NURS-6512N Week 2 Walden Diversity and Health Assessments

In this NURS-6512N WEEK 2 DIVERSITY AND HEALTH ASSESSMENTS 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 NURS-6512N WEEK 2 DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION .

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.

Case Study 1:

In this first case study, we have John Green, a 33-year-old man who is of Caucasian descent. He is a new patient at the clinic. Although he was born female, he identifies as a male and transitioned to a male about two years ago. He successfully transitioned socially and with the support of his family last year. Currently, John is back home and is currently without a job. He has been obtaining testosterone from the internet for self-administration. Except for receiving suppression medications through Telehealth three months ago, he hasn’t sought any other healthcare since his transition.

John’s medical history includes a long history of smoking, where he has been smoking two packages of cigarettes per day for the past ten years. He also uses marijuana, smoking 3-6 joints every weekend, and has a valid medical marijuana card. Additionally, he experiences episodes of depression. John has been living with HIV for the past three years, but his last blood test six months ago showed that the virus was effectively controlled. Lately, he has been feeling very weak, which led him to move back in with his parents. He currently takes a daily dose of Biktarvy, which is delivered to him for free by mail and is well-tolerated. He also self-administers 100 mg of Testosterone Intramuscularly every seven days. His Past Medical History is unremarkable. He has never been married, and his family history doesn’t include any significant medical issues. John is concerned about being a burden to his family since he is unemployed and suspects that his health might be deteriorating.

Case Study 2:

In the second case study, we have Shawn Billings, a 28-year-old African American patient who frequents the clinic. He visited the clinic last week and four days ago due to severe migraines, receiving injections of Toradol and Ativan before being sent home. Today, Shawn is back at the clinic, experiencing an intense headache. He appears very agitated. He is accompanied by his father and is concerned that he won’t receive any medication this time.

NURS-6512N WEEK 2 DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION POST

John is a 33-year-old man, and he is Caucasian. He is not married and identifies as a transgender individual. John prefers to use the pronouns he/him/his.

Socioeconomic Status:

John is currently not employed and doesn’t provide any additional information about this change in his status. At the moment, he is living with and relying on his parents for support. Given his current situation, it is advisable for John to undergo a mental health screening. He has expressed feeling like a burden and unhappiness with his current life circumstances. A depression screening, specifically the PHQ-9 screening, can help assess and quantify his thoughts and emotions, providing the healthcare provider with a better understanding of his mental state.

Furthermore, studies have shown that the prevalence of suicidal thoughts and attempts is significantly higher among transgender adults than the general U.S. population. In 2015, 51% of transgender individuals had attempted suicide, and this number is likely higher today. Therefore, it is crucial to conduct regular suicide screenings for transgender patients. John would benefit from regular sessions with a counselor or mental health professional who is trained to work with LGBTQ patients.

Medical History:

John is HIV positive, sexually active, and is in the process of transitioning from male to female. There is no mention of reassignment surgery. It’s important to note that he is transitioning from female to male. Apart from these details, there are no notable medical issues in John’s history. John receives ongoing treatment and care for his HIV medications from a physician. Since John mentioned obtaining testosterone from an online source, it’s vital to explore this medication further. Questions to address include whether John is taking an appropriate dose, the safety of this medication purchased outside of FDA regulations, and its potential interactions with his prescription for Biktarvy, which he takes for HIV. Although he had labs and saw a provider six months ago, gathering a comprehensive health history is still important.

Social History:

Understanding a patient’s social history is essential. John is a long-term smoker, with a history of smoking two packs a day for ten years. He also engages in recreational illicit drug use on weekends and currently resides with his parents. He recently came out to his parents and publicly. As a healthcare provider, it’s necessary to delve deeper into each of these aspects. It’s important to discuss John’s thoughts on smoking and whether he is interested in quitting. His use of marijuana should be explored, including the frequency and quantity consumed. Information about other illicit drugs should also be gathered, and it’s essential to understand the reasons behind his engagement in these activities.

It’s worth noting that transgender individuals are more likely to face challenges such as sexual abuse, engagement in sex work, and experience intimate partner violence. Building trust and rapport is crucial for patients to open up about such topics. Healthcare providers can benefit from training programs, like Safe-Zone Training, to become more culturally aware and understanding of the LGBTQ community. Questions to ask include the type of sexual activity, the gender of sexual partners, condom usage during sexual activity, and whether there’s any possibility of pregnancy, given John’s assigned female gender and HIV status.

