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Students to Case:
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.\"
• 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?
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.
Note: please use APA format and at least 3 references not more than 5 years.
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The increasingly diverse American population poses challenges and opportunities for the healthcare sector. Healthcare professionals are required to understand the value of knowing a patient’s cultural background to deliver culturally competent care. This is important because culture plays a central role in shaping people’s perspectives on issues including health and healing (Kaihlanen et al., 2019). At the same time, some cultural elements such as diet and nutrition may act as a barrier to achieving positive health outcomes. Moreover, the cultural assessment also assists in the identification of social circumstances that facilitate or hinder positive health outcomes (Dains et al., 2019). Cultural competence is a necessity for every APRN and requires evaluation of a patient’s beliefs, lifestyle, behaviors, attitudes, and socioeconomic factors. Understanding a patient’s culture allow a practitioner to provide respect tailored to address the specific needs of the patient.
In this exercise, an at-risk 86-year-old Asian male present to the clinic for a routine examination. The patient is dependent on her daughter both financially and physically and has multiple chronic conditions that require management. In addition, the patient expresses concern that he feels he is being a burden to the daughter. The first consideration when conducting the assessment is to consider that the patient is Asian meaning, they might not understand English well. Thus, I will first inquire with the patient about the language he would be comfortable with for the process. This will show that I respect the patient’s background and help in developing a trustful relationship that promotes positive interaction. Secondly, I have learnt that in Asian culture respect for elders is paramount and thus, the patient expects nothing but to be treated with respect (Ryu & Lee, 2016)t. For example, not making direct eye contact is one way of showing respect as making and maintaining eye contact is considered rude in this culture.
Spirituality is most cultures is directly linked to health matters in most cultures including the Asian culture. thus, I will apply cultural humility and ask the patient about any spiritual beliefs that might impact health outcomes. This will provide an understanding of the role spirituality plays in the patient’s healthy life in consideration of healing and even issues to do with death and dying as this is an important conversation given the patient’s age (Ryu & Lee, 2016). I will also inquire about the patient’s support system, that is, religious or ethnic/racial groups that the patient may belong to in the community. Such groups provide the essential support needed by such patients to manage their health and adjust to the foreign environment (Ball et al., 2019). Socioeconomically, the patient’s background shows financial constrain because of dependence on the daughter who does not earn much. Thus, connecting the patient with social services and other community-based services that can assist in this area is highly necessary.
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The patient has comorbid conditions for which he is under medications. Thus, the patient requires close monitoring and management to stay well. One concern that may arise is the possible use of traditional medicine, which is a common tendency in Asian communities. These drugs may cause drug interactions with biomedical medicines, which would compromise the health and safety of the patient (Ball et al., 2019). Similarly, given that the patient is elderly, it is important to evaluate functional vulnerabilities such as the ability to handle activities of daily living without help or if they need assistance in this area (Dains et al., 2019). The financial constrain is also a sensitive issue needs to be handled because of its impact on patient’s nutrition and other elements that cause negative health outcomes. Finally, given that the patient is elderly, I will also look out for any possible signs of abuse and neglect, by closing observing the patient’s behavior, cues, and other non-verbal expressions in addition to physical examination data.
Are you able to dress, bathe, feed, and move around the house without any assistance?
Do you often check your blood pressure at home?
What kinds of foods do you commonly eat at home?
In the past two weeks, have you felt sad, hopeless, experienced sleep disturbance, loss of appetite, thoughts of guilt or contemplated suicide?
How do you believe that you are a burden to your daughter?
Do you take your medications as directed?
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.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Kaihlanen, A., Hietapakka, L., & Heponiemi, T. (2019). Increasing cultural awareness: qualitative study of nurses’ perceptions about cultural competence training. BMC Nursing, 18, 38. https://doi.org/10.1186/s12912-019-0363-x.
Ryu, S., & Lee, O. E.-K. (2016). Faith, spirituality, and values among Asian-American older adults: An exploratory factor analysis of the multidimensional measures of religion and spirituality. Mental Health, Religion & Culture, 19 (8), 920-931. https://doi- org.ezp.waldenulibrary.org/10.1080/13674676.2017.1290593.
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