NURS 6512 Discussion Diversity and Health Assessments

Walden University NURS 6512 Discussion Diversity and Health Assessments-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6512 Discussion Diversity and Health Assessments assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6512 Discussion Diversity and Health Assessments                     

Whether one passes or fails an academic assignment such as the Walden University NURS 6512 Discussion Diversity and Health Assessments depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6512 Discussion Diversity and Health Assessments                     

The introduction for the Walden University NURS 6512 Discussion Diversity and Health Assessments is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6512 Discussion Diversity and Health Assessments                     

After the introduction, move into the main part of the NURS 6512 Discussion Diversity and Health Assessments assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6512 Discussion Diversity and Health Assessments                     

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6512 Discussion Diversity and Health Assessments                     

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Social determinants of health (SDOH) are the non-medical factors that influence health outcomes. SDOH is linked to a lack of opportunity and resources to protect, improve, and maintain health. This week’s case study examines Paula Apraez. A 26-year-old, Spanish speaking patient who presents to the clinic for abdominal pain. She relies on her bilingual daughter to translate. She was treated with Omeprazole with no improvement. Paula has usual issues going to the bathroom regularly and more GI issues.

Female Hispanic Americans have several healthcare barriers that my lead to poor health. Low socioeconomic status means that many Hispanic Americans have financial barriers to quality healthcare. Poverty among many Hispanic woman contributes to lack of insurance. Health insurance reduces the out-of-pocket costs of healthcare and has been shown to be the single most important predictor of utilization (Da Costa, 2023). Without insurance coverage, many Hispanics find health care unaffordable and decline care even when they think they need it.

Lifestyle choices such as smoking, drinking alcohol, high fat diet, and sedentary lifestyle leads to obesity. Obesity is one of the most important health problems facing Hispanics today. According to the National Center of Health Statistics (2023), fifty-two percent of Spanish women are overweight. The risk prevalence of obesity in Hispanic adults is likely to lead higher rates of diabetes, hypertension, diabetes, and cardiovascular disease. These conditions have major implications for disability and mortality rates among Hispanics (Da Costa, 2023).

Hispanic culture and spiritually also plays a critical role in health care. Hispanic patients may rely on traditional remedies or healers and acknowledge folk illnesses about their care. The use of folk remedies or medicine may not be mentioned to their provider. One study by Fowler found that eighty-three percent of respondents have used at least one cultural remedy for their children, the most frequent being, medical teas, oil/ointments, and massage (Fowler et al., 2021). Supernatural and spiritual forces are seen as major contributors both to the etiology of illness and healing techniques. Family plays an integral role in the diagnosis and management of illnesses and patients may trust the advice of a senior family member over that of a physician.

As healthcare professionals, we must be sensitive to cultural factors while creating health history for the patient. A provider should be culturally competent and know how cultural differences may impact healthcare decisions (Turkson-Ocran et al., 2023). They can modify care to align with the patient’s culture. Overcoming linguistic barriers is the first challenge to obtaining pertinent information. Because patient-provider communication is key to the health care delivery process, communication resulting from language barriers has implications for the quality and outcomes of care. Paula’s daughter may know English but is may not fluent enough to understand what the provider is asking or prescribing. The provider should ask the facility if a translator is available. Small doctor’s offices may rely on new translations technology if a translator is not an option.

Once the communication barrier has been eliminated, the provider can start building trust and rapport with the patient (Turkson-Ocran et al., 2023). This starts by not making assumptions. If they are unsure about something, simply ask. Most people will happily answer questions about their culture and beliefs. This is when providers should practice active listening, so patients feel they are heard and validated, particularly when they are in a vulnerable position. Healthcare professionals should also educate themselves outside of the hospital. They can visit the area where that culture is dominant or read about the culture from reputable books and online sources. These strategies can help the provider ask targeted questions, so a thorough health history can be completed for the patient.

