NURS 6512 Week 2 Discussion: Diversity and Health Assessments Sample Essay

My case study covers a 32-year-old female TJ, being seen for an annual physical exam.  She is currently pregnant without complications from receiving sperm at a local sperm bank.  She has a family history of diabetes and is presently experiencing vaginal discharge. She has been currently being seen by an obstetrician for prenatal care.  Current medications include prenatal vitamins and occasional Tylenol for pain. Her sexual orientation is lesbian, and her pregnancy history is Gravida1; Para 0; Abortions 0.

Patients that identify as lesbian or bisexual tend to participate in more risky behaviors such as smoking or occasional alcohol use compared to heterosexual women (Gonzales, G., Quinones, N., & Attanasio, L., 2019). Lesbian and bisexual individuals experience discrimination and stigma and may delay care related to fear (Fagan, M. P., & Ireland, C. L., 2020). Mental health factors are a concern related to depression, suicide ideation, and self-harm (Fagan, M. P., & Ireland, C. L., 2020).

Sexual orientation may place the patient at a higher risk for sexually transmitted diseases and HIV, but testing should only be based on the level of risk, not orientation (Fagan, M. P., & Ireland, C. L., 2020).  Patients within the LBGT community have increased health disparities due to the lack of insurance and physician care due to fear of bias and discrimination (Anticuar, S., 2021).  Should a patient come out to disclose sexual orientation, it should be acknowledged, but sexual behavior should not be assumed (Fagan, M. P., & Ireland, C. L., 2020).

The following questions may be asked to develop a health history assessment without regard to sexual orientation.

“Currently, how many weeks pregnant are you? Or How many weeks along are you?”

“Current due date?” “When was your last Obstetrician appointment?”

“Is there a significant other involved with the pregnancy?”

“Can you tell me how long you have had vaginal discharge? Color? Consistency? Any Odor?”

“Have you had any other symptoms?” Burning with Urination? Vaginal pain or itching?”

“Do you smoke or drink?”

Anticuar, S. (2021). Examining Health Disparities Among Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning Adults in Davidson County, Tennessee.

Fagan, M. P., & Ireland, C. L. (2020). Guide for Providing Care for Lesbian, Gay and Bisexual Patients in Primary Care Quick Reference Guide.

Gonzales, G., Quinones, N., & Attanasio, L. (2019). Health and access to care among reproductive-age women by sexual orientation and pregnancy status. Women’s Health Issues, 29(1), 8-16.

Your post regarding the potential nuances of caring for LGBTQ females was informative.  I also felt that your line of questioning was a good start to get some basic, helpful information related to her health and well-being.  While there is a large quantity of evidence-based research and data surrounding heterosexual pregnant females and their care, the same is not so for LGBTQ patients; although, the information is on the rise given the changes to our culture.  However, it will still be many years before a robust database will be available. 

As noted by Malmquist et al. (2019), healthcare providers often still address LGBTQ patients with a heteronormative undertone, that is mother/father directed, especially with forms and pre-printed material.  As a heterosexual female, this is something that could easily be overlooked as offensive because we aren’t looking at patient information from the same lens.  According to Malmquist et al. (2019), as well as others I have read specifically for this discussion post, the experiences in healthcare for LGBTQ patients have been a mix of positive and negative.

Another line of questioning to consider would be her thoughts on the sperm donor profile.  Since the women are permitted to visualize the physical and other attributes of the donor, we can initiate conversation to the thought process behind the chosen donor.  In the future, the child may want to know more about the other, biological side of their genetics. More recently, some information has become available to donor recipients that includes a donor profile including hobbies, education, and character traits, physical description, and even some inclusion of staff perceptions of the donor, a practice that originated in sperm banks that initially served only lesbian couples (Scheib & McCormick, 2016). 

Utilizing a sperm bank donor requires that the sperm be frozen which decreases the chances of conception (Scheib & McCormick, 2016).  This may or may not have been her first round of insemination.  This can become a profound source of financial and emotion stress if it’s taken multiple rounds to produce a pregnancy.  There are several more layers to this patient’s pregnancy than surface value that need to be investigated and discussed in order to provide inclusive, well-rounded care.

