BK is a 16-year-old Caucasian female – NURS 6512 week 2 discussion
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.
Module 2: Functional Assessments and Assessment Tools
Week 2: Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment
Discussion: Diversity and Health Assessments
Initial Post: Patient Profiles – BK is a 16-year-old Caucasian female
As an Advances Practice Nurse (APN), it is essential to the success of the patient outcomes to become culturally competent. The APN will provide services to many different cultures throughout their career. According to Ball, et al, (2015), each patient should be treated according to their culture religious, socioeconomic, and personal beliefs. A competent and successful healthcare provider will be able to offer competent care to people belonging to other cultures different from their own (Corona, et al, 2017) when educating themselves on the different cultures and their specific needs. Seeking out cultural training is one way to be successful in the delivery of patient-specific healthcare. Culturally competent healthcare providers can adapt to the unique needs of patients from various cultural backgrounds, developing a trusting relationship between the healthcare provider and the patient (Ball, Dains, Flynn, Solomon, & Stewart, 2015). In order to build a trusting provider-patient working relationship, it begins with the provider being knowledgeable of the patient’s specific culture. Avoiding stereotypes is imperative in succeeding in positive patient outcomes.
In this patient scenario, BK is a 16-year-old Caucasian female, who presents to the clinic for an annual well-child visit. BK doesn’t make eye contact with the APN, she is obese and currently not on medications. BK is accompanied by her Grandmother who has concerns and believes BK is now acting strange, staying in her room all the time, and refusing to do all the things BK use to enjoy like singing in the youth choir at their church. The grandmother is fearful that BK might be using drugs and is requesting a drug screen since BK’s mother has a history of drug use and is currently incarcerated. It appears that BK has lived with the grandmother for some time since the grandmother can see a change in BK.
Being sensitive on the subjects of her weight, and her views on her mother. Teenage girls are very sensitive about their weight and might have a hard time opening up about their feelings regarding their weight. All teenagers, but especially girls need extra support, guidance, and nurturing from their mothers and fathers. Since BK’s mother is not currently in her life, this may be an emotional trigger for BK to discuss. Asking questions specific to her spirituality will help the APN understand why BK suddenly stopped participating in the youth choir at church. Finding out about how BK feels about living with her grandmother and if they have any socioeconomic issues or concerns that can be addressed by the APN or referred to another source for assistance. Engaging in conversation about BK’s friends, activities, and risky behaviors also helps the APN learn BK’s lifestyle and any cultural issues.
- Have you had anything traumatic happen to you? Have you ever participated in counseling?
- How do you feel about your mother not being around and her drug situation? What do you believe is the cause of drug use by your mother? How do you feel about drugs?
- How high is your self-esteem? Do you have thoughts of self-harm? Do you find joy in your life?
- What do you see has changed in your life? Is your life satisfying?
- Do you attend church? Do you feel that you are a spiritual person?
- What do you and your friends do for fun? Have you participated in any risky activities with friends? Drugs, Alcohol, skipping school?
- What do you normally eat during the week? Do you feel that you are at a healthy weight? What is your goal weight?
- Is there anything else you want to talk about today?
- What else can I help you with today?
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Corona, R., Rodríguez, V. M., McDonald, S. E., Velazquez, E., Rodríguez, A., & Fuentes, V. E. (2017). Associations between cultural stressors, cultural values, and Latina/o college students’ mental health. Journal of youth and adolescence, 46(1), 63-77
Lonneman, W. (2015). Teaching strategies to increase cultural awareness in nursing students. Nurse educator, 40(6), 285-288.
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.
I enjoyed reading your post and getting your perspective on treatment of BK. I especially liked how you made sure to focus on her spirituality that you focused on the importance of shying away from things that may be emotional triggers for her, (her weight; her mother). While I think that those issues are of great importance, I believe that it would benefit more to build trust and focus on those issues at a later appointment; possibly at an appointment where she is alone.
Ensuring that we, as APRNs, address the individual as well as their culture. In this case, the fact that the patient’s mother has a history of drug abuse is definitely a risk factor, but should not be the only piece of the puzzle when evaluating the patient for potential risk behaviors. An individual may belong to many subgroups and that the behaviors and attitudes of a subgroup can override the impact of the cultural values of the larger group (Ball et al, 2019).
Screening for depression in this particular patient will also be of great importance. When doing so, it is imperative that screening is be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. (Siu, 2016). Treatment of this particular patient should occur over multiple visits and her completed treatment plan should not be based off of the single visit.
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.
Siu, A. (2016). US Preventive Services Task Force Pediatrics. Screening for Depression in Children and Adolescents 137 (3) e20154467; DOI: 10.1542/peds.2015-4467
Patients who are in this age group are going through a lot in life. Stressors includes school, part time job, family, hormonal changes, body image disturbance, peer pressure, introduction to substances, etc. It may take a longer time or a few sessions to build rapport with a teenager, especially one of the opposite sexes. During the physical the practitioner would have to examine the patient’s genitalia. So, if the practitioner is a woman and the patient is a male, or visa versa, there will be a chance the patient will feel uncomfortable and not agree with the total health assessment. A teen client can be a master at putting up the invisible force field while pushing our buttons or telling us what we want to hear and side-stepping responsibility. (Selekman, 2020). Once the teen feels pressured or obligated to do something against their will, the patient will shut down and either be untruthful or not answer the question.
