Main discussion post – Week 2 – Case 1
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Main Question Post – Week #2
Diversity and Health Assessments
I have been assigned to build a health history for patient JC, who is an 86-year-old Asian male who is financially and physically dependent on his daughter. First and foremost, I would research his specific culture to identify effective communication techniques to use while interacting with the patient before the assessment. For example, Japanese culture tends to use indirect conversation with more focus on feelings, an addition to eye contact may be considered rude in some Asian cultures (Ball, Dains, Flynn, Solomon, & Stewart, 2019, p. 27). A great way to get a complete detailed history, as well as effective care plan, would be to invite his daughter along during the visit with the patient’s permission.
If the patient’s daughter can partake in the routine physical with her father, I would confirm with the patient that speaking about his health history in his daughter’s presence is acceptable. I would allow enough time for both the patient and his daughter to contribute to the health history, with concluding the visit with just JC to do his physical assessment as well as address any concerns he has in private.
With JC having a history of multiple health diagnoses including hypertension, GERD, b12 deficiency, and chronic prostatitis; health literacy and medication adherence must first be confirmed. Once the patient’s preferred language is identified, I would first ask the patient using the appropriate available translator, “Tell me what you know about your various diagnoses.” This question would help determine the health literacy of the patient which will, in turn, contribute to their medication adherence. According to an article found in the Southeast Asian Journal of Tropical Medicine and Public Health, it was discovered that patients lacking adequate knowledge about their hypertension, as well as the treatment, did not take their prescribed medications (Wannasirikul, Termsirikulchai, Sujirarat, Benjakul, & Tanasugarn, 2016, p. 116).
The second question I would ask JC includes, “Are there any religious or spiritual preferences that may impact your health care needs?” This question is a great way to learn about the spiritual beliefs of the patient, as well as discover their involvement in a religious community. Learning about their spiritual community can help identify other possible resources for JC so he would not feel like such a burden to his daughter, as well as explore his social network.
The third question I would include is, “Who makes decisions for the family?” This question helps determine the familial roles of the household according to their culture. In many Asian cultures, the children take responsibility for caregivers of their parents, with rarely ever relying on more formal support such as institutions (Kanti & Falconier, 2017, p. 74). Knowing the cultural considerations of this family, perhaps providing more support options to the daughter could be beneficial or even encouraging the patient to contribute to child-care or cooking needs could benefit the household. Even if it is very small tasks for JC to help with, it could assist his daughter with her responsibilities as well as helping JC feel like less of a burden.
The fourth question I would ask includes, “Who prepares the meals at the household?” This question would help investigate the knowledge of food preparation at home, as well as introduce some teaching regarding dietary changes that could benefit JC. For example, a Chinese patient with hypertension could benefit from limited use of soy sauce or monosodium glutamate to help lower their sodium intake (Ball, Dains, Flynn, Solomon, & Stewart, 2019, p. 29). This question may also introduce areas that JC could contribute to meal prep in some way, even it is just setting the table.
The last significant question I would ask both the patient and his daughter is, “Tell me about what we discussed today,” in order to obtain a teach-back to ensure the information was understood. With the opportunity for a cultural barrier in obtaining the health history on JC, it is essential to explore how much of the assessment/education was comprehended. This question can also help identify areas that need more focus and discussion.
As a future advanced provider, it is critical to be culturally competent when providing care to our patients. Educating ourselves on cultural diversity will assist in ensuring our patients are receiving the best care to suit their individual needs.
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.
Kanti, M. K., & Falconier, M. K. (2017). Asian Americans Caring for Elderly Parents in the U.S. Journal of Cultural Diversity, 24(3), 73–83. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=125586773&site=eds-live&scope=site
Wannasirikul, P., Termsirikulchai, L., Sujirarat, D., Benjakul, S., & Tanasugarn, C. (2016). Health Literacy, Medication Adherence, and Blood Pressure Level among Hypertensive Older Adults Treated at Primary Health Care Centers. Southeast Asian Journal of Tropical Medicine and Public Health, 47(1), 109–120. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edswsc&AN=000370676000013&site=eds-live&scope=site
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