Thank you for your informative post. You provided a comprehensive overview of the several factors that need to be considered. Practicing cultural competence enables clinicians to create rapport more effectively and enhance the quality of therapy (Centers for Disease Control and Prevention. (2021).

• Are there any home remedies or traditional practices you’ve used to try to alleviate your symptoms?

For a patient experiencing recurrent abdominal pain, understanding their use of home remedies or traditional practices is crucial. It helps the healthcare provider appreciate the patient’s cultural context, beliefs, and potential self-care strategies that may impact their symptoms. Hispanic patients may employ traditional treatments or seek healers, believing in folk ailments that their healthcare practitioners may not be aware of. Patients may accept the opinion of an elderly family member more than that of a doctor or scientific specialist in diagnosing and managing diseases (Fowler et al., 2021).  The patient may interpret this question as an invitation to share any cultural or familial practices they’ve used to manage their symptoms. It provides insights into their health-seeking behaviors, which cultural beliefs and socioeconomic factors can influence.

• Do you have any chronic conditions or take any medications regularly?

Chronic conditions and regular medication use can have a significant impact on abdominal pain symptoms. The question is highly relevant as it addresses the patient’s medical history, chronic conditions, and medication use. Recurrent abdominal pain may be associated with underlying chronic conditions, and understanding the patient’s health status is essential. The patient may interpret the question as inquiring about her overall health, chronic conditions, and medication regimen. It allows the patient to communicate relevant health information, potentially shedding light on any pre-existing conditions that might contribute to her abdominal discomfort (Ball. et al., 2023). In addition, the healthcare providers are able to assess the patient’s health literacy, adherence to treatment plans, and potential contributors to her abdominal pain.

Both questions encourage patient-centered care, respect cultural diversity, and provide valuable information for tailoring an effective and culturally sensitive healthcare approach.

References

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

Centers for Disease Control and Prevention. (2021). Cultural competence in health and human services. https://npin.cdc.gov/pages/cultural-competence

Links to an external site.

 

Fowler, A. L., Mann, M. E., Martínez, F., Yeh, H., & Cowden, J. D. (2021). Cultural health beliefs and practices among Hispanic parents. Clinical Pediatrics, 61(1), 56–65. https://doi.org/10.1177/00099228211059666

Diversity and Health Assessments: NURS 6512 Week 2 Discussion

Your questions probe very intimate areas, such as one’s state of mind, the strength of one’s social network, access to resources, state of health, and past encounters with the medical system (Mikulak et al.,2020). Let us discuss how a patient could take in each of these questions:

When asked, “How often are you feeling signs of depression?” The frequency with which the patient experiences depressed symptoms is the focus of this inquiry. Mikulak et al. (2020) say that trans people have it harder to get medical treatment than anybody else, which can be depressing. The patient may see this as probing into their psychological well-being, which the patient could interpret as the healthcare professional caring about their mental well-being.

“Is your family supportive and understanding of your lifestyle?“

This question probes the complex interplay between the patient’s family, his current way of life, and his gender identity because Abreu et al. (2022) say that it is critical to understand how families have helped their transgender loved ones during the transition process and how they have worked to overcome obstacles to receiving care. The question suggests that the patient’s well-being may benefit from a family accepting and understanding their non-traditional lifestyle or identity. The patient may interpret this question as meaning that his family’s acceptance and love are important, especially since he leads an unconventional lifestyle or identifies as transgender and went for gender reassignment surgery instead of being straight.

“Do you need assistance in paying for your hormone replacement or HIV medication?“:

The patient’s capacity to pay for life-sustaining drugs is explicitly addressed in this question. People who identify as transgender may be reluctant to seek sexual-related health care if they have had previous negative interactions with medical professionals (Mikulak et al., 2020). The patient may interpret this question as the healthcare provider caring about his health and feel more at ease with the healthcare professional if they see that they care about them getting the care they need.

“Can you describe why you feel your health is declining? When did those symptoms start?”:

There is a correlation between transgender people’s socioeconomic status and the prevalence of their chronic health issues (Abramovich et al.,2020). This question aims to ascertain the patient’s perspective on the onset and progression of their health deterioration. The patient may see this as a chance to express their worries and offer a history of their symptoms, which might aid in arriving at a correct diagnosis and improving the quality of care they get.

“What barriers have you experienced in receiving transgender-competent healthcare?“:

Society views transgender people negatively because of the stigma attached to their identification (Teti et al., 2021). This question aims to probe the patient’s experiences obtaining trans-welcoming medical treatment. It shows that you, as the provider, are prepared for difficulties and dedicated to meeting your patient’s needs in the best way possible. The patient may use this as an opening to discuss their hopes and concerns about receiving treatment that respects their gender identity.

