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NURS 6512 Discussion: Diversity and Health Assessments

NURS 6512 Discussion: Diversity and Health Assessments

Scenario

A 26-year-old Spanish-speaking patient has presented to the clinic for the last two days in a row complaining of abdominal pain that is getting worse. The staff relied on her younger bilingual daughter to translate on the first visit. She was treated with Omeprazole and encouraged to take OTC medication. Today she presents with the same problem. Her daughter states it is the same problem but worse today.

Culturally competent healthcare is vital for patient care when dealing with culturally diverse populations. While practicing as nurses, we know that patients generally desire attentive and respectful relationships with providers and staff alike. As providers, it is incumbent upon us to be non-judgmental, respectful, and understand that we will encounter many walks of life. We encounter an individual of Hispanic descent who does not speak English in this scenario. To retrieve a comprehensive health

NURS 6512 Discussion Diversity and Health Assessments
NURS 6512 Discussion Diversity and Health Assessments

history, social and economic determinants, lifestyle, spiritual, and other cultural factors will need to be concerned for the provider. It is essential to recognize that these determinants significantly affect health and longevity. The ability to make healthy choices, stress management, spiritual concerns, and the ability to afford housing and medical care are just some of the existential factors that can tie into a health history.

Socioeconomic Factors

Social and economic factors are crucial when determining some of these disparities. “Hispanics encounter social determinants of health that negatively impact their ability to access healthcare services such as being uninsured, low-income, low health literacy and limited English proficiency” (Amirehsani et al., 2017). Generally, these barriers can contribute to poorer outcomes and delays in seeking healthcare.   The socioeconomic status of Hispanics is comparable to African Americans. Income, poverty rates, education level, and occupation are the most common comparable factors. I want to stress the importance of income as it can directly affect and influence health outcomes.

NURS 6512 Discussion Diversity and Health Assessments
NURS 6512 Discussion Diversity and Health Assessments

Populations with lower income are generally associated with increased stress and illness. If the patient is in poorer health, this will decrease access to stable employment opportunities, hence affecting income status. Hispanics also tend to occupy “high risk-low social position occupations,” which can be physically taxing and stressful with a much higher risk of injury (Morales, 2002). Lower socioeconomic status is also related to education level and literacy. It is essential to adjust our words, including avoiding medical jargon, to level with patients’ ability to articulate the information. Although there are many Hispanics who reside in the U.S., this patient is still in the minority group. Cultural sensitivity will be vital in developing a warm and trusting relationship with this patient, as she may have suffered from racial or ethnic discrimination. Recognizing that those individuals of lower socioeconomic status also tend to use acute hospital care compared to primary care settings which can create an enormous cost burden to the healthcare system (Kangovi, 2013). Given the patient’s condition of GERD, studies have also suggested a correlation between GERD and social status. “GERD has a considerable economic burden on the society and decreases the quality of life resulting in social burdens” (Farjam et al., 2018).

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Spiritual Factors

               Healthcare professionals are seemingly becoming more aware of how spirituality is a salient factor in maintaining good health and longevity. “The continuing societal oppression many Latino people experience, particularly those from the lower class, shape spiritual perspectives” (Campesino & Schwartz, 2006). Defining boundaries with spirituality may help the provider identify if the patient is willing to partake in treatment or take certain medications. The element of spirituality can also help providers grab hold, at least at a certain level, of the patient’s mental health status. Spirituality may be intertwined with cultural values, which can be a crucial determinant of how the provider interacts with the patient. Having a relationship with the divine can also produce better health outcomes from a “positivity” perspective.

Lifestyle

               The lifestyle of the patient can be directly related to socioeconomic status. Frequently those of lower-income involve themselves with unhealthy habits or life decisions. Studies suggest that among Hispanic women, health-related behaviors such as smoking cigarettes, being overweight, and being physically inactive are more common than those with a higher economic status (Morales, 2002). Alcohol consumption, smoking, obesity, and dietary intake can all directly affect her current condition of GERD. Dietary choices may be particularly important when dealing with diverse populations as some cultural foods are much less healthy than others. “Research suggests that diet quality among Hispanic/Latino adults is negatively influenced by sociodemographic and sociocultural factors such as younger age, less education, lower household income, and lower preference for using the Spanish language for reading, speaking, and listening” (Overcash & Reicks, 2021). According to studies, dietary choices will ultimately dictate the prevalence of obesity that Hispanics sadly face. Of course, drug use assessment should also be considered as it is more prevalent amongst lower-income individuals. In addition to making healthier choices, it would be important to ask this patient if she has health insurance, as some evidence has shown that the Hispanic population has lower health coverage rates.             

Building a health history with five targeted questions

  1. There are trained medical interpreters available, and we recommend using them instead of family members or friends. Would you like an interpreter?
  2. How would you like to be addressed by our staff, and is there anything we might say or perform that you would find offensive?
  3. Are there special treatments/medications/foods/herbs that you have found helpful with GERD and how do you feel about our preferred treatment?
  4. Do you have any previous history of medical o surgical treatments?
  5. Do you have a history of smoking, drinking, or using any illicit drugs?
  6. Are you married or have children? And how do you feel about their health and safety at home?
  7. Do you tend to choose healthy foods when preparing a meal?
  8. Is there anything I or the nurses can do to help you find spiritual strength at this time?

References

Amirehsani, K. A., Hu, J., Wallace, D. C., Silva, Z. A., Dick, S., West-Livingston, L. N., & Hussami, C. R. (2017). U.S. Healthcare Experiences of Hispanic Patients with Diabetes and Family Members: A Qualitative Analysis. Journal of community health nursing34(3), 126–135. https://doi.org/10.1080/07370016.2017.1340556

Campesino, M., & Schwartz, G. E. (2006). Spirituality among Latinas/os: implications of culture in conceptualization and measurement. ANS. Advances in nursing science29(1), 69–81. https://doi.org/10.1097/00012272-200601000-00007

Farjam, M., Sharafi, M., Bahramali, E., Rezaei, S., Hassanzadeh, J., & Rezaeian, S. (2018). Socioeconomic Inequalities in Gastroesophageal Reflux Disorder: Results from an Iranian Cohort Study. Middle East journal of digestive diseases10(3), 180–187. https://doi.org/10.15171/mejdd.2018.108

Kangovi, S., Barg, F. K., Carter, T., Long, J. A., Shannon, R., & Grande, D. (2013). Understanding why patients of low socioeconomic status prefer hospitals over ambulatory care. Health affairs (Project Hope)32(7), 1196–1203. https://doi.org/10.1377/hlthaff.2012.0825

Morales, L. S., Lara, M., Kington, R. S., Valdez, R. O., & Escarce, J. J. (2002). Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes. Journal of health care for the poor and underserved13(4), 477–503. https://doi.org/10.1177/104920802237532

Overcash, F., & Reicks, M. (2021). Diet Quality and Eating Practices among Hispanic/Latino Men and Women: NHANES 2011-2016. International journal of environmental research and public health18(3), 1302. https://doi.org/10.3390/ijerph18031302

The Office of Minority Health. (n.d.) Office of Minority Health. Hispanic/Latino -. Retrieved March 7, 2022, from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64

Case study 4 Attachment

    CASE STUDY 4

“Mono Nu, a 44-year-old Filipino patient comes to the clinic today to have his “blood thinner” labs drawn since he started them two weeks ago. Upon assessing the labs, the nurse practitioner notes that he is still out of range. When assessing the patient’s compliance both stated that he had been taking them just as prescribed. He has been doing well and eating a diet rich in fish and tofu. He doesn’t understand why his medications are not working.”

Socioeconomic status

The patient is a Filipino and the socioeconomic status is judged by a combination of the individual’s education,income and occupation. Most Filipinos believe that education can provide upward mobility and skin color,beauty,light colouring and money is correlated to intelligence. There’s no indication of the patient’s socioeconomic status, I can only try to make my own assumptions.

Spiritual status

The Roman catholicism is the most dominantly practiced religion in the Philippines and this is as a result of the four centuries of the Spanish colonial rule. The Catholic faith has been integrated into the Filipino culture.

For many Filipinos and Filipino Americans, religious practices and cultural practices are being incorporated into their various lives.

Lifestyle

There is a popular saying among the Filipinos “Bahala na” and this means “Never mind what happens” but it is also connected to their notion of “Leave it to God”.

This helps in explaining the influence of religion, spirituality and culture in the decision making process of Filipinos towards healing and health.

Sensitive issues

• I would approach conversations concerning the patient’s income, financial status and standards of living with delicacy. This is important because I would be trying to make the patient feel open and welcome to discussing anything with me.

• I would avoid criticizing the Philippines and generalizing observations about Filipinos.

• I would approach discussions about sexual orientation and gender identity with delicacy.

Health History

I would ask the following open ended questions from the patient to build his/her health history. I already know the patient’s Ethnicity,name and age.

• Have you ever been admitted to the hospital?

• Have you ever been treated in an emergency room?

• Have you ever been rushed to the hospital in an ambulance, if so (Why?)

• Have you ever received stitches?

• Do you carry an medication in case of an emergency?

• What does your diet consist of?

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Week 2 Original Post

Week 2 Original Post

The purpose of this discussion is to discuss the patient in the given case study:

Paloma Hernandez, 26-year-old, Spanish speaking patient who presents to the clinic for the last 2 days in a row complaining of abdominal pain that is getting worse. The first visit the staff relied on her younger bilingual daughter to translate. She was treated with Omeprazole and encouraged to take OTC medication. Today she presents with the same problem. Her daughter states it is the same problem but worse today.

