May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this 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.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

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 population

Angel D ShamlinSaturdaySep 2 at 8:31pmManage Discussion Entry

Shamlin Initial PostLanguage Barrier     The patient for this week’s discussion is a 26-year-old Spanish speaking female who presents with ongoing abdominal pain. For the provider to assess her needs, they must first acknowledge the language barrier that exists. If the provider receives any federal funded patient, they are required to provide a medically qualified interpreter (TLC Translation, n.d.). This is often accomplished using a language line, which is a phone conferencing system that allows the provider and patient to talk with an interpreter on the third line. The provider should not rely on the family member to translate due to the possibility of incorrect information being relayed to the patient that may negatively impact care. “Language interpretation requires a specific set of skills, including bilingual fluency and the ability to switch fluidly between two languages while interpreting the meaning and tone of what has been said from one language to another” (Karliner, 2018).Socioeconomic Disparities     The Latino population has significant socioeconomic disparities the provider needs to consider when completing their medical history assessment. Many Latino patients lack health insurance and live beneath the poverty level (SCU, 2019). “Latinos are far more likely than the overall population to live in poverty; the poverty rate in 2006 was 20.8 percent, compared to 12.3 percent for the overall U.S. population” (SCU, 2019). This patient population often also lacks regular primary care and is nearly two and a half times more likely than white patients to lack a regular primary care provider (SCU, 2019).Cultural Factors     Latino patients may delay seeking medical care due to many cultural factors. One of these may be the culture of tolerating pain without complaint or that certain conditions, such as pregnancy, are natural and do not require medical intervention (SCU, 2019). Additionally, the beliefs of alternative medicine and traditional folk illnesses exist that influence this population to try these methods before seeking care (Juckett, 2013). Providers must be sensitive to these beliefs and determine if conventional medical treatments and patient treatment beliefs can be accommodated.Medical History Interview     The provider needs to ensure they are sensitive to this patient’s cultural, socioeconomic, and spiritual factors when completing their assessment. Since the patient recently sought medical care for a similar complaint, the provider needs to first assess if the treatment prescribed on the last visit was completed. If the previous medical plan was not properly communicated, the patient may not have adhered to the medical regimen and might benefit from further reeducation (Juckett, 2013). If the patient did adhere to the medical regimen previously prescribed, the provider needs to continue with further diagnostic and physical assessment techniques.Targeted Medical Questions

Were you able to get the medication prescribed and have you taken it each day?

(If so), did the medication help your symptoms?

• Have the symptoms changed, and if so, how?
• Have you experienced this problem before?

Are you sexually active? (for need to determine possibility of pregnancy or STD)

