Feb 23, 2024 Discussion: Diversity and Health Assessments
Discussion: Diversity and Health Assessments
Discussion Diversity and Health Assessments
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).
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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.
My assignment is based on working with an 85-year-old white female living alone with no family in declining health. While working on this task, I assume the patient is my mother, and I interrogate him with empathy, knowing that she is an elderly person who is likely to be more isolated and lonelier than individuals living with their loved ones. Here, I need to create an interviewing strategy to employ in assessing this patient’s medical condition, taking into account his advanced age that his health is declining.
Communication is a difficult endeavor that requires empathy and courtesy, especially when dealing with senior individuals. It’s critical to observe, listen, and gather information when pertinent information is offered when speaking with these kinds of patients. To preserve a constant pace with the patient, the medical practitioner not only should go slowly and be very patient (Ball et al., 2019).
Furthermore, by observing, the healthcare professional can connect to and be brought into the environment of the elderly. It is critical to comprehend the participant’s reality and the circumstances that may impact their responses. It’s critical for health care professionals to establish a good connection with patients in the interview session to create a favorable interaction.
The nurse tells the patient to introduce themselves to create familiarity and as the patient settles in the interview. Showing sincerity is vital while getting to know the social circle’s nature and the living condition of the patient. The questions could be personal, but they are meant to know the situation of the healthcare provider.
In May 2012, Alice Randall wrote an article for The New York Times on the cultural
Discussion Diversity and Health Assessments
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.
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Case 1
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.”
Case 2
TJ, a 32-year-old pregnant lesbian, 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 Tylenol over the counter for aches and pains on occasion. She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.
Case 3
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 him 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.
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.
Select one of the three case studies. Reflect on the provided patient information.
Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?
By Day 3
Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
CASE STUDY WEEK 2
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.
“In the United States, 39 percent of African American children and adolescents and 33 percent of Latino children and adolescents are living in poverty, which is more than double the 14 percent poverty rate for non-Latino, White, and Asian children, and adolescents” (Kids Count Data Center, Children in Poverty 2014). That figure is important information as a provider to know as it gives perspective.
The way a patient grows up and the socioeconomic area they come from makes a big difference in the care they will need and the resource they may be seeking. As a provider I would never want a patient to think that I was judging them or providing sub-pair care to them because they are African American (or any other ethnical decent). Providing culturally competent care consists of the provider being sensitive when interacting with patients on many cultural aspects of their lives. Some of these aspects include health beliefs and practices, spirituality, language and communication, family roles, sources of support, and dietary preferences (Ball, Dains, Flynn, Solomon, & Stewart, 2019).
Most African Americans identify as Christian, and many are highly religious by traditional measures of belief (Pew Research, 2001). “About six-in-ten of African American adults (59%) say religion is very important in their lives. Another 21% say it is somewhat important, while smaller shares say it is not too (9%) or not at all (9%) important in their lives” (Pew Research, 2001).
Socioeconomic status and race/ethnicity have been associated with avoidable procedures, avoidable hospitalizations, and untreated disease (Fiscella, Franks, Gold, & Clancy, 2008). Issues that I would need to be sensitive to when interacting with the patient include substance use, spirituality, and medication. Sensitivity should be practiced when discussing these topics because certain verbal and nonverbal communication can be perceived as judgmental or bias (NIH, 2021).
It is important to maintain a judgment-free zone with the patient to ensure that they feel safe and can build a therapeutic relationship with the provider. When patients feel stigmatized, they may be less likely to seek treatment (NIH, 2021). Recognizing that each patient is an individual and has different needs that need to be met is what allows providers to practice in a culturally competent manner (ASU, 2017). This means being mindful about this patient’s spirituality, substance use, and medication beliefs and practices.
Targeted questions that I would include in the building of Shawn’s health history would include:
What would you like me to know about you and how you are feeling?
How often do you drink alcohol?
When was the last time that you drank alcohol?
Do you use any drugs including marijuana?
Does anyone in your family has a history of alcoholism?
Do you have any spiritual beliefs that I should understand in order to best work with you?
What have you tried before to help with your chronic headaches besides medication?
What Medications have you been prescribed before?
Can you describe what your anxiety feels like to me?
Is there anything that you feel triggers your anxiety?
Does anything help alleviate your anxiety?
Does anything make your anxiety worse?
How do you feel about taking medications?
References
ASU. (2017). How to Provide Nonjudgmental Holistic Care. Arkansas State University. Retrieved on June 7, 2023. From: https://degree.astate.edu/articles/nursing/provide-nonjudgmental-holistic-care.aspxLinks to an external site..
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. Retrieved on June 7, 2023.
Fiscella, K., Franks, P., Gold, M. R., & Clancy, C. M. (2008). Inequality in quality: Addressing socioeconomic, racial, and ethnic disparities in health care. Journal of the American Medical Association, 283, 2579- 2584. doi:10.1001/jama.283.19.2579.
National Center for Education Statistics. (2007). Status and trends in the education of racial and ethnic minorities. Retrieved from http://nces.ed.gov/pubs2007/minoritytrends/Links to an external site..
NIH. (2021). Words Matter – Terms to Use and Avoid When Talking About Addiction. National Institute on Drug Abuse. Retrieved on June 7, 2023. From: https://www.drugabuse.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addictionLinks to an external site..
