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
- What is your level of income? Do you have financial challenges in obtaining your prescribed medications?
- Do you understand the mode of action of your blood thinner medications and why they are necessary for your current state?
- Are there some cultural beliefs that may negatively influence your willingness to take the prescribed medications?
- Do you have any social program that can assist you in obtaining your medications as prescribed?
- 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. Religions, 13(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 Reports, 3.
Sharifi, N., Adib-Hajbaghery, M., & Najafi, M. (2019). Cultural competence in nursing: A concept analysis. International journal of nursing studies, 99, 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.
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?
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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 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