Socioeconomic, spiritual, lifestyle, and other cultural factors

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.
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 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.
Colleague1
BK is a 16-year-old Caucasian female who comes in with her grandmother for an annual exam. The grandmother reports BK has been “acting strange, staying in her room all the time and refusing to do all the things she used to enjoy like singing in the youth choir”. Grandmother shares that BK’s mother is a drug addict is currently incarcerated, so she is worried BK is using drugs and wants her tested for drugs. BK is not on any medications. She is obese and does not make eye contact when you enter the room.
When interviewing adolescent patients for a health history, there are many factors the provider must consider gaining the trust of the patient. In my scenario, a 16-year-old obese Caucasian female who lives with her grandmother has recently become withdrawn. The grandmother is concerned that the patient may be using drugs and is requesting a drug test, as the patient’s mother has a history of drug abuse. Initially, I would speak with the patient and the grandmother together to discuss any health concerns they may have. I would then have the grandmother step out so I could have a confidential conversation with the patient. Adolescents are typically more apt to respond when they are able to speak with the medical provider privately and understand that the provider is there to support them and maintain their confidentiality, when possible (Ball et al., 2019).
I would ask the patient open-ended questions and use the HEEADSSS assessment screening tool to guide the health history interview (Ball et al., 2019). In obese adolescents, it is a common finding to have depression, anxiety, and other psychological disorders. Indirect pathways show that stressful life events, peer pressure, and bullying can lead to depression in obese adolescents (Sagar & Gupta, 2018). Early signs of depression include withdrawing from activities the patient typically enjoys, changes in mood, sleeping more, eating more, and a decline in grades. This could explain the change in behavior the grandmother is noticing. It is possible the patient also has substance abuse problems, as that can lead to depression as well (Steingard, n.d.).
The questions I would ask the patient would be:
Tell me about your living situation.
How is school? What do you enjoy most about school?
Tell me about your friends. What do you like to do together?
Are you dating anyone? Are you sexually active? If so, how many partners have you had? Do you use protection?
Do you drink alcohol? Smoke cigarettes? Do you use any recreational drugs?
What does your daily diet consist of?
What issues can I help you address?
Do you have any thoughts of wanting to hurt yourself?
Do you feel safe at home
Colleague 2
EB is a 68-year-old black female who comes in for follow-up of hypertension. She has glaucoma and her vision has been worsening during the past few years. She lives alone and is prescribed four hypertension medications (Hydralazine 50 mg PO Q8H, Metoprolol XL 200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily ). She brings in her medication bottles and she has some medication bottles from the previous year full of medications. She is missing one medication she had been prescribed and says she may have forgotten it at home. Her BP in clinic today is 182/99 with HR of 84.
A geriatric assessment tool can help focus the assessment of the older adult, which is especially important when there are factors such as chronic illnesses present. A geriatric assessment recognizes that the patient’s health is multidimensional and that there are numerous factors that contribute to their overall health status. In the opinion of Reuben & Leonard, hearing, vision, polypharmacy, mobility, and cognition are all areas that should be evaluated. Social, functional, economic, psychosocial, and environmental assessments are also performed in addition to medical needs assessments (Merchant et al., 2020).
Associated Factors
In this case, EB is a 68-year-old black female who has a history of hypertension that has been treated with a variety of medications. She also lives alone, suffers from glaucoma, and may be experiencing memory problems as a result. She faces a number of socioeconomic challenges that must be taken into account when gathering health history, including living alone and the possibility of being unable to work, which results in a low-income household. As a healthcare provider, the patient’s diagnosed hypertension and polypharmacy are two of the most serious concerns you can have. The patients’ glaucoma and the possibility of memory loss complicate the discussion of these two topics even further. Several empty pill bottles from a year ago have been brought in with the patient, indicating that she isn’t taking her medications properly. This is evident from the medication brought in with the patient. There is also concern that she is taking the correct medications at the correct times due to the fact that the labels are difficult to read with glaucoma and worsening vision, and the pills are all the same shape and color, raising the possibility that she is taking the wrong medications. Every visit should include a review of medications, especially as patients grow older and experience a corresponding decline in kidney function.
Sensitive Issues
It is critical that the patient does not feel degraded or that she is unable to care for herself completely. Even though they are becoming dependent on others, older adults experience psychological distress as a result of losing their sense of independence and control over their own bodies. In order to obtain a thorough health history from the patient, it will be necessary to establish a sense of comfort and trust with her by empathizing with her concerns and needs rather than marginalizing them. There will be a healthy balance of empathy and suggestions for how she can maintain her health and independence to the greatest extent possible. When it comes to making sure that the proper medications are taken, a pill box is a convenient and often straightforward solution. As a provider, it may be suggested to her that she enlists the assistance of a family member to assist her with dispensing, or even that she utilizes video conferencing to receive their assistance (Heyman et al., 2017).
It is important to maintain respect for cultural differences. Providers must be aware that this goes beyond mere cultural awareness and includes ongoing cultural encounters, a desire to participate in the process of becoming culturally competent, cultural knowledge, and cultural competence, among other things. Cultural competence is an integration and understanding that requires one to maintain and pursue cultural knowledge, sensitivity, and awareness on a continual basis, among other things.
Targeted Questions:
In the past year, have you gone to the hospital or to an urgent care center? Please tell me about them if you can. When you entered, what was the primary reason you had for doing so?
Assessing independence and safety by using an evaluation tool, such as the Lawton Instrumental Activities of Daily Living Scale.
Do you believe that you are able to control your blood pressure and medications, as well as take the necessary dosages on a daily basis?
The past month, have you been plagued by feelings of grief and despair? Have you ever been bored or dissatisfied with something you were doing?
What health goals do you and your partner want to accomplish together?
Conclusion
In order to show respect to an older adult, it is necessary to make them believe that you are interested in what they are feeling and experiencing. Belittlement can have a negative impact on the provider-patient relationship and make it more difficult to achieve health-related objectives. In all patient encounters, cultural competence should be demonstrated, and emphasis should be placed on the provider’s desire to work as a team with the patient. Because of the patient’s decreased vision, the provider should avoid using visual-based learning tools with him or her. Making sure to give adequate time for appropriate responses and asking the patient to teach back could be effective ways to maintain clear communication (Parker et al., 2017).