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Discussion: NURS 6512 Diversity and Health Assessments

Discussion: NURS 6512 Diversity and Health Assessments

Discussion: NURS 6512 Diversity and Health Assessments

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In May 2012, Alice Randall wrote for The New York Times about the cultural forces that led black women to maintain weights over what was considered healthy. According to Randall’s observations and personal experience as a black woman, many African-American communities and cultures regard fat women as more attractive and desirable than healthy-weight women. As she noted, many black women are heavy because we want to be (Randall, 2012).

Although Randall’s remarks sparked much debate and controversy, they illustrate a fundamental truth in the medical industry: different people, races, and groups have distinct beliefs and behaviors that affect their health. Nurses and other healthcare providers should be aware of this fact and adjust their recommendations and health-evaluation methods to accommodate for variation.

You will examine different social, spiritual, behavioral, and other cultural variables that should be taken into account while constructing a health history for individuals from varied backgrounds in this topic.

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 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.

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.

Also Read: Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children NURS 6512N

Case 1

JC, an 86-year-old Asian male in need, is physically and financially dependent on his daughter, a single mother with little time or money to devote to her father’s medical requirements. He has high blood pressure (HTN), gastroesophageal reflux disease (GERD), a vitamin B12 deficiency, and chronic prostatitis. He is currently taking Lisinopril 10mg QD, Prilosec 20mg QD, monthly B12 injections, and Cipro 100mg QD. He walks in for his yearly physical and says, “I came for my annual physical, but I don’t want to be a burden to my daughter.”

Case 2

TJ, a 32-year-old pregnant lesbian, is getting a physical exam and has been experiencing vaginal discharge. So far, her pregnancy has been trouble-free. She has been seeing an obstetrician for prenatal care. She obtained sperm from a nearby sperm bank. She is now taking prenatal vitamins and occasionally takes Tylenol over the counter for aches and pains. She comes from a long line of diabetics. Abortions 0; Gravida 1; Para 0;

Case 3

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.

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NURS 6512 Discussion comprehensive health history for a patient is important in developing a treatment plan for them

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.

Select one of the three case studies. Reflect on the provided patient information.

Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.

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?

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: Discussion: NURS 6512 Diversity and Health Assessments 

By Day 3

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected. 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 “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses

By Day 6

Respond on or before Day 6 to at least two of your colleagues who selected a different patient than you, using one or more of the following approaches:

Suggest additional socioeconomic, spiritual, lifestyle, and other cultural factors related to the patient.

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.

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

Courtney Barber  

Dec 4, 2023 Dec 4, 2023 at 1:18pm  

Main Post: 

Patient Scenario 

John Green, a 33-year-old Caucasian male, presents to the office after moving back home due to his health concerns. He has not received any healthcare for the past 2 years since transitioning from a female to a male. He presents to the office today to establish as a new patient. He states he last had a telehealth visit 3 months ago to receive his suppression medication for HIV and obtains testosterone by ordering off the internet. Other past medical history includes smoking 2 packs of cigarettes per day for the last 10 years, smokes 3-6 marijuana joints every weekend, suffers from depression, and as prior stated he is HIV positive in which he remains virally suppressed at his last blood draw 6 months ago. His current medication list includes Biktarvy that he takes once daily and 100mg of testosterone IM weekly. He has never been married and does not have any significant family history. Today he states that “for the past several weeks I have been feeling very weak and I am worried that since I am moving back home and I am unemployed, I will be a burden to my family.” 

Socioeconomic, Lifestyle, and Cultural factors with Explanation  

Transgender individuals may often feel discriminated against and not accepted, unfortunately they may also feel this way in the healthcare setting. For transgender patients to feel comfortable and safe within the healthcare setting, providers must acknowledge this difference among patients and be able to be culturally sensitive when asking questions during an assessment (Ball et al., 2023). When referring to a transgender patient, referring to them as their preferred pronoun is most appropriate. The provider shall not assume but ask the patient how they’d like to be addressed (Johnson et al., 2020). Leading with this ensures the patients’ healthcare needs are of the utmost importance. It also allows for the patient to feel more comfortable when referred to the gender they prefer. 

As a healthcare provider, speaking with your patient about possible health concerns is important. Transgender individuals have a higher prevalence of being homeless, live in poverty, ensure discrimination, psychological stress, unemployment, HIV infection, substance abuse, suicide, violence, and lack healthcare insurance (Radix, 2020). John falls into this category of not having insurance. This should be acknowledged and discussed during the initial visit. He currently receives his medications through the mail for free, does he want to continue receiving his testosterone and Biktarvy this way, if not discussing with the patient what his plans are is important, referring him to the local health department for assistance may be necessary. 

John has a history of HIV infection, another sensitive issue that must be addressed. Discussing with John whether he is currently sexually active, and his ways of protection are important in helping him to not spread HIV but also to not receive any other infections such as sexually transmitted diseases. The transgender community is particularly vulnerable to HIV and STDs and providing risk assessments and education to these patients is important in slowing and/or stopping the spread (Radix, 2020). 

Special considerations during the physical exam for John may need to be made. Having pelvic and breast exams may be traumatic and induce anxiety in transgender men. Speaking with him about cervical cancer screenings and staying up to date is very important. Transgender males may also wear a chest binder to hold down the breast and create a more masculine appearance, these may lead to skin breakdown or other skin infections due to the tightness and how often it is worn. John may be hesitant and require education about safe binding (Julian et al., 2021). 

Targeted Questions 

  1. How would you like me to address you, and do you have a preferred pronoun you’d like for me to use during your visit today? 
  1. Do you feel that you have adequate social support? 
  1. Are there any resources that you haven’t been provided that you’d like to discuss such as counselling? 
  1. Where do you obtain your prescriptions and who is currently prescribing them for you? 
  1. Are you currently sexually active and with how many partners? Is your partner(s) aware of your HIV infection? Are precautions taken? 

