experience episodes and any triggers that you have noticed?
- How are you managing your HIV positive status, and have you ever experienced any side effects or difficulties with your treatment?
References
Jacob, M., Cox, S., & Cox, S. R. (2017). Examining transgender health through the International
Classification of Functioning, Disability, and Health’s (ICF) Contextual Factors. Quality
of Life Research, 26(12), 3177–3185. https://doi.org/10.1007/s11136-017-1656-8Links to an external site.
Redcay, A., Counselman Carpenter, E., & Lally, K. (2022). The Impact of Gender Identity,
Medical Transition, and Other Substances on Marijuana Use for Transgender
Adults. Journal of Social, Behavioral, and Health Sciences.
Sundus, A., Shahzad, S., & Younas, A. (2021). Ethical and culturally competent care of
transgender patients: A scoping review. Nursing Ethics, 28(6), 1041–1060.
https://doi.org/10.1177/0969733020988307
Yasser, Q. R., Agrawal, R., & Ahmed, I. (2021). Transgender disclosure decisions and workplace
socio-cultural dynamics. Labour & Industry, 31(2), 87–105.
https://doi.org/10.1080/10301763.2020.1847023
Sample Answer 4 for NURS 6512 Discussion: Diversity and Health Assessments
It’s evident from your description that you encounter many challenges when caring for frequent healthcare service users, particularly those like SB, who face barriers to treatment adherence and access to care due to socioeconomic factors. Your consideration of these issues and the cited research by Brodeur et al. (2020), Langenbahn et al. (2021), and Charleston et al. (2020) highlights the need for a comprehensive and culturally sensitive approach to patient care. Here’s a response to your prompt:
Firstly, I appreciate your recognition of the frequent flyers in your facility and your commitment to providing them with the best possible care. It’s unfortunate that many of these patients face difficulties in following through on their discharge plans due to transportation or the cost of medications. These barriers underscore the importance of addressing social determinants of health, such as socioeconomic status, when developing treatment plans.
Your mention of SB, a 28-year-old African-American patient, and his father’s concerns further highlight the need for culturally competent care. As you rightly pointed out, healthcare disparities related to socioeconomic status and insurance coverage can impact access to treatment, especially among minority populations. It’s essential to acknowledge the historical mistrust that some African-Americans may have towards the healthcare system, which can be attributed to past injustices like the Tuskegee Experimental Study.
A comprehensive health assessment that includes an evaluation of SB’s socioeconomic status and potential barriers to treatment adherence is a crucial step in providing effective care. Identifying the triggers and causes of his headaches and differentiating between headache types, as you suggested, is essential for accurate diagnosis and treatment planning. Considering the possibility of cardiovascular-related issues is also a wise approach, given the relationship between headaches and blood pressure.
Your emphasis on involving the patient in shared decision-making and educating them about nonpharmacological treatment options aligns with patient-centered care principles. Many patients may not be aware of these evidence-based alternatives, so providing information and support in this area can be highly beneficial.
Cultural sensitivity, as mentioned in Charleston et al. (2020), is of utmost importance. Understanding the historical context and potential cultural factors affecting SB’s healthcare decisions can help build trust and improve communication. As healthcare providers, we must adapt our approaches to meet the unique needs and preferences of each patient, regardless of their cultural background.
Lastly, your reference to Ball et al. (2023) underscores the importance of using culturally validated screening tools and ensuring their appropriateness for specific patient populations. This ensures that the assessments and interventions are relevant and effective for patients like SB.
In summary, your approach to caring for frequent flyers like SB by considering socioeconomic factors, cultural sensitivity, and comprehensive health assessments is commendable. It reflects a commitment to patient-centered care and addressing healthcare disparities, ultimately contributing to improved patient outcomes.
References
Brodeur, M., Margo-Dermer, E., Chouinard, M.-C., & Hudon, C. (2020). Experience of being a frequent user of primary care and emergency department services: A qualitative systematic review and thematic synthesis. BMJ Open, 10(9), e033351. https://doi.org/10.1136/bmjopen-2019-033351
Charleston, L., Spears, R. C., & Flippen, C. (2020). Equity of African American men in headache in the United States: A perspective from African American headache medicine specialists (part 1). Headache: The Journal of Head and Face Pain, 60(10), 2473–2485. https://doi.org/10.1111/head.14004 Links to an external site.
Cutter, E. (n.d.). How to diagnose a migraine. American Headache Society. https://americanheadachesociety.org/wp-content/uploads/2021/01/AHS-First-Contact-Diagnosing-Migraine-.pdf
Sample Answer 5 for NURS 6512 Discussion: Diversity and Health Assessments
I appreciate your informative post on addressing the specific socioeconomic, spiritual, lifestyle and other cultural factors associated with Shawn Billings, a 28-year-old African American patient with complaints of severe headaches or migraines. It can be assumed that the health assessment interview was inadequate at the first office visit. Making presumptions on other cultures can interfere with proper diagnostic work up. That is why asking specific targeted health interview questions is crucial. As an interview is conducted, one must understand and decipher between the content of what the patient is describing and their emotional and personal insight. The content includes a chronology, onset, description, intensity, exacerbating factors, remitting factors, associated symptoms, social history, medical history, allergies, surgical history, hospitalizations, family medical history, current medications, and other conditions. This information will potentially lead to a diagnostic path for the patient (Slade & Sergent, 2022).