References:

Malmquist, A., Jonsson, L., Wikstrom, J., & Nieminen, K.  (2019).  Minority stress adds

Additional layer to fear of childbirth in lesbian and bisexual women, and transgender

People.  Midwifery, 79, 1-7.

Scheib, J. & McCormick, E.  (2016).  Sperm donor, choosing a.  In Goldberg, A. (Ed.),

The SAGE Encyclopedia of LGBTQ Studies (pp. 1109-1113).  SAGE Publications.

DOI: http://dx.doi.org/10.4135/9781483371283.n390

Week 2 – Initial Post

Patient Summary

The patient selected is John, a 33-year-old male that has been transitioning from a female for the last two years and made a full transition with family and socially last year. He has been administering testosterone obtained via telehealth (he was previously receiving medication from the internet). He also takes Biktarvy as he tested positive for HIV 3 years ago but virally suppressed as of his blood draw six months ago. His medical history includes depression, smoking two packs of cigarettes daily, and smoking 3-6 marijuana joints on the weekend (he has an active green card). He is currently unemployed and has been feeling very weak over the last few weeks, which prompted him to move back into his parent’s house.

Factors Affecting The Patient

This patient has a multitude of factors that could lead to isolation or worsening of his depression if he does not have a proper outlet or trusted healthcare provider. Socioeconomic factors affecting this patient include his unemployment status and moving back in with his parents. A patient’s socioeconomic status can influence how they seek medical care and the type of care they receive from providers (Ball et al., 2019, p. 24). Spirituality wasn’t mentioned in the summary, but it is helpful to understand the patient’s beliefs in order to tailor their care and offer resources if they haven’t been able to attain them (Ball et al., 2019, p. 10).

The patient’s lifestyle has probably changed since he has been feeling weaker, and this could take a toll on his mental health. Changes to his lifestyle could include leisure activity, sexual experiences, and diet or exercise habits. Cultural factors for this patient include his beliefs, sexual orientation, the people he surrounds himself with, heritage, ethnicity, and socioeconomic status (Ball et al., 2019, p. 23). All of these factors together make each individual unique and should be considered when having discussions about their health, as they might impact how a patient feels about medication or treatment.

Building a Health History & Targeted Questions 

Building a trusting relationship with this patient is the initial priority because it seems his healthcare recently has been solely online, which may indicate he has apprehension about an in-person visit. Patients of the LGBTI community have faced bias and undesired interactions with healthcare providers, which has steered many away from seeking care (Coleman et al., 2022). The goal is to make sure this patient is comfortable throughout the visit so he can openly communicate and return for follow-up appointments.

The first question would be asking the patient about his identity. The summary did indicate that he transitioned two years ago, but it is important to hear from the patient how they want to be addressed, and this is a great opportunity to be open and supportive while building rapport. If the patient is comfortable, asking about their medical journey with transitioning is important because this will help understand why he has been seeking most of his care online.

The second question would be directed toward his chief complaint. The patient mentioned feeling weaker in the last few weeks. I would ask the patient about specific symptoms because often, weakness and fatigue are mixed up and can mean different things. Weakness could indicate overall muscle weakness from an electrolyte imbalance, thyroid issues, or an overall new development of a disease (HealthLink BC, 2020).

Fatigue is the feeling of exhaustion, and this could be attributed to the patient’s HIV, depression, or marijuana usage (Ethan et al., 2020; HealthLink BC, 2020). Once established with exactly what he is feeling, I would ask how often he feels this way or if it is consistent, if there are other symptoms associated, and how it affects his daily life.

The third question would address his mental health status because he feels his health is declining, he is unemployed, he had to move in with his parents, and he has had episodes of depression. This can all weigh heavy on a person that does not have the right support system.

I would also want to address how his depression has been, if he has had any recent episodes, what he does to help them, and if he feels he is ready to start on an antidepressant. It would also be appropriate to perform the PHQ-9, which helps identify major depressive disorder, and the Columbia-Suicide Severity Risk Screener to identify suicide risk (Ball et al., 2019, p. 94).