Targeted Questions

1. When did the pain start?
2. Does the pain feel the same as last visit?
3. Can you describe the pain?
4. What helps the pain and what makes it worse?
5. What medications are you taking?
6. What type of foods do you eat daily?
7. Do you smoke or drink alcohol?
8. What type of spices do you cook with?
9. Do you take any home remedies for the pain?
10. How often do you have diarrhea?
11. Have your bowel movements been regular?
12. Have you been stressed recently?

NURS 6512 Discussion Diversity and Health Assessments

NURS 6512 Discussion Diversity and Health Assessments

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). 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.

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 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.

Diversity and Health Assessment

For being able to care for each patient’s needs without bias, healthcare professionals must be culturally aware. A healthcare worker is required to have the necessary skills to deliver excellent care to patients from different walks of life (Corona at al., 2018).

We reside in a nation with numerous customs, perspectives, and origins. As a result, it is essential to at least try to comprehend various socioeconomic briefings and be religiously sensitive to individuals who hold various religious beliefs.

Socioeconomic, Spiritual, Lifestyle, and Cultural Factors

John is a 33-year-old Caucasian man in my case study, but John’s biological gender is a woman. John has been using telehealth to get his testosterone. Due to financial hardships brought on by losing his job, John was forced to relocate and stay with his parents. He has no notable family history or a history of marriage.

In this situation, it’s critical for a healthcare professional to be aware of and understand the Caucasian culture Additionally, because John identified as a woman, it’s critical for a medical professional to understand and be aware of lesbian beliefs. When providing care, it is crucial not to follow the same pattern to deliver high-quality and effective treatment (Dains et al., 2018).

Sensitive Issues

John is currently facing individual, monetary, and psychological problems, and it is crucial to deal with all the issues in a professional manner. When a patient receives an HIV diagnosis, it’s critical to give them appropriate guidance and teach them how to take Biktarvy without causing any type of embarrassment. A patient’s testosterone use is another delicate subject that should be handled with respect, and the healthcare provider should check to make sure the appropriate dosage is being administered.

John should be made aware of the significance of quitting due to the negative effects it could potentially have on his well-being since he also smokes cigarettes and marijuana. John should be treated carefully to prevent bullying because of his gender identity and to help him appear like everyone. John should be treated gently and with care, as he is also depressed (Kisey et al., 2018).

Targeted 5 Questions

1 When did you first notice that you were depressed?

1. Have you ever considered harming yourself in any way?
2. What is the primary cause of your depression?
3. Do you feel content with your life?
4. Has receiving an HIV diagnosis changed the way you think and live?

 References:

Radcliff, Z., Al Ghriwati, N., Derlan, C. L., Velazquez, E., Halfond, R., & Corona, R. (2018). The relationship between Latina/o youth’s internal health locus of control, cultural factors, and body mass index. Journal of Latina/o Psychology, 6(3), 190-203. https://doi.org/10.1037/lat0000093Links to an external site.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care. Mosby.

Kisely, S., Li, A., Warren, N., & Siskind, D. (2018). A systematic review and meta-analysis of deep brain stimulation for depression. Depression and Anxiety, 35(5), 468-480. https://doi.org/10.1002/da.22746Links to an external site.

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.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 of Week 2 and Respond by Day 6 of Week 2

To Participate in this Discussion:

Week 2 Discussion

What’s Coming Up in Week 3?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you examine assessment techniques, health risks and concerns, and recommendations for care related to patient growth, weight, and nutrition. You will also begin your first DCE: Health History Assessment which will be due in Week 4. Plan your time accordingly.

Overview of Digital Clinical Experiences (DCE) and Lab Components

Throughout this course, you are required to not only complete your standard course assignments and discussions, but you will also complete DCE and Lab Components that are either structured as optional or required assignment submissions. Please take the time to review your DCEand Lab Components for this course that are required submissions. See the table below and the attached table for specific DCE and Lab Components for the course.

Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total score of 80% or better, but you must take all attempts by the Day 7 deadline. You must pass BOTH the Health History and Comprehensive (head-to-toe) Physical Exam of at least a total score of 80% in order to pass the course.