References:Culturally Competent Care for Latino Patients. Santa Clara University. (2019).  @SantaClaraUniv. https://www.scu.edu/ethics/focus-areas/bioethics/resources/culturally-competent-care/culturally-competent-care-for-latino-patients/Links to an external site.Do I have to Provide Medical Interpreting to My Patients? (n.d.). Www.tlctranslation.com. https://www.tlctranslation.com/do-i-have-to-provid…Juckett, G. (2013). Caring for Latino Patients. American Family Physician, 87(1), 48–54. https://www.aafp.org/pubs/afp/issues/2013/0101/p48…Karliner, L. S. (2018, April). When Patients and Providers Speak Different Languages | PSNet. Ahrq.gov. https://psnet.ahrq.gov/web-mm/when-patients-and-pr…?Rayanne Abood
YesterdaySep 4 at 11:15amManage Discussion EntryWEEK # 2 Discussion:Case Study # 1 – John Green John Green’s case presents a complex interplay of socioeconomic, spiritual, lifestyle, and cultural factors that healthcare providers must be sensitive to when interacting with him. His unique circumstances require a holistic approach to ensure comprehensive care and address his specific needs. As a healthcare provider we need to learn how to be diverse in in our care approach to serve patient needs while being culturally sensitive. There are always cultural differences including similarities and differences between people. Healthcare providers must be aware of their own biases and set them apart when delivering care, his will help us as providers to try to solve our patient’s health problems effectively.Socioeconomic Factors: John’s socioeconomic factors significantly impact his health and well-being. His unemployment and reliance on free medications, such as Biktarvy, highlight potential financial limitations. Additionally, his concern about being a burden on his family suggests heightened financial and emotional stress (Chen et al., 2016). John’s current unemployment status is a significant socioeconomic factor that can affect his access to healthcare, financial stress, and overall well-being. It may lead to concerns about being a burden on his family. Additionally, John’s limited access to healthcare, apart from telehealth for suppression medications, raises concerns about the continuity of care, monitoring of his health conditions, and addressing any potential health issues. Spiritual and Cultural Factors: John’s gender identity and transition are paramount. Healthcare providers must respect and validate his identity as a transgender male. This includes using appropriate pronouns and terminology and acknowledging the spiritual and emotional aspects of his transition journey (Almeida et al., 2016). Social stigmetazation and discrimination against transgenders lead to suicidality, being victims of violence, HIV/STI exposures, and lower rates of insurance coverage (James et al., 2016). Taking into consideration these statistics we need to target specific factors when delivering to John. John’s gender identity and transition are crucial aspects of his life that must be respected and understood. Sensitivity to his gender identity is essential for providing culturally competent care. Lifestyle & Health Related Factors:John’s tobacco and marijuana use are important lifestyle factors that contribute to health risks. Heavy smoking increases the risk of cardiovascular disease and lung cancer, while marijuana use may affect respiratory health. These habits may also interact with his other medical conditions (Agrawal et al., 2018; Tindle et al., 2017). John’s heavy smoking and marijuana use are lifestyle factors that can have a significant impact on his health. These habits may contribute to his feeling weak and may interact with his medical conditions.  John’s HIV-positive status requires consistent monitoring and adherence to antiretroviral therapy (Biktarvy). His feeling weak could be attributed to various factors, including his HIV status or substance use. Healthcare providers should evaluate potential causes and address them accordingly (Havlir et al., 2018). John’s HIV-positive status and adherence to antiretroviral therapy (Biktarvy) are important health-related factors. Ensuring he continues to manage his HIV effectively is crucial.Sensitive Interaction Considerations:When interacting with John, healthcare providers should be sensitive to the following factors. Ensure that John’s gender identity as a male is acknowledged and respected throughout the healthcare encounter. Use appropriate pronouns and terminology. John is a 33-year-old individual who was assigned female at birth but identifies as male. He has successfully transitioned socially and with his family, which is important to note for providing culturally sensitive care. Additionally, a non-judgmental attitude is essential when approaching discussions about substance use (smoking and marijuana) without judgment, focusing on harm reduction strategies and support for cessation if desired. Conduct a thorough assessment of substance use, including the type, frequency, and duration of use. Explore any underlying factors contributing to substance abuse, such as mental health issues or past trauma. Tailor the assessment to be sensitive to the patient’s gender identity and experiences (Pflum et al., 2015). Ensure that the plan is gender-affirming and addresses the patient’s unique needs, including potential hormonal interactions with substance use and mental health support (Center of Excellence for Transgender Health, 2016). Furthermore, conduct a thorough assessment of John’s depression episodes and provide a safe and supportive environment for him to discuss his mental health concerns. Recognize the cultural and societal challenges faced by transgender individuals, including discrimination and social support. Be aware of the potential impact on his mental and emotional well-being.Five Targeted Questions for Health History and Risk Assessment:1. Can you tell me more about your gender transition journey, including when you transitioned and how it has been socially and emotionally for you?2. How has your unemployment status affected your daily life and access to healthcare? Are there any specific concerns you have regarding your financial situation?3. Can you provide more details about your smoking and marijuana use, including when you started, the quantity consumed, and any desire to reduce or quit these habits?4. How have you been managing your depression episodes, and have there been any recent changes in your mental health that you would like to discuss?5. Regarding your HIV status, can you share your experiences with treatment, adherence to medications, and any recent monitoring or tests related to HIV?

References:Almeida, J., Johnson, R. M., Corliss, H. L., Molnar, B. E., & Azrael, D. (2016). Emotional distress among LGBT youth: The influence of perceived discrimination based on sexual orientation. Journal of Youth and Adolescence, 45(3), 725-735.Grant, J. M., Mottet, L. A., & Tanis, J. (2011). National Transgender Discrimination Survey Report on Health and Health Care. National LGBTQ Task Force. https://www.thetaskforce.org/wp-content/uploads/2019/07/ntds_full.pdfLinks to an external site.Havlir, D. V., Bassett, I. V., & Levitt, N. S. (2018). HIV in South Africa: Translating science into policy. The Lancet HIV, 5(11), e671-e672.Pflum, S. R., Testa, R. J., Balsam, K. F., Goldblum, P. B., & Bongar, B. (2015). Social support, trans community connectedness, and mental health symptoms among transgender and gender nonconforming adults. Psychology of Sexual Orientation and Gender Diversity, 2(3), 281-286.