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NURS 6512 Discussion: Diversity and Health Assessments

NURS 6512 Discussion: Diversity and Health Assessments

NURS 6512 Discussion: Diversity and Health Assessments

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

Discussion Diversity and Health Assessments
Discussion Diversity and Health Assessments

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.

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Targeted Questions

  1. What is your level of income? Do you have financial challenges in obtaining your prescribed medications?
  2. Do you understand the mode of action of your blood thinner medications and why they are necessary for your current state?
  3. Are there some cultural beliefs that may negatively influence your willingness to take the prescribed medications?
  4. Do you have any social program that can assist you in obtaining your medications as prescribed?
  5. Are there any other health concerns that you feel that I should be aware of?

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. Religions13(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 Reports3.

Sharifi, N., Adib-Hajbaghery, M., & Najafi, M. (2019). Cultural competence in nursing: A concept analysis. International journal of nursing studies99, 103386.

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

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 Research26(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 Ethics28(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 & Industry31(2), 87–105.

https://doi.org/10.1080/10301763.2020.1847023

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