Week	Digital Clinical Experiences	Lab Components
Module 1:  Comprehensive Health History
Week 1: Building a Comprehensive Health History
Module 2: Functional Assessments and Assessment Tools
Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment
Week 3: Assessment Tools, Diagnostics, Growth, Measurement, and Nutrition in Adults and Children	DCE: Health History Assessment (assigned in Week 3, due in Week 4)	Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children
Module 3: Approach to System Focused Advanced Health Assessments
Week 4: Assessment of the Skin, Hair, and Nails	DCE: Health History Assessment	Lab Assignment: Differential Diagnosis for Skin Conditions (SOAP Note for differential diagnosis)
Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat	DCE: Focused Exam: Cough	Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat (Episodic SOAP Note)
Week 6: Assessment of the Abdomen and Gastrointestinal System		Lab Assignment: Assessing the Abdomen (Analyze SOAP Note)
Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System	DCE: Focused Exam: Chest Pain
Week 8: Assessment of the Musculoskeletal System		Discussion: Assessing Musculoskeletal Pain (Episodic SOAP Note)
Week 9: Assessment of Cognition and the Neurologic System	DCE: Comprehensive (head-to-toe) Physical Assessment	Case Study Assignment: Assessing Neurological Symptoms (Episodic SOAP Note)
Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal		Lab Assignment: Assessing the Genitalia and Rectum (analyze SOAP Note)
Module 4: Ethics in Assessment
Week 11: The Ethics Behind Assessment		Lab Assignment: Ethical Concerns

Next Week

To go to the next week:

Week 3

Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment

Diversity is not about how we differ. Diversity is about embracing one another’s uniqueness.

—Ola Joseph

Countless assessments can be conducted on patients, but they may not be useful. In order to ensure that health assessments result in the necessary care, health assessments should take into account the impact of factors such as cultures and developmental circumstances.

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Learning Objectives

Students will:

• Analyze diversity considerations in health assessments
• Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment

Learning Resources

Required Readings (click to expand/reduce)

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.

• Chapter 1, “The History and Interviewing Process”  (Previously read in Week 1)

This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients.

• Chapter 2, “Cultural Competency”

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

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

 

• Chapter 2, “Evidenced-Based Clinical Practice Guidelines”

Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2014). Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis. Journal of Asthma, 51(7), 703–713. doi:10.3109/02770903.2014.906605

Credit Line: Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis by Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J., in Journal of Asthma, Vol. 51/Issue 7. Copyright 2014 by Taylor & Francis, Inc. Reprinted by permission of Taylor & Francis, Inc. via the Copyright Clearance Center.

 

The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma.

Centers for Disease Control and Prevention. (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence

 

This website discusses cultural competence as defined by the Centers for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website.

United States Department of Human & Health Services. Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent care. Retrieved June 10, 2019, from https://cccm.thinkculturalhealth.hhs.gov/

 

From the Office of Minority Health, this website offers CME and CEU credit and equips healthcare professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.

Espey , D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health, 104(Suppl 3), S303–S311. 

The authors of this article present patterns and trends in all-cause mortality and leading cause of death in American Indians and Alaskan Natives.

Wannasirikul, P., Termsirikulchai, L., Sujirarat, D., Benjakul, S., & Tanasugarn, C. (2016). Health literacy, medication adherence, and blood pressure level among hypertension older adults treated at primary health care centers. Southeast Asian Journal of Tropical Medicine and Public Health, 47(1), 109–120.

The authors of this study explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving healthcare services at primary healthcare centers.

Required Media (click to expand/reduce)

Module 2 Introduction

Dr. Tara Harris reviews the overall expectations for Module 2. Consider how you will manage your time as you review your media and Learning Resources for your Discussion, Case Study Lab Assignment, and your DCE Assignment (3m).

Functional Assessments and Cultural and Diversity Awareness in Health Assessment – Week 2 (10m)

Walden University. (n.d.). Instructor feedback. https://mym.cdn.laureate-media.com/2dett4d/Walden/WWOW/1001/pulse_check/instructor_feedback/index.html#/

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

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.

