DIVERSITY AND HEALTH ASSESSMENTS NURS 6512

   

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The patient in this case study is a 33 year old caucasian male. John has multiple factors that affect his life from a socioeconomic, spiritual, lifestyle, and cultural perspective. From a socioeconomic perspective, John is unemployed and living with his parents. He also is on several expensive medications including testosterone and suppression medications. In addition, John has multiple lifestyle factors that need to be considered. He has smoked two packages of cigarettes per day for the last 10 years and smokes 3-6 marijuana joints every weekend. Cultural factors potentially affecting John’s current health situation may include, his HIV status, and that he has transitioned from his natal sex, female, to male.

While interviewing John there are a few things we must be sensitive to. First, its important to note that John reports having a history of depression and feeling worried about his health and moving in with his family. Caucasian men are more likely to receive treatment than men of other ethnic background (ball et al., 2023). Yet, treatment can vary largely due to patient perspective of treatment (Bailey et al., 2019). In addition, studies shows that depression and anxiety rates amongst the transgender population are 45% higher than those of the general population (Chumakov et al., 2021). Concerning John’s depression and anxiety, I would ask the following two targeted questions.

• How do you feel your anxiety and depression affects your life and your current situation?
• If we were going to look into treating your depression and anxiety, what types of treatment would you be most comfortable with?

John completed his transition from female to male a year prior to our interview with him. Yet, we must remember that patient may have side effects of treatment or surgeries that need our continued attention. New symptoms may also appear at any time. Because many things about a transitioned body may be new to this individual, we must create a space where the client is comfortable speaking to us about their transitioned body. Questions I would ask John regarding ongoing care of his transitioned body would include:

• Do you have any concerns related to transition or affects of your transition on your body currently?
• Are you having any difficulty getting your medications, or do you anticipate having any difficulty getting your medications?

Another sensitive area I would want to discuss with John while interviewing him, is if he is currently engaging in any high risk behaviors that could complicate his own HIV status or spread the disease to others. There are many options currently available to reduce the risk of passing on this virus, so it is imperative that John feel comfortable talking to his provider about his life from a social perspective. To begin this conversation with John I would ask the following questions:

• Can you tell me about your HIV diagnosis and treatment up to this point?
• Do you currently participate in any high risk activities such as unprotected sexual activities or use any drugs administered with a needle?

References

Bailey, R., Mokonogho, J., & Kumar, A. (2019). Racial and ethnic differences in depression: current perspectives. Neuropsychiatric Disease and Treatment, Volume 15, 603–609. https://doi.org/10.2147/ndt.s128584

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.

Chumakov, E. M., Ashenbrenner, Y. V., Petrova, N. N., Zastrozhin, M. S., Azarova, L. A., & Limankin, O. V. (2021). Anxiety and depression among transgender people: findings from a cross-sectional online survey in russia. LGBT Health, 8(6), 412–419. https://doi.org/10.1089/lgbt.2020.0464

Diversity and Health Assessments

            When evaluating the patient and providing a diagnosis, nurses are crucial. They ensure high-quality care and act as a link between patients and healthcare professionals (Sharifi et al., 2021).

                                  Specific Socioeconomic, Spiritual, Lifestyle, and other Cultural factors associated with the Patient

            The specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient include:

            Cultural food practices- Mono Nu being a Filipino it is known that in their culture their preferable diet consist of fish foods. However, it is to be noted that several fish species have anti- clotting elements in them such as the fish he is eating and also the tofu. The food is high in omega-3 fatty acids and vitamin K. Omega-3 fatty acids prevent blood thinners from working as intended and instead raise the risk of blood clot formation (Coleman, 2019).

            Low income- this could be another factor whereby he may not be able to purchase a diet suitable to meet his medical needs and the fish rich food is the one that’s affordable to him. Hence he is not able to meet the expected lab values (Coleman, 2019).

            Lifestyle- whereby he could be living a sedentary lifestyle not exercising and primary eating the fish and tofu. Thus this could lead to his lab values remaining out of range as such a lifestyle is unhealthy and could stagnate or worsen his condition. Hence his lifestyle is influencing his health. Hence his risk of blood clot formation increases (Coleman, 2019).

            Spiritual- he could be religiously aligned to his tribe and their practices of worship and part of that would involve consumption of fish rich food that has been known to be negatively impacting his health. This is because it leads to blood thinner labs being out of range despite compliance with medication due to his diet (Coleman, 2019).

                                                                                                  Sensitive Issues

            The topic around his diet could be a cultural issue hence should be handled with care. This is because it could lead to possibly discriminating against a culture hence a medical practitioner should be cautious in the terms they use in order not to speak against a certain culture’s practices and way of life. The practitioner should also be ready to offer alternative methods of treatment that could be more effective and also to be respectful of the patient’s wishes (Veziari et al., 2021).

                                                                                           Targeted questions

1. What health concern do you consider is the most important to you?
2. Do you engage in exercise from time to time?
3. Do you have issues in accessing resources to improve your health?
4. What other diet do you also consume?
5. Are there some cultural beliefs that may prevent you from accepting some life changes to improve your health? (Young & Guo, 2016).

                                                                                                  References

Coleman, D. E. (2019). Evidence based nursing practice: The challenges of health care and cultural diversity. Journal of Hospital                                       Librarianship, 19(4), 330-338. https://doi.org/10.1080/15323269.2019.1661734

Links to an external site.

Sharifi, N., Adib-Hajbaghery, M., & Najafi, M. (2019). Cultural competence in nursing: A concept analysis. International Journal of                                     Nursing Studies, 99, 103386. https://doi-

Links to an external site.org.resu.idm.oclc.org/10.1016/j.ijnurstu.2019.103386

Veziari, Y., Kumar, S., & Leach, M. (2021). Barriers to the conduct and application of research    among complementary and alternative                             medicine professions in Australia and New Zealand: A cross-sectional survey. Complementary Therapies in Medicine, 60.                           https://doi-org.ezp.waldenulibrary.org/10.1016/j.ctim.2021.102752

Links to an external site.

Young, S., & Guo, K. L. (2016). Cultural diversity training Links to an external site. The Health   Care Manager, 35(2), 94–102.                                             https://doi.org/10.1097/hcm.0000000000000100

DIVERSITY AND HEALTH ASSESSMENTS NURS 6512

DIVERSITY AND HEALTH ASSESSMENTS NURS 6512

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).

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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

1. What is your level of income? Do you have financial challenges in obtaining your prescribed medications?
2. Do you understand the mode of action of your blood thinner medications and why they are necessary for your current state?
3. Are there some cultural beliefs that may negatively influence your willingness to take the prescribed medications?
4. Do you have any social program that can assist you in obtaining your medications as prescribed?
5. 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.

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.

As in the case of John Green, a 33-year-old Caucasian male who transitioned from female to male two years ago, is my patient. Last year, John went away from home and established himself socially, but he recently returned and is now jobless. To his knowledge, he has not received any health care since making the decision to modify his lifestyle three months ago, other from Telehealth, where he has been receiving his suppression drugs since then.

For the past three years, John has been HIV positive, but his virus was suppressed at his most recent blood draw, which was six months ago. In the last few weeks, he has been feeling weak, so he has decided to move back in with his parents. John takes Biktarvy once a day, which he receives for free, and 100 mg of testosterone intramuscularly every seven days. There is a slew of financial, spiritual, personal style, and cultural aspects that should be discussed in relation to John Green.

I will like to add that the fact that John found the process of transitioning from female to male to be challenging in a variety of different ways is of the utmost significance. One of the many obstacles he has been forced to surmount is a deficiency in the amount of support he receives from his friends and family. This is probably because his transition took place during a period in which society was far less tolerant of transgender people. John has also been forced to deal with significant monetary challenges as a direct consequence of his shift. All the costs associated with his transition, such as those for surgery, hormones, and counseling, have been entirely self-funded by him.

According to reports, because of this, he has been compelled to live in abject poverty to pay for the costs associated with his transition from one employment to another. As the tale of John demonstrates, transgender people face significant economic disadvantages today. People who identify as transgender are more likely than people who do not identify as transgender to be unemployed, to have a lower income, and to be homeless. It’s possible that the fact that transgender people face a variety of challenges in the workplace and in society is what’s behind this phenomenon. Some of the problems that women encounter include being subjected to discrimination, harassment, and even physical assault.

To add insult to injury, John also struggles with his mental health, which is unfortunate. He has been given a diagnosis of HIV, and his feelings of hopelessness have been intermittent. People who identify as transgender experience the same problems as those mentioned above. Numerous studies have shown that people who identify as transgender are more likely than people who do not identify as transgender to suffer from mental health concerns such as depression, anxiety, and even suicidal thoughts.

References

van Buuren, Asia, et al. “Making Social Determinants of Health Screening Truly Universal Means Including Adolescents.” Canadian Family Physician, vol. 67, no. 1, Jan. 2021, pp. 17–19, https://doi.org/10.46747/cfp.670117. Accessed 27 July 2022.

Zumstein-Shaha, Maya, et al. “Nurses’ Response to Spiritual Needs of Cancer Patients.” European Journal of Oncology Nursing, vol. 48, Oct. 2020, p. 101792, https://doi.org/10.1016/j.ejon.2020.101792. Accessed 8 Oct. 2020.

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.

My patient is TJ, a 32-year-old pregnant lesbian, who 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.

It is important for the provider to be aware of the sexual orientation of a patient. When working with a patient who is of a sexual minority it becomes equally important for the provider to know of any potential feelings regarding heterosexism and homophobia within themselves. Feelings of apprehension or reluctance to discuss preferences can be assuaged by using nonjudgmental words, tone, posture, and approach to examining the patient (Ball, et al 2019).

In order to build a health history for my patient, trust and honesty can be initially instilled by offering informational pamphlets and resources in the office and waiting areas. Then a supportive relationship can be best developed by asking gender neutral questions and then building upon the initial interaction with more direct and open questions. Questions that are open-ended versus simple yes or no responses would be more likely to create a discussion rather than close down the discussion. For example, asking about the patient’s living situation rather than whether they are married or if the patient has a boyfriend/girlfriend would be a nonjudgmental approach to any circumstances.

To start the patient assessment, general questions such as establishing why the patient has made the appointment with the provider; when the health problem started; and the length of time for symptoms. The patient’s age, marital status, gender, occupation, previous hospital/medical concerns/medications prescribed; over the counter/natural supplements used; pregnancy insemination date; and last lab draw date can be noted in the patient’s record.

A completed patient history would include a timeline of the symptoms and what the patient status was prior to the symptoms starting; female productive history, sexual history, aggravating factors; and alleviating techniques. This is also a good time to be alert for a secondary health concern that the patient may want to discuss and determining the patient’s support system that is available over the next few months.

Vaginal discharge in pregnant women is common and may be normal or abnormal. Physiological vaginal discharge in pregnancy is colorless or white, non-irritating, and odorless with no sequelae. It is important to ask the patient:

1. When did the discharge begin?
2. Color of discharge?
3. Is there any odor?
4. Do you have any vaginal pain?
5. Any symptoms of urinary tract infection?

Once these questions are answered, it would also be important to complete a vaginal exam with swabs taken to determine if there is any infection in the discharge and obtain a urine sample to test for a urinary tract infection. This is also an opportune time to complete patient education on some of the reasons why a female can have a discharge during pregnancy (Ball, et al 2019).

Resources

Ball. J. W., Dains. J. E., Flynn. J. A., Solomon. B. S. & Steward. R. W. (2019). Seidel’s guide to

physical examination: An interprofessional approach (9^th ed.). St. Louis, MO: Elsevier

Mosby. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883588/

Prasad. D., Parween. S., Kumari. K. & Singh. N (2021). Prevalence, etiology, and associated

symptoms of vaginal discharge during pregnancy in women seen in a tertiary care

hospital in bihar. Cureus. Jan 14;13(1): e12700. doi: 10.7759/cureus.12700. PMID:

33614308; PMCID: PMC7883588. Retrieved from: https://www.ncbi.nlm.nih. gov/pmc/articles/PMC7883588/

The assigned case study features a White young adult male patient who underwent a gender transition two years ago. Numerous socioeconomic, spiritual, lifestyle and other cultural factors have an impact on the patient’s health and well-being. The patient’s socioeconomic situation prevents him from affording to seek proper medical care services because he is currently unemployed and has no health insurance (Bringedal & Isaksson R, 2021).

His lifestyle, which includes marijuana and tobacco use, is detrimental to his physical and emotional well-being. In terms of his spirituality, the patient would find it challenging to join a faith that endorses gender transition without risking his mental health. As a Caucasian, the client may face discrimination for being transsexual.

It will be necessary for the Nurse Practitioner to utilize tact when speaking with the patient about several topics about his health and way of life (Safer & Tangpricha, 2019). For instance, it’s vital to use inclusive language and ask open-ended inquiries that let patients describe their gender identity and sexuality in their own words. It’s crucial to inquire about the patient with care and consideration about his HIV diagnosis and depressive episodes.

When it will be required to disclose information about a patient’s body to other healthcare practitioners for medical purposes, the nurse practitioner should presume that this information is very confidential and should notify patients in advance (López et al., 2020). Frequently, more pertinent, direct queries are preferable.