The fourth question will be related to the last, asking if he does feel like he has a support system. This patient is going through a lot, and a strong support system is vital. I would ask the patient about his relationship with his parents, friends, and community. Offering resources where he lacks support, whether that be his mental health, personal relationships, or medical condition, will help him find people who are going through similar issues and form a trusting community (White & Fontenot, 2019).

The fifth question would be if he would want to start getting his medications (testosterone and Biktarvy) through me instead of online. Offering this service to the patient will let him feel he is receiving thorough care without judgment. This will hopefully be a gateway into a long-term relationship with the patient and help him create a healthier future for himself. In future visits, addressing smoking cessation and other healthy lifestyle habits will be addressed.

Strategies

All of these questions are very personal, and as the patient’s provider, it is our job to create a trusting environment. One strategy to use while performing his examination would be incorporating patient-centered care in which the provider asks the patient their preferences and their needs to ensure a care plan can be developed that will properly suit them (Ball et al., 2019, p. 2).

Another strategy includes asking open-ended questions, as this will allow the patient to answer with as much or as little information but never try and force answers from the patient (Ball et al., 2019, p. 4). When confronted with a patient that has different ideals, cultural beliefs, or any other significant differences, it is important to keep an open mind and never pass judgment. This will allow for the smoothest conversation and keep the patient at ease throughout their visit.

References

Ball, J. W., Dains, J. E., & Flynn, J. A. (2018). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). Mosby.

Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., Nahata, L., . . . Arcelus, J. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(sup1), S1–S259. https://doi.org/10.1080/26895269.2022.2100644 Links to an external site.

Ethan, X., Logan, A., Liam, M., & Leonard, J. (2020). Impact of Marijuana (Cannabis) on Health, Safety and Economy. Int. Digit. Organ. Sci. Res, 5, 43-52.

HealthLink BC. (2022). Weakness and Fatigue. https://www.healthlinkbc.ca/illnesses-conditions/fatigue-and-sleep/weakness-and-fatigue

White, B. P., & Fontenot, H. B. (2019). Transgender and non-conforming persons’ mental healthcare experiences: An integrative review. Archives of Psychiatric Nursing, 33(2), 203–210. https://doi.org/10.1016/j.apnu.2019.01.005Links to an external site.

Discussion: Diversity and Health Assessments

May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Photo Credit: Getty Images

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

• Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
• By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
• Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
• Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
• Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

By Day 3 of Week 2

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

This case study involves John Green, a 33 year-old Caucasian male, who 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 packs of cigarettes per day for the last 10 years, smoking 3-6 marijuana joints every weekend (has an active green card), and suffering from depression episodes. He has been 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.

In recent days, there has been a greater push to explore the needs and improve care for transgender individuals.  Transgender individuals experience stigmatization, discrimination, and unethical and insensitive attitudes in healthcare settings.  Because of this, it’s imperative that healthcare workers be knowledgeable about the ways to deliver ethical and culturally competent care (Sundus et al., 2021).  Transgender health needs can be complex and may be intimidating to healthcare providers. 

The World Health Organization (WHO) defines gender-affirming care as all-inclusive healthcare that supports transgender person in their gender transition (WHO, n.d.).  The WHO also recommends that health providers should not be solely treatment focused.  They recommend instead creating a safe environment that promotes trust.  This allows the patient to ask questions, explore concerns, and express emotions (Safer & Tangpicha, 2019).   

There are several things to consider when performing a health history of this patient such as socioeconomic concerns and lifestyle choices.  HIV is a disease of social and economic bias.  His fear of discrimination may have kept him from getting his prescriptions from a physician and resorting to the internet.  His financial situation may also be a factor.  His mental health is also a priority concern.  There is so much to address with this patient, but I would start with these 5 questions:

1. Have you been feeling down, depressed, or hopeless?
2. Are you currently taking any medication related to your HIV diagnosis?
3. Are you comfortable discussing your current anatomy so I can best tailor this visit to you?
4. When was your last PAP smear or gynecological exam?
5. What brought you in to the clinic today?