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Name: NURS_6512_Week_2_Discussion_Rubric

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		Excellent	Good	Fair	Poor
Main Posting		Points Range: 45 (45%) – 50 (50%) “Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 40 (40%) – 44 (44%) “Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 35 (35%) – 39 (39%) “Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	Points Range: 0 (0%) – 34 (34%) “Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness		Points Range: 10 (10%) – 10 (10%) Posts main post by Day 3.	Points Range: 0 (0%) – 0 (0%) N/A	Points Range: 0 (0%) – 0 (0%) N/A	Points Range: 0 (0%) – 0 (0%) Does not post main post by Day 3.
First Response		Points Range: 17 (17%) – 18 (18%) “Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	Points Range: 15 (15%) – 16 (16%) “Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	Points Range: 13 (13%) – 14 (14%) “Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 12 (12%) “Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response		Points Range: 16 (16%) – 17 (17%) “Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	Points Range: 14 (14%) – 15 (15%) “Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	Points Range: 12 (12%) – 13 (13%) “Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 11 (11%) “Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation		Points Range: 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	Points Range: 0 (0%) – 0 (0%) N/A	Points Range: 0 (0%) – 0 (0%) N/A	Points Range: 0 (0%) – 0 (0%) Does not meet requirements for participation by posting on three different days.
Total Points: 100

Sample Answer for NURS 6512 Discussion Diversity and Health Assessments

M.R. is a 23-year-old Native American male who is experiencing anxiety. He is seeking treatment for his symptoms. He has stated that he has been consuming alcohol and marijuana to help his symptoms. He has concerns that he will not get into heaven if he continues his lifestyle. The patient denies taking any prescription medications or other non-prescription drugs. His family history includes diabetes, hypertension, and alcoholism. 

Mental disorders are among the top ten leading causes of Indian Health Services (HIS) hospitalization and ambulatory care visits. Approximately 70% of Native American men meet the criteria of some type of mental disorder. It is also reported that common psychiatric disorders tend to be most prevalent among the American Indian (AI) population when compared to the rest of the population. Substance abuse, alcohol use, drug use, mood, anxiety, and personality disorders are commonly reported among the AI population. AI men suffer anxiety more than women (Brave Heart et al., 2016). 

According to Adakai et al. (2018), AI have a lower life expectancy, lower quality of life, and are disproportionately affected by many chronic conditions compared with other racial/ethnic groups (Adakai et al., 2018). Suicide is the second leading cause of death for Native youth aged 15-24. They are also at a higher risk for depression and substance abuse (Asher BlackDeer & Patterson Silver Wolf, 2020). 

When taking into consideration the high risks of mental disorders and substance abuse, it is important to gain as much information as possible from the patient to build an adequate health history and develop a diagnosis and treatment plan. I would start with the following targeted questions: 

#1: How long have you been experiencing anxiety? Does it occur daily or all the time? Have you experienced or witnessed any type of trauma that you feel has affected you? Has anyone in your immediate family ever been diagnosed with any mental illness or disorder? 

#2: Do you feel that you partake in unusual risky behaviors? Promiscuous behavior? Are you impulsive or have extreme mood swings? Do you feel sad or depressed? Has anyone in your family said that you are acting different or strange? 

#3: How much alcohol do you consume? Do you drink every day? How many drinks per day/week? Has your alcohol use affected your job or relationships? Has anyone told you that you drink too much? 

#4: How often and how much “pot” do you smoke? Does it make you feel better? How long have you been smoking pot? 

#5: What are your religious/spiritual beliefs? Would you like a chaplain or a spiritual leader to give you guidance and support? 