The following five inquiries will be made to further evaluate the patient’s health (Ball et al., 2019):

1. What surgical procedures have you had?
2. What additional symptoms are you having besides feeling weak?
3. How long have you been receiving hormone treatment?
4. How are you dealing with your recent depressive episode?
5. What kind of health promotion do you perform?

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.

Bringedal, B., & Isaksson RØ, K. (2021). Should a patient’s socioeconomic status count in decisions about treatment in medical care? A longitudinal study of Norwegian doctors. Scandinavian Journal of Public Health, 140349482110336. https://doi.org/10.1177/14034948211033685

López, S. R., Ribas, A. C., Sheinbaum, T., Santos, M. M., Benalcázar, A., Garro, L., & Kopelowicz, A. (2020). Defining and assessing key behavioral indicators of the Shifting Cultural Lenses model of cultural competence. Transcultural Psychiatry, 57(4), 594–609. https://doi.org/10.1177/1363461520909599

Safer, J. D., & Tangpricha, V. (2019). Care of Transgender Persons. New England Journal of Medicine, 381(25), 2451–2460. https://doi.org/10.1056/nejmcp19036

Shawn Billings – 28 year old African American “Frequent Flyer”

Culture is defined as values, beliefs, customs, traditions, patterns of thinking, norms, learned behaviors, ideas, and perceptions of an individual or populations. Cultural beliefs frame our thinking, decision making, and perceptions of life. All patients deserve to be treated and assessed in a culturally sensitive manner (Young & Guo, 2016).  It is apparent that Shawn Billings is an African American male, but it would still be beneficial to ask him questions regarding his beliefs, education level, and socioeconomic status to help gauge their effects on his health. It is also important to establish a trusting relationship where Shawn feels that you are going to help him, since he probably has had experiences with other practitioners who have dismissed his complaints.

As a practitioner you should be careful not to assume that all members in a particular cultural group share the same beliefs, attitudes and behaviors. Shawn has already been characterized as a “frequent flyer” so in performing his assessment, one must be careful not to let any unconscious biases impede accurately forming a diagnosis on the patient (Ball et al., 2019).

Since the assessment of pain is more subjective, questions can be centered around the characteristics of his pain. Examples include:

1. When did your migraines first begin?
2. Does anything trigger them or make them worse?
3. What makes them better? And what treatments have previously been used do not work?
4. Does the pain disrupt normal activities of daily living? Does it disrupt your sleep?
5. What type of education have you received from other practitioners regarding your pain and relief of symptoms? (Ball et al., 2019).

African Americans suffer from an increased risk of chronic illness, which includes an increased prevalence of chronic pain, poor chronic pain outcomes, and poorer treatment of chronic pain. Individuals with chronic pain are vulnerable to under treatment, especially African Americans who are subjected to increased negative stereotypes. African Americans living in urban poverty lack safe access to physical activity, have decreased social support because of neighborhood characteristics, and face increased exposure to neighborhood violence, which have a cumulative effect on the experience of chronic pain.

Due to his socioeconomic status, he may lack the insurance coverage required to meet his needs.  Individuals of lower socioeconomic status also hold more physically demanding jobs that increase the risk for pain-related injury and may be less able to take time off to seek medical care. Primary care providers also tend to underestimate the severity of pain in African Americans as they tend to report a higher pain rating with a longer duration (Maly & Vallerand, 2018).

It is important that Shawn is educated regarding his migraines and the etiology of migraines so that he may help to prevent and remedy them. It may also be helpful to explain the mechanisms in which certain medications work, and how they may or may not be working to help his pain so that he understands that it may be beneficial to try different combinations of medications and be more open to the idea.

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.

Maly, A., & Vallerand, A. H. (2018). Neighborhood, socioeconomic, and racial influence on chronic pain. Pain Management Nursing, 19(1), 14-22.

Young, S., & Guo, K. L. (2016). Cultural diversity training. The Health Care Manager, 35(2), 94–102. https://doi.org/10.1097/hcm.0000000000000100

In 2020, 10.6 percent of African American were uninsured compared with 5.9% non- Hispanic whites (Carratala, 2020). It’s important as a healthcare provider not to judge a patient who does not have medical insurance. As healthcare practitioners it is important to treat everyone equally, rather they have medical insurance or not. The majority of African American adults say they have less access to quality medical care where they live.

