20 Aug The purpose of this discussion board is to review case study 3 and address the different cultural aspects of how to approach building a health history of this patient
Introduction
The purpose of this discussion board is to review case study 3 and address the different cultural aspects of how to approach building a health history of this patient. Patient MR is a Native American male that is complaining of anxiety and seeking help. He has been drinking and smoking “pot” to help himself deal with his anxiety. His fear of not going to Heaven is also a concern he mentioned.
Cultural Considerations
Some Native American cultures practice traditional healing, which includes a range of holistic treatments for acute and chronic conditions (Koithan & Farrell, 2010). “Herbs, manipulative therapies, ceremonies, and prayer are used in various combinations to prevent and treat illness” (Koithan & Farrell, 2010). This is why MR is reluctant to receive any prescription medications for his anxiety. He believes that health issues and other problems are a result of leaving traditional practices behind. One example of this is that diabetes was basically non-existent in most Native American communities less than 100 years ago, while now it is a common comorbidity that is affecting the Native American communities (Koithan & Farrell, 2010).
From the perspective of a health care provider, it would be important to recognize and accommodate for cultural differences, when possible, without harming the patient or not providing adequate care. It is important that due to MR’s family history of alcoholism and his statements of alcohol use that we do an SBIRT assessment on him as well as a full physical examination. An SBIRT assessment stands for screening, brief assessment, and referral to treatment (Ball et al., 2019). Upon ruling out any abnormal or concerning findings, we can begin to address his anxiety and different approaches to treatment.
Treatment
Because MR never sought treatment for anxiety, the approach will begin with trying to diagnose the type of anxiety disorder MR may have, if any, and discuss possible lifestyle changes such as dietary adjustments that may be beneficial to look into. Upon further assessment and conversation, we find that MR is struggling with generalized anxiety disorder (GAD). MR is agreeable to trying psychological therapy and lifestyle changes to increase more traditional practices, and if that does not work, he will consider a combination of pharmacotherapy and psychological therapy which would include prescriptions to first-line drugs which include “selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors (Bandelow et al., 2017).
Conclusion
Treating a patient with insight of their background, or at least having the ability to approach treatment for a patient of a different cultural background with a dialogue will optimize the care provided to that patient. There are components of different cultures that are important to note in the treatment process, as it will provide more data on the patient and help the health care provider in understanding their current condition or situation more efficiently.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to
physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues
in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
Koithan, M., & Farrell, C. (2010). Indigenous Native American Healing Traditions. The journal
for nurse practitioners : JNP, 6(6), 477–478. https://doi.org/10.1016/j.nurpra.2010.03.016
SECOND POST
As a healthcare professional, one can expect to see and care for individuals from many populations, cultural backgrounds, ethnicities, and socioeconomic groups. With this, healthcare providers must be equipped to understand different cultural beliefs and health traditions to provide culturally competent care to their patients. According to the Centers for Disease Control and Prevention (2021), cultural competence is a set of policies, practices, and attitudes that come together to enable an organization or system to perform across cultures.
Concerning the 23-year-old Native American male I was assigned, many socioeconomic, spiritual, and cultural factors must be taken into consideration and sensitized. To begin, this patient has reported smoking “pot” and drinking alcohol frequently. He has expressed that he is afraid that he will not get into heaven if he continues the same path. Traditionally, Native Americans have strong spiritual beliefs and values in that they are called to “walk in the sacred way” (Metropolitan Chicago Healthcare Council, 2004). When steering off of the traditional path of prayer and purity, Native Americans may struggle to understand their future and may fear spiritual rejection according to the Metropolitan Chicago Healthcare Council (2004). However, according to the American Addiction Centers (2022), Native Americans are at an increased risk for substance abuse due to poverty, high rates of violence, unemployment, discrimination, lack of health insurance, and lower education levels. Each of these socioeconomic issues plays into the increased risk for diabetes, hypertension, heart disease, mental illness, and cancer; some of which are present in this patient’s family history.
To respect this patient’s traditions, it is important to make this patient feel comfortable within the modern healthcare setting. To do this, this patient should be greeted with a handshake and direct eye contact should be avoided as this can be perceived as threatening. Family should be included if present, a translator offered if needed, and lastly, the patient should be given ample time to talk (Metropolitan Chicago Healthcare Council, 2004). The main questions I would ask to address this patient’s risks and establish a health history based upon the works of Ball et al. (2018) would be: What led you to seek medical attention? What is your cultural background? Can you tell me about your childhood? What do you think makes you anxious? What coping skills do you use in stressful situations? What remedies have you tried to help with your anxiety before coming in today? How often do you drink alcohol? How many drinks do you think you have on average? Do you know the risks of drinking alcohol regularly? Are you open to hearing about how we can improve your alcohol use?
References
American Addiction Centers. (2022, January 7). Substance abuse statistics for Native Americans. https://americanaddictioncenters.org/rehab-guide/addiction-statistics/native-americans
Ball, J. W., Danis, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2018). Seidel’s physical examination handbook: An interprofessional approach (Mosby’s physical examination handbook) (9th ed.). Mosby.
Centers for Disease Control and Prevention. (2021, September 10). Cultural competence in health and human services. NPIN. https://npin.cdc.gov/pages/cultural-competence
Metropolitan Chicago Healthcare Council. (2004, November 4). Guidelines for health providers interacting with American Indian patients and their families. https://www.advocatehealth.com/assets/documents/faith/cg-native_american.pdf
