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.
Sample Essay
RE: Discussion – Week 2
COLLAPSE
Diversity and Health Assessments
It is important for healthcare providers to develop their cultural competency and identify their own beliefs and culture before caring for others. Nurse practitioner could accidentally offend their patient or family by not knowing about a crucial cultural practice; that is why awareness, acceptance, and questioning are good practice habits when carrying for your patients. Knowledge of the center of cultural issues, awareness of self and reflective practice are all important aspects for a nurse practitioner to consider when attempting to attain cultural competence (Ball et al., 2019).
Case Study # 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 over the counter Tylenol for aches and pains on occasion. She has a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.
The patient in this scenario could potentially be feeling uneasy as she comes to the healthcare provider’s office for a consultation due to health disparity. According to Healthy People (2020), achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities. Lesbians are part of the vulnerable population impacted by health disparity. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity (Healthy People, 2020). Culturally competent care requires that Healthcare providers be sensitive to patient’ s heritage, sexual orientation, socioeconomic situation, ethnicity, and cultural background (Ball et al., 2019).
Through cultural humility, the practitioner and the patient can be more evenly balanced and equally beneficial in their patient/nurse practitioner relationship. Although some of the LGBT people are receiving support and high-quality care, many are still experiencing discrimination, marginalization, and at times, blatant harm within the United States healthcare system (Yingling, Cotler, & Hughes, 2017).
Sensitive Issues
Health history including a psychosocial history will need to be obtained as well about marital status, support at home, and sexual orientation (Sullivan, 2019). Depending on how comfortable the patient is in their relationship, this may or may not be a sensible issue. Discussing how the patient feels about raising a child in a non-heterosexual home is an important subject to review as well. The practitioner should be non-judgmental while discussing these subjects with a patient, for optimal success in acquiring information concerning these potentially sensitive issues.
The fact that the patient is experiencing a vaginal discharge will lead the practitioner through a series of questions to identify if this discharge is normal discharge or if the patient is experiencing an abnormality that needs to be addressed. The sexual history will need to be obtain. Understanding the sexual health needs of women who have sex with women is important as there are documented sexually transmitted diseases that have been documented in research with the highest risk with these sexual practices being bacterial vaginosis (Schick, Rosenberg, Herbenick, & Reece, 2012). The use of sex toys or devices can allow for transmission of infection from one individual to another if not properly cleaned or covered properly between uses (Schick, Rosenberg, Herbenick, & Reece, 2012).
Target Questions
1- Tell me more about this vaginal discharge. When does it occur?
2- What do you think caused your illness or condition?
3- Can you describe your current sexual activity? Any sexual toys used? Any other partners?
4- Did you experience excessive thirst or hunger? any vaginal itching, inflammation, or pain with this discharge? Frequent urination?
5- Do you have a support system at home?
Conclusion
TJ is at risk for sexually transmitted disease (STD) due to the facts that she might be using sex toys which require high hygiene practice to keep the toys clean and she could also have more than one partner. Exploring her sexual life history could help determine if that is where the vaginal discharged originated. Since TJ has a strong family history of diabetes, exploring possible sign and symptoms of diabetes like excessive thirst or hunger, frequent urination, and vaginal itching associated to check her A1c could help determine if she has developed the diabetes condition. Practitioners will need to be culturally competent incorporating appropriate measures into their practice to ensure their health assessments achieve success and lead to the provision of necessary and complete care.
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.
Healthy People 2020. (2019). Disparities. Retrieved from
https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities
Schick, V., Rosenberger, J. G., Herbenick, D., & Reece, M. (2012). Sexual behavior and risk
reduction strategies among a multinational sample of women who have sex with women.
Sexually Transmitted Diseases, 88(6). 407-412.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A.
Davis
Yingling, C. T., Cotler, K., & Hughes, T. L. (2017). Building nurses’ capacity to address health
inequalities: Incorporating lesbian, gay, bisexual, and transgender health content in a
family nurse practitioner program. Journal of Clinical Nursing, 26, 2807-2817. doi: 10.1111/jocn.13707
