EB is a 68-year-old black female with hypertension – NURS 6512 wk 2 Discussion: Diversity and Health Assessments
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.
Scenario: EB is a 68-year-old black female who comes in for follow-up of hypertension. She has glaucoma and her vision has been worsening during the past few years. She lives alone and is prescribed four hypertension medications (Hydralazine 50 mg PO Q8H, Metoprolol XL 200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily). She brings in her medication bottles and she has some medication bottles from the previous year full of medications. She is missing one medication she had been prescribed and says she may have forgotten it at home. Her BP in clinic today is 182/99 with HR of 84.
Explanation of Factors Associated with the Assigned Patient
Every patient is a unique individual, and providers need to approach their patients as such to provide patient-centered care. Factors that should be considered in providing patient-centered, quality care include the patient’s culture, age, gender, race or ethnicity, and socioeconomic status, among others. Similar to the individual patient with unique needs and considerations, providers are also unique in their cultures and biases. Barriers, such as language and culture, between providers and patients, interfere with effective delivery of care (Saha, Beach & Cooper, 2008). To ensure safe, quality healthcare delivery, providers need to have cultural awareness as well as the ability to provide culturally competent care. In the above scenario, factors that can affect the patient’s health and which require the provider’s attention include the patient’s age, culture, socioeconomic status, health belief system, and health literacy.
Given the patient’s profile, being an African American and a minority is a major contributory factor to healthcare disparity in the United States. The racial and ethnic disparity in healthcare is apparent throughout the spectrum of healthcare, including health access, utilization, and healthcare insurance (Watts, 2003). For example, lack of health insurance in the African American population accounts for why a significant percentage of African Americans are less likely to visit providers for preventive services such as annual physical and or screening tests. Riley (2012) explains that the consequences of lack of health insurance include adverse health outcomes, higher rates of mortality and disability, and lost wages due to sickness. Lower socioeconomic status among blacks, compared to their white counterpart, affects medication adherence as many patients cannot afford to pay for their medications. Spirituality and affiliation with the church among African Americans may contribute to how they perceive their health and illness.
Sensitive Issues When Interacting With the Patient
Issues that are considered sensitive can be handled poorly or appropriately based on the provider’s communication. Respectful and culturally competent communication may ease the patient’s tension and allow them to answer questions openly and accurately. As an elderly patient, asking the patient about sexual activity or drug use may be offensive, especially if the provider is the opposite gender. Also, if the patient is a religious person who believes her health can be improved through faith and prayers, asking about spirituality as a way of questioning her beliefs may be misperceived. Addressing these sensitive issues can be handled by establishing a trusting relationship and effective communication.
Targeted question for the patient may include:
- Can you tell me how you are taking each of your medications?
- How important is it for you to have your blood pressure under control?
- How has your worsening vision affected how you take your medications?
- Is there anything we can do to make remember when and how to take your medications?
- When was the last time you had your vision checked?
Riley W. J. (2012). Health disparities: gaps in access, quality and affordability of medical care. Transactions of the American Clinical and Climatological Association, 123, 167–174.
Saha, S., Beach, M. C., & Cooper, L. A. (2008). Patient centeredness, cultural competence and healthcare quality. Journal of the National Medical Association, 100(11), 1275–1285. https://doi.org/10.1016/s0027-9684(15)31505-4
Watts, R. (January 31, 2003). Race Consciousness and the Health of African Americans. Online Journal of Issues in Nursing, 8(1), Manuscript 3. www.nursingworld.org//MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume82003/No1Jan2003/RaceandHealth.aspx
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.
The list of questions you have drawn for your patients are important ones, especially the first question. Finding out how the patient is taking medications can help with medication adherence, which can be an issue with patients. Should medication adherence be an issue for your patient, some tips to improve that includes customizing support tools for your patient including apps for her phone and compliance packaging (McCaslin, 2016).
The second question you have formulated for the patient, is also a great one, as it helps to assess what level of knowledge the patient has, regarding their condition. In the event that the patient does not have adequate information, the patient can be given more information. Patient education is a very important part of dealing with patients because it results in better outcomes by helping the patient make informed decisions (Heath, 2016) and adhere to any administered therapies including medication.
Heath, S. (2016). Why Patient Education is Vital for Engagement, Better Outcomes. Patient Engagement. Retrieved from https://patientengagementhit.com/news/why-patient-education-is-vital-for-engagement-better-outcomes#:~:text=Education%20helps%20patients%20make%20informed%20decisions&text=Ensuring%20informed%20decision%2Dmaking%20relies,want%20to%20receive%20their%20healthcare.
McCaslin, J. (2016). Nine tips for improving medication adherence. AmerisourceBergen. Retrieved from https://www.amerisourcebergen.com/insights/pharmacies/nine-tips-for-medication-adherence
Thank you for your informative post. Your case study is similar to a few of my elderly clients, she lives alone, has worsening vision, hypertensive, and is taking multiple medications. EB brings in her medication bottles for review and reconciliation, however, she has bottles from last year and is missing a current medication and her BP is elevated. The first question you asked is the top priority, by asking the patient to tell you how she takes her medications to assess for knowledge of her regime. You also addressed her vision, reading the writing on the medication bottles can be challenging, and you want to know when last she had a vision evaluation (Feinberg, Rogers, & Sokol-McCay, 2009).
After assessing if the patient can identify her medications and read the labels note the mistakes she is making, ask is she needs assistance with methods to remind her when and which medications to take, for example, singles dose med-packs, pillboxes, or color-coding bottles. I would also include asking about nutrition and meals because some people often associate taking medications with a meal, so if meals are missed so are the pills. Ask the patient is she has a BP monitor at home, the use of self-monitoring tools can be incorporated into health education/ literacy when talking BP medications significantly promotes adherence (Delavar, Pashaeypoor, & Negarandeh, 2020).
Delavar, F., Pashaeypoor, S., & Negarandeh, R. (2020). The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: A randomized controlled trial. Patient Education and Counseling, 103(2), 336–342. https://doi-org.ezp.waldenulibrary.org/10.1016/j.pec.2019.08.028
Feinberg Jl, Rogers PA, & Sokol-McKay D. (2009). Age-related eye disease and medication safety. Annals of Long Term Care, 17(6), 17–22.
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