Based on the AI culture, it is important to incorporate traditional healing approaches to assist the patient with their health needs. Clinicians should be culturally aware and utilize the DSM-5 Culture Formulation Interview to increase the validity of the diagnostic process during patient encounters with Native Americans (Brave Heart et al., 2016). Future endeavors should seek to combine both Indigenous and Western approaches to practice with a particular focus on holistic wellness (Asher BlackDeer & Patterson Silver Wolf, 2020). By utilizing the tools available as mentioned, AI patients should be more comfortable and confident with the treatment provided. 

References 

Adakai, M., Sandoval-Rosario, M., Xu, F., Aseret-Manygoats, T., Allison, M., Greenlund, K. J., & Barbour, K. E. (2018). Health disparities among american indians/alaska natives — arizona, 2017. MMWR. Morbidity and Mortality Weekly Report, 67(47), 1314–1318. https://doi.org/10.15585/mmwr.mm6747a4 

Asher BlackDeer, A., & Patterson Silver Wolf, D. A. (2020). Evidence mapping: Interventions for american indian and alaska native youth mental health. Journal of Evidence-Based Social Work, 17(1), 49–62. https://doi.org/10.1080/26408066.2019.1624237 

Brave Heart, M., Lewis-Fernández, R., Beals, J., Hasin, D. S., Sugaya, L., Wang, S., Grant, B. F., & Blanco, C. (2016). Psychiatric disorders and mental health treatment in american indians and alaska natives: Results of the national epidemiologic survey on alcohol and related conditions. Social Psychiatry and Psychiatric Epidemiology, 51(7), 1033–1046. https://doi.org/10.1007/s00127-016-1225-4 

Sample Answer for NURS 6512 Discussion Diversity and Health Assessments

MR, a 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 himself too. He tells you he is afraid that he will not get into heaven if he continues in this lifestyle. He is not taking any prescription medications and denies drug use. He has a positive family history of diabetes, hypertension, and alcoholism. 

  

                The Native American population in the United States (U.S) consists of 1.7% of the population, with 0.9% identifying as purely Native American (NCAI, 2020). The life expectancy of this smaller group is 5.5 years lower when compared to other races in the U.S. Causes of death include heart disease, diabetes, and liver disease. These are chronic conditions present in the case scenario that many Americans manage with the help of healthcare providers. The socioeconomic status of this community is also poor as there are 6 times as many Native Americans that live in poverty compared to the rest of the country (Kao, 2020). Cultural beliefs play a major role in the daily life of Natives Americans, composed of hundreds of different tribal groups, many believe that ill health results from disharmony with nature, social, and supernatural environments (Handzo, 2020). 

                In this particular scenario, cultural competency is required to establish and maintain a clinician-patient rapport. The use of marijuana in this culture may be seen as a form of traditional/herbal medicine and asking, “What else have you tried?” can help establish a thorough medication history with a nonjudgmental approach, as living in harmony with their environment may reflect the use of substances such as psychedelic mushrooms. It is important to note, however, that traditional medicine and healing is considered sacred knowledge and is sometimes restricted and not shared with individuals outside of the tribal community (Esposito, & Kahn-John, 2020). This culture is also known for its respect towards female and male elders (Handzo, 2020), including these people to assist in the healthcare process and open-ended questions such as “Tell me about your elders and how they help you” or “How are things at home?” may be of benefit. In the scenario, the patient is “afraid that he will not get into heaven if he continues with his lifestyle” questions such as “what problems concern you most?” and “Has it gotten worse lately?” may help clarify things he is doing that he feels is non-beneficial. It is important to be aware and respect his point of view and to discuss with no belittlement when offering a medical point of view (Ball, Dains, Flynn, Solomon, & Stewart, 2019). Lastly, many practitioners will likely have little or no knowledge about their culture, it is imperative to avoid pretending or being familiar with the traditions they have and it is more important to refrain from interfering with them. 

Reference 

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. 