Research studies demonstrate racial or ethnic differences in pain perception. For instance, research shows that African Americans have low pain thresholds or tolerance. Thus, African American patients experience more unpleasant and intense pain than their non-Hispanic white counterparts (Knoebel et al., 2021). Analyzing the chief complaint of migraines in addition to the patient and family history goes hand-in-hand. If Billings didn’t state he has a family history of blood pressure or his brother is taking “Lisinopril” it could have delayed making a final diagnosis of hypertension. African Americans are also known for delaying treatment in preventing acute long term illnesses due to healthcare discrimination. About one-third of blacks (32 percent) reported experiencing discrimination in clinical encounters, while 22 percent avoided seeking health care for themselves or family members due to anticipated discrimination (Bleich et al., 2019).
References
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Bleich, S. N., Findling, M. G., Casey, L. S., Blendon, R. J., Benson, J. M., SteelFisher, G. K., … & Miller, C. (2019). Discrimination in the United States: experiences of black Americans. Health services research, 54, 1399-1408.
Knoebel, R. W., Starck, J. V., & Miller, P. (2021). Treatment disparities among the black population and their influence on the equitable management of chronic pain. Health Equity, 5(1), 596–605. https://doi.org/10.1089/heq.2020.0062
Slade. S. & Sergent, S. R. (2022). Interview techniques. National Library of Medicine National Center of Biotechnology Information.
https://www.ncbi.nlm.nih.gov/books/NBK526083/ |
NURS 6512 ASSESSMENT OF NUTRITION IN CHILDREN
Assignment 2: Digital Clinical Experience (DCE): Health History Assessment NURS 6512N-32
Assignment: NURS 6512 Differential Diagnosis for Skin Conditions
NURS 6512 ASSESSING THE HEAD, EYES, EARS, NOSE, AND THROAT
NURS 6512 Assignment 2: Digital Clinical Experience: Focused Exam: Cough
NURS 6512 Assignment 1: Lab Assignment: Assessing the Abdomen
NURS 6512 Assignment 1: Digital Clinical Experience: Assessing the Heart, Lungs, and Peripheral Vascular System
NURS 6512 Discussion Musculoskeletal Pain
NURS 6512 Assignment 1: Case Study Assignment: Assessing Neurological Symptoms
Discussion: NURS 6512 Assessing Neurological Symptoms
NURS 6512 Assignment 3: Digital Clinical Experience: Comprehensive (Head-to-Toe) Physical Assessment
NURS 6512 Assignment Assessing The Genitalia And Rectum
NURS 6512 Assignment Ethical Concerns
NURS 6512 Week 9 Assessment Of Cognition And The Neurologic System
NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children
NURS 6512 Assignment 1: Lab Assignment: Assessing the Genitalia and Rectum
Discussion: NURS 6512 Assessing the Ears, Nose, and Throat
Discussion: NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children
Discussion: NURS 6512 Effective Communication
NURS 6512 Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned
Assignment: NURS 6512 Assessment Tools and Diagnostic Tests in Adults and Children
NURS 6512 The Ethics Behind Assessment
NURS 6512 Cognition and the Neurologic System
NURS 6512 Assessment of the Musculoskeletal System
NURS 6512 Assignment Cardiovascular Disease (CVD)
NURS 6512 Abdomen and Gastrointestinal System
NURS 6512 Functional, Cultural and Diversity Awareness in Health
NURS 6512 Building a Comprehensive Health History
NURS 6512 TJ Pregnant Lesbian Essay
NURS 6512 Health History of Tina Jones
NURS 6512 Discussion Week 1 Main Post
NURS 6512 Assignment 2 Focused Exam
NURS 6512 Practice Assessment Skin, Hair, and Nails Examination
NURS 6512 Digital Clinical Experience
NURS 6512 Tools and Diagnostic Tests in Adults and Children
NURS 6512 Episodic/Focused SOAP Note Template
NURS 6512 Discussion Episodic/Focused SOAP Note
NURS 6512 Discussion Adolescent Patients
NURS 6512 how social determinants of health such as age, gender, ethnicity, and environmental situation impact the health and risk assessment of the patients you serve
NURS 6512 The use of nursing theories is critical to patient care because of the different purposes that they serve
NURS 6512 Effective communication is required needed in any patient-healthcare provider interaction
NURS 6512 Primary care is a critical aspect of patient care
NURS 6512 Cultural beliefs played a key role in patient health
NURS 6512 Research the health-illness continuum and its relevance to patient care
NURS 6512 discuss the relevance of the continuum to patient care
NURS 6512 Cultural and linguistic competence
NURS 6512 it is important to treat all patients with respect and dignity despite any differences in race, ethnicity, socioeconomic status, sexual orientation, or belief systems
NURS 6512 Assessment tests and tools play an important role in the diagnosis of various diseases conditions in both adults and children
NURS 6512 Allergies
NURS 6512 Health assessment of the skin, hair and nails
NURS 6512 Asthma Diagnosis
NURS 6512 The abdomen and the gastrointestinal system Assignment
NURS 6512 Congestive Heart Failure
NURS 6512 Acute Lateral Ankle Sprain
NURS 6512 Lower Back Pain
NURS 6512 Bilateral Ankle Pain
NURS 6512 Discussion Categories to Differentiate Knee Pain
NURS 6512 Assessing The Neurologic System
NURS 6512 Hypertension
NURS 6512 Comprehensive Physical Assessment
NURS 6512 Assessment of the genitalia and rectum is vital in depicting genitourinary and gastrointestinal abnormalities respectively
NURS 6512 ethical dilemmas Assessment
NURS 6512 History of Present Illness (HPI)
NURS 6512 provision of quality and effective healthcare services to the diverse population
NURS 6512 Discussion comprehensive health history for a patient is important in developing a treatment plan for them