NURS 6512 Discussion Diversity and Health Assessment

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.

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).

Photo Credit: Getty Images

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.
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 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.

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

Discussion Week 2

Patient Scenario:

TJ, a 32-year-old pregnant lesbian, is being seen for an annual physical exam and has been having vaginal discharge. Her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. She is currently taking prenatal vitamins and takes over the counter Tylenol for aches and pains on occasion. She has a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.
Specific Socioeconomic, Spiritual, Lifestyle, and other Cultural Factors
Despite impressive advances towards LGB equality in many countries, including the United States, research suggests that LGB persons continue to experience health disparities on almost every major US health indicator, including tobacco use, alcohol and drug use, depression, anxiety and suicidality, reproductive and sexual health, nutrition, physical activity and obesity (Dorsen & Van Devanter, 2017). While working with this patient, it is essential to be aware of the patients’ demands and provide non-judgmental care. Identifying risk factors for sexually transmitted infections are a necessary part of the sexual history (Ball et al., 2019). For this patient focusing on the chief complaint, when discharge may have begun, and how long it has been happening. Lifestyle could be a focus to examine further due to the strong family history of diabetes; it would be essential to ask questions related to diet, unusual fatigue, or history of vaginal/bladder infections.

Culturally Sensitive Issues

Being competent in cross-cultural functioning means learning new behavior patterns and effectively applying them in the appropriate settings (Cultural Competence in Health and Human Services, 2020). Culturally competent suggestions would be understanding and showing interest in the patient as a unique person, exploring and respecting the patient, beliefs, values, and preferences for care (Ball et al., 2019). While interacting with this 32-year-old pregnant patient, who identifies themself as a lesbian, it would be vital to inquire how the patient would like to be identified throughout the plan of care. Also, particular attention should be paid to care for patients who self-identify as being lesbian, gay, bisexual, and transgender (LGBT) (Ball et al., 2019). As a healthcare provider, I would need to invest time studying and becoming culturally competent to provide efficient care.

Five Targeted questions to ask patient

1. How are you feeling today?
2. How would you like to be addressed?
3. How are you coping with pregnancy?
4. Do you want or expect emotional support from the healthcare team
5. Are there medical matters that you do not wish to disclose to others?
6. Is there a religion or faith in which you wish to follow?

References

Ball, J., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). In Seidel’s guide to
physical examination: an interprofessional approach (9th ed., pp. 28-93). essay, Mosby.
Centers for Disease Control and Prevention. (2020). Cultural Competence In Health and Human
Services. Centers for Disease Control and Prevention. https://npin.cdc.gov/pages/cultural-
competence.
Dorsen, C., & Van Devanter, N. (2017). Open arms, conflicted hearts: nurse-practitioner’s
attitudes towards working with lesbian, gay and bisexual patients. Journal of Clinical
Nursing, 25(23-24), 3716–3727. https://doi.org/10.1111/jocn.13464

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