When considering a 44-year-old Filipino male patient whose anticoagulant medication has not been effective after two weeks, the most pertinent issue concerns the patient’s deteriorating health and the onset of symptoms. Providers may utilize this data to better understand why a certain treatment is not working and make necessary adjustments (Nichol et al.,2022). The remaining questions are not directly relevant to the anticoagulant therapy problem but are significant for addressing other areas of the patient’s health and well-being.A healthcare provider may ask questions like these to build rapport, find pertinent details, and tailor their treatment to each patient. Thank you for sharing.

                                                                                            References

Abramovich, A., de Oliveira, C., Kiran, T., Iwajomo, T., Ross, L. E., & Kurdyak, P. (2020). Assessment of Health Conditions and Health Service Use Among Transgender Patients in Canada. JAMA network open, 3(8), e2015036. https://doi.org/10.1001/jamanetworkopen.2020.15036

Abreu, P. D., Andrade, R. L. P., Maza, I. L. S., Faria, M. G. B. F., Valença, A. B. M., Araújo, E. C., Palha, P. F., Arcêncio, R. A., Pinto, I. C., Ballestero, J. G. A., Almeida, S. A., Nogueira, J. A., & Monroe, A. A. (2022). Support for Mothers, Fathers, or Guardians of Transgender Children and Adolescents: A Systematic Review on the Dynamics of Secondary Social Networks. International journal of environmental research and public health, 19(14), 8652. https://doi.org/10.3390/ijerph19148652

Mikulak, M., Ryan, S., Ma, R., Martin, S., Stewart, J., Davidson, S., & Stepney, M. (2021). Health professionals’ identified barriers to trans health care: a qualitative interview study. The British Journal of General Practice: the journal of the Royal College of General Practitioners, 71(713), e941–e947. https://doi.org/10.3399/BJGP.2021.0179.

Nichol, J.R., Sundjaja, J.H., & Nelson G (2022). Medical History. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534249/

Teti, M., Kerr, S., Bauerband, L. A., Koegler, E., & Graves, R. (2021). A Qualitative Scoping Review of Transgender and Gender Non-conforming People’s Physical Healthcare Experiences and Needs. Frontiers in public health, 9, 598455. https://doi.org/10.3389/fpubh.2021.598455.

The Scenario

Shawn Billings, a 28-year-old African American patient comes into the clinic today. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and 4 days ago with a migraine, given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache. He is very agitated today. He is here with his father and worried that he will not get any medication.

Data on Socioeconomic and Education Status for Black Males

Black men are the least likely, when compared to black women, white men, and white women, to have an advanced degree (Eggly et al., 2017). 4% of black men in America have a master’s degree, 9% of black women have a master’s degree, 8% of white men have a master’s degree, and 13% of white women have a master’s degree (Nzau et al., 2020). Black men are much more likely to be born into poverty and much less likely to get out of it compared to these same groups (Eggly et al., 2017). Black men make up about 6% of the population but account for over 30% of the prison population (Nzau et al., 2020).

Black men have a shorter life expectancy than white men by about 4 years (Nzau et al., 2020). Black men are perceived as the most violent group of individuals, based on studies conducted to measure implicit bias (Nzau et al., 2020). More than 40% of white respondents ranked almost all or all black men as violent (Nzau et al., 2020). White males and black females were perceived as similarly violent, and white women were perceived as the least violent (Nzau et al., 2020).  Black men earn more than black women, but less than white women and white men (Nzau et al., 2020). Black men are twice as likely to be unemployed than white men (Nzau et al., 2020).

Other Statistics to Consider

Statistics can sometimes be a blunt object to use when thinking of groups of people. For example, it is important to observe that the black population is diverse with people of various ethnic backgrounds and immigrants. Why does this matter? It is estimated that about 59% to over 70% of Nigerians hold a bachelor’s degree or higher (Ajobaju, 2021). The number varies in percentage levels for Nigerians because the number of Nigerians who took the survey, are estimated from the U.S. Census Bureau and is thought to have been grossly underestimated (Muri, 2012). About 31% of black immigrants have at least a bachelor’s degree while 33% of U.S. population has a bachelor’s degree or higher (Pew Research Center, 2022).

