Feb 23, 2024 NURS 6512 Week 2 Discussion: Diversity and Health Assessments Sample Essay
NURS 6512 Week 2 Discussion: Diversity and Health Assessments Sample Essay
NURS 6512 Week 2 Discussion Diversity and Health Assessments Sample Essay
There are several important factors to consider related to the patient’s health history in this given scenario. These could primarily be related to the fact that the patient is transgender. The patient in this scenario underwent surgery two years ago to transition from female to male. And since that time, has not received any medical care other than telehealth to receive hormone therapy. This patient has a history of HIV, a decade of smoking, and depressive episodes. Transgender people often experience stigma, discrimination, and socioeconomic disadvantages that can result in poor health outcomes and higher disease rates (Abramovich et al., 2020). The transgender population commonly experiences housing, employment, and education barriers, resulting in higher poverty rates. These socioeconomic factors could explain why this patient is unemployed and moving back in with his family.
I would be sensitive when inquiring why the patient has not sought medical care for the last two years. It has been found that transgender people often experience increased mortality, adverse outcomes, and lower quality of life (Feldman et al., 2021). Disparities exist between transgender and cisgender individuals regarding insurance coverage and the likelihood of seeking care if copays are required. This could be a sensitive topic because transgender individuals often have challenges finding transgender-competent health services or a provider equipped to care for their specific needs. Providers can be unsupportive or hostile about the unique needs of transgender people (Safer & Tangpricha, 2019). I would strive to provide the opposite type of care, being supportive and attentive to this patient’s needs.
I would use caution when discussing how the patient needs to live with his parents now due to declining health. The scenario states that he made a complete transition with friends and family, but it was not stated if his family supports his choice to transition. This could be a complicated issue since he now relies on them for support.
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I would be sensitive when inquiring about the mental health of this patient. Given the history of depressive episodes, marijuana use, and declining health, I believe it warrants thorough examination. Transgender individuals are commonly diagnosed with mental health problems such as depression, anxiety, post-traumatic stress disorder, and schizophrenia (Abramovich et al., 2020). Since he has not had a thorough exam or care for an extended period of time, he might need more support managing any mental health problems.
Sensitivity would need to be utilized when discussing with this patient their HIV treatment and status. For continued management of his diagnosis, consideration needs to be made regarding the impact of age, gender, socioeconomic status, sexual orientation, race, or ethnicity (Centers for Disease Control and Prevention, 2020). This is essential for giving culturally competent care.
Five Targeted Questions
How often are you feeling signs of depression?
Is your family supportive and understanding of your lifestyle?
Do you need assistance in paying for your hormone replacement or HIV medication?
Can you describe why you feel your health is declining? When did those symptoms start?
What barriers have you experienced in receiving transgender-competent healthcare?
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
Links to an external site.
Centers for Disease Control and Prevention. (2020, October 21). Cultural competence in health and human services. Retrieved from https://npin.cdc.gov/pages/cultural-competence
Feldman, J. L., Luhur, W. E., Herman, J. L., Poteat, T., & Meyer, I. H. (2021). Health and health care access in the US transgender population health (TransPop) survey. Andrology, 9(6), 1707–1718. https://doi.org/10.1111/andr.13052
Links to an external site.
Safer, J. D., & Tangpricha, V. (2019). Care of the Transgender Patient. Annals of internal medicine, 171(10), 775–776. https://doi.org/10.7326/L19-0535
Many transgender people experience stigma and discrimination in their day-to-day lives which can affect access to healthcare (CDC,2022). This patient has a lot of different factors that play a role in his current mental state. The patient is currently unemployed, has multiple diagnoses, and currently not feeling his best. The patient has also been transitioning, which is the biggest phase of this patient’s life. Transgender people may also have unique needs and concerns when interacting with the healthcare system (CDC, 2022). You are correct about using the proper pronouns when referring to the patient, that shows that you respect the patient’s wishes and current state of mind during this transition. We must also consider how this patient feels about moving with his parents after becoming unemployed. It is important for the health care provider to build a trusting relationship with this individual to provide the best care.