Cultural/Lifestyle Sensitivity:

In providing care today, it’s essential to practice gender-affirming care, which supports and affirms a person’s gender identity while delivering medical care. This approach helps build trust and security so that patients don’t fear judgment or criticism for their gender identity. Many LGBTQ patients, including John, experience high levels of gender dysphoria due to discrimination and stigmatization. Gender dysphoria is the psychological distress resulting from the mismatch between one’s gender assignment and their experienced gender.

Spiritual-Religion/Cultural Factors:

John does not disclose his religious or spiritual beliefs. It’s possible that he doesn’t have a strong affiliation with any religion, as he hasn’t reported any sources of support. Even in today’s society, a significant percentage of religiously unaffiliated Americans believe that more acceptance of the transgender population is needed. This emphasizes the importance of healthcare providers being supportive and understanding when caring for transgender and LGBTQ patients.

Barriers to Health Care:

Transgender adults encounter various barriers to healthcare, stemming from discrimination in healthcare, insurance policies, employment, financial challenges, public policies, or a lack of awareness among healthcare providers regarding transgender-related health issues. Some general barriers to healthcare include insufficient insurance coverage, healthcare staffing shortages, and language barriers. Given John’s current unemployment, he may require assistance with affording medications and other healthcare expenses. Additionally, he might be hesitant to seek care due to concerns about potential bias or judgment regarding his life choices.

5 Targeted Questions for John:

To evaluate John’s mental health, it’s important to ask the following questions:

1. Have you ever felt so down that you wished you were not alive or wished to fall asleep and never wake up?

2. Have you had thoughts of hurting yourself or causing harm to yourself?

3. In the past, have you made any attempts to harm yourself with the intention of ending your life?

Additional questions can focus on his sexual activity and history:

4. Do you engage in sexual activity with men, women, or both?

5. Do you consistently use condoms during vaginal and anal sexual activity?

6. How many sexual partners have you had in the past year?

References

Boyle, P., & Writer, S. S. (2022, April 12). What is gender-affirming care? your questions answered. AAMC. Retrieved March 8, 2023, from https://www.aamc.org/news-insights/what-gender-affirming-care-your-questions-answered

Gerritse, K., Hartman, L., Antonides, M. F., Wensing-Kruger, A., de Vries, A. L. C., & Molewijk, B. C. (2018, November). Moral challenges in transgender care: A thematic analysis based on a focused ethnography. Archives of sexual behavior. Retrieved March 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245036/#:~:text=Six%20main%20themes%20of%20moral,6)%20decision%2Dmaking%20process.

Lipka, M., & Tevington, P. (2022, July 7). Attitudes about transgender issues vary widely among Christians, religious ‘nones’ in U.S. Pew Research Center. Retrieved March 8, 2023, from https://www.pewresearch.org/fact-tank/2022/07/07/attitudes-about-transgender-issues-vary-widely-among-christians-religious-nones-in-u-s/

Loyal |. (2020, April 9). Suicide thoughts and attempts among transgender adults. Williams Institute. Retrieved March 8, 2023, from https://williamsinstitute.law.ucla.edu/publications/suicidality-transgender-adults/

Office for Victims of Crime (OVC). (2014, June). The numbers. Sexual Assault: The Numbers | Responding to Transgender Victims of Sexual Assault. Retrieved March 8, 2023, from https://ovc.ojp.gov/sites/g/files/xyckuh226/files/pubs/forge/sexual_numbers.html

What is safe zone? ” The Safe Zone Project. The Safe Zone Project. (n.d.). Retrieved March 8, 2023, from https://thesafezoneproject.com/about/what-is-safe-zone/

response

This is an informative post, I really enjoyed it. To add on your post, I will analyze the targeted questions that you plan to ask your patients. First and foremost, mental assessment on the patient as a nurse helps in giving a clear picture on how the nurse will reason or think out the patient problem (Välimäki et al., 2022). Your question on suicidal risk are meant to check if the patient is capable of harming himself. Some of the other areas that you could have based as a nurse are questions on personal history such as work history, marital status, current social situation, issues with alcohol or drugs among others. The question on suicidal thoughts would also be applicable to the patient I interviewed because one of the symptoms that I noticed was depression, this would be beneficial in preventing the patient from causing harm to himself. The importance of the assessment questions helps in decision making and diagnosis. As per Aboraya et al., (2016),  health providers use patients; responses to observe their behavior and make final rating of signs and symptoms.