About 1 in 10 blacks are immigrants (Pew Research Center, 2022). About 25 % of black immigrants make $100,000 yearly or higher compared to 17% of black born Americans (Pew Research Center, 2022). The average median income for immigrants is $63,000 and for black immigrants is $56,000 (Pew Research Center, 2022). Less than 1 out of 5 black immigrants lived below the poverty line in 2019 when about 1 in 5 black Americans lived below the poverty line in 2019 (Pew Research Center, 2022). On certain levels, black immigrants have a different experience in America than black Americans.

Blacks and Religion

U.S. born blacks are much more likely to be protestant than any other religion when compared to immigrant blacks (Pew Research Center, 2022). Immigrant blacks are more likely to claim to be Catholic and non-Christian (Pew Research Center, 2022). African blacks are the least likely to say they are unaffiliated to any religious groups (Pew Research Center, 2022). Overall, most black people in America seem to derive their sense of spirituality from religion (Pew Research Center, 2022).

Males

 Generally speaking, men seem to be suffering within today’s culture (Reeves, 2022). The factors that are contributing to this are multifactorial. In some corners of pop culture, feminism is often deemed the primary culprit. However, there are many other factors that seem to play a significant role in why men are falling behind (Reeves, 2022). Traditionally male dominated jobs, which include construction workers, automotive jobs, truck drivers, farmers, pilots, and other male dominated sectors, have been areas where technology has dominated (Casey & Nzau, 2019). It should also be noted that male dominated sectors are also at the highest risk for death and fatal injuries (Industrial Safety & Hygiene News, 2020).

The jobs with the highest risk for on-the-job deaths, include roofers, oil miners, firefighter supervisors, lineman, garbage collectors, iron workers, and power liners which all made the top 10 for the most dangerous jobs in America list (Industrial Safety & Hygiene News, 2020). Jobs that are traditionally dominated by women, like nurses and teachers, have been impacted by automation to a much lesser extent (Casey & Nzau, 2017). Studies are showing that men, on average, tend to be better risk takers than women and have poorer impulse control when compared to women (Reeves, 2022). To some degree, this explains some of why more men than women, on average, tend to gravitate to jobs that are physically more dangerous, in free societies where women can choose to work these same jobs (Peterson, 2018).

Today’s economy requires impulse control and long-term planning as humans continue to increase lifespan (Reeves, 2022). With the economy also demanding less labor-intensive jobs, like farming or factorial work, and instead prefer people with a psychological make-up that is less impulsive, and more prone to long term planning, the gap in education makes more sense and the problem for those who are less risk averse and wise in short sightedness, compounds (Reeves, 2022).

5 questions

With all of this in mind, it is important to understand my clients social and economic situation and temperamental make up. My questions would be holistic in approach. I would keep in mind, that as an ethnic woman, there will be men who are uncomfortable with being completely honest with me. I grew up in several places as a kid. I’ve grown up in small southern towns, I’ve grown up in northern cities, and I’ve grown up around a plethora of different ethnic cultures. Amongst every group, there’s always several things that most of the people in a culture love. 

Diversity and Health Assessments: NURS 6512 Week 2 Discussion

https://onlinenursingessays.com/diversity-and-health-assessments-nurs-6512-week-2-discussion/

This week a 44-year-old Filipino patient represents to the clinic for blood thinner lab evaluation. The patient was placed on a blood thinner, presumably warfarin, two weeks ago, and now his PT/INR needs evaluation to see if his levels are within the normal therapeutic range. The expected range for prothrombin time (PT) is 11-13.5 seconds, and the international ratio (INR) range is 0.8- 1.1, but a provider may want your levels to be between 2.0-3.0 to prevent blood clots (Prothrombin Time (PT): MedlinePlus Medical Encyclopedia, n.d.). The patient is not currently in the therapeutic range.  The patient reports compliance with the daily use of medication, eating a diet rich in fish and tofu, and expressed a lack of understanding as to why the drug is ineffective.

Family, culture, spiritual beliefs, and socioeconomic status sum up who an individual is and how they live their lives. All these facets largely influence people’s health outcomes. The Filipino culture is an interdependent matriarchal society with proud Catholic beliefs (Miller, 2023). Family is of the utmost importance as well as upholding Filipino values. Language and traditions include eating several times daily, hosting fiestas, and helping others in need (Dumaraos, 2022). However, the patient’s lab results may reflect cultural barriers such as a language barrier.

