Discussion: Diversity and Health Assessments NURS 6512N

April 5, 2022
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NURS 6512 Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment

Discussion: Diversity and Health Assessments NURS 6512N

Discussion 1. Initial Post.

It is very important that APRNs understand and be aware of the cultural differences we may encounter out in the field. “Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.” (CDC.2015.) Cultural competency is beneficial to treat and care for our patients. Cultural competency models have been created that help to understand different cultural better, respect individuals from other cultures, and develop skills to treat patients from other cultures. (Ball, J. 2019. Pg. 23.) This also helps to build a connection or bond with the patient when different cultural backgrounds create barriers. For this case study we are focusing on the following.  JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. He has a hx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter.” When focusing on this patient one would as what cultural factors someone might face when treating a person from an Asian culture. Some challenges that one may be faced with when caring for someone from Asian culture would be communication styles, health beliefs/disease causation, family structure/support system, respect, and use of traditional traditions.  (Juckett, G. 2014.) The first thing to consider is any kind of communication barriers. Is an interpreter needed? When communicating with this patient it important to understand that Asian culture find it rude to make direct eye contact when having a conversation, in American culture we often hold direct eye content when discussing important information. (Bell, J. 2019. Pg. 27.) A socioeconomic factor to address would be the fact that this patient lives with his daughter. This patient most likely has to depend on his daughter financially, I would ask if he had any concerns paying for his medication. Health literacy is also an issue to focus on with this patient, does he understand the use of his medications. “Health care illiteracy leads to medication errors due to the inability to understand instructions.” (Juckett, G. 2014.) The questions I would try to focus when assessing this patient would be:

  1. What are main concerns about your health?
  2. Do you have any concerns about your medications? Do you have any concerns about paying for your medicine?
  3. Who is your support system? How is your relationship with your daughter?
  4. Why do you feel like a burden to your daughter?
  5. Do you ever feel depressed?

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

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.

Juckett, G., Nguyen, C., & Shahbodaghi, S. D. (2014). Caring for Asian immigrants: Tips on culture that can enhance patient care. Journal of Family Practice, 63(1), E1–E9.

Discussion: Diversity and Health Assessments NURS 6512N

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.

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.

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

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).

 

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.

Discussion – Week 2 Initial Post

Discussion: Diversity and Health Assessments

Initial post

In our cultural melt pot country, physicians and nurse practitioners (NP) must understand how each patient’s sociocultural background could affect their behavior and health beliefs to warrant for all patients a quality and safe healthcare (Shepard, 2019). On predominant cultures, certain everyday routines are taken for granted. But some aspects like touch, eye contact, modesty, non-verbal communication, personal space, compliments, time orientation, health-beliefs, healthcare practices, and decision-making process; could be dramatically different among cultures, religions, and ethnic groups. For example, autonomous Americans might consider unethical to allow a family member to speak and make decisions for an aging parent dictating all medical care. Concerning non-verbal communication, for the Caucasian avoiding direct eye contact is disrespectful or suspicious, while it is expected and recommended to interview Native American patients (Ferwerda, 2016). Furthermore, inadequate provider-patient communication leads to noncompliance, poor patient outcomes, and lawsuit. While effective provider-patient communication is a contributing factor to increase satisfaction, promote patient’s compliance, and improve healthcare outcomes (Ball et al., 2019).

Summary

To interview a 54-year-old Caucasian male recently discharged from the hospital due to an alcohol withdrawal seizure episode. This writer will recommend using a communication model such as ESFT (Explanatory, Social Risk, Fears, Therapeutic Contracting) model or LEARN model such as:

Listen to the AG patient’s perception of his problem.

Explain to the patient the NP’s perception of the problem.

Acknowledge and discuss with the patient similarities and differences.

Recommend a plan of treatment.

Negotiate the treatment giving the patient the ability to carry out his everyday practices as much as possible (Shepard, 2019).

Factors Associated with Assigned Patient and Sensitive Issues

This patient has a past medical history of hypertension, alcohol and cocaine abuse (trying to abstain for them), and smoking. Also, he is in noncompliance with the antihypertensive treatment with amlodipine due to a lack of medication. The social history classifies him as homeless currently living at a local homeless shelter. Substance use disorders (SUDs) are highly prevalent in the United States, as per a 2017 national survey, more than 7.2 % of the population over 12 years of age had been diagnosed with SUD. This disease assessment embraces a detailed inventory of the type of substance used, the amount, frequency, and consequences for the patient. Also, it is essential to evaluate his perception of their use and readiness to change (if he really is trying to quit), in addition to his accurate medical history, an assessment of co-occurring psychiatric disorders, a further physical examination, and laboratory tests. Other essential elements to keep in consideration are the presence of substance use disorder in this patient’s family and to review social factors like his homeless status and shelter safety environment that may contribute to facilitating treatment or recidivism of illicit drug use (Dugosh & Cacciola, 2020).

To be more inclusive of the personal and cultural preferences in today’s healthcare trend demand an open and knowledgeable response from the health professionals. But as per Julie Ferwerda (2016), by incorporating just three simple practices, the NPs can make these interactions more manageable and successful, and they are:

  • Awareness. The most critical element is to identify the NP’s owns beliefs and culture before caring for others.
  • Acceptance. The key to healing is accepting and loving yourself. It becomes a powerful tool, but it demands solidarity between nurse practitioners and patients.
  • Asking. The nurse practitioners cannot always be aware of and practice cultural sensitivity; there is no way to do it. Therefore, when in doubt, the best way to provide sensitive care to patients of diverse cultures is to ask.

Understand the patient’s specific socio-economic situation (homeless status and why), his spirituality and beliefs, prior and actual lifestyle, educational level, his perspective regarding the impact of his illness process, as well as what he expects from the health professional; will help to keep the interview on track without making the patient feel uncomfortable (Hashim, M.J, 2017). Also, it facilitates the NP to explore the patient’s feelings, concerns, ideas, and experience about the illness process to create a patient-centered plan of care, promote health, inform and refer him to the available community resources need (Ball et al., 2019). According to Julie Ferwerda (2016), it is essential to allow more liberty in patient choices and involvement. Cultural sensitivity is to be aware that every patient fit into a unique cultural group based on his practices and beliefs. Furthermore, a reliable health professional can show, respect, and nurture his patients through mindful awareness, acceptance, and asking the necessary questions.

The targeted questions that this writer will select to ask this patient are primarily focused on the Ask Me 3® educational program. This tool encourages patients and their relatives for a better understand their health conditions and what they need to do to stay healthy, to ask three specific questions to their providers, such as:

What is my main problem?

What do I need to do?

Why is it important for me to do this?

Other questions recommended during the interview could be:

  • How are you feeling today?
  • How can we help you today?
  • What is the way you deal with stress?
  • How do you think about yourself?
  • Ask yourself if there is anything preventing you from changing. What could help you make the change? (Institute for Healthcare Improvement, 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. Chapter 2, “Cultural Competency”

Dugosh, K. L., & Cacciola, J. S. (2020). Clinical assessment of substance use disorders. UpToDate. https://www.uptodate.com/contents/clinical-assessment-of-substance-use-disorders.

Ferwerda, B. J. (2016). How to Care for Patients from Different Cultures. https://nurse.org/articles/how-to-deal-with-patients-with-different-cultures/.

Hashim, M. J. (2017). Patient-Centered Communication: Basic Skills. American family physician. https://pubmed.ncbi.nlm.nih.gov/28075109/.

Institute for Healthcare Improvement. (2019). Ask Me 3: Good Questions for Your Good Health: IHI. Institute for Healthcare Improvement. http://www.ihi.org/resources/Pages/Tools/Ask-Me-3-Good-Questions-for-Your-Good-Health.aspx.

Shepard, S. (2019). Challenges of Cultural Diversity in Healthcare: Protect Your Patients and Yourself. The Doctors Company. https://www.thedoctors.com/articles/challenges-of-cultural-diversity-in-healthcare-protect-your-patients-and-yourself/.

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

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6512_Week_2_Discussion_Rubric
Grid View
List View
Excellent Good Fair Poor
Main Posting
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

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