Teens face an especially hard time when the practitioners ask them about their sexual orientation, sexual partners and if they think they have been exposed to any sexual transmitted diseases. As part of the physical, this patient will be asked about her last menstrual cycle, the flow, cramps, and any abnormal discharge. Also, a pelvic exam will be done to test for STDs and possible cervical disease. If the patient has never had any sexual activity, this procedure can be especially traumatic. A speculum is inserted inside her, this procedure is invasive and can be painful. Recent studies show that if the patient is not sexually active, this exam is not deemed necessary. Bimanual pelvic exams and Pap tests used to be standard parts of annual gynecological checkups, but leading professional associations no longer recommend them for most younger patients. (Vaughn, 2020).
Many teen girls deal with body image disturbance. All they see on television are skinny supermodel like movie stars. Taking this ideal image as something that is normal, so if they differ and especially if they are overweight or obese, they will feel a sense of not belonging to the norm. This female patient is obese, she currently does not have any medical issues and not taking any meds. But, to her grandma she is acting strange and staying in her room and refusing to do extracurricular activities like singing in her youth choir at church. The grandmother disclosed that the patient’s mother has a history of drug use and is currently incarcerated. There can be an arranged of possibility with this patient. She is in a current stage of life where she might feel more comfortable being alone, and this is totally normal. Or, the grandmother is correct, and she may be exposed to illegal substances and is currently using drugs. Ethically and legally a drug test should not be ordered just because the grandma wants it done on the patient. The practitioner needs the consent of the patient, even though she is a minor. We as practitioners cannot force the patient to do the test unless it is an emergency.
A psych social can also be done if the practitioner deems it is necessary because during this period the patient can develop depression or anxiety related to her many stressors in life. Untreated depression and anxiety can lead to self-harm, self-medicating with substances or worst-case scenario, suicide. The practitioner can refer the patient to a therapist or psychiatrist. Teens sometimes feel like multiple stressors is too much for them to handle and they rather not deal with it. Carefully monitoring the patient and if she exhibits any abnormal behavior is a good indicator of potential self-harm.
Selekman, M. (2020). How to make teen therapy engaging. Retrieved on June 12, 2020 from https://www.psychotherapynetworker.org/blog/details/405/creating-a-therapeutic-alliance-with-the-troubled-teen
Vaughn, E. (2020). Teen girls do not need routine pelvic exams. Why are doctors doing so many? Retrieved on June 12, 2020 from https://www.npr.org/sections/health-shots/2020/01/09/794991658/teen-girls-dont-need-routine-pelvic-exams-why-are-doctors-doing-so-many
BK being in her teens, the NP must find ways of conversing with her. During the adolescence period, teens like privacy, and therefore she might not speak freely with the NP. Forming a trusting relationship is key and can allow BK to confide in the NP on what is presently going on in her life. The NP should make BK feel comfortable and not ask questions that may be deemed as intrusive per Klein et al. (2020). An adolescent patient is likely to disclose sensitive information when confidentiality is guaranteed per Klein et al. (2020) and therefore providers must offer confidential screening and counseling.
The provider can perform a short psychosocial screening which can include existing stressors, whether BK has a confidant and how her experience is at school. Teens older than 12 years of age should also be screened for major depressive disorder according to Spithoven et al.(2017). Klein et al. (2020) also explain that teens with a BMI of 95th percentile and higher can be referred for a comprehensive behavioral intervention. It is only after the NP gains the trust of BK, can she then talk about BK’s feelings and how the incarceration of her mother has influenced her life.
Adolescents have stressors that the NP can focus on during the initial well visit. Threats to the well being of teenagers can both be experimental and psychosocial stressors per Klein et al. (2020). According to Klein et al. (2020), this includes school, home, activities, drugs, emotions or eating, sexuality, strengths and safety. The NP must not only gather a psychosocial history but also emphasize on BK’s strengths to deter the feeling of shame per Klein et al. (2020). A provider can also talk about digital literacy and how to have boundary settings while online as Klein et al. (2020) advices us. The NP should not only focus on the patient’s physical being but also in general. Questions to ask can include what BK likes to do, what she is most proud of, whether she has friends. More questions include whether she has been feeling stressed, any trouble sleeping, any feeling of being down, sad or depressed, any thoughts of hurting herself, or if she has had any attempts.
Klein, D. A., Paradise, S. L., & Landis, C. A. (2020). Screening and Counseling Adolescents and Young Adults: A Framework for Comprehensive Care. American Family Physician, 101(3), 147–158.
Spithoven, A., Lodder, G., Goossens, L., Bijttebier, P., Bastin, M., Verhagen, M., & Scholte, R. (2017). Adolescents’ Loneliness and Depression Associated with Friendship Experiences and Well-Being: A Person-Centered Approach. Journal of Youth & Adolescence, 46(2), 429–441. https://doi-org.ezp.waldenulibrary.org/10.1007/s10964-016-0478-2
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