An assessment of the patient’s primary language and the need for an interpreter will need to be reviewed. Blood thinners such as warfarin have many interactions with other medications, supplements, herbs, and foods. The patient reports a diet rich in fish and tofu. Research says that soy products such as tofu, a staple protein source in Asian cultures, can decrease the effectiveness of warfarin on the INR (Tan & Lee, 2020). Additionally, Tan and Lee (2020) report that fish, another Asian staple, can cause a hypo-coagulant state, putting patients at risk of bleeding. Therefore, obtaining more information regarding daily diet, cultural beliefs regarding a medical condition, and faith in alternative options will help the provider educate the patient and family on possible lifestyle changes. Alternatively, the provider will need to modify therapy to accommodate the patient.

Addressing sensitive matters regarding individuals’ beliefs needs to be handled with care. Using the RESPECT model will aid in navigating these sensitive topics while maintaining effective patient-centered care communication (Ball et al., 2019). The provider should build a rapport and show empathy and support; next, the provider should partner with the patient to develop a viable solution and provide any explanation or clarification if needed. Lastly, the provider must respect the patient’s cultural beliefs and strive to be culturally competent, and work on establishing trust.

Five Questions to aid in building the patient’s health history include:

1. What is your primary language?

1. This question evaluates if a language barrier may interfere with the patient’s understanding of how diet affects INR and warfarin levels. It also assesses if there is a need for an interpreter.

1. Who decides for the family?

1. This question gives the provider context if their family is matriarchal or patriarchal. This information will help the provider understand who needs to be present to help make healthcare decisions with the patient.

1. Who is responsible for food preparation?

1. This information will inform the provider who makes meals because they will also need to be educated on possible modifications that need to be made to accommodate the patient’s health needs.

1. Are there specific beliefs or preferences concerning food, such as those believed to cause or cure an illness?

1. We need to understand the cultural view of food so the provider can better understand how to treat the patient to accommodate their lifestyle and beliefs.

1. What is the tendency to use alternative care approaches/ or herbal remedies exclusively or as a complement?

1. This question is similar to question four; however, this question focuses on alternatives other than food that need to be understood to better care for the patient.

References

Ball, J. W., Dains, J. E., & Flynn, J. A. (2019). Seidel’s Guide to Physical Examination (9th ed.). Elsevier Health Sciences (US). https://mbsdirec

Links to an external site.t.vitalsource.com/books/9780323481953

Dumaraos, G. (2022, November 30). Things You Should Know About Filipino Culture. Culture Trip. https://theculturetrip.com/asia/philippines/articles/11-things-you-should-know-about-the-filipino-culture/

Links to an external site.

Miller, J. (2023). Religion in the Philippines. Asia Society. https://asiasociety.org/education/religion-philippines#:~:text=The%20Philippines%20proudly%20boasts%20to,well%20over%20100%20Protestant%20denominations

You did a great job thinking about those potential factors that may be a contributing factor to the patient’s out of range lab even after taking the blood thinner for two weeks. However, i will look more into his ability to afford the medications, his diet, compliance, and culture in relation to medication taking.  When assessing the patient’s culture and beliefs, it is important to consider how these factors could be impacting the patient’s blood thinner medications not working. He may believe prayer will cure him or may not be to afford the medications as prescribed. This patient assessed for medication noncompliance and use multifactorial strategies to improve adherence because medication-taking behavior is extremely complex and individual (Brown & Bussell 2011). Also, he should be asked about using garlic to cook as this is a known plant food among Filipinos for prevention and treatment of different diseases (Bayan, et al., 2014). 

References

Bayan, L., Koulivand, P. H., & Gorji, A. (2014). Garlic: a review of potential therapeutic effects. Avicenna journal of phytomedicine, 4(1), 1–14.

Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO cares?. Mayo Clinic proceedings, 86(4), 304–314. https://doi.org/10.4065/mcp.2010.0575

In 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).

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the health care field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and health care 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.

Case 1

Subjective Data

CC: “I came for my annual physical exam, but do not want to be a burden to my daughter.”

History of Present Illness (HPI): At-risk 86-year-old Asian male – who is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs.

PMH: hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis

PSH: S/P cholecystectomy

Drug Hx:

Current Meds: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and cipro 100mg daily.

Review of Systems (ROS)

General: + weight loss of 25 lbs over the past year; no recent fatigue, fever or chills.

Head, eyes, ears, nose & throat (HEENT): no changes in vision or hearing, no difficulty chewing or swallowing.

Neck: no pain or injury

Respiratory:

CV:

GI:

GU: no urinary hesitancy or change in urine stream

Integument: multiple bruises on his upper arms and back.

MS/Neuro: + falls x 2 within the last 6 months; no syncopal episodes or dizziness

Psych:

Objective Data

PE: B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, ornasopharynx clear, edentulous.

