Week 2 Main Discussion Post Essay.

Your post was very comprehensive and included important details that every healthcare provider should consider to provide culturally competent patient-centric care to patients in the LGBT community. The LGBT community comprises of patients from different religions, ethnicity, and social class.Week 2 Main Discussion Post Essay.

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It is integral for healthcare providers to create a trusting relation and environment that inspires a patient to communicate their specific needs freely. As suggested by Ball et al. (2019), this should however start with identifying and addressing personal biases and acknowledging that   LGBT patients are at a high risk of discrimination. The approach a nurse uses in the societal diversity of her needs should be sensitive and nondiscriminatory. The cultural knowledge that the patient identifies with must not be formative in making conclusions. Rather, the nurse should use the knowledge to formulate more constructive questions.Week 2 Main Discussion Post Essay.

The purpose of identifying TJs gender preference is to develop highly sensitive target questions to ask her when building her health history. According to the CDC (2020), even though there are no known differences in the physiology of heterosexual women and lesbians, sexual orientation (lesbian) does not inherently affect a person’s health status. Instead, specific risk factors and behaviors that are common among lesbians can lead to grave health consequences. Knowing the specific risk factors and practices associated with a person’s sexual orientation can help clinicians to formulate focused questions and determine the best strategy to assess a person’s risks (CDC, 2020). Clinicians should not use their knowledge in cultural and diversity differences to make assumptions but rather, incorporate that knowledge to determine and address the individual needs of a patient.

Your post was very informative and insightful on the cultural issues to consider when obtaining a health history from patients with Asian American descent. It is important to obtain JC’s thoughts about the financial assistance that he receives from his daughter, who has limited finances and lacks a form of income. Most Asians with a low socio-economic status believe that it is culturally shameful to seek public assistance. Therefore, for those who are unable to obtain much-needed assistance, they are likely to have poor healthcare-related outcomes. Obtaining this information also helps to inform the decision to involve social workers and making him aware of the available social services.

Healthcare practices and beliefs also affect the delivery of healthcare services to Asian American patients. Most of them only seek Western healthcare services when traditional medicine fails. The most common traditional medicine practices are skin scraping, herbal supplements, acupuncture, and cupping. It is thus important to note that some herbal medicines have active pharmacological ingredients, which can interfere with the pharmacokinetics and pharmacodynamics of prescribed medications. Therefore, as suggested by the CDC (2015), when exploring the history of this patient, the nurse practitioner should also explore the use of herbal supplements and traditional medicines.Week 2 Main Discussion Post Essay.

As you have highlighted, nurse-patient communication is also a fundamental part of building a comprehensive health history. Therefore, as emphasized by Ball et al (2015), when taking JC’s health history, a nurse should pay special consideration to language, as it is a potential communication barrier. In such a case, healthcare providers can always consider using professional interpreters. Besides, it is also important to comprehend what various non-verbal communication cues imply. In Asian cultures, smiling may be a sign of embarrassment and confusion, avoiding eye contact demonstrates respect, and nodding does not imply understanding.Week 2 Main Discussion Post Essay.

Week 2: Ann-Marie Douglas Main Discussion Post

Scenario:  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”

This is an elderly patient who lives with his daughter as stated in the above-mentioned scenario. This patient is no longer independent where he can provide for himself financially therefore, he depends on his daughter for support. His daughter has all these extra responsibilities and appears to be overwhelmed according to his utterance of “I do not want to be a burden to my daughter”. Caring for the elderly in the family according to Asian culture is the responsibility of the immediate family members, as they remain the main source of emotional, physical, spiritual and financial support for their ageing parents (“Caring for aging Chinese: Lessons learned from the United States,” n.d.).Week 2 Main Discussion Post Essay.

It is important to ensure patient comfort as this will allow for openness and trust between patient and caregiver. It is also very important to ask open ended questions and to allow this patient to express themselves fully. It is very important that the caregiver understands, respect and observe the cultural beliefs and preferences of this patient. It is very important to view each patient as an individual and not group people who tend to have the same physical characteristics together thinking they are all the same. The caregiver needs to maintain safe but comfortable distance between themselves and the patient, avoid piercing eye contact, be on time for their meeting and touch appropriately as these are some of the factors affecting persons in this cultural group (“Understanding transcultural nursing : Nursing2020,” n.d.).Week 2 Main Discussion Post Essay.

I would ask this patient the following five questions:

1. Why do you feel like you are a burden to your daughter?
2. How have you been eating?
3. Are you able to afford your medications?
4. Have your daughter ever raised her voice at you or voiced her frustrations about taking care of you?
5. Have you been compliant with your medications?

As primary care nurse, it is important to understand and appreciate that our patient population is diverse and that persons may look like a group but not share the exact same belief due to cultural diversities and independence of beliefs. To communicate effectively with patients, we need to be aware of this and be sensitive in our approach to care. It is important to provide patient privacy and establish trust. This can be done by asking culturally appropriate questions and providing patients with the opportunity to show us how they want to be treated. Management can help by implementing programs that help to improve cultural awareness and ethnic diversity into staff education as this will intern improve healthcare outcomes for patients and their families (“Cultural competence and ethnic diversity in healthcare,” n.d.).Week 2 Main Discussion Post Essay.

Case Study Assignment: TJ, a 32-year-old pregnant lesbian, is being seen for an annual physical exam and has been having vaginal discharge. Her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. She is currently taking prenatal vitamins and takes over the counter Tylenol for aches and pains on occasion. She has a strong family history of diabetes. Gravida 1; Para 0; Abortion 0

In this discussion, I will explain the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with this patient. I will explain the issues that I would need to be sensitive to when interacting with the patient, and why. Lastly, I will provide at least five targeted questions that I would ask the patient to build her health history and to assess her health risks.

Cultural competency calls for every nurse and future practitioner to be aware of and sensitive to cultural and diversity issues. It is not possible to know all customs, rules, laws of every patient’s background but we can start by examining our own beliefs and assess our own biases when it comes to other cultures and the way in which people differ from us.  As providers of care, we will inevitably have encounters with patients of diverse backgrounds and beliefs.  Cultural competency often recalls patients with different races and ethnic backgrounds; however, culture can also include socioeconomic status, sexual orientation, age, occupation, profession, disability, and many other examples (Andrews, 2016). The United States has been known as a melting pot of cultures for many decades and with that diversity plays a significant role in healthcare; “approximately 4% of the U.S. adult population (or 9 million people) identified themselves as lesbian, gay, bisexual, or transgender (LGBT), and even larger numbers stated that they had same-sex experiences or were attracted to the same sex without necessarily identifying themselