AG is a 54-year-old Caucasian male – NURS 6512 discussion post

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.

WK 2 Health Assmt.   Discussion.

AG is a 54-year-old Caucasian male who was referred to your clinic to establish care after a recent hospitalization after having a seizure related to alcohol withdrawal. He has hypertension and a history of alcohol and cocaine abuse. He is homeless and is currently living at a local homeless shelter. He reports that he is out of his amlodipine 10 mg which he takes for hypertension. He reports he is abstaining from alcohol and cocaine but needs to smoke cigarettes to calm down since he is not drinking anymore.

Socio-Economic, Spiritual, Lifestyle and Cultural Factors

Ball et al. (2019), explain that patients age differently and their knowledge, cognitive abilities, personality, and experience will influence how the interview is conducted by a provider.  There could be a multitude of reasons as to why an older adult can become homeless.  This includes unemployment due to corporate age discrimination as told by Murphy and Eghaneyan (2018).  AG’s drug and alcohol use could be a reason as to why he lost his employment and due to financial constrains, was unable to pay rent or mortgage.  It is the responsibility of the nurse practitioner to gather information from the patient and not make assumptions about situations.  The socioeconomic factors we are looking at are employment, education, and income per Coogle and Owens (2015).

An individual’s income plays an important role in the determinant of health according to Mullen (2015). Having a higher income enables better nutrition, housing, health care, and recreation per Tsai (2018). On the other hand,  poverty has a strong detrimental effect on health and is normally associated with unhealthy or risky behaviors as reported by Tsai (2018).  People with low income have been observed to have more association with the consumption of unhealthy goods, like tobacco, alcohol and illicit drug use according to Tsai (2018). AG has no income and therefore has fewer chances of seeking healthcare resources or preventative services.  These services could mean the difference between having a manageable health condition versus late stage multiple diagnosis and treatment.   AG smokes, uses drugs and alcohol which shows his lack of health promoting behaviors.

Education is one of the focal determinants of health and is an indicator of a person’s socio-economic status per Mullen (2015).  People who are better educated have fewer morbidities than their counterparts according to Hook and Markus (2020).  We do not know AG’s level of education and therefore we cannot draw any conclusions.  AG’s lifestyle is contributing to his present status which is having a negative effect on his health.   From his chosen lifestyle, AG can end up having a heart attack or death from uncontrolled hypertension and the use of illicit drugs.  Cigarette smoking can also increase cardiovascular problems as well as cause cancer.

AG needs support and education in the management of his illness.  Due to the socioeconomic factors unfolding in his life, he may become depressed and without help, may contemplate suicide.  Inquiring about AG’s mood like depression or anxiety can allow the NP to analyze what resources are appropriate.  There is no mention of any religious preferences and this could be a question that the NP can ask during patient interviews.

Drug users and homeless individuals experience severe health inequalities and barriers to accessing healthcare.   It is the duty of the healthcare workers to change their perception of others and be receptive to other people’s cultures as O’Donnell et al. (2019) explain.

Sensitive Issues while Interacting with Patient

AG may have reservations about speaking about his adversities with a new provider for fear of being judged or prejudice.   As a nurse practitioner, one should be cautious about how questions are posed to the patient as Coogle and Owens (2015) explain.  A tone that is accusatory will not yield pertinent information.   The NP should make sure that they are not passing judgement or being prejudice against any patient that they encounter per Ball et al. (2019).  The nurse practitioner should listen carefully to AG during the information gathering process.  The nurse practitioner should also be careful of the non-verbal cues they present.  How a clinician controls their emotions is also a strong communication skill that is very important during the interview process.

AG did not choose a healthy lifestyle and therefore the nurse practitioner can offer AG resources that can aid him in his health quest.  Smoking cessation resources should also be offered when AG is ready to give up the unhealthy habit.  At this time, it is imperative that the clinician offers full support and not force AG to give up any behaviors unwillingly.   The nurse practitioner does not know anything about AG and therefore must use the RESPECT model as adviced by Ball et al. (2019).

