Diversity and Health Assessment

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 colleagues targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

First Response ( 1 page and two references)
Discussion WK2-Main Post

The patient in this scenario is a 54-year-old Caucasian male referred to the clinic after a recent hospitalization for seizure activity related to alcohol withdrawal. His past medical history includes alcohol and cocaine abuse, and hypertension. He is living in a homeless shelter and is out of his antihypertensive medicine. He states he is currently abstaining from alcohol and cocaine use but is smoking cigarettes to calm down from not consuming alcohol.

Homelessness creates challenges for the community, healthcare providers, and patients. Living in crowded shelters or on the streets exposes an individual to many communicable diseases, violence, poor nutrition, and weather exposure. Compounded with behavioral health issues, such as substance abuse, makes the situation even more of a challenge for providers (National Health Care for the Homeless Council [NHCHC], 2019). Basic needs for survival such as nutrition, safety, and shelter often become barriers to treatments and medications for acute and chronic illnesses. Other barriers can include lack of insurance, money, and transportation to clinics (Kiser & Hulton, 2018).

A patient-centered approach to care is necessary, as it identifies the patients perspective on illness and helps to reach shared treatment goals based on the patients values and beliefs. This can be achieved by asking open-ended questions, being an active listener, and expressing empathy. Shared decision-making empowers patients and leads to better adherence to treatment regimens. In establishing primary care for the patient in this scenario, it is important to assess his ability to access care and any necessary follow-up, his perception of these needs, his desire for the care offered, and if he is committed to continuing healthy lifestyle behaviors. Nurse practitioners are in the perfect position to help patients achieve positive health behaviors (Nesbitt et al., 2014).

On this initial visit with the patient, I would first ask if he had any questions or concerns that I can address. After obtaining his past medical/surgical histories and medication, I would ask about his current living situation. Does he have access to nutritional meals? What is his overall goal for seeking primary care? Does he have a support network of family or friends that he can rely on? Does he have access to transportation to get to appointments? How will he afford prescriptions to manage his hypertension? Can he safely store his medication? Long-term goals would be to assess his motivation to continue to abstain from substance abuse to prevent a relapse. Does he have a plan in place to achieve this and how can I help? Smoking cessation is also important to his overall health. While these are important goals, I feel they are not priorities on the initial visit. Managing hypertension, obtaining medication, and ensuring he returns for continuing care need addressed initially.

Creating a mutually agreed-upon plan to improve access to primary care and managing health issues will lead to better health outcomes and quality of life. Being empathetic and nonjudgmental to the adversities this patient may be facing will foster a trusting and respectful rapport.

References

Kiser, T., & Hulton, L. (2018). Addressing health care needs in the homeless population: A new approach using participatory action research. SAGE Open, 8(3), 215824401878975. https://doi.org/10.1177/2158244018789750

National Health Care for the Homeless Council. (2019, February). Homeless & Health: What’s the connection. https://www.nhchc.org

Nesbitt, B. J., Murray, D. A., & Mensink, A. R. (2014). Teaching motivational interviewing to nurse practitioner students: A pilot study. Journal of the American Association of Nurse Practitioners, 26(3), 131135. https://doi.org/10.1002/2327-6924.12041

Second Response (1 page and 2 References)
Diversity and Health Assessments

According to American Psychological Association (2019), socioeconomic status is the social standing or class of an individual or group. It is often measured as a combination of education, income and occupation. All of these issues are not only personal to an individual, but also a touchy subject to discuss. My patient, AG the 54 year old Caucasian male with a history of alcohol and cocaine abuse, is also homeless. When interacting with this patient, we need to be conscious of his socioeconomic status (his income, his housing situation, and his education level) and his lifestyle (alcohol and cocaine abuse). Questions I would ask are:

How long have you been without your amlodipine? Asking this question lets me know about his money situation. It also lets me know what kind of resources I need to find to help make sure he is able to get his medication.
How long has it been since you have drank or used cocaine? Asking this alerts me if he will go through withdrawals. This is a question that the patient may not be honest about due to embarrassment. If the patient is at risk for detox, we would need to get him into a facility as his blood pressure would go up and likely be uncontrolled with his current prescription.
How long have you been without stable living? Again, another sensitive question. I would not call him homeless as that can be taken the wrong way by the patient and make building rapport harder.
Can you tell me about your employment status? This leads me to more questions about income. If he doesnt work, I can ask about disability or unemployment. If he works, I can ask where and how long. This question falls into the lifestyle question.
What other medical problems do you have? This gives me history on the patient. It also alerts me to more medication that the patient may not be able to afford.
When doing a health assessment we as professionals need to be as professional and as unbiased as possible. Becoming aware of your biases and respecting differences is the first step in creating a safe zone. Introspection first (Grover, Murthy, & Bedzow, 2020). When asking questions, we must understand that some questions (such as drug and alcohol use) are uncomfortable for the patient to answer but they are questions that need to be answered without judgement. Cultural sensitivity infused into the healthcare field provides a greater amount of efficiency in regards to reaching many diverse groups of people and providing a non- bias approach to care, which can promote more beneficial services and provide further outreach (Dell’Osso, 2016).
References:

American Psychological Association. (2019). Socioeconomic Status. https://www.apa.org/advocacy/socioeconomic-status

Dell’Osso, D. (2016). Cultural Sensitivity in Healthcare: The New Modern Day Medicine. https://scholar.dominican.edu/cgi/viewcontent.cgi?article=1072&context=senior-theses

Grover, V., Murthy, P., & Bedzow, I. (2020). 11 Tips for Providing Culturally Sensitive Healthcare. https://www.medbridgeeducation.com/blog/2020/06/11-tips-for-providing-culturally-sensitive-healthcare/

My discussion to be used for (Explain whether any of the questions would apply to your patient, and why. part of the answer)
Diversity and Health Assessment

The patient is an 86-year-old Asian male dependent on his daughter, a single mother, for physical and financial support. The available data reveals that the patient is from an economically disadvantaged background and belongs to an ethnic minority group. Socioeconomic disparities can negatively influence ethnic minorities’ health and medical care (Centers for Disease Control and Prevention, 2020). This aspect requires the cultural assessment to establish more information about the patient’s beliefs, practices, spiritual background, and other vital details.

Cultural Competence

Cultural competence manifests strongly in communication with the patient. As a nurse, I strive to make sense of the patient’s world to avoid misinterpretations and misperceptions. I will focus on attitude and feelings. Consistent with Ball et al. (2019), history and physical examination are essential aspects. Therefore, I will examine the patient physically and relate my observation with his experiences.

I would be concerned about the patient’s chronic prostatitis, elevated blood pressure, gastroesophageal reflux disease, visible bruises, and evidence of falls. The patient also appeared weak and malnourished. These signs could suggest physical abuse and poor nutrition, issues that are a bit sensitive to interrogate. Challenges, such as language barriers and trust issues, could make it difficult to obtain more information from this patient. Therefore, understanding the patient’s cultural perspective is critical (Wannasirikul et al., 2016). In addition, it is necessary to inquire about the support system, stressors, expectations, and the patient’s sense of control.

Targeted Questions for Building the Health History and Assessing the Health Risks

The following questions would help build the patient’s health history and assessing his health risks:

What do you think is the leading cause of your problem?
How has this problem affected your life?
Are there periods when your religion requires you to fast? If so, how does it affect your health?
Other than your daughter, do you have someone who offers support?
Do you usually take your medicine at the recommended time?
What are the most important outcomes you hope to achieve from this treatment?
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.

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

Wannasirikul, P., Termsirikulchai, L., Sujirarat, D., Benjakul, S., & Tanasugarn, C. (2016). Health literacy, medication adherence, and blood pressure level among hypertension older adults treated at primary health care centers. Southeast Asian Journal of Tropical Medicine and Public Health, 47(1), 109-120.

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