The strategies that you have chosen will best fit this scenario, asking open-ended questions, and involving the patient in care would help the patient to lead care and be actively involved in care. Everything that the patient is currently dealing with can cause him to struggle mentally. It would be safe to do a thorough mental exam, it would be important to build a trusting relationship because you would want to make sure that the patient is being 100% honest about his mental state. Recent changes in living situations, death, relocation of friends or family members, or changes in physical health (Ball & et al, 2019). I would be sure to ask the patient if he has any feelings about harming himself or anyone else or if he has had any feelings recently about harming himself since the recent changes in his life. This patient could be a good candidate for a thorough mental health exam.
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.
Centers for Disease Control and Prevention. (2022, February 18). Patient-centered care. Centers
for Disease Control and Prevention. Retrieved December 10, 2022, from
https://www.cdc.gov/hiv/clinicians/transforming-health/health-care-providers/affirmative-
Most people’s decisions are based on their culture, while not all individual belongs to the same group or subgroup. As healthcare providers, we are obligated to meet each patient where the patient is at. Healthcare providers are not supposed to categorize our patients based on religion, race, gender, ethnicity, sexual orientation, or the patient culture (Ball et al., 2019).
Unfortunately, we are part of the problem. Ethnic minority patients face disparities regarding access to health care, health outcomes, and mortality. “Current studies revealed that low to moderate level of implicit bias against ethnic minorities is present among many health care professionals”(Drewniak et al., 2017, p.89).
Mono Nu’s spiritual beliefs, practices, socioeconomic situation, and education might have influenced his lab result. Monu Nu might have chosen to eat lots of fish and tofu because of his cultural preferences, scarcity of money to buy a variety of healthier food, or lack of education about nutrition, herbal medicines, and drug interactions (Di Minno, et al., 2017). Fish and tofu have nutrients that significantly interfere with blood thinner medication metabolism.
Mono Nu’s food choice indicated his poor knowledge about the potential interactions of omega-3 fatty acids in fish and soy in tofu which contain significant amounts of Vitamin K, which may impair the anticoagulant activity of blood thinner (Di Minno, et al., 2017). The provider must respect Mono’s Nu’s choice while respectfully educating the patient about compliance, medication, adverse reactions, food and drug interactions, and healthier food choices for positive outcomes.
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.). Elsevier Mosby.
Di Minno, A., Frigero, B., Spadarella, G., Ravini, A., Sansaro, D. Amato, M., Kitzmiller, J. P., Pepi, M., Tremoli, E. & Baldassarre, D. ( 2017). Old and new oral anticoagulants: Food, herbal medicines, and drug interactions. Blood Reviews, 31, 193-203. https://dx,doi,org/10.1016/j.bire.2017.02.001Links to an external site.
Unique communication and effective self-awareness skills are required to improve patient-center care. There are specific socioeconomic, spiritual, lifestyles, and other cultural factors associated with patients throughout the health care arena. Encouraging the patient to communicate sensitive and private personal information has its difficulties.
Practitioners and other health care providers have to be non-bias and
NURS 6512 Week 2 Discussion Diversity and Health Assessments Sample Essay
unconsciously aware of any self-behaviors that limit patients’ ability to disclose information needed to properly diagnose and treat illnesses including non-verbal communication. Developing and using effective diverse communication with all patients increases professional relationships between patients and providers. The patient assigned to me is a 32-year-old pregnant lesbian with vaginal discharge seeking help to mitigate her health disparity.
In our course readings by Ball et al. (2019), it was said that LGBT patients should be particularly paid attention to with great detail and care. Ball et al. (2019) went on to say that these patients are unfortunately faced with bias throughout the health care system. Kano et al. (2016) explained how some socioeconomic disparities LGBTQs face is from lack of sufficient resources needed in clinics to be integrated into practice.
Having a safe space is another socioeconomic disparity LGBTQ face worldwide. Goh (2018) explained that LGBTQ is faced with homelessness and violence. Rosentel et al. (2020) explained how other lifestyle factors include low-socioeconomic status, that increases LGBTQ risks of higher burdens of health disparities related to less accessible services.
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Interviewing these patients, Practitioners must first gain competency in cultural awareness. Ball et al. (2019) explained how incorporating flexible and creative skills increases health care providers’ approach. Be honest with the patient with upfront limitations, expectations, knowledge base. Apologize when appropriate and encourage an organizational culture with strategies to stop the stigma against the LGBTQ population. I believe that being honest with the patient upfront can set a stage for transparency and credibility.