Lungs: CTA AP&L

Cor: S1S2 without rub or gallop

Abd: benign, normoactive bowel sounds x 4

Ext: no cyanosis, clubbing or edema

Integument: multiple bruises in different stages of healing – on his upper arms and back.

Neuro: No obvious deformities, CN grossly intact II-XII

Case 2

Subjective Data

CC: “I am here for my annual physical exam and have been having vaginal discharge.”

History of Present Illness (HPI): 32-year-old pregnant lesbian – 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.

Drug Hx:

Current Medications: prenatal vitamins and takes Tylenol over the counter for aches and pains on occasion

Family Hx: She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.

Review of Systems (ROS)

General: no fatigue, fever or chills.

Head, eyes, ears, nose & throat (HEENT):

Neck: no pain or injury

Respiratory:

CV:

GI:

GU:

Integument: multiple piercings, and tattoos. Old scars related to “cutting”.

Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements

Objective Data

PE: B/P 128/76; Pulse 83; RR 16; Temp 99.0; Ht 5,6; wt 128; BMI 20.98

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, ornasopharynx clear, good dentition. Piercing in her right nostril and lower lip.

Lungs: CTA AP&L

Cor: S1S2 without rub or gallop

Abd: benign, normoactive bowel sounds x 4

GU: external genitalia intact, no lesions or masses. White copious discharge with an amine odor; no cervical motion tenderness; adenxa intact.

Ext: no cyanosis, clubbing or edema

Integument: intact without lesions masses or rashes.

Neuro: No obvious deficits and CN grossly intact II-XII

Case 3

Subjective Data

CC: “Annual physical exam”

History of Present Illness (HPI): 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle.

Drug Hx:

Current medication – denie

Allergies: no allergies to food or medications.

Family history: is very positive for diabetes, hypertension, and alcoholism.

Review of Systems (ROS)

General: no recent weight gains of losses, fatigue, fever or chills.

Head, eyes, ears, nose & throat (HEENT):

Neck:

Respiratory:

CV: no chest discomfort or palpitations

GI:

GU:

Integument: history of eczema – not active

MS/Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements

Psych:

Objective Data

PE: B/P 158/90; Pulse 88; RR 18; Temp 99.2; Ht 5,7; wt 208; BMI 32.6

General: 23 year old male appears well developed and well nourished. He is anxious – pacing in the room and fidgeting, but in no acute distress.

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, ornasopharynx clear, poor dentition – multiple carries.

Lungs: CTA AP&L

Cor: S1S2, +II/VI holosystolic murmur; without rub or gallop

Abd: benign, normoactive bowel sounds x 4; Hepatomegaly 2cm below the costal margin.

Ext: no cyanosis, clubbing or edema

Integument: intact without lesions masses or rashes.

Neuro: No obvious deficits and CN grossly intact II-XII

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: Diversity and Health Assessments: NURS 6512 Week 2 Discussion

To prepare for Diversity and Health Assessments:

• Reflect on your experiences as a nurse and on the information provided in this week’s

  Learning Resources on diversity issues in health assessments.

• Select one of the three case studies. Reflect on the provided patient information.

• Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.

• 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

• Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected. 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.

Week 2 Main Post

Case Study 1: 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.

Factors Impacting Patient Care

Culturally competent care is an important aspect of healthcare. Every person deserves to receive unbiased care. Transgender persons often experience discrimination within the healthcare system (Kcomt, 2018). They experience increased rates of cancers, substance abuse, mental health conditions, infections, and other chronic diseases because they are not always able to access culturally competent care (Safer & Tangpricha, 2019). This patient is a new patient, and I would want to make him feel comfortable receiving care. I would make sure to address him by his preferred name and pronoun.

There are a few issues I would be sensitive when asking about including his transition and medication and/or surgical history related to that, his HIV status and the medication history related to that, and even his current living and employment situation. Being sensitive relating to the patient’s transition is important because there are parts of the transition that are medically relevant, but I do not want him to be uncomfortable or think that he is being discriminated against. HIV is another sensitive issue because of the stigma that tends to surround it. Many people who have HIV fear discrimination or being judged negatively because of their diagnosis. They often experience feelings of shame, isolation, and shame (CDC, n.d.).

This is another instance where his HIV status and medications are medically relevant, but I do not want him to experience emotional distress or fear discrimination or judgement. Finally, his current living and employment status is sensitive because I understand how those things can affect a person’s mental health. As a person who already has a history of depressive episodes, I would want to be sensitive to the fact that he is probably experiencing some depression related to his living and employment situation and his declining health. I want to convey that this is a safe place and that I will not judge him or discriminate against him.

