NURS 6512 JC an at-risk 86-year-old Asian male is physically and financially dependent on his daughter
JC an at-risk 86-year-old Asian male is physically and financially dependent on his daughter
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 ahx 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”
There has been a lot of attention in recent years to cultural competence/diversity and what this means to the field of healthcare in the United States. With the inclusion of many different races and ethnicities, it is estimated that by the year 2044, non-Latino whites will account for less than 50% of the U.S. population (DeSilva, Aggarwal, & Lewis-Fernandez, 2015). As such, it is imperative to address social disparities, including structural and cultural factors and close the gap in regards to access to health services. In order to improve quality of life and patient outcomes for these diverse populations, the APRN must be knowledgeable about different cultures, what cultural competence entails, and how socioeconomic, spiritual, lifestyle, and other cultural factors should be taken into consideration when gathering a health history and developing a plan of care.
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Culture can be quite broad and multifaceted and refers to a system of concepts, rules, practices, and knowledge that are learned and transmitted across generations and can include race and ethnicity, but also language, religion, gender identity, and even social or occupational groups (Desilva et al., 2015). In the scenario presented, the patient is J.C., an at risk 86 year old Asian male who 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 history of hypertension (HTN), gastroesophageal reflux disease (GERD), Vitamin B12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10 mg daily, Prilosec 20 mg daily, vitamin B12 injections monthly, and Cipro 100 mg daily. He comes in for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter”.
Based on the information provided, there are a number of cultural factors for the APRN to consider. Initially when meeting with a person of a different ethnicity or race, language and communication should first be considered. Since the patient appears to speak adequate English based on his statement, a translator is not necessary but other communication considerations are warranted. For example, when conversing with Asian patients, it is often considered disrespectful to make eye contact with persons of authority or elders and can even be considered flirtatious when between members of the opposite sex, an excellent point with this 86 year old male patient (Centers for Disease Control and Prevention, 2008). Communication is often indirect and many Asians avoid saying no, using silence or a nod of the head to signal a lack of understanding or disagreement. Touching is also uncommon unless in the healthcare setting and if the necessity is first explained. Although a translator may not be needed, the clinician may still have one present or use one for clarification. For example, I have a large Hispanic population in my current position. I kept getting confused because one of my Hispanic patients would often tell me whether or not he drank his medication correctly every day. I would ask him a variety of questions, not understanding why he said he was drinking medications that were in a pill form. I incorporated the assistance of a Hispanic translator who informed me that in the Spanish language, they do not say they “take” the medication. The closest translation in English is “drink”. Now that I am aware of this, I notice that many of my Hispanic patients also say “drink” when referring to taking their medications, regardless of form. JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter
Another area to address would be the relationship between the patient and his daughter, upon whom he is financially and physically dependent, and the presence of additional supportive structures. He states he does not want to be a burden to his daughter and I wonder if that is his perception or hers. Traditionally, Asian families have been patriarchal in structure, often deferring to the father to make decisions while women have a subordinate role. In addition, there has been the belief of filial piety in that there is reverence for parents, with children caring for them until their death (Jayaram, 2020). However, recent studies show that there is a shift away from traditional values among younger Asians living in the U.S. Elders more commonly live independent from their children and rely more on friends and neighbors for day to day health needs, with the children stepping in when conditions become serious or when the parents request assistance (Pang, Jordan-Marsh, Silverstein, & Cody, 2003).
Another area of concern I would address is that of spirituality and how it affects the healthcare beliefs and practices of this patient. Many Asians use traditional nutrition, herbal supplements and remedies, or protective amulets or practices such as acupuncture and coining to treat specific conditions or the person as a whole (Centers for Disease Control and Prevention, 2008). Clinicians should become familiar with the concepts of Yin and Yang, hot and cold, and attempt to incorporate them into the plan of care if possible and when appropriate.