Safer, J., & Tangpricha, V. (2019). Care of the transgender patient.Annals of internalmedicine,171(1), ITC1-ITC16

Sundus A, Shahzad S, Younas A. Ethical and culturally competent care of transgender patients: A scoping review. Nursing Ethics. 2021;28(6):1041-1060. doi:10.1177/0969733020988307

World Health Organization.  (n.d.).  Gender incongruence and transgender health in the ICD.  Retrieved on June 9, 2023 from  https://www.who.int/standards/classifications/frequently-asked-questions/gender-incongruence-and-transgender-health-in-the-icdLinks 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.

Several issues affect patient’s lives and influence their health and ability to access care. Lifestyle, culture, and socioeconomic factors are among these issues experienced by patients. As providers, it is important to be sensitive to these factors and to be culturally competent in providing care. According to the Centers for Disease Control and Prevention (2020), cultural competency refers to the ability of healthcare providers to integrate and transfer knowledge about individual’s and group’s cultures into policies, practices, and attitudes to increase services, thereby improving the quality of care provided.

Factors influence care

 The patient in the case study does have factors that can influence care. The patient is transitioned female to male and has an HIV diagnosis. This gender change presents a lifestyle factor. The patient identifies as a member of the LGBTQ community, this associates the patient in a sexual minority group. The change in identity can influence the type of care the patient receives or how the patient seeks care. The case study outlines that the patient, prior to this presentation, gets medical care via telehealth.

The patient might have previously hesitated to establish in-person care due to fear of being judged, stigmatized, or simply uncomfortable with assessment. Socioeconomic factors are also present as the patient is also unemployed. Unemployment could also affect the patient’s ability to afford care as the patient might not be able to afford insurance. Unemployment can also affect the patient’s ability to purchase medication. Additionally, it can result in increased stress and like this patient feeling like a burden that can ultimately influence the patient health by worsening his depression and consequently impact his physical health.

Issues that require sensitivity

The patient’s identifying as a male is one factor that must be treated with sensitivity. It is important not to be bias, display stigma or discriminate due to the patient’s person preferences and identity.  LGBTQ patients are entitled to the same level of care that all other patients receive. Cultural competence care for members of this community includes social and structural equality of care and avoidance of discrimination and stigmatization (Bass & Nagy, 2022).

Challenges exist in the care for patients who identifies differently from other patients. As a result, the patient may feel disrespected and not adequately cared for. To avoid challenges in caring for members of this community, healthcare providers must aim to establish a rapport with the patient and provide a safe environment to communicate their health needs.

Knowledge of specific sensitive target care areas, such as higher rates of anxiety, depression, stress, homelessness, higher rates of sexually transmitted infections, and prior traumatic experiences with clinicians, must not be ignored but instead should be assessed, and a delicate approach be implemented to provide care. Providers must practice cultural diversity and ensure that while beliefs may differ, respect for the patient is maintained and no unconscious bias is demonstrated (Ball et al., 2019). The provider must be keen to provide the same excellent quality care to LGBTQ patients as they would for all patients.

  Another factor that requires sensitivity is the patient’s HIV status. HIV is still a condition with a perceived stigma. While stigma and discrimination can be from others the patient interacts with, there is also internal stigma. Patients can experience negative thoughts or feelings about themselves due to their HIV diagnosis. According to HIV.gov (2020), 8 out of 10 adults with HIV in the United States report feeling internalized HIV-related stigma.

This can affect the patient’s adherence to medication treatment and impact the patient’s desire to seek care. Minority groups also might experience unequal access to care. Therefore, for the prevention and treatment care of HIV to be successful, sensitivity of care must be implemented. As a result, when patients such as the patient in the case study do present for care, they must be treated with delicate care to ensure a good health history is obtained, and adequate respectable care is given. It is important not to assume that all patients of these minority groups are the same.

Patient-sensitive care encourages providers first to recognize their own biases and beware of assuming that all members of any culture/group act and behave the same way (Coleman, 2019). Patients should be perceived as individuals, and information is collected on the patient’s preferences and personal specific history. It is also important to develop a therapeutic relationship in which the patient will develop trust, be open and continue to seek care from the provider.

Target questions for this patient to obtain information.

The scenario outlines factors identifying the patient as high risk for mental health concerns. Therefore, the Columbus suicidal scale is an appropriate tool to use to gather information on the patient’s present mental health status.

Do you wish to go to sleep and not wake up?

Do you have thoughts of hurting yourself?

Do you have a plan with the intent to kill yourself?

Have you ever done anything to hurt yourself?

Describe how the changes in employment and moving back in with your parents have impacted you emotionally/mentally? (This allows the patient to explain thoughts and emotions related to recent events and outline present mental health problems.)

What physical changes have you noticed lately?

How do you practice safe sex?

What coping skills do you use to help with stress and adapting to changes? Are they effective?

Do you have a support system?

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.

Week 2 Initial Post – JC 86-year-old Asian male

This week’s assigned patient is JC, an at-risk 86-year-old Asian male who is physically and financially dependent on his daughter, a single parent who has little time or money for her father’s health needs. JC has a past medical history of hypertension (HTN), gastroesophageal reflux disease (GERD), B12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10 mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. JC comes for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter.

Gathering preliminary information before the assessment can help to make efficient use of time. At introduction of self, it would be important to determine JC’s spoken and preferred language. Because he is an elder Asian person, this clarification is vitally important to ensuring the assessment is accurate and all parties involved will have a clear understanding of the conversations taking place. Important to note is the term “Asian” is encompassing of more than thirty different nationalities and ethnic groups.

Furthermore, within each nationality there exists significant differences in dialect, religion, and education. Further diversity can be noted within generation, genders, and lifestyles (Klang, 2022). Because the description of patient is generalized, finite details regarding actual cultural differences proves to be difficult.

Socioeconomic status for JC is also hard to determine. Socioeconomic status is often measured as a combination of education, income, and occupation. The information provided does not glean any of these measures, however the information does state that JC is financially and physically dependent on his daughter. JC’s daughter is a single parent with minimal income and time constraints.

There is no clear explanation regarding JC’s prior work experience nor his daughter’s occupation. This knowledge is needed to help determine areas in which JC could be at risk for health problems. Whether JC has healthcare coverage available is another important item to clarify. If he does not, he it is possible he does not have regular exams with his medical doctors or dentists, which could lead to illnesses existing without treatment or follow up.

Based on the past medical history and current medication regimen provided in JC’s description, he has sought medical care. Clarification regarding compliance with medications and diet should be determined. Another important item to clarify for social history is if there has been any travel recently or in the past because of potential exposures to disease and illness during travel.

A person’s spiritual health includes a purposeful life, transcendence and actualization of different dimensions and capacities of human beings. Spiritual health creates a balance between physical, psychological, and social aspects of human life. Sometimes it is difficult to determine a difference between spiritual and cultural beliefs.

This determination is not always necessary, however any belief affecting health and illness must be documented in the social history area of the health history and should be addressed if the belief threatens the health and well being of the patient. Cultural factors comprise of set of values and ideologies of a particular community or group of individuals.

It is the culture of an individual which decides the way he/she behaves. In simpler words, culture is nothing but values of an individual. Culture can include things such as art, architecture, music and literature, philosophy, political views, religious beliefs, and lifestyle choices. Additionally, values within the culture help to determine how family dynamic affects daily living.

Loyalty and respect of authoritative figures (including family hierarchy, such as a father) drive interactions among members of the community. In the case of JC, the daughter may have an expectation placed upon her that JC must live with her, and she must ensure his needs are met. Getting this information confirmed through patient assessment has its challenges, as the expectation is known and expected, without additional discussions necessary.

Because males and elders are higher positions requiring respect, issues requiring sensitivity include considerations for family role changes, as the father is now dependent upon the daughter for all his needs, financial, medical, physical, and daily. Language limitations may also be an area of sensitivity. Younger generations cannot tell elders what to do, they can make suggestions about changes, but the wishes of the elder person must be honored.