Questions

1. Are you taking Biktarvy as prescribed?
2. Is the testosterone you’re taking prescription?
3. Is it okay if we get some labs drawn? (Testosterone and viral load for HIV)
4. How long have you been unemployed? Do you need resources to help?
5. How do you think these major changes in your life and health are affecting your mental health?

References

Centere for Disease Control and Prevention (CDC). (n.d.). HIV Stigma and Discrimination. https://www.cdc.gov/hiv/basics/hiv-stigma/index.html

Kcomt, L. (2018). Profound Health Care Discrimination Experienced by Transgender People: Rapid Systematic Review. Social Work in Health Care. https://scholar.uwindsor.ca/socialworkpub/62

Safer, J. D., & Tangpricha, V. (2019). Care of the transgender patient. Annals of internal medicine, 171(1), ITC1-ITC16. doi:10.7326/AITC201907020

Read a selection of your colleagues’ responses.

By Day 6

Respond on or before Day 6 to at leastone of your colleagues who selected a different patient than you, using one or more of the following approaches:

Suggest additional socioeconomic, spiritual, lifestyle, and other cultural factors related to the patient.

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.

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.
• Selectone of the three case studies. Reflect on the provided patient information.
• Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
• 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?

Questions to be addressed in my paper:

1. An explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected.
2. Explain the issues that you would need to be sensitive to when interacting with the patient, and why.
3. 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.
4. Summary with Conclusion

OR

Select one of the following assessment tools or diagnostic tests to explore for the purposes of this Discussion:
-Mammogram
-Physical tests for sore throat (inspecting the throat, palpating the head and neck lymph nodes, listening to breath sounds)
-Prostate-specific antigen (PSA) test
-Dix-Hallpike test
-Body-mass index (BMI) using waist circumference for adults

*Search for credible sources for resources explaining the tool or test you selected. What is its purpose, how is it conducted, and what information does it gather?

*Examine the literature and resources you located for information about the validity and reliability of the test or tool you selected. What issues with sensitivity, specificity, and predictive values are related to the test or tool?

*Are there any controversies or issues related to any of these tests or tools?

*Consider any ethical dilemmas that could arise by using these tests or tools.

REMINDERS:

1)      2 pages (addressing the 4 questions above excluding the title page and reference page).

2)      Kindly follow APA format for the citation and references! References should be between the period of 2011 and 2016. Please utilize the references at least three below as much as possible and the rest from yours.

3)     Make headings for each question.

References:

Readings

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015).Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

o    Chapter 2, “Cultural Competency” (pp. 21–29)

This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.

o    Chapter 3, “Examination Techniques and Equipment” (pp. 30-49)

This chapter explains the physical examination techniques of inspection, palpation, percussion, and auscultation. This chapter also explores special issues and equipment relevant to the physical exam process.

• Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

o    Chapter 1, “Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis”

This chapter introduces the diagnostic process, which includes performing an analysis of the symptoms and then formulating and testing a hypothesis. The authors discuss how becoming an expert clinician takes time and practice in developing clinical judgment.

• Sullivan , D. D. (2012).Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.

o    Chapter 2, “The Comprehensive History and Physical Exam” (pp. 19–36)

o    Appendices A–E (pp. 225–236)

• Laine, C. (2012). High-value testing begins with a few simple questions.Annals of Internal Medicine,156(2), 162–163.Retrieved from the Walden Library databases.This article supplies a list of questions physicians should ask themselves before ordering tests. The authors provide general guidelines for maximizing the value received from testing.
• Qaseem, A., Alguire, P., Dallas, P., Feinberg, L. E., Fitzgerald, F. T., Horwitch, C., & … Weinberger, S. (2012). Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care.Annals of Internal Medicine,156(2), 147–150.Retrieved from the Walden Library databases.This article highlights the increasing cost of health care and stresses the need for high-value and cost-conscious testing. The authors provide a list of 37 situations in which more testing provides no benefit or may be harmful.
• Shaw, S. J., Huebner, C., Armin, J., Orzech, K., & Vivian, J. (2009). The role of culture in health literacy and chronic disease screening and management.Journal of Immigrant & Minority Health, 11(6), 460–467.Retrieved from the Walden Library databases.This article examines cultural influences on health literacy, cancer screening, and chronic disease outcomes. The authors postulate that cultural beliefs about health and illness affect a patient’s ability to comprehend and follow a health care provider’s instructions.
• Wians, F. H. (2009). Clinical laboratory tests: Which, why, and what do the results mean?LabMedicine, 40, 105–113.Retrieved from http://labmed.ascpjournals.org/content/40/2/105.fullThis article analyzes the laboratory testing cycle and its impact on diagnostic decision making. This article also examines important diagnostic performance characteristics of laboratory tests, methods of calculating performance, and tools used to assess the diagnostic accuracy of a laboratory test.