References

Aboraya, A., Nasrallah, H., Muvvala, S., El-Missiry, A., Mansour, H., Hill, C., … & Price, E. C. (2016). The Standard for Clinicians’ Interview in Psychiatry (SCIP): A Clinician-administered Tool with Categorical, Dimensional, and Numeric Output—Conceptual Development, Design, and Description of the SCIP. Innovations in clinical neuroscience, 13(5-6), 31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5077257/

Välimäki, M., Lantta, T., Lam, Y. T. J., Cheung, T., Cheng, P. Y. I., Ng, T., & Bressington, D. (2022). Perceptions of patient aggression in psychiatric hospitals: a qualitative study using focus groups with nurses, patients, and informal caregivers. BMC psychiatry, 22(1), 344.https://link.springer.com/article/10.1186/s12888-022-03974-4Links to an external site.

NURS-6512N WEEK 2 DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION Case Study

Patient History

John Green is a 33-year-old white man who is a new patient in our office. John was assigned female at birth but identifies as male. He made a complete transition to living as a male a year ago. Currently, he’s living with his parents and is unemployed. He’s been getting testosterone from the internet and has not seen a healthcare provider for anything other than his hormone suppression medications in the last three months. John has been a heavy smoker for the past ten years, smoking two packs of cigarettes daily. He also uses marijuana, with 3-6 joints each weekend (he has a legal permit for this). He has episodes of depression. John has been living with HIV for the past three years but was doing well with his treatment six months ago. Lately, he’s been feeling weak, which prompted him to move back in with his parents. He’s currently taking Biktarvy once daily and 100 mg of testosterone every seven days. There is no other significant medical history. He’s never been married, and there are no notable family health issues. He’s concerned about being a burden to his family and is worried about his declining health since becoming unemployed.

Patient Risk Factors and Health Assessment

Several factors have played a role in shaping John Green’s health. As a transgender individual, he may have faced discrimination and social stigma. Being unemployed and dependent on his family could impact his mental and emotional well-being. His smoking habit, marijuana use, and experiences with depression also affect his health. Additionally, living with HIV without regular healthcare check-ups has implications for his physical health.

To build John’s health history, it’s crucial to approach him with sensitivity to his background, lifestyle, and culture. Here are five targeted questions to guide the assessment:

1. Can you tell me how your gender identity has influenced your experiences with healthcare?
2. How long have you been smoking, and how many cigarettes do you typically smoke in a day?
3. Could you describe your marijuana use, including how often you use it and its effects on you?
4. How do you manage your episodes of depression, and have you sought any treatment for it?
5. How have you been managing your HIV status, and have you had recent tests to check your viral load?

Communication with patients from diverse backgrounds can be challenging. It’s essential for healthcare providers to approach patients with an open mind and a willingness to learn about their culture and beliefs. Using interpretive services, if necessary, can facilitate effective communication. Avoiding assumptions and asking open-ended questions allows patients like John to share their experiences and concerns.

References

Hines, D. D., Laury, E. R., & Habermann, B. (2019). They just don’t get me: A qualitative analysis of transgender women’s health care experiences and clinician interactions. The Journal of the Association of Nurses in AIDS Care, 30(5), e82. https://doi.org/10.1097/JNC.0000000000000023Links to an external site.

Seelman, K. L., Colón-Diaz, M. J., LeCroix, R. H., Xavier-Brier, M., & Kattari, L. (2017). Transgender noninclusive healthcare and delaying care because of fear: connections to general health and mental health among transgender adults. Transgender health, 2(1), 17-28. https://doi.org/10.1089/trgh.2016.0024Links to an external site.

Truong, M., Paradies, Y., & Priest, N. (2018). Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC health services research, 14(1), 1-17. https://doi.org/10.1186/1472-6963-14-99Links to an external site.

NURS-6512N WEEK 2 DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION  CASE STUDY 2

NURS-6512N WEEK 2 DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION SAMPLE POST 2

Cultural Competence

Being culturally competent means that healthcare providers should consider and improve their ability to communicate effectively with people from different cultures (Ball et al., 2019). The RESPECT model is a useful tool for healthcare providers to ensure that patients receive personalized care (Ball et al., 2019). The RESPECT model includes several steps: Rapport, Empathy, Support, Partnership, Explanations, Cultural competence, and Trust (Ball et al., 2019).

In the context of cultural competence, it’s crucial for healthcare providers to be aware of their own preconceived ideas and cultural biases (Ball et al., 2019). This paper will apply the RESPECT model to a case study involving a 28-year-old African American male patient who frequently experiences migraines.

Rapport is essential, especially for this patient who has visited the healthcare provider multiple times with unresolved symptoms. It’s important not to make assumptions about the patient, even though he’s been labeled a frequent visitor. The patient should be treated with respect and without judgment. Gathering information about when the symptoms started, their duration, and the patient’s history of migraines and treatment is crucial (Ball et al., 2019).

Empathy is necessary because this patient is in pain and seeking help. Simply acknowledging the patient’s distress can show empathy and alleviate his agitation. His agitation may be due to not being taken seriously in the past (Ball et al., 2019). It’s worth noting that African American patients have been less likely to receive a migraine diagnosis and appropriate treatment, which might contribute to the patient’s frustration (Befus et al., 2018).

Support is the third step, and the patient needs it. He is worried that he won’t receive the necessary medications, reflecting his underlying fear that his headache won’t go away. Understanding the patient’s perceived barriers to care is essential in addressing the problem. Asking targeted questions like, “What do you think has been a barrier to your migraine treatment in the past?” can guide the current treatment (Ball et al., 2019). This leads to the fourth element, Partnership. The patient should feel like he’s working with the healthcare provider as a team to find a solution. Questions like, “What do you think will help your migraine?” or “What has worked for your migraines in the past?” can help clarify the patient’s expectations for this visit.

Explanations are the next step, where the healthcare provider must frequently check for understanding to ensure clear communication. Using statements like, “To make sure I’m understanding correctly, you mentioned,” and restating the patient’s words can help ensure the patient feels heard and the conversation is clear (Ball et al., 2019).

Cultural competence can be challenging for healthcare providers as it involves asking personal questions that patients might not share with a stranger. Different cultures have different comfort levels with certain topics. It’s crucial to approach these questions with respect for the patient’s cultural background. For instance, some cultures find it inappropriate to make direct eye contact while speaking, and this should be considered, especially when asking sensitive questions. Questions should aim to identify any cultural, lifestyle, spiritual/religious, or socioeconomic factors that may impact or have impacted the patient’s care. These questions should be asked respectfully while setting aside any biases the healthcare provider may have (Ball et al., 2019).

Stress, lack of sleep, and dietary choices can trigger migraines. Cultural practices can influence food choices, work habits, and sleep patterns, among other factors. Asking about the patient’s recent food habits and other migraine triggers can provide valuable insights. It’s also important to ask if the patient has tried any alternative therapies for migraines, which might include herbal remedies.

Trust is the final step in the RESPECT model. When a patient trusts their healthcare provider, they are more likely to share information they might otherwise keep to themselves. If trust is lacking, it might be necessary to consider a change in the patient’s care provider (Ball et al., 2019).

Cultural competence is a dynamic concept that requires constant learning and adjustment by healthcare providers. One of the most valuable ways to improve cultural competence is by learning from our patients. Gathering feedback on patients’ perceptions of their healthcare experience can help healthcare providers develop greater cultural competency and humility (Ball et al., 2019).

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.). Elsevier.

Befus, D. R., Irby, M. B., Coeytaux, R. R., & Penzien, D. B. (2018). A Critical Exploration of Migraine as a Health Disparity: the Imperative of an Equity-Oriented, Intersectional Approach. Current Pain and Headache Reports, 22(12), 79. https://doi.org/10.1007/s11916-018-0731-3

McCance, K.L. & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children, (8^th ed.). Elsevier.

Pace, A., Barber, M., Ziplow, J., Hranilovich, J. A., & Kaiser, E. A. (2021). Gender Minority Stress, Psychiatric Comorbidities, and the

Experience of Migraine in Transgender and Gender-Diverse Individuals: a Narrative Review. Current Pain & Headache Reports, 25(12), 1–9. https://doi.org/10.1007/s11916-021-00996-7

Rosenthal, L.D. & Burchum, J.R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants, (2^nd ed.) NURS-6512N WEEK 2 DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION .

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