Questions pertaining to why he chose to use drugs and alcohol should be asked respectfully without any preformed notions from the NP per Ball et al. (2019).   A trusting relationship must be formed with AG who may probably be embarrassed about the life choices he has made.  AG is in his early fifties and mid-life crisis is also a concern at this time and therefore the NP must not make him feel like he is a  failure.  Instead AG needs reassurance, support, guidance and with the help of the NP, he can set a goal that is attainable per Coogle and Owens (2015).

Questions to ask AG

Part of the information gathering involves asking the patient his allergies and the reactions experienced, the patient’s family history of illnesses, any previous surgeries to name a few.

  1. Have you had any  other previous hospitalizations including any mental health stay
  2. Can you please tell me how you ended up staying at the shelter or being homeless
  3. When did you start using cocaine, alcohol and tobacco substances
  4. What were your last employment and the duration
  5. What is your highest level of education
  6. Do you have any religious or cultural preferences, that we need to put in place
  7. Do you ever experience feelings of hopelessness, depression, sadness
  8. Are there are resources that you would like to have access to
  9. Is there anything else you think we might be able to assist you with

AG should have an opportunity to ask any questions or clarify information.  Resources should be offered by the nurse practitioner who can also put AG in contact with a social worker for further commendations.

 

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.

Coogle, C., & Owens, M. (2015). Screening and Brief Intervention for Alcohol Misuse in Older Adults: Training Outcomes Among Physicians and Other Healthcare Practitioners in Community-Based Settings. Community Mental Health Journal51(5), 546–553. https://doi-org.ezp.waldenulibrary.org/10.1007/s10597-014-9804-x

Hook, C. J., & Rose Markus, H. (2020). Health in the United States: Are Appeals to Choice and Personal Responsibility Making Americans Sick? Perspectives on Psychological Science15(3), 643–664. https://doi-org.ezp.waldenulibrary.org/10.1177/1745691619896252

Mullen, J. (2015). Living Longer Better: A Call to Action to Promote the Health of Older Adults and Their Communities. Journal of Public Health Management & Practice21(4), 410–412. https://doi-org.ezp.waldenulibrary.org/10.1097/PHH.0000000000000280

Murphy, E. R., & Eghaneyan, B. H. (2018). Understanding the Phenomenon of Older Adult Homelessness in North America: A Qualitative Interpretive Meta-Synthesis. British Journal of Social Work48(8), 2361–2380. https://doi-org.ezp.waldenulibrary.org/10.1093/bjsw/bcx163

O’Donnell, P., Tierney, E., O’Carroll, A., Nurse, D., & MacFarlane, A. (2016). Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study. International Journal for Equity in Health15(1), 197.

Tsai, J. (2018). Lifetime and 1-year prevalence of homelessness in the US population: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Journal of Public Health40(1), 65–74. https://doi-org.ezp.waldenulibrary.org/10.1093/pubmed/fdx034

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.

response

Great post! I thought that you addressed a situation that had several layers of difficulty extremely well. It’s clear that you were very aware of the cultural and socioeconomic factors at play. Treating a patient with a history of ETOH abuse is difficult in itself, but given that fact that the patient is currently homeless adds another hurdle for the patient as well as the practitioner. I especially enjoyed your acknowledgment of the sensitivity of the patient’s situation and that you used that knowledge to form well thought out and pointed questions.

Given the prevalence of mental health and substance abuse in the homeless population, I do think that establishing a timeline will be extremely important in the treatment of this patient. Did the patient begin drinking heavily before or after he was homeless? Had he been diagnosed with any mental health disorder and at what age?

Research estimates that 38 percent of homeless people are alcohol dependent and that their living conditions made it more difficult to remain sober and achieve stability. That makes appropriate treatment and follow up an important part of ensuring this patient is successful with their sobriety.  Effective communication is always key, but maybe more so in complex and difficult situations. Establishing a positive patient relationship depends on communication built on courtesy, comfort, connection, and confirmation. Building a history is important, of course, but building trust from the start will help to ensure that the patient is open and honest and in turn, or treatment will be more effective.

 

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.

Murray, K. (2019). Homeless Alcoholism. Retrieved June 13, 2020 from https://www.alcoholrehabguide.org/resources/homeless-alcoholism/#sources

 

 

 

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.

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.

 

 

 

Week 2 Discussion: Diversity

Case Study 2:

AG is a 54-year-old Caucasian male who was referred to the clinic to establish care after a recent hospitalization after having a seizure related to alcohol withdrawal. He has hypertension and a history of alcohol and cocaine abuse. He is homeless and is currently living at a local homeless shelter. He reports that he is out of his amlodipine 10 mg which he takes for hypertension. He reports he is abstaining from alcohol and cocaine but needs to smoke cigarettes to calm down since he is not drinking anymore.

 

The socioeconomic issues affecting AG is homelessness, finances, and lack of adequate health care. During the initial interview, I would assess for financial income and the ability to secure stable long term housing. Establish if any family or friends are involved in his life, ask the patient if he has been to rehab in the past and if he is willing to go to inpatient rehab to stabilize and receive counseling and coping strategies (Cuevas & Whitiney, 2019). Ask the patient what are his plans, and how long he plans to stay at the shelter because accommodation is only temporary and safe housing is to be included in planning (Manning & Greenwood, 2019).

The patient’s perceived quality of life is based on his current lifestyle which includes substance abuse, lack of stable housing. AG is a 54-year-old caucasian male and sensitivity to cultural differences to avoid miscommunication is to be considered in cultural factors, and history of substance abuse and seizures he should be assessed for cognitive function. Issues I need to be sensitive about are his finances, be sensitive in the questioning line of income, does he have an income from unemployment, SSI, or disability, does he he have health insurance or the ability to pay for medications and food. Family relations can be a source of anxiety to some individuals, I will be sensitive to line of questioning on family, friends, and community relations if he has any support or in contact with any members. Religion and faith-based beliefs can create a barrier to communication and the ability to accept some interventions. As far as his substance abuse I would ask about when last he used, how long he has been using, identify his triggers to reduce relapse. I will be sensitive to his personal space and mode of communication, ask what is his preferred mode of communication, language, what name he wants to be called (Ball, Dains, Flynn, Solomon, & Stewart, 2019).

Targeted questions to the patient to build his health history and to assess his health risks include

1. Medical and familial history, when was he first diagnosed with hypertension, and family history of cardiac disease. What medications he currently take and when was his last dose. Where did he last seek medical attention?

2. Level of education and any work skills, this is to assess his level of comprehension and processing of information to be exchanged.

3. Depression screening tool to assess for level of anxiety, what does he mean he needs a cigarette to calm down, how many does he smoke daily, what are his triggers?

4. History of substance abuse, what are his substances of choice, did he ever attempt to quit before, did he ever have the professional help to quit. How much money does he usually spend on his habit?

5. Well- maintenance evaluation, when last did he have physical, including prostrate screening, colorectal screening, diabetes risk assessment, cardiovascular disease risk assessment, and STD risk assessment screening?

6. Any history of abuse or trauma, any history military service to rule out PTSD

7. Vaccination history for immunity against community-acquired infections because of his housing disposition.

 

References

Ball, J. W., Daines, 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.

Cuevas, R., & Whitney, G. (2019). Better Together: An Early Head Start Partnership Supporting Families in Recovery Experiencing Homelessness. ZERO TO THREE39(4), 29–34.

Manning, R. M., & Greenwood, R. M. (2019). Recovery in Homelessness: The Influence of Choice and Mastery on Physical Health, Psychiatric Symptoms, Alcohol and Drug Use, and Community Integration. Psychiatric Rehabilitation Journal42(2), 147–157. https://doi-org.ezp.waldenulibrary.org/10.1037/prj0000350

 

response

Your post categorically addresses the socioeconomic factors that affect this patient. According to Health People (2020), race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health(“Disparities,” n.d.). The targeted questions are structured to provide detailed information that will assist in the patient’s care plan. Numerous studies have shown that the homeless seek treatment late in their disease process; fall out of disease management plan including non-adherence to prescribed medications,  and have a frequent  habit of visiting the Emergency Room and Inpatient services. It is important for clinicians to inquire about readiness to change and the resources available for this patient. Examples of questions that bring forth the need for change are: What are the benefits of staying sober?; Have you ever thought of committing suicide?”; If you did want to make a change, how would you go about it?” (Cooper, 2016). Such inquiry elicits the individual’s commitment to making change.

Cooper, D. B. (2016). Intervention in mental health-substance use. CRC Press.

Disparities. (n.d.). Healthy People 2020 |. https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities

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