Five targeted questions to ask this patient to build his health history and assess health care risks include the following: 1) Would you like to have a translator present today to assist with the interview? As mentioned earlier, it seems as though the patient speaks adequate English. However the use of a translator may be useful to clarify meaning and phrases and may also help to assess the patient’s level of comprehension; 2) Who makes the healthcare decisions in your family? This question is useful to determine the hierarchy and relationship between the patient and his daughter, pertinent information when assessing health care needs; 3) What form of health insurance do you have? This question is important because the patient states that he does not want to be a burden and the scenario indicates that he is financially dependent on his daughter. Not only may this dynamic have a negative impact on his self-esteem, but as a clinician, I must be aware of a patient’s financial burdens when deciding upon treatment options and refer them to social services or the local health department; 4) Tell me are there any special foods or home remedies you have tried or are currently using? If possible, it is important to incorporate traditional beliefs and practices of the patient with those of Western medicine. In this way, the patient is more likely to be compliant and the clinician can also identify if any home remedies may have interactions with a prescribed course of treatment (Jayaram, 2020); 5) Is there anything I have not asked you about that you think I should know or want to discuss? I always ask this question because many patients, especially in the beginning, may expect the clinician to guide the interview and ask all the pertinent questions. This allows the patient to bring up any concerns in a safe environment and gives them permission to speak freely. JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter
Centers for Disease Control and Prevention. (2008). Promoting cultural sensitivity: A practical guide for tuberculosis programs that provide services to persons from China. Atlanta, GA: U.S. Department of Health and Human Services
DeSilva, R., Aggarwal, N.K., & Lewis-Fernandez, R. (2015). The DSM-5 cultural formulation interview and the evolution of cultural assessment in psychiatry. Psychiatric Times, 32(6). Retrieved from https://www.psychiatrictimes.com/view/dsm-5-cultural-formulation-interview-and-evolution-cultural-assessment-psychiatry
Jayaram, G. (2020). Working with Asian-American patients. Retrieved from https://www.psychiatry.org/psychiatrists/cultural-competency/education/best-practice-highlights/working-with-asian-american-patients
Pang, E.C., Jordan-Marsh, M., Silverstein, M., & Cody, M. (2003). Health-seeking behaviors of elderly Chinese Americans: Shifts in expectations. The Gerontologist, 43(6), 864-874. doi: 10.1093/geront/43.6.864
Discussion: Diversity and Health Assessments
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).
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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.
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.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
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.
Submission and Grading Information
To access your rubric:
Week 2 Discussion Rubric
Post by Day 3 of Week 2 and Respond by Day 6 of Week 2
To Participate in this Discussion:
Week 2 Discussion
What’s Coming Up in Week 3?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
Next week, you examine assessment techniques, health risks and concerns, and recommendations for care related to patient growth, weight, and nutrition. You will also begin your first DCE: Health History Assessment which will be due in Week 4. Plan your time accordingly.
Overview of Digital Clinical Experiences (DCE) and Lab Components
Throughout this course, you are required to not only complete your standard course assignments and discussions, but you will also complete DCE and Lab Components that are either structured as optional or required assignment submissions. Please take the time to review your DCEand Lab Components for this course that are required submissions. See the table below and the attached table for specific DCE and Lab Components for the course.
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total score of 80% or better, but you must take all attempts by the Day 7 deadline. You must pass BOTH the Health History and Comprehensive (head-to-toe) Physical Exam of at least a total score of 80% in order to pass the course.
Week Digital Clinical Experiences Lab Components
Module 1: Comprehensive Health History
Week 1: Building a Comprehensive Health History
Module 2: Functional Assessments and Assessment Tools
Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment
Week 3: Assessment Tools, Diagnostics, Growth, Measurement, and Nutrition in Adults and Children DCE: Health History Assessment (assigned in Week 3, due in Week 4) Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children
Module 3: Approach to System Focused Advanced Health Assessments
Week 4: Assessment of the Skin, Hair, and Nails DCE: Health History Assessment Lab Assignment: Differential Diagnosis for Skin Conditions (SOAP Note for differential diagnosis)
Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat DCE: Focused Exam: Cough Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat (Episodic SOAP Note)
Week 6: Assessment of the Abdomen and Gastrointestinal System Lab Assignment: Assessing the Abdomen (Analyze SOAP Note)
Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System DCE: Focused Exam: Chest Pain
Week 8: Assessment of the Musculoskeletal System Discussion: Assessing Musculoskeletal Pain (Episodic SOAP Note)
Week 9: Assessment of Cognition and the Neurologic System DCE: Comprehensive (head-to-toe) Physical Assessment Case Study Assignment: Assessing Neurological Symptoms (Episodic SOAP Note)
Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal Lab Assignment: Assessing the Genitalia and Rectum (analyze SOAP Note)
Module 4: Ethics in Assessment
Week 11: The Ethics Behind Assessment Lab Assignment: Ethical Concerns
To go to the next week: