Discussion: Diversity and Health Assessments

Discussion: Diversity and Health Assessments

Discussion: Diversity and Health Assessments

Week 2 discussion

In May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain 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

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 prescription medications and denies drug use. He has a positive family history of diabetes, hypertension, and alcoholism.

Discussion Week 2

Initial Post

Case Study 2: 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.

Socioeconomic, Spiritual, lifestyle, Cultural Factors

Homeless people face many challenges in accessing and utilizing health care treatments offered by the hospitals, clinics, and community care due to the complex nature of health issues and lack of service providers involved with their care. The complex nature of health issues of homeless patients is exacerbated by poor nutrition, alcohol, drug use, and lack of appropriate and safe housing. Homeless patients have a unique set of health care needs that are unrecognized and untreated (Mcenroe, D., M., 2020). The socio-economic assessment of homeless patients includes getting information about the social circle such as family members, friends, social groups, community, and the sources of financial and emotional support available from that relationship. The quality of life of a person is closely linked to the success of the social function. Formal social supports include programs such as welfare, social services, semi-formal support groups include church, neighborhood groups, and informal social supports include family and close friends. It is important to know that if the patient has anybody available to help the person if she or he becomes ill. The Norbeck social support questioner is developed to measure the multiple components of social support. It helps to determine the person’s perceived social support from the social network. In this case, scenario, as the patient is homeless and lives in a homeless center, knowing about his social support and groups helps to determine the financial and social services that the patient needs to improve his lifestyle and health condition. Spirituality assessment provides information regarding the person’s view of looking at life and the meaning and purpose of one’s own life. Spirituality is also a powerful mechanism during stressful life events and illness. Open-ended questions such as, “do you consider yourself as a spiritual person?” “How does your spirituality relate to your health?” can help to know about patient views on spirituality. Providing chaplains and clergy members when appropriate can provide patients with support. Cultural factors that influence life involve food habits, dietary beliefs. Cultural factor also affects how the patient perceives illness, expression of pain, interpretation of symptoms and the meaning of illness as it varies among and within different cultures. The lifestyle of homeless people is a major barrier to getting appropriate healthcare needs. Homeless people suffer from many complex health problems such as HIV/AIDS, Pneumonia, foot infections, malnutrition, substance abuse, cancer, various communicable disease, etc. due to poor living conditions, unhealthy lifestyles, poor hygiene, poor nutrition, and lack of access to health care. Primary healthcare programs that aimed at taking care of homeless people should emphasize a multidisciplinary approach and should consider an integrated care model ( Maeva  J., et al., 2018).

Sensitive issues interacting with the patient 

The health care providers should aware of the diverse background and cultural beliefs of the homeless population and how these perceptions affect the patient attitude towards the health caregiver. Homeless people sometimes perceive healthcare providers as uncompassionate and disrespectful due to their own personal experience. The caregivers have to be aware of the underlying needs of these vulnerable populations and apply their knowledge compassionately in providing care for them. In the homeless population, the risk of mental disorders, sexual exploitation, substance abuse, and physical assault is elevated. Nearly 90% of youths who are unsheltered experience psychiatric disorders at the rate of four times greater than that of their housed counterparts and alcohol, drug abuse affects 75% of homeless youth (Stevenson E., 2018). Violence is another risk factor in taking care of homeless patients. The health caregiver has to be sensitive and empathetic towards their underlying cause of the complex health care problems and provide guidance, offer support, encouragement to feel valued, and contribute towards ensuring the health needs. 

Five targeted questions

Did you try to commit suicide in the past or thinking of killing yourself in the future?

Do you feel safe going back to the place where you are leaving now? 

Do you have any chronic health conditions?

Have you used drugs other than those required for medical reasons?

In the past two months have you been living in stable housing, rent, or stay in as part of the household? 

References: 

Mcenroe D., M., (2020). Caring for patients who are homeless. Nursing Care. 50(3). 24-31. CINAHL Plus.

Stevenson E., (2018). Homeless people: Nursing care with dignity. Nursing Volume.48(6). 58-62. Ovid 

Maeva J., Julien A.,Diana S., Celine M., Stephanie G., (2018). Improving health care management in primary care for homeless people. International Journal of Environmental 

Research and Public Health. 15(2). NCBI. 

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 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.

Discussion: Diversity and Health Assessments 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

Respond on or before Day 6 to at least two of your colleagues who selected a different patient than you, using one or more of the following approaches:

Suggest additional socioeconomic, spiritual, lifestyle, and other cultural factors related to the patient.

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: Functional Assessments and Cultural and Diversity Awareness in Health Assessment

 

Diversity is not about how we differ. Diversity is about embracing one another’s uniqueness.

—Ola Joseph

 

Countless assessments can be conducted on patients, but they may not be useful. In order to ensure that health assessments result in the necessary care, health assessments should take into account the impact of factors such as cultures and developmental circumstances.

Learning Objectives

Students will:

  • Analyze diversity considerations in health assessments
  • Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment

Learning Resources

Required Readings (click to expand/reduce) 

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.

 

  • Chapter 1, “The History and Interviewing Process”  (Previously read in Week 1)

This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients.

 

  • Chapter 2, “Cultural Competency”

This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.

The authors of this article present patterns and trends in all-cause mortality and leading cause of death in American Indians and Alaskan Natives.

The authors of this study explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving healthcare services at primary healthcare centers.

Required Media (click to expand/reduce) 

Module 2 Introduction
Dr. Tara Harris reviews the overall expectations for Module 2. Consider how you will manage your time as you review your media and Learning Resources for your Discussion, Case Study Lab Assignment, and your DCE Assignment (3m).

 

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6512_Week_2_Discussion_Rubric
Grid View
List View
Excellent Good Fair Poor
Main Posting
45 (45%) – 50 (50%)
“Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
“Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of the post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
“Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.
0 (0%) – 34 (34%)
“Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
10 (10%) – 10 (10%)
Posts main post by Day 3.
0 (0%) – 0 (0%)
N/A
0 (0%) – 0 (0%)
N/A
0 (0%) – 0 (0%)
Does not post main post by Day 3.
First Response
17 (17%) – 18 (18%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered if posed. The response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. The response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered if posed. The response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
“Response may not be on-topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response
16 (16%) – 17 (17%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered if posed. The response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. The response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered if posed. The response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
“Response may not be on-topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%)
N/A
0 (0%) – 0 (0%)
N/A
0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on three different days.
Total Points: 100
Name: NURS_6512_Week_2_Discussion_Rubric

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