The first step to properly care for this patient would be to connect with a Spanish interpreter as a large part of the problem could be that the patient’s young daughter is being used as a translator. Recognizing language barriers is part of having cultural competence and using an interpreter should be used in this situation (Ball et al., 2017).  Miscommunication from language barriers contributes to misdiagnoses, medical errors, as well as decreased satisfaction between patients and providers (Al Shamshi et al., 2020). After establishing an interpreter, it would be important to clarify what the patient understood from the treatment plan from the day prior. Considering the patient is only 26-years-old, it would be important to understand where she came from and how much education she has. To establish an accurate health history, the most important questions to ask would be 1. Can you tell me what you understood about your treatment plan from yesterday? 2. Were you able to pick up your prescription and start taking it?  3. What do you do for a living? 4. How old is your daughter? Do you have family close by who is able to help you?  5. Do you drink alcohol or do any illegal drugs? Knowing whether she drinks alcohol would be especially important in this situation since she is complaining about stomach pain.

Knowing how literate and educated the patient is in this situation can help understand why she returned to the clinic a second time for the same complaints. Knowing how old her daughter is and whether she has a support system would also be important as she may be struggling to care for herself and her daughter. If the patient is under a lot of stress, this could be the cause of her stomach pain and could be caused by an ulcer in which she would need to take the omeprazole that was prescribed. In this case, it would be important to know if she had prescription insurance and if she was able to pick up the prescription and begin taking it. If she was unable to pick it up, asking why and being sensitive to the fact that she may not be able to afford it would be important. In this case, social service resources should be provided so the patient can get help with paying for medications and any other services the patient may need (Henderson, 2017).

References

Henderson, D. (2017). In adults with multimorbidity, does the provision of social care services have an effect on the use of primary care and secondary care health services? International Journal of Population Data Science1(1). https://doi.org/10.23889/ijpds.v1i1.136

Week 2

      In this scenario, patient Paloma Hernandez is a 26-year Spanish-speaking patient. She has presented to the clinic for the last two days in a row complaining of abdominal pain that is getting worse. The staff relied on her younger bilingual daughter to translate on the first visit. She was treated with Omeprazole and encouraged to take OTC medications.

Culture refers to the combination of ideas, customs, and behaviors shared by a given people or society. These combinations determine members’ membership in a group and distinguish them from other groups (Myridis, 2015).

Every culture has a different belief about health. Hispanics expect health care personnel to be warm and personal and express a strong need to be treated with dignity. Verbal and nonverbal communication should be centered around “respecto” (respect) (Ide, 2004).

A healthcare professional should realize that some things are generally not discussed but are necessary to plan the best care. Using patient’s children to translate puts the parent and child in a problematic reversed power and authority position.

Since our patient came with her daughter, the patient is probably the primary caregiver because men like to play the “Macho” role, and he would have been with her at the hospital. She likely didn’t seek immediate medical attention, and she waited as long as possible in the hope that her pain would go away.

Health inequalities are higher among Hispanic patients, mainly associated with social determinants such as unfair paid labor, violence, abuse, and schooling (Bayles et al., 2009).

Hispanics have the most elevated poverty rate (20%) compared to national poverty estimates (10%), and health insurance is a crucial determinant of access to health care services (Velasco-Mondragonet al., 2016).

5 Targeted questions in our case with a professional interpreter will be: are you employed, what is your level of education and what do you do when you are sick? When were you aware that you were ill? Did you use any traditional medication to control pain? Do you drink alcohol? “Overall, how much stress do you or your family have regarding financial issues?”

A health history is an essential tool that will help a healthcare professional detect people with a higher-than-usual chance of having medical disorders and allows him to target the best course of action to fix it promptly.

References

Myridis, N. E. (2015). Culture’s definition. 2015 Digital Heritage, Digital Heritage, 20152, 351–354. https://doi.org/10.1109/DigitalHeritage.2015.7419521

Ide B. (2004). Communicating with Mexican-American clients. Online Journal of Rural Nursing & Health Care4(1), 2p. https://doi.org/10.14574/ojrnhc.v4i1.204

Bayles, B. P., & Katerndahl, D. A. (2009). Culture-bound syndromes in Hispanic primary care patients. International Journal of Psychiatry in Medicine39(1), 15–31. https://doi.org/10.2190/PM.39.1.b

Velasco-Mondragon, E., Jimenez, A., Palladino-Davis, A. G., Davis, D., & Escamilla-Cejudo, J. A. (2016). Hispanic health in the USA: a scoping review of the literature. Public Health Reviews (2107-6952)37(1), 1–27. https://doi.org/10.1186/s40985-016-0043-2

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