Pew Research Center. (February 16, 2021). Faith Among Black Americans. Religious beliefs among Black Americans. Retrieved on June 7, 2023. From: https://www.pewresearch.org/religion/2021/02/16/religious-beliefs-among-black-americans/Links to an external site.
week 2 – discussion post
COLLAPSE
Diversity and Health Assessment
Cultural competence is the ability of the health care provider to effectively render care to the patient with diverse values, beliefs, behaviors and tailor these health services to meet the patient’s social and cultural needs. This week’s discussion is focused on a 68-year-old black woman named EB who came into the clinic for a follow–up of hypertension.
There are many factors to consider when providing care to the African American population such as the socioeconomic factor, spiritual beliefs, and health practices. The socioeconomic factor is essential to consider as it affects the patient’s ability to access adequate health care services and effectively to attend to her health care needs. According to Noonan et al. (2016), African Americans are the poorest ethnic group in the United States.
Low socioeconomic status correlates to poverty, lower educational attainment, and poor health outcome. The patient’s spiritual beliefs and health practices are important to consider as these may affect the decisions they make about their health and the treatment choices they make .O’Rourke and McDowell (2018) states that African Americans may seek treatment from home, remedies prayers, spiritual healers, and advice from family and friends.
Noonan et al. ( 2016) report that thirty percent of African Americans believe that their health is dependent upon fate or destiny and only about 50 percent feel that their health is a priority. Moreover, African Americans are less likely than other races or groups to trust the health care system due to negative past experiences such as the Tuskegee experiment research (Muvuka et al., 2020). Mistrust can interfere with health literacy development and hinders access to health-related resources and health decision making (Bhattacharya, 2013).
Based on the limited information available, EB appears that she may have been to multiple health care providers as evidenced by having multiple medications for hypertension. According to Drugs.com, the recommended maximum number of medicines in the antihypertensive category to be taken concurrently is usually two. EB also appears to be non- compliant with her medication and may have been experiencing cognitive decline and memory loss due to advanced age.
Her hypertension seems to be uncontrolled as evidenced by a blood pressure of 182/99. Moreover, she has glaucoma that has been worsening over the past few years. Hypertension can increase the intraocular pressure of the eye which can damage the optic nerve and leads to the formation of glaucoma (Vision Service Plan, 2020). EB lives alone which can indicate a limited support system.
When interacting with EB, it is essential to be culturally sensitive by maintaining respect, asking non-judgmental questions and utilizing open-ended questions to explore the patient’s health practices, beliefs, and feelings. The sensitive issue I would discuss with EB is her living arrangement as this affects her safety and whether she has a support system that can help her attend to her health needs. I would also assess her cognitive ability and health literacy as it affects her health outcome.
The 5 target questions I would ask to help build a patient’s health history and assess for risks are
What is your understanding of high blood pressure and how does it affect your health?
Can you tell me how long have you had high blood pressure and when did you last see your health care provider?
What are the healthy practices you can incorporate to lower your blood pressure?
What are your beliefs when it comes to medication and how do you manage your medication?
Who lives with you and can you tell me about your support system?
Engaging in culturally competent communication requires communicating with awareness and knowledge of healthcare disparities and understanding that socio-cultural factors have important effects on health beliefs and behaviors as well as having skills to manage these factors appropriately ( Brown et al., 2016).
Overall, it is vital for health clinician to be culturally sensitive and competent to ensure the patient receives the best quality care, promote patient participation and satisfaction which leads to a better health outcome.
References :
Brown, O., Ten Ham-Baloyi, W., van Rooyen, D. R., Aldous, C., & Marais, L. C. (2016). Culturally competent patient-provider communication in the management of cancer: An integrative literature review. Global health action, 9, 33208. https://doi.org/10.3402/gha.v9.33208
Gauri Bhattacharya (2013) Contextualizing Disparity Reduction in Rural Health Care: A Call to Action, Journal of Family Social Work, 16:1, 86-100, DOI: 10.1080/10522158.2012.736079
Noonan, A. S., Velasco-Mondragon, H. E., & Wagner, F. A. (2016). Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public health reviews, 37, 12. https://doi.org/10.1186/s40985-016-0025-4
Muvuka, B., Combs, R. M., Ayangeakaa, S. D., Ali, N. M., Wendel, M. L., & Jackson, T. (2020). Health Literacy in African-American Communities: Barriers and Strategies. Health literacy research and practice, 4(3), e138–e143. https://doi.org/10.3928/24748307-20200617-01
O’Rourke, M. & McDowell, M. ( 2018). Providing Culturally Competent Care for African Americans. Retrieved from https://www.aana.com/docs/default-source/about-us-aana.com-web-documents-(all)/providing-culturally-competent-care-to-african-americans-jan-2018.pdf?sfvrsn=54115cb1_2
Vision Service Plan. (2020). Hypertension and Your Eyes: The Connection. Retrieved from https://www.vsp.com/eyewear-wellness/eye-health/the-causes-of-hypertension
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!
Learning Resources: Discussion: Diversity and Health Assessments
Required Readings
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
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
Retrieved from the Walden Library Databases.
The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 2, “Evidenced- Based Health Screening” (pp. 6-9)
Centers for Disease Control and Prevention (2015). Cultural competence<
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