Five questions I would ask this patient are as follows:
What would you like to be called?
How do you identify yourself?
Are you comfortable talking about this with me?
Do you have a friend or a family member you would like to be present in the interview to make you more comfortable?
Are there any concerns of fear from anyone in your home, neighborhood, school, or work we need to talk about?
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.
Goh, K. (2018). Safe Cities and Queer Spaces: The Urban Politics of Radical LGBT Activism. Annals of the American Association of Geographers, 108(2), 463–477. https://doi.org/10.1080/24694452.2017.1392286
Kano, M., Silva-Bañuelos, A. R., Sturm, R., & Willging, C. E. (2016). Stakeholders’ Recommendations to Improve Patient-centered “LGBTQ” Primary Care in Rural and Multicultural Practices. Journal of the American Board of Family Medicine : JABFM, 29(1), 156–160. https://doi.org/10.3122/jabfm.2016.01.150205
Rosentel, K., VandeVusse, A., & Hill, B. J. (2020). Racial and Socioeconomic Inequity in the Spatial Distribution of LGBTQ Human Services: an Exploratory Analysis of LGBTQ Services in Chicago. Sexuality Research & Social Policy: Journal of NSRC, 17(1), 87–103.
Your post regarding the potential nuances of caring for LGBTQ females was informative. I also felt that
NURS 6512 Week 2 Discussion Diversity and Health Assessments Sample Essay
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 main post
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JC’s Case Study JC, the octogenarian Asian patient, is financially constrained and is dependent on his low-paid daughter. It is significant to assess how the patient plans to fund healthcare services since he is unemployed, and his daughter has less to offer. In this case, social workers can be instrumental in directing the patient where to seek assistance, especially on the available social programs (Biegel, Farkas & Wadsworth, 2021).
The cultural inclinations of some Asian patients tend to border on the avoiding public cry for help, especially among the low socioeconomic persons.Moreover, culturally rooted Asian patients may seek conventional treatment when the traditional methods fail. According to Chinese culture, a person may opt-out to seek a doctor when the patient feels better without treatment (Ko & Turner, 2017). Acupuncture, cupping, herbal medicine, and other therapies are what some Asian patients resort to when faced with an illness.
Therefore, it is important to address the specific cultural factors for a patient to provide care appropriately.The physician-patient verbal engagement is probably one of the most critical in providing health care (Drossman & Ruddy, 2020). In this case, the patient should be considered, especially when in contact with a practitioner, since there could be communication barriers such as language.
An interpreter may come in handy in such a scenario while through a video call or a phone call since professional interpreters are not readily available on demand. Also, Asian non-verbal cues may be contextually different from how Western cultures communicate non-verbally. As a health provider, I would be more adept in considering the patient’s heritage, socioeconomic status, and cultural background to achieve quality care.
My five targeted questions will entail evaluating JC’s emotional wellness, accessibility to care, safety status at home, and medicine availability. These questions would be:
Are you able to perform personal tasks such as cleaning or cooking food?
Can you consider seeking the services of a social worker based in our institution?
Are you aware of the social services available for you?
Are you okay/ I mean, do you feel isolated and sad?
Are you able to discern the various medication prescribed to you?
When prescribed medication, are you able to take medicine, or do you need assistance?
References
Ko, A., & Turner, J. (2017). Culturally sensitive care for Asian immigrants: Home healthcare perspectives. Home healthcare now, 35(9), 507-513.
https://pubmed.ncbi.nlm.nih.gov/28953541/
Drossman, D. A., & Ruddy, J. (2020). Improving patient-provider relationships to improve health care. Clinical Gastroenterology and Hepatology, 18(7), 1417-1426.
https://theromefoundation.org/wp-content/uploads/Drossman_Ruddy_Improving-PPR-to-improve-health-care_CGH-2020.pdf
Biegel, D. E., Farkas, K. J., & Wadsworth, N. (2021). Social service programs for older adults and their families: Service use and barriers. In Services to the Aging and Aged (pp. 141-178). Routledge.
https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.890.645&rep=rep1&type=pdf
Week 2 Main Post
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.
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