. What can I do for you today to make you even better than you were when you came in?
Functional Assessments and Cultural and Diversity Awareness in Health Assessment
THE ASSIGNMENT TO BE COMPLETED:
Respond to your colleagues posting below on a “32-year-old lesbian, pregnant via insemination, during an annual physical where she is noted to have vaginal discharge” in the following ways
• Critique your colleague’s targeted questions.
• Explain how the patient might interpret those questions.
• Explain whether any of the questions would apply to your patient, and why. (MY PATIENT: “A 68-year-old female living alone who has worsening glaucoma has forgotten a medication at home and has a full bottle of medicine from the year before.”)
• Support your work by at least four current, credible sources within the last 5yrs (2 FROM ATTACHED LEARNING RESOURCES AND 2 FROM OUTSIDE CREDIBLE RESOURCES)
COLLEAGUE’S POST BY JEN.
A health assessment is only valuable to a patient and the provider when it considers the specific lifestyle, cultural, socioeconomic, and spiritual factors that impact an individual’s health and behaviors. The style of communication is critical to obtain open and honest rapport with patients, building the foundation of a trusting patient-provider relationship. For this post, I will focus on the health assessment of a 32-year-old lesbian, pregnant via insemination, during an annual physical where she is noted to have vaginal discharge.
Factors Influencing the Care of Lesbian Patients
Social determinants that influence health include socioeconomic status, education level, geographic location, support systems, and routine access to health care. However, sexual orientation is a strong social determinant of health. According to Everett et al. (2019), individuals in same-sex relationships are marginalized, shaping the stress and outcomes of these populations. Research has demonstrated that these marginalized populations experience more discrimination and victimization, higher incidence of mental health and substance abuse issues, familial and social isolation, and are less likely to have adequate health insurance and routine care. These issues are of the utmost importance when dealing with a woman who is pregnant.
Open communication between providers and their lesbian patients is crucial in determining the factors that influence the health and wellbeing of individual patients and the unborn children they carry. Tzur-Peled, Kushnir, and Sarid (2019) note that in a study conducted in Israel, of 184 registered nurses, “60.4% were unaware of the importance of knowing the patient’s sexual orientation” (Abstract), and only 17.9% felt professionally equipped to work with lesbians. While this study could have a cultural or spiritual influence, other studies conducted in England and Sweden note providers feeling discomfort and embarrassment in caring for lesbian patients (Tzur-Peled et al., 2019). Additionally, Nordqvist et al. (2014) report that lesbians have higher prevalence rates of smoking, obesity, sexually transmitted disease, and polycystic ovary syndrome, which may be embarrassing for patients and providers alike to discuss. Patients can feel the judgment and discomfort in those providing their care, creating further gaps in care and adverse health outcomes.
Building a Health History and Assessing Risks
TJ is a 32-year-old lesbian, pregnant from insemination from a local sperm bank, who has received routine prenatal care. She is G1:P0:A0; she takes her prenatal vitamins and Tylenol as needed for discomfort. She has a family history of diabetes mellitus. She presents to the office for an annual physical, noted to have vaginal discharge upon physical exam.
When conducting the health assessment for this patient, the provider must be sensitive to the fact that she is a lesbian and use the term partner (not husband or boyfriend) when asking questions about her relationships and sexual activities. Additionally, replacing the word father with the donor when asking about the donor’s health helps to determine any possible risks associated with insemination to the mother or the child without offending the patient. When determining social or familial support, sensitivity should be given to the fact that many gay and lesbian patients have been ostracized from their families, friend groups, or religious affiliations they may have had before “coming out.”
For this patient, I would ask the following five targeted questions when assessing this patient’s health risks, while building rapport and a comprehensive health history:
TARGETED QUESTIONS
1. Tell me about your health up to this point, and any concerns you have regarding the health of you or your baby and/or pregnancy
2. How did you come to decide on insemination, and what do you know about the donor?
3. Tell me about your work/life balance, and what a normal day looks like for you (to include diet, physical activity, work, play, and living arrangements)
4. Tell me about your support system and significant family and friends (to determine if the patient is in a romantic relationship with anyone, with further focus on potential violence or STDs, depending on the information given)
5. What can I do for you today to make you even better than you were when you came in?
Conclusion
Understanding the social determinants of each patient allows practitioners to provide individualized care, addressing specific health risks, concerns, and issues, increasing positive outcomes, and decreasing healthcare gaps. Although the HEEADSSS assessment tool is geared towards adolescent patients, it is comprehensive and can be tailored to address the complex needs of each patient (Ball et al., 2019). Maintaining an interested posture with an open and respectful communication style allows patients that are marginalized to reveal their real needs and builds the foundation of trust between patients and providers.
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.
Everett, B., Kominiarek, M., Mollborn, S., Adkins, D., & Hughes, T. (2019). Sexual orientation disparities in pregnancy and infant outcomes. Maternal & Child Health Journal, 23(1), 72–81. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1007/s10995-018-2595-x
Nordqvist, S., Sydsjö, G., Lampic, C., Åkerud, H., Elenis, E., & Skoog Svanberg, A. (2014). Sexual orientation of women does not affect outcome of fertility treatment with donated sperm. Human Reproduction, 29(4), 704–711. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1093/humrep/det445
Tzur, P., Sarid, O., & Kushnir, T. (2019). Nurses’ perceptions of their relationships and communication with lesbian women seeking perinatal care. Journal of Clinical Nursing, 28(17/18), 3271–3278. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1111/jocn.14904
GRADING RUBRIC:
Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.
Learning Resources
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.
• Chapter 1, “The History and Interviewing Process” (Previously read in Week 1)
This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients.
• Chapter 2, “Cultural Competency”
This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.
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.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
• Chapter 2, “Evidenced-Based Clinical Practice Guidelines”
Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2014). Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis. Journal of Asthma, 51(7), 703–713. doi:10.3109/02770903.2014.906605
Credit Line: Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis by Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J., in Journal of Asthma, Vol. 51/Issue 7. Copyright 2014 by Taylor & Francis, Inc. Reprinted by permission of Taylor & Francis, Inc. via the Copyright Clearance Center.
The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma.
Centers for Disease Control and Prevention. (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence
This website discusses cultural competence as defined by the Centers for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website.
United States Department of Human & Health Services. Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent care. Retrieved June 10, 2019, from https://cccm.thinkculturalhealth.hhs.gov/
From the Office of Minority Health, this website offers CME and CEU credit and equips healthcare professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.
Espey , D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health, 104(Suppl 3), S303–S311.
The authors of this article present patterns and trends in all-cause mortality and leading cause of death in American Indians and Alaskan Natives.
Wannasirikul, P., Termsirikulchai, L., Sujirarat, D., Benjakul, S., & Tanasugarn, C. (2016). Health literacy, medication adherence, and blood pressure level among hypertension older adults treated at primary health care centers. Southeast Asian Journal of Tropical Medicine and Public Health, 47(1), 109–120.
The authors of this study explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving healthcare services at primary healthcare centers.
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