Optional Resources

• LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw- Hill Medical.

o    Chapter 3, “The Physical Screening Examination”

o    Chapter 17, “Principles of Diagnostic Testing”

o    Chapter 18, “Common Laboratory Tests”

NURS 6512 Week2 quiz

Question 1When percussing, a dull tone is expected to be heard over:

Question 2Which technique should be used to stabilize the stethoscope during auscultation?

Question 3The degree of percussion tone is determined by the density of the medium through which the sound waves travel. Which statement is true regarding the relationship between density of the medium and percussion tone?

Question 4Which of the following describes a physical, not a cultural, differentiator?

Question 5Your new patient is a 40-year-old Middle Eastern man with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to:

Question 6Which statement is true regarding the impoverished?

Question 7To perform a deep tendon reflex measurement, you should:

Question 8In terms of cultural communication differences, Americans are more likely to _____ than are other groups of patients.

Question 9Underestimation of blood pressure will occur if the blood pressure cuff s bladder:

Question 10Guidelines for Standard Precautions indicate that mask and eye protection or a face mask should be worn while performing:

Question 11A patient in the emergency department has a concussion to the head. You suspect the patient may also have a retinal hemorrhage. You are using the ophthalmoscope to examine the retina of this patient. Which aperture of the ophthalmoscope is most appropriate for this patient?

Question 12A nonambulatory 80-year-old male patient tells the female nurse that he feels like he is having drainage from his rectum. Which initial nursing action is appropriate?

Question 13For a woman with a small vaginal opening, the examiner should use a _____ speculum.

Question 14Which statement is true regarding the relationship of physical characteristics and culture?

Question 15You are performing a vaginal examination for a patient with a history of spina bifida. As you insert the metal speculum, the patient suddenly feels nauseated and is sweating, and her skin turns blotchy. What is your most immediate reaction to this situation?

Question 16The infant should be placed in which position to have his or her height or length measured?

Question 17Which question has the most potential for exploring a patient s cultural beliefs related to a health problem?

Question 18Expected normal percussion tones include:

Question 19A naturalistic or holistic approach to health care often assumes:

Question 20Because of common cultural food preferences, avoidance of monosodium glutamate (MSG) is likely to be most problematic for the hypertensive patient of which group?

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/

• On a scale of 0-10, 0 being no pain and 10 being the worst pain, how can you rate your headache? This is a reasonable inquiry since it enables the doctor to gauge how severely the patient is hurting. The complaint of worst headache of life has a broad differential diagnosis, usually caused by migraines or other less serious processes. However, because 1%- 4% of these headaches are caused by subarachnoid hemorrhage, which is life threatening, patients with appropriate history and physical findings should undergo a CT scan, and if negative, a lumbar puncture (Gage et al. 2007).
  • Do you smoke cigarettes, drink alcohol, or use any recreational drugs? This is a valid inquiry, as it may assist the provider to zero in on the source of the patient’s pain. Unless it was already known how many packs a day my patient smokes, this query would have been acceptable.
  • How much sleep do you get daily? This is a legitimate concern because headaches are a common symptom of sleep deprivation. To acquire more particular information regarding the patient’s sleep habits, however, follow-up questions should be asked. Migraine with and without aura, cluster headache, hypnic headache, and paroxysmal hemicranias are each reported as intrinsically related to sleep. Chronic migraine, chronic tension-type headache, and medication overuse headache may cause sleep disturbance (Ferini-Strambi et al., 2019).
  • Do you feel safe at home? Considering the patient’s agitation, it would be wise to inquire as to the existence of any stresses or anxieties that could be exacerbating their condition. As my patient has depression, I think this is a valid concern to raise with him. The provider should inquire as to whether the patient has a roommate and whether that roommate is encouraging of the patient’s recovery.
  • Do you feel depressed? Because depression often coexists with chronic pain, this is a crucial inquiry to make. While answering this question, however, it’s vital to do so with care and avoid making judgments or labeling the patient in any way. For my patient, this is an important question, but as a provider, you should also be trying to determine what’s triggering his depression and whether he has attempted suicide. The relationship of interpersonal stigma to structural stigma was also found; LGBTQ people who were exposed to more negative ads, billboards, and conversations leading up to the Referendum and those with the most familiarity with the Referendum approaching the election reported greater Referendum-related anxiety, raising their risk for depression (Horne et al., 2022).
  • Do you feel like hurting yourself? Although this may not have anything to do with the patient’s headaches, it is a vital question to ask in any mental health assessment. I think it’s crucial for my patient to know if he’s ever thought about suicide or has any plans or resources to carry them out, thus this information is useful to me.
  • What coping skills/mechanism works for you when you are stressed? This is a good topic to ask since it may lead the patient to reveal some of the coping mechanisms they have been using to deal with their headaches or other symptoms. My transgender patient can benefit from this since he needs to understand the origins of his worry.
  • What do you do for a living? This is a good topic to ask because it might give insight into the patient’s normal routine and identify probable sources of mental or physical exhaustion. One must exercise caution before assuming anything about the patient’s way of life or potential risk factors based on their line of work.