This is a wellness check-up; five targeted questions include:

1. Please tell me your name, date of birth, age, race, and gender
2. Please tell me why you are here today
3. Can you please tell me more about your hypertension (HTN), gastroesophageal reflux disease (GERD), B12 deficiency, and chronic prostatitis, do you take medication for these and when were you diagnosed with each one?
4. Please tell me about the prescribed medications you take. How often do you take the medication? Do you take all doses? What do you do if you miss a dose. Are you able to pay for your medication?
5. Do you drink alcohol, take illicit drugs or smoke? If so, how often do you drink? Smoke? Take drugs?

Challenges to this population include speaking to an elder without a true understanding of his expectations in how he should be spoken to. Language barriers could also be a problem. Comprehension of conversation and affirmation to what has been comprehended is needed. Reluctance from JC to answer questions he does not believe should be asked of him. Assisting him with finding help and resources is needed. This ethnicity is most at risk for cancer, heart disease, stroke, unintentional injuries (accidents), and diabetes. This patient has HTN, GERD, as well as

Strategies to employ sensitivity to a different culture would be to research the culture being cared for to try to care for the patient in the most appropriate manner possible. During the research help to determine what is expected from the patient when caring for them, also talk with the patient to confirm what is believed to be is what they anticipate. Also trying to limit the need for the patient to tell his information only once rather than multiple times to different staff members, using affirming acknowledgements can help to make the interview process easier (National Institute on Aging, 2017).

References

Klang, P. (2022). Asian Customs and Values: Preservation within American Communities. Retrieved from Asia Society: Center for Global Education: https://asiasociety.org/education/asian-customs-and-values

National Institute on Aging. (2017, May 17). Obtaining an Olders Patient’s Medical Hisotry. Retrieved from National INstitute on Aging: https://www.nia.nih.gov/health/obtaining-older-patients-medical-history

Sullivan, D. P. (2019). The Comprehensive History and Physical Examination. In D. P. Sullivan, Guide to Clinical Documentation (pp. 23-44). Philadelphia: FA Davis.

Response

Hello Tanita! This is an exceptional and interesting post. The targeted questions you have asked your patient are appropriate because they are aimed at gathering pertinent information regarding the current patient’s condition. They are critical in helping you to seek improvement in patient’s healthcare and begin appropriate actions to enhance patient experience with care.

The questions are critical in developing a trusting relationship with patient, who is likely to interpret these questions as a way in which a nurse intends to determine appropriate health condition to provide correct intervention. The question that is likely to apply to my patient is determination of the prescribed medication the patient takes. I would also ask my patient these exact questions, how often do you take the medication? Do you take all doses?

What do you do if you miss a dose? Are you able to pay for your medication? Determination of these questions is critical in establishing polypharmacy (Nwadiugwu, 2020). It is important to determine if a patient has inappropriate polypharmacy that may increase risk of negative events and poor health outcomes.

References

Licqurish, S. M., Cook, O. Y., Pattuwage, L. P., Saunders, C., Jefford, M., Koczwara, B., … & Emery, J. D. (2019). Tools to facilitate communication during physician‐patient consultations in cancer care: An overview of systematic reviews. CA: A Cancer Journal for Clinicians, 69(6), 497-520. https://doi.org/10.3322/caac.21573

Nwadiugwu, M. C. (2020). Frailty and the risk of polypharmacy in the older person: enabling and preventative approaches. Journal of aging research, 2020. https://doi.org/10.1155/2020/6759521Bottom of Form

Week 2 Main Discussion Post

Patient Assessment

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/

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Response

Hello Mary! This is an outstanding post. The targeted questions you have asked your patient are appropriate because they are aimed at gathering pertinent information regarding the current patient’s condition. They are critical in helping you to seek improvement in patient’s healthcare and begin appropriate actions to enhance patient experience with care.

The questions are critical in developing a trusting relationship with patient, who is likely to interpret these questions as a way in which a nurse intends to determine appropriate health condition to provide correct intervention (Licqurish et al., 2019). Personally, the most applicable question here is determination of color of vaginal discharge.