References: 

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby. 

Johnson, A. H., Hill, I., Beach-Ferrara, J., Rogers, B. A., & Bradford, A. (2020). Common barriers to healthcare for transgender people in the US Southeast. International Journal of Transgender Health, 21(1), 70-78. 

Julian, J. M., Salvetti, B., Held, J. I., Murray, P. M., Lara-Rojas, L., & Olson-Kennedy, J. (2021). The impact of chest binding in transgender and gender diverse youth and young adults. Journal of Adolescent Health, 68(6), 1129-1134. 

Radix, A. E. (2020). Addressing needs of transgender patients: the role of family physicians. The Journal of the American Board of Family Medicine, 33(2), 314-321. 

Laura Suzanne Carson  

Dec 8, 2023 Dec 8, 2023 at 6:54pm  

  Courtney, 

You have such a well thought out approach to this patient. If you reflect back on your nursing school, I’m sure you will remember the lessons about the different cultures and the need to be educated on these different types of patients. Now that there are more and more transgender patients, it is important that providers have at minimum a basic knowledge of their health needs. (Juarez et al, 2023) I posted that it is important to let the patient know that they are not experts of transition health, but their transition providers would be able to give guidance for any concerning health issues and how it may affect their treatment plan.  I found an interesting study about seeking healthcare for older transgender patients. It is very easy to just think of transgender patients as being young. The article talked about older patients being afraid to seek care because they were scared of discrimination or downright abuse from the providers. (Walker et al, 2023) The older patients remember the awful treatment most transgenders received years ago and it makes them not want to see a provider now. That is so sad.  

I took the statement he was fully transitioned for two years to mean he had had surgery. But you mentioned that he might still have information on pelvic exams and binding. Those are some very important points. They would make for great assessment questions. Have you had any surgery and if yes, what surgeries?  

 

Laura S Carson 

 

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby. 

Juarez, P. D., Ramesh, A., Reuben, J. S., Radix, A. E., Holder, C. L., Brown, K. Y., Tabatabai, M., & Matthews-Juarez, P. (2023). Transforming Medical Education to Provide Gender-Affirming Care for Transgender and Gender-Diverse Patients: A Policy Brief. Annals of Family Medicine, 21(Suppl 2), S92–S94. 

Walker, R. V., Powers, S. M., & Witten, T. M. (2023). Transgender and Gender Diverse People’s Fear of Seeking and Receiving Care in Later Life: A Multiple Method Analysis. Journal of Homosexuality, 70(14), 3374–3398. 

 

Meagan Victoria Jean Pruden (She/Her 

Dec 9, 2023 Dec 9, 2023 at 12:01am  

Hello Courney, 

Your main post shows a great understanding of transgender individuals in healthcare settings. Your consideration of special requirements during physical exams, such as pelvic and breast exams, and awareness of potential challenges related to chest binders showcases a patient-centric approach to transgender healthcare (Ball et al., 2023). I had not thought of the implications of chest binders and skin integrity. Your emphasis on cultural sensitivity, respecting preferred pronouns, and recognizing the unique challenges faced by transgender patients aligns with the best practices outlined in the literature (Julian et al, 2021)  

  Links to an external site.. I mentioned in my last post to our colleague Dominique that there are very few nurses on my unit who respect our LGBTQ+ patients and their identities.  

Have a great night,
Meagan Pruden 

References 

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby 

Julian, J. M., Salvetti, B., Held, J. I., Murray, P. M., Lara-Rojas, L., & Olson-Kennedy, J. (2021). The impact of chest binding in transgender and gender diverse youth and young adults. Journal of Adolescent Health, 68(6), 1129-1134 

 

Shirley Moreta  

Dec 14, 2023 Dec 14, 2023 at 11:53pm  

Hello Courtney. The assigned patient provides an interesting discussion. It indicates that the patient had not accessed any healthcare services for the past two years since the transition from a female to a male. This might be due to pertinent stigma in the healthcare system. It is asserted that transgender individuals encounter stigma, discrimination, and socioeconomic adversities (Abramovich et al., 2020). The outcome is poor health outcomes lead to increased disease burden. Another important in healthcare provision for transgender individuals is the decision to conceal their transgender identity. There is skepticism that disclosure of identity might lead to discrimination. However, it is reported that disclosure can lead to potential access to social support (Kcomt et al., 2020). It would be important for the healthcare practitioner to determine how the patient would like to be addressed. The discussion also indicates that the patient has a history of HIV infection which is a sensitive issue. There are HIV-related stigmas that might impede the provision of healthcare services (Challacombe, 2020). The healthcare practitioner needs to understand various issues such as whether the patient is sexually active. These would be essential in understanding how to better formulate the best treatment options. 

 

References 

Abramovich, A., de Oliveira, C., Kiran, T., Iwajomo, T., Ross, L. E., & Kurdyak, P. (2020). Assessment of Health Conditions and Health Service use among transgender patients in Canada. JAMA Network Open, 3(8). https://doi.org/10.1001/jamanetworkopen.2020.15036  

Links to an external site. 

Challacombe, S. J. (2020). Global inequalities in HIV infection. Oral Diseases, 26(S1), 16–21. https://doi.org/10.1111/odi.13386  

Links to an external site. 

Kcomt, L., Gorey, K. M., Barrett, B. J., & McCabe, S. E. (2020). Healthcare avoidance due to anticipated discrimination among transgender people: A call to create trans-affirmative environments. SSM – Population Health, 11, 100608. https://doi.org/10.1016/j.ssmph.2020.100608