Feb 23, 2024 Diversity and Health Assessments: NURS 6512 Week 2 Discussion
Diversity and Health Assessments: NURS 6512 Week 2 Discussion Your questions probe very intimate areas, such as one’s state of mind, the strength of one’s social network, access to resources, state of health, and past encounters with the medical system (Mikulak et al.,2020). Let us discuss how a patient could take in each of these questions: When asked, “How often are you feeling signs of depression?” The frequency with which the patient experiences depressed symptoms is the focus of this inquiry. Mikulak et al. (2020) say that trans people have it harder to get medical treatment than anybody else, which can be depressing. The patient may see this as probing into their psychological well-being, which the patient could interpret as the healthcare professional caring about their mental well-being. “Is your family supportive and understanding of your lifestyle?“ This question probes the complex interplay between the patient’s family, his current way of life, and his gender identity because Abreu et al. (2022) say that it is critical to understand how families have helped their transgender loved ones during the transition process and how they have worked to overcome obstacles to receiving care. The question suggests that the patient’s well-being may benefit from a family accepting and understanding their non-traditional lifestyle or identity. The patient may interpret this question as meaning that his family’s acceptance and love are important, especially since he leads an unconventional lifestyle or identifies as transgender and went for gender reassignment surgery instead of being straight. Struggling to Meet Your Deadline? Get your assignment on Diversity and Health Assessments: NURS 6512 Week 2 Discussion done on time by medical experts. Don’t wait – ORDER NOW! Meet my deadline “Do you need assistance in paying for your hormone replacement or HIV medication?“: The patient’s capacity to pay for life-sustaining drugs is explicitly addressed in this question. People who identify as transgender may be reluctant to seek sexual-related health care if they have had previous negative interactions with medical professionals (Mikulak et al., 2020). The patient may interpret this question as the healthcare provider caring about his health and feel more at ease with the healthcare professional if they see that they care about them getting the care they need. “Can you describe why you feel your health is declining? When did those symptoms start?”: There is a correlation between transgender people’s socioeconomic status and the prevalence of their chronic health issues (Abramovich et al.,2020). This question aims to ascertain the patient’s perspective on the onset and progression of their health deterioration. The patient may see this as a chance to express their worries and offer a history of their symptoms, which might aid in arriving at a correct diagnosis and improving the quality of care they get. “What barriers have you experienced in receiving transgender-competent healthcare?“: Society views transgender people negatively because of the stigma attached to their identification (Teti et al., 2021). This question aims to probe the patient’s experiences obtaining trans-welcoming medical treatment. It shows that you, as the provider, are prepared for difficulties and dedicated to meeting your patient’s needs in the best way possible. The patient may use this as an opening to discuss their hopes and concerns about receiving treatment that respects their gender identity. When considering a 44-year-old Filipino male patient whose anticoagulant medication has not been effective after two weeks, the most pertinent issue concerns the patient’s deteriorating health and the onset of symptoms. Providers may utilize this data to better understand why a certain treatment is not working and make necessary adjustments (Nichol et al.,2022). The remaining questions are not directly relevant to the anticoagulant therapy problem but are significant for addressing other areas of the patient’s health and well-being.A healthcare provider may ask questions like these to build rapport, find pertinent details, and tailor their treatment to each patient. Thank you for sharing. References Abramovich, A., de Oliveira, C., Kiran, T., Iwajomo, T., Ross, L. E., & Kurdyak, P. (2020). Assessment of Health Conditions and Health Service Use Among Transgender Patients in Canada. JAMA network open, 3(8), e2015036. https://doi.org/10.1001/jamanetworkopen.2020.15036 Abreu, P. D., Andrade, R. L. P., Maza, I. L. S., Faria, M. G. B. F., Valença, A. B. M., Araújo, E. C., Palha, P. F., Arcêncio, R. A., Pinto, I. C., Ballestero, J. G. A., Almeida, S. A., Nogueira, J. A., & Monroe, A. A. (2022). Support for Mothers, Fathers, or Guardians of Transgender Children and Adolescents: A Systematic Review on the Dynamics of Secondary Social Networks. International journal of environmental research and public health, 19(14), 8652. https://doi.org/10.3390/ijerph19148652 Mikulak, M., Ryan, S., Ma, R., Martin, S., Stewart, J., Davidson, S., & Stepney, M. (2021). Health professionals’ identified barriers to trans health care: a qualitative interview study. The British Journal of General Practice: the journal of the Royal College of General Practitioners, 71(713), e941–e947. https://doi.org/10.3399/BJGP.2021.0179. Nichol, J.R., Sundjaja, J.H., & Nelson G (2022). Medical History. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534249/ Teti, M., Kerr, S., Bauerband, L. A., Koegler, E., & Graves, R. (2021). A Qualitative Scoping Review of Transgender and Gender Non-conforming People’s Physical Healthcare Experiences and Needs. Frontiers in public health, 9, 598455. https://doi.org/10.3389/fpubh.2021.598455. The Scenario Shawn Billings, a 28-year-old African American patient comes into the clinic today. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and 4 days ago with a migraine, given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache. He is very agitated today. He is here with his father and worried that he will not get any medication. Data on Socioeconomic and Education Status for Black Males Black men are the least likely, when compared to black women, white men, and white women, to have an advanced degree (Eggly et al., 2017). 4% of black men in America have a master’s degree, 9% of black women have a master’s degree, 8% of white men have a master’s degree, and 13% of white women have a master’s degree (Nzau et al., 2020). Black men are much more likely to be born into poverty and much less likely to get out of it compared to these same groups (Eggly et al., 2017). Black men make up about 6% of the population but account for over 30% of the prison population (Nzau et al., 2020). Black men have a shorter life expectancy than white men by about 4 years (Nzau et al., 2020). Black men are perceived as the most violent group of individuals, based on studies conducted to measure implicit bias (Nzau et al., 2020). More than 40% of white respondents ranked almost all or all black men as violent (Nzau et al., 2020). White males and black females were perceived as similarly violent, and white women were perceived as the least violent (Nzau et al., 2020). Black men earn more than black women, but less than white women and white men (Nzau et al., 2020). Black men are twice as likely to be unemployed than white men (Nzau et al., 2020). Other Statistics to Consider Statistics can sometimes be a blunt object to use when thinking of groups of people. For example, it is important to observe that the black population is diverse with people of various ethnic backgrounds and immigrants. Why does this matter? It is estimated that about 59% to over 70% of Nigerians hold a bachelor’s degree or higher (Ajobaju, 2021). The number varies in percentage levels for Nigerians because the number of Nigerians who took the survey, are estimated from the U.S. Census Bureau and is thought to have been grossly underestimated (Muri, 2012). About 31% of black immigrants have at least a bachelor’s degree while 33% of U.S. population has a bachelor’s degree or higher (Pew Research Center, 2022). About 1 in 10 blacks are immigrants (Pew Research Center, 2022). About 25 % of black immigrants make $100,000 yearly or higher compared to 17% of black born Americans (Pew Research Center, 2022). The average median income for immigrants is $63,000 and for black immigrants is $56,000 (Pew Research Center, 2022). Less than 1 out of 5 black immigrants lived below the poverty line in 2019 when about 1 in 5 black Americans lived below the poverty line in 2019 (Pew Research Center, 2022). On certain levels, black immigrants have a different experience in America than black Americans. Blacks and Religion U.S. born blacks are much more likely to be protestant than any other religion when compared to immigrant blacks (Pew Research Center, 2022). Immigrant blacks are more likely to claim to be Catholic and non-Christian (Pew Research Center, 2022). African blacks are the least likely to say they are unaffiliated to any religious groups (Pew Research Center, 2022). Overall, most black people in America seem to derive their sense of spirituality from religion (Pew Research Center, 2022). Males Generally speaking, men seem to be suffering within today’s culture (Reeves, 2022). The factors that are contributing to this are multifactorial. In some corners of pop culture, feminism is often deemed the primary culprit. However, there are many other factors that seem to play a significant role in why men are falling behind (Reeves, 2022). Traditionally male dominated jobs, which include construction workers, automotive jobs, truck drivers, farmers, pilots, and other male dominated sectors, have been areas where technology has dominated (Casey & Nzau, 2019). It should also be noted that male dominated sectors are also at the highest risk for death and fatal injuries (Industrial Safety & Hygiene News, 2020). The jobs with the highest risk for on-the-job deaths, include roofers, oil miners, firefighter supervisors, lineman, garbage collectors, iron workers, and power liners which all made the top 10 for the most dangerous jobs in America list (Industrial Safety & Hygiene News, 2020). Jobs that are traditionally dominated by women, like nurses and teachers, have been impacted by automation to a much lesser extent (Casey & Nzau, 2017). Studies are showing that men, on average, tend to be better risk takers than women and have poorer impulse control when compared to women (Reeves, 2022). To some degree, this explains some of why more men than women, on average, tend to gravitate to jobs that are physically more dangerous, in free societies where women can choose to work these same jobs (Peterson, 2018). Today’s economy requires impulse control and long-term planning as humans continue to increase lifespan (Reeves, 2022). With the economy also demanding less labor-intensive jobs, like farming or factorial work, and instead prefer people with a psychological make-up that is less impulsive, and more prone to long term planning, the gap in education makes more sense and the problem for those who are less risk averse and wise in short sightedness, compounds (Reeves, 2022). 