This is a major reason why African American people in the U.S. generally have worse health outcomes than other races of adults (Funk, 2022). When treating a patient, it’s important to gather as much information as possible from the patient’s medical history. Family history is also important to know. I suggest using open-ended questions to obtain our patient medical history. It’s important for the healthcare provider to have a good relationship with their patient. 

You submitted a very thoughtful and thorough approach to this patient’s assessment. There are many factors that needed to be addressed considering the patient’s sexuality, socioeconomic, and mental health state. As you stated creating a safe and secure environment is essential to building trust with the patient to best identify the needs and resources available (Ball et al., 2019). I found it interesting that the patient has an active green card. Using the RESPECT model would allow the patient to feel at ease discussing his cultural beliefs and values (Ball et al., 2019). This allows the provider to connect on a social level even if the provider is not on the same level-Rapport. 

The patient has multiple issues that need assistance and has been brave enough to come to the clinic, so providing help and empathy creates security and safety in the patient-provider relationship-Empathy. Understanding the patient’s preference for pronouns, as you stated, is important to acknowledge how the patient identifies and shows respect (Ball et al., 2019). Identifying the patient’s barriers are necessary to also discover his support  (Ball et al., 2019). Since the patient is unemployed, it would be beneficial to determine if he has insurance (Schembri & Ghaddar,2017). Referring the patient to a financial counselor would benefit him in discovering resources available to help with medication assistance and regular provider visits (Ball et al., 2019).

Understanding the country of origin will help the provider understand if the patient is battling cultural beliefs and values with his decision to transition from his natural gender assignment (Young & Guo 2016). This may be a factor contributing to his depression. As you reported, it is important to discover his support system as being a green card holder and transgender patient raises concern for the need for a good support system so the patient does not feel alone (Pankaew & Nuchanad, 2022). Depression is ranked high in the transgender population, therefore finding appropriate resources for counseling and medications is essential for the holistic health of the patient (Pankaew & Nuchanad, 2022).

With the prescribing of gender-altering hormones, anxiety and depression are higher among the transgender population (Aldridge, et al., 2022). As the provider, it is important to communicate to the patient that you are a team and working toward the same goal (Ball et al., 2019). Continually assessing if the patient is understanding your communication is key as he is not from this country. Explaining the rationale for questions and treatment is essential to determine mutual goals and understanding (Coleman, 2019). Respecting the patient’s decision is essential for gaining trust (Ball et al., 2019). This is a sensitive subject so the patient needs to feel confident in trusting the provider to disclose inhibitions, lifestyle, and limitations (Ball et al., 2019). 

I agree with the open-ended questions, but see the importance of specific questions to target specific needs for medication assistance as having a provider to follow medication administration and socioeconomic factors is essential (Ball et al., 2019). 

With the patient’s history of HIV, addressing The Five P’s of Sexual History is essential as the transition completion does not negate safe sex (Ball et al., 2019). The Five P’s include partners, practices, protection of STIs, past history of STIs, and prevention of pregnancy for the patient. 

I appreciate your thorough assessment approach and wish you continued success in the program!

References

Aldridge, Z., Patel, S., Guo, B., Nixon, E., Pierre Bouman, W., Witcomb, G. L., & Arcelus, J.

(2021). Long-term effect of gender-affirming hormone treatment on depression and anxiety symptoms in transgender people: A prospective cohort study. Andrology, 9(6), 1808–1816. https://doi.org/10.1111/andr.12884

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 (9^th ed.). St. Louis, MO: Elsevier Mosby.

Coleman, D. E. (2019). Evidence based nursing practice: The challenges of health care and cultural diversity Links to an external site.Links to an external site.. Journal of Hospital Librarianship, 19(4), 330–338. https://doi.org/10.1080/15323269.2019.1661734

Links to an external site.

Pankaew Tantirattanakulchai, & Nuchanad Hounnaklang. (2022). Perceived social support and its relationship with depression among Bangkok’s trans women. Journal of Health Research, 36(2), 365–375. https://doi.org/10.1108/JHR-05-2020-0165/full/pdf?title=perceived-social-support-and-its-relationship-with-depression-among-bangkoks-trans-women

Schembri, S., & Ghaddar, S. (2017). A Cultural View on Healthcare Access: Considering the

Hispanic Perspective. Advances in Consumer Research, 45, 469–473.

Young, S., & Guo, K. L. (2016). Cultural diversity training Links to an external site.Links to an external site.. The Health Care Manager, 35(2), 94–102. https://doi.org/10.1097/hcm.0000000000000100