       The healthcare professional, in general, should treat each patient with respect and compassion regardless of the history of their visits or the patient’s personal characteristics. In addition to being open and receptive to the patient’s wants and concerns, the questions offered can be useful in assessing the patient’s headache complaint and identifying potential contributing variables.

References

Ferini-Strambi, L., Galbiati, A., & Combi, R. (2019). Sleep disorder-related

          headaches. Neurological Sciences, 40(Suppl 1), 107–113. https://doi.org/10.1007/s10072-Links to an external site.

          019-03837-z

Gage, K., Sherman, P., & Smirniotopoulos, J. (2007). Radiology corner. Worst headache of

          life. Military Medicine, 172(11), xiv–xv.

Horne, S. G., McGinley, M., Yel, N., & Maroney, M. R. (2022). The stench of bathroom bills

          and anti-transgender legislation: Anxiety and depression among transgender, nonbinary,

          and cisgender LGBQ people during a state referendum. Journal of Counseling

          Psychology, 69(1), 1–13. https://doi.org/10.1037/cou0000558

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

Response #1

I agree that it is imperative that an APRN continue to be educated on cultural competence. When a patient feels comfortable and understood they will be more open to speaking about sensitive topics and divulging information that may be vital to adequately care for patients. Cultural competence is an ongoing learning process that requires self-awareness, reflective practices, and knowledge of core cultural issues (Ball, Dains, Flynn, Solomon, & Stewart, 2019). This would include recognizing your own culture, values, and biases, while using effective patient centered communication skills (Ball, Dains, Flynn, Solomon, & Stewart, 2019).

The Transgender or LGBTQ+ community faces many barriers, and unfortunately healthcare is one of the major ones. The LGBTQ+ community are often faced with discrimination, disrespect, oppression, marginalization, and violence; all of which affect their social determinants of health and access to healthcare (Hana, Butler, Young, Zamora, & Lam, 2021). These barriers lead to high rates of unemployment, poverty, lack of support systems, and lack of education which makes accessing healthcare a challenge (Hana, Butler, Young, Zamora, & Lam, 2021). Special considerations should be taken around sensitive topics like in this case the patient being a transgender male, HIV +, depression (feeling like a burden), smoking (cigarettes and marijuana), and purchasing testosterone on the internet.

Providing an environment that is safe, welcoming, and nonjudgmental will allow you to build that rapport with your patient, making them feel heard and understood, which in turn will hopefully make them want to return to the healthcare facility for follow ups, treatments, and voice their concerns if they were to arise. A culturally competent healthcare provider should be able to adapt to the unique needs of patients with different backgrounds and cultures than their own (Ball, Dains, Flynn, Solomon, & Stewart, 2019).

Healthcare systems should continue to require all staff to be educated on different cultures, to learn about what is acceptable and what is not, including the LGBTQ+ community, so that staff will know how to address someone within this community or culture, being sensitive to their individualized needs. Cultural humility is needed to be able to adequately care for patients of different backgrounds and cultures (Ball, Dains, Flynn, Solomon, & Stewart, 2019). Cultural humility involves being able to recognize one’s knowledge limitations and cultural perspectives and be open to gaining new perspectives and knowledge (Ball, Dains, Flynn, Solomon, & Stewart, 2019).

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 (Vol. 9th Edition). St. Louis: Elsevier.

Hana, T., Butler, K., Young, L. T., Zamora, G., & Lam, J. S. (2021). Transgender Health in Medical Education. Bull World Health Organ, 296-303.

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.