5 questions With all of this in mind, it is important to understand my clients social and economic situation and temperamental make up. My questions would be holistic in approach. I would keep in mind, that as an ethnic woman, there will be men who are uncomfortable with being completely honest with me. I grew up in several places as a kid. I’ve grown up in small southern towns, I’ve grown up in northern cities, and I’ve grown up around a plethora of different ethnic cultures. Amongst every group, there’s always several things that most of the people in a culture love. Diversity and Health Assessments: NURS 6512 Week 2 Discussion https://nursingmasters.blog/diversity-and-health-assessments-nurs-6512-week-2-discussion/ This week a 44-year-old Filipino patient represents to the clinic for blood thinner lab evaluation. The patient was placed on a blood thinner, presumably warfarin, two weeks ago, and now his PT/INR needs evaluation to see if his levels are within the normal therapeutic range. The expected range for prothrombin time (PT) is 11-13.5 seconds, and the international ratio (INR) range is 0.8- 1.1, but a provider may want your levels to be between 2.0-3.0 to prevent blood clots (Prothrombin Time (PT): MedlinePlus Medical Encyclopedia, n.d.). The patient is not currently in the therapeutic range. The patient reports compliance with the daily use of medication, eating a diet rich in fish and tofu, and expressed a lack of understanding as to why the drug is ineffective. Family, culture, spiritual beliefs, and socioeconomic status sum up who an individual is and how they live their lives. All these facets largely influence people’s health outcomes. The Filipino culture is an interdependent matriarchal society with proud Catholic beliefs (Miller, 2023). Family is of the utmost importance as well as upholding Filipino values. Language and traditions include eating several times daily, hosting fiestas, and helping others in need (Dumaraos, 2022). However, the patient’s lab results may reflect cultural barriers such as a language barrier. An assessment of the patient’s primary language and the need for an interpreter will need to be reviewed. Blood thinners such as warfarin have many interactions with other medications, supplements, herbs, and foods. The patient reports a diet rich in fish and tofu. Research says that soy products such as tofu, a staple protein source in Asian cultures, can decrease the effectiveness of warfarin on the INR (Tan & Lee, 2020). Additionally, Tan and Lee (2020) report that fish, another Asian staple, can cause a hypo-coagulant state, putting patients at risk of bleeding. Therefore, obtaining more information regarding daily diet, cultural beliefs regarding a medical condition, and faith in alternative options will help the provider educate the patient and family on possible lifestyle changes. Alternatively, the provider will need to modify therapy to accommodate the patient. Addressing sensitive matters regarding individuals’ beliefs needs to be handled with care. Using the RESPECT model will aid in navigating these sensitive topics while maintaining effective patient-centered care communication (Ball et al., 2019). The provider should build a rapport and show empathy and support; next, the provider should partner with the patient to develop a viable solution and provide any explanation or clarification if needed. Lastly, the provider must respect the patient’s cultural beliefs and strive to be culturally competent, and work on establishing trust. Five Questions to aid in building the patient’s health history include: What is your primary language? This question evaluates if a language barrier may interfere with the patient’s understanding of how diet affects INR and warfarin levels. It also assesses if there is a need for an interpreter. Who decides for the family? This question gives the provider context if their family is matriarchal or patriarchal. This information will help the provider understand who needs to be present to help make healthcare decisions with the patient. Who is responsible for food preparation? This information will inform the provider who makes meals because they will also need to be educated on possible modifications that need to be made to accommodate the patient’s health needs. Are there specific beliefs or preferences concerning food, such as those believed to cause or cure an illness? We need to understand the cultural view of food so the provider can better understand how to treat the patient to accommodate their lifestyle and beliefs. What is the tendency to use alternative care approaches/ or herbal remedies exclusively or as a complement? This question is similar to question four; however, this question focuses on alternatives other than food that need to be understood to better care for the patient. References Ball, J. W., Dains, J. E., & Flynn, J. A. (2019). Seidel’s Guide to Physical Examination (9th ed.). Elsevier Health Sciences (US). https://mbsdirec Links to an external site.t.vitalsource.com/books/9780323481953 Dumaraos, G. (2022, November 30). Things You Should Know About Filipino Culture. Culture Trip. https://theculturetrip.com/asia/philippines/articles/11-things-you-should-know-about-the-filipino-culture/ Links to an external site. Miller, J. (2023). Religion in the Philippines. Asia Society. https://asiasociety.org/education/religion-philippines#:~:text=The%20Philippines%20proudly%20boasts%20to,well%20over%20100%20Protestant%20denominations You did a great job thinking about those potential factors that may be a contributing factor to the patient’s out of range lab even after taking the blood thinner for two weeks. However, i will look more into his ability to afford the medications, his diet, compliance, and culture in relation to medication taking. When assessing the patient’s culture and beliefs, it is important to consider how these factors could be impacting the patient’s blood thinner medications not working. He may believe prayer will cure him or may not be to afford the medications as prescribed. This patient assessed for medication noncompliance and use multifactorial strategies to improve adherence because medication-taking behavior is extremely complex and individual (Brown & Bussell 2011). Also, he should be asked about using garlic to cook as this is a known plant food among Filipinos for prevention and treatment of different diseases (Bayan, et al., 2014). References Bayan, L., Koulivand, P. H., & Gorji, A. (2014). Garlic: a review of potential therapeutic effects. Avicenna journal of phytomedicine, 4(1), 1–14. Brown, M. T., & Bussell, J. K. (2011). Medication adherence: WHO cares?. Mayo Clinic proceedings, 86(4), 304–314. https://doi.org/10.4065/mcp.2010.0575 In May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012). Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the health care field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and health care professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity. In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Case 1 Subjective Data CC: “I came for my annual physical exam, but do not want to be a burden to my daughter.” History of Present Illness (HPI): At-risk 86-year-old Asian male – who is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. PMH: hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis PSH: S/P cholecystectomy Drug Hx: Current Meds: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and cipro 100mg daily. Review of Systems (ROS) General: + weight loss of 25 lbs over the past year; no recent fatigue, fever or chills. Head, eyes, ears, nose & throat (HEENT): no changes in vision or hearing, no difficulty chewing or swallowing. Neck: no pain or injury Respiratory: CV: GI: GU: no urinary hesitancy or change in urine stream Integument: multiple bruises on his upper arms and back. MS/Neuro: + falls x 2 within the last 6 months; no syncopal episodes or dizziness Psych: Objective Data PE: B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8 HEENT: Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, ornasopharynx clear, edentulous. Lungs: CTA AP&L Cor: S1S2 without rub or gallop Abd: benign, normoactive bowel sounds x 4 Ext: no cyanosis, clubbing or edema Integument: multiple bruises in different stages of healing – on his upper arms and back. Neuro: No obvious deformities, CN grossly intact II-XII Case 2 Subjective Data CC: “I am here for my annual physical exam and have been having vaginal discharge.” History of Present Illness (HPI): 32-year-old pregnant lesbian – her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. Drug Hx: Current Medications: prenatal vitamins and takes Tylenol over the counter for aches and pains on occasion Family Hx: She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0. Review of Systems (ROS) General: no fatigue, fever or chills. Head, eyes, ears, nose & throat (HEENT): Neck: no pain or injury Respiratory: CV: GI: GU: Integument: multiple piercings, and tattoos. Old scars related to “cutting”. Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements Objective Data PE: B/P 128/76; Pulse 83; RR 16; Temp 99.0; Ht 5,6; wt 128; BMI 20.98 HEENT: Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, ornasopharynx clear, good dentition. Piercing in her right nostril and lower lip. Lungs: CTA AP&L Cor: S1S2 without rub or gallop Abd: benign, normoactive bowel sounds x 4 GU: external genitalia intact, no lesions or masses. White copious discharge with an amine odor; no cervical motion tenderness; adenxa intact. Ext: no cyanosis, clubbing or edema Integument: intact without lesions masses or rashes. Neuro: No obvious deficits and CN grossly intact II-XII Case 3 Subjective Data CC: “Annual physical exam” History of Present Illness (HPI): 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle. Drug Hx: Current medication – denie Allergies: no allergies to food or medications. Family history: is very positive for diabetes, hypertension, and alcoholism. Review of Systems (ROS) General: no recent weight gains of losses, fatigue, fever or chills. Head, eyes, ears, nose & throat (HEENT): Neck: Respiratory: CV: no chest discomfort or palpitations GI: GU: Integument: history of eczema – not active MS/Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements Psych: Objective Data PE: B/P 158/90; Pulse 88; RR 18; Temp 99.2; Ht 5,7; wt 208; BMI 32.6 General: 23 year old male appears well developed and well nourished. He is anxious – pacing in the room and fidgeting, but in no acute distress. HEENT: Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, ornasopharynx clear, poor dentition – multiple carries. Lungs: CTA AP&L Cor: S1S2, +II/VI holosystolic murmur; without rub or gallop Abd: benign, normoactive bowel sounds x 4; Hepatomegaly 2cm below the costal margin. Ext: no cyanosis, clubbing or edema Integument: intact without lesions masses or rashes. Neuro: No obvious deficits and CN grossly intact II-XII Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: Diversity and Health Assessments: NURS 6512 Week 2 Discussion To prepare for Diversity and Health Assessments: Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments. Select one of the three case studies. Reflect on the provided patient information. Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected. Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks. Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information? By Day 3 Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated wi
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