Esposito, M. & Kahn-John, M. (2020). How should allopathic physicians respond to Native American patients hesitant about allopathic medicine? American Medical Association Journal of Ethics, 22(10), 837-844. DOI: 10.1001/amajethics.2020.837 

Handzo, G. (2020). Cultural approaches to pediatric palliative care in central Massachusetts: Native American spirituality. Lamar Soutter Library. Retrieved March 10, 2021 from https://libraryguides.umassmed.edu/diversity_guide/native_american_spirituality 

Kao, A. (2020). Health of the first Americans. American Medical Association Journal of Ethics, 2(10), 833-836. DOI: 10.1001/amajethics.2020.833 

NCAI. (2020). Demographics. National Congress of American Indians. Retrieved March 10, 2021 from https://www.ncai.org/about-tribes/demographics 

Sample Answer for NURS 6512 Discussion Diversity and Health Assessments

MR, a 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 himself too. He tells you he is afraid that he will not get into heaven if he continues in this lifestyle. He is not taking any prescriptions medications and denies drug use. He has a positive family history of diabetes, hypertension, and alcoholism. 

  

Culture reflects the whole of human behavior, ideas, and attitudes, manners of speaking, language and so on. A nurse practitioner who is culturally competent, genuinely adopts the patient’s beliefs and values that involves recognizing one’s own culture, values, and biases and effective patient-centered communication skills (Ball, Dains, Flynn, Solomon, & Stewart, 2019).  

Within the cultural whole, different population exits in groups and subgroups with different cultural characteristics and physical characteristics. Therefore, stereotyping of group, such as all individuals in a group must have the same beliefs, attitude, and behaviors should be avoided. And understanding and respecting patients’ cultural and spiritual beliefs in the assessment process should be put into consideration to ensures quality care, better outcomes, and improved patient satisfaction. To provide culturally competent care, it is very important for healthcare providers to be sensitive to the patient’s heritage, sexual orientation, socioeconomic situation, ethnicity and cultural background (Ball et al., 2019).  

  

Socioeconomic, Spiritual, Lifestyle, and other cultural factors 

  

The 23-year-old male patient in the case study who is Native American (NA) comes in with anxiety and admits to the fear of not getting into heaven due to his current lifestyle of smoking “pot” and drinking. Of note he has a family history of alcoholism, diabetes, and hypertension. Thus, it is imperative to assess patient’s specific cultural, socioeconomic, spiritual, and lifestyle factors without stereotype while being sensitive to his culture.  

  

Spiritual Factors 

  

Culture, spirituality, and lifestyle is important in the treatment of native Americans. According to the case study presented above, patient may not have any socioeconomic factors affecting his health, but he has spiritual and lifestyle factors that could affect his health. The patient also states that he has anxiety about his drug use that could prevent him from reaching “heaven” when he dies. Culture has a crucial influence in the development of spirituality. In NA culture, health and well-being are centrally balanced with spirituality for it contributes to a sense of life meaning, purpose, and connectedness to nature and people, which extends beyond the self. Given its central role in the promotion of life quality, spirituality contributes to wellness or the onset of suffering when not addressed. And when spirituality is not addressed, healing is prevented (Terpstra, Lehto, & Wyatt, 2021). 

  

Therefore, the  healthcare provider should determine how spirituality is connected to quality of life among NA and  include spiritual assessment and respect for culture in every health care setting (Terpstra et al., 2021). By asking patient to explain more about his specific beliefs and if a certain church or religion he follows will create rapport with the patient that can lead to a trustful one to implement treatment options. 

  

Lifestyle Factors 

  

The NA population suffers from numerous health disparities, including high rates of substance use and poor mental and physical health (D’Amico et al., 2020). The loss of traditional foods due to the decreased access other traditional foods also create a nutritional health disparity leading to decreased dietary quality, obesity, and cardiovascular disease within NAs. They have higher rates of accidental and alcohol-related death, diabetes, liver disease and cirrhosis, and infant mortality. Smoking, overweight and obesity, and binge drinking are also more common in NAs (Mannix, Austin, Baayd, & Simonsen, 2018). Discussing sensitive topics about his lifestyle may add to more his anxiety. Therefore, proper assessment of the patient, good history taking and through evaluation to avoid stereotypes and misdiagnosis should be incorporated for better treatment outcome of this patient. 

  

Other Cultural Factors 

  

It is not known from the scenario, but NAs are likely move to, and choose to reside in, urban areas because of the opportunities these areas offer (Mannix et al., 2018). They are less likely to have graduated from high school, with fewer receiving college degrees. They face higher levels of poverty, unemployment, and homelessness, and are less likely to own their own homes. In addition, mental health and substance abuse-related conditions are among the leading causes of death for urban NAs (Mannix et al., 2018). 

Thus, it is important for a provider to assess culturally adapted risk communication to resonate with this  vulnerable populations (Dellinger, Olson, Clark, Pingatore, & Ripley, 2018). 

  

Targeted Questions 

  

What language is spoken at home? 

In addition to alcohol, do you smoke? 

How much do you drink daily? 

What do you do for a living?
Within the last month has your anxiety impacted your daily living?
Have you tried any methods to help alleviate your anxiety?
Is there a significant person to whom you can go to, talk to, and get guidance and support?  

Do you have a religion or faith you adhere to? 

Are there specific beliefs or preference concerning food that you believe cause or cure an illness? 

  

When incorporating questions in assessment, it is important that a provider strives to humanize patient, monitors biases, considers patient’s health literacy and responds thoroughly to patient’s complaints that ensures high-quality care (Ball et al., 2019). 

  

Challenges and Strategies  

  

Often people from different cultures feel health care providers are culturally insensitive. Many do not seek health care due to lack of health insurance, lack of transportation, and higher health care cost, which can impact prevention and timely treatment (Mannix et al., 2018). Cultural and practice differences also exist among healthcare providers. But a provider can stop the skepticism and start by asking the patient questions to find out how patient can obtain treatment (Ball et al., 2019). 

The healthcare provider needs to be sensitive about when talking to the patient in any population regarding use of alcohol and recreational drugs. Many are culturally sensitive to seek treatment for mental illness or drug/alcohol because of the stigma attached to it. So, the nurse practitioner should begin by acknowledging and overcoming their own biases and cultural stereotypes. When communicating with patents, the healthcare providers must know how to effectively use medical interpreters when language barriers arise. Particular attention should be provided to caring for patients who are lesbian, gay, transgender and /or bisexual as they may have already faced discrimination and disrespect in the health care setting. Thus, it is crucial that as health care providers, we invest time in becoming culturally competent and develop culture humility to work effectively with patients from population that is different than their own (Ball et al, 2019). 

When cultural differences exist, it is our responsibility that we avoid assumptions and fully understand what the patient means and know exactly what patient thinks of what we mean in words and actions (Ball et al, 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 (9th ed.). St. Louis, MO: Elsevier Mosby. 

D’Amico, E. J., Dickerson, D. L., Brown, R. A., Johnson, C. L., Klein, D. J., & Agniel, D. (2020). Motivational interviewing and culture for urban Native American youth (MICUNAY): A randomized controlled trial. Journal of Substance Abuse Treatment, 111, 86–99. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jsat.2019.12.011 

Dellinger, M. J., Olson, J., Clark, R., Pingatore, N., & Ripley, M. P. (2018). Development and pilot testing of a model to translate risk assessment data for Great Lakes Native American communities using mobile technology. HUMAN AND ECOLOGICAL RISK ASSESSMENT, 24(1), 242–255. https://doi-org.ezp.waldenulibrary.org/10.1080/10807039.2017.1377596 

Mannix, T. R., Austin, S. D., Baayd, J. L., & Simonsen, S. E. (2018). A Community Needs Assessment of Urban Utah American Indians and Alaska Natives. Journal of Community Health, 43(6), 1217–1227. https://doi-org.ezp.waldenulibrary.org/10.1007/s10900-018-0542-9 

Terpstra, J., Lehto, R., & Wyatt, G. (2021). Spirituality, Quality of Life, and End of Life Among Indigenous Peoples: A Scoping Review. Journal of Transcultural Nursing, 32(2), 161–172.