Discussion: Diversity and Health Assessments

May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain 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).

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.

Scenario

n 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. You are assigned a case study for this Discussion. 

CASE STUDY  1 

AG is a 54-year-old Caucasian male who was referred to your clinic to establish care after a recent hospitalization after having a seizure related to alcohol withdrawal. He has hypertension and a history of alcohol and cocaine abuse. He is homeless and is currently living at a local homeless shelter. He reports that he is out of his Amlodipine 10 mg which he takes for hypertension. He reports he is abstaining from alcohol and cocaine but needs to smoke cigarettes to calm down since he is not drinking anymore. 

Discussion 1 HKis

Culturally Competent Care towards Lesbian and LGBTQ

Understanding the patient’s attitudes, beliefs, diversity, and culture is key in providing competent patient-centered care. This concept especially applies to the member of the LGBT community who constantly face discrimination and poor healthcare services from healthcare providers who do not understand how to communicate with them (Banerjee et al, 2018). Practitioners lack the basic education and terminology of the LGBTQ culture which further complicates the matter. It is important therefore for nursing professional to learn and educate themselves about the culture to create an environment that is inclusive and understanding of the needs of these population. To establish trust and seeking to understand, Landry (2017) suggest avoiding assumptions especially when it comes to addressing the patient. Therefore, I would start the meeting by asking “what brought you to the office today” avoiding words such as “sir or maam” and keeping remarks open and general.  I will ask open-ended questions that will allow the patient to express and share relevant information. It is as important to be flexible and adjust communication techniques that seek to understand the unique factor of each individual. With this in mind, I would include the partner in the conversation asking, “how are you and your partner feeling about the pregnancy”.

As a practitioner, its important to understand the patient’s health risk and disparities in order to tailor appropriate interventions. For example, marginalization of the Lesbian community has translated to significant health inequities such as substance use, lack of access to and use of preventive healthcare services, cardiovascular disease, diabetes mellitus, and sexually transmitted infections/HIV (Dorsen & Caceres, 2019). With this in mind I will ask the patient “ Have you and your partner been sexually active with other men? To determine the risk for STI’s which can be a source of virginal discharge. I will follow by asking “how long have you been having virginal discharge? in order to gain a better understanding of the presenting issue. Lastly, I would ask the patient she has been attending regularly attending her obstetric visits to ensure she is not lagging behind or determine any issues with access to proper prenatal care.  

Nurse practitioners needs to be competent in taking care of patient’s from all different background in order to eliminate any barriers to patient care. To facilitate partnership towards mutual goals it is crucial for clinicians to create a safe space that fosters provider-client trust, respect and understanding.  

Reference

Banerjee, S. C., Walters, C. B., Staley, J. M., Alexander, K., & Parker, P. A. (2018). Knowledge, Beliefs, and Communication Behavior of Oncology Health-care Providers (HCPs) regarding Lesbian, Gay, Bisexual, and Transgender (LGBT) Patient Health care. Journal of health communication, 23(4), 329–339. https://doi.org/10.1080/10810730.2018.1443527

Dorsen, C., & Caceres, B. (2019). Improving healthcare for LGBTQ+ patients: how NPs can make a difference. Nurse Practitioner, 44(7), 9. doi: 10.1097/01.NPR.0000559848.29614.40

Landry, J. (2017). Delivering culturally sensitive care to LGBTQI patients. The Journal for Nurse Practitioners, 13(5), 342-347. https://doi.org/10.1016/j.nurpra.2016.12.015

Discussion 2Amndlitt

TJ, a 32-year-old pregnant lesbian, is being seen for an annual physical exam and has vaginal discharge. Her pregnancy has been without complication. She is receiving prenatal care from her 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.

                Culture is described as reflecting every aspect of human behavior. Culture includes ideas, attitudes, ways of relating to one another, manners of speaking, and the material products of physical effort, ingenuity, and imagination. Culture competence care requires that healthcare providers be sensitive to the patient's heritage, sexual orientation, socioeconomic status, ethnicity, and cultural background (Ball, 2019). Applying the RESPECT model inpatient can be helpful as a provider by verbal, nonverbal, or written. The importance of remaining open-minded and maintaining a sense of respect for the patient is crucial in developing a relationship. RESPECT stands for rapport, empathy, support, partnership, explanations, cultural competence, and trust (Ball, 2019). A helpful format that integrates critical components of a well-constructed question is PICO: problem, intervention or exposure, comparison, and outcome (Dains, 2019).

Tell me about your support system. It will be helpful to understand the patient’s home life in gaining an insight into the patient’s history. Do you have a spouse or domestic partner? Do you have the support of family? Learning about her socioeconomic status can be insightful as a provider. What are her living arrangements? What are her religious views? What is her education level?

How are your OB/GYN appointments going? Have you had any problems or issues that concern your doctor? Does your doctor have any concerns with the pregnancy? Have you taken your glucose tolerance test? It is also essential to know if she was given information on the father, such as past medical history.

When did the vaginal discharge begin? It is vital to identify any primary factors and interventions when the problem began (duration). Are there any factors that relieve or worsen the symptoms? Is the discharge worse at any time during the day (morning, night)?

Have you ever been diagnosed with a sexually transmitted disease? It would be beneficial to discuss sexual activity and is there a history of sexually transmitted diseases. Is the patient in a monogamous relationship?

                Have you had any sickness, illness, or injuries during your pregnancy? Are you having much morning sickness? Have you had any injuries during your pregnancy?

                Lesbians and bisexual women face the same health issues as heterosexual women, but they often have difficulty accessing appropriate care. Physicians can improve care for lesbians and bisexual women by acknowledging the potential barriers to care (hesitancy of physicians to inquire about sexual orientation and of patients to disclose their sexual behavior) and working to create a therapeutic physician-patient relationship. Taking an inclusive and nonjudgmental history and being aware of the range of health-related behaviors and medicolegal issues pertinent to these patients enables physicians to perform relevant screening tests and make appropriate referrals (Mravcak, 2016).

References

Ball, J. D. (2019). Seidel's Guide to Physical Examination: An interprofessional approach (9th ed). St. Louis, MO: Elsevier Mosby.

Dains, J. B. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby. Retrieved from Retrieved http://www.class.content.net/c04a9d258581156f956f82676a610b32.pdf

Mravcak, S. (2016). Primary Care for Lesbian and Bisexual Women. American Family Physician, 74 (2), 279-286.