A healthy vaginal discharge should be clear or whitish. However, changes in the color, smell, texture, or amount could imply a problem (Anh et al., 2021). Therefore, if the patient in this case reported changes in color of vaginal discharge to yellow, green, grey, or brown, it could be indicative of infection or other problem.

References

Anh, D. N., Hung, D. N., Tien, T. V., Dinh, V. N., Son, V. T., Luong, N. V.,  & Trung, D. M. (2021). Prevalence, species distribution and antifungal susceptibility of Candida albicans causing vaginal discharge among symptomatic non-pregnant women of reproductive age at a tertiary care hospital, Vietnam. BMC infectious diseases, 21(1), 1-10. https://doi.org/10.1186/s12879-021-06192-7

Licqurish, S. M., Cook, O. Y., Pattuwage, L. P., Saunders, C., Jefford, M., Koczwara, B., … & Emery, J. D. (2019). Tools to facilitate communication during physician‐patient consultations in cancer care: An overview of systematic reviews. CA: A Cancer Journal for Clinicians, 69(6), 497-520. https://doi.org/10.3322/caac.21573

A Sample Answer For the Assignment: NURS 6512 Week 2 Discussion: Diversity and Health Assessments Sample Essay
Title: NURS 6512 Week 2 Discussion: Diversity and Health Assessments Sample Essay

Main Question Post

Building a health history could be challenging due to cultural, spiritual, socioeconomic, patient beliefs, and lifestyle. Cultural sensitivity is essential as we try to understand and relate to our patients in order to diagnose and treat their problems. Awareness of diversity and non-bias in patients’ chief complaints removes barriers to effective treatment.

According to research done by Huang, van der Borght, Leithaus,  Flamaing,  & Goderis in 2020,  patients that frequently come to the hospital can be an indicator that the patient may be having physical, mental, spiritual, and social deprivation in their home situation. This young 28-year-old African American male patient should be screened for any physical, mental, spiritual, and socioeconomic deprivation that is making him a frequent flier to the hospital.

As he is very agitated, he should be screened for any psychological problems. Regardless of the patient’s background, the goal is to meet the patient where he is without judgment but rather with a genuine interest in the patient’s perspective through cultural humility in order to deliver optimum care (Stubbe, 2020).

The nurse practitioner should be sensitive that the patient is worried he will not get any medication because African-American men should be recognized and acknowledged as a vital component of American society and not be viewed as an American problem (Bennett,2022).

He should also be sensitive about the patient’s level of education, family history, and cultural background while interacting with him because this will create a non-bias approach that will foster efficient care delivery to the patient. It is important to be respectful to the patient and avoid stigmatization that will inhibit good diagnostic judgment, which potentially places the patient at increased risk of poor hospital experience because of a lack of appropriate medical care as a result of patient stigmatization.

Targeted Questions

On a scale of 0-10, 0 being no pain and 10 being the worst pain, how can you rate your headache?

Do you smoke cigarettes, drink alcohol, or use any recreational drugs?

How much sleep do you get daily?

Do you feel safe at home?

Do you feel depressed?

Do you feel like hurting yourself?

What coping skills/mechanism works for you when you are stressed?

What do you do for a living?

References

Bennett, M. D. (2022). Still makes me wanna holler: African American males, dilemmas, and disparities. Journal of Human Behavior in the Social Environment, 32(2), 156–171. https://doi.org/10.1080/10911359.2021.1875098

Huang, M., van der Borght, C., Leithaus, M., Flamaing, J., & Goderis, G. (2020). Patients’ perceptions of frequent hospital admissions: a qualitative interview study with older people above 65 years of age. BMC geriatrics, 20(1), 332. https://doi.org/10.1186/s12877-020-01748-9

Stubbe, D. E. (2020). Practicing cultural competence and cultural humility in the care of diverse patients. FOCUS, 18(1), 49–51. https://doi.org/10.1176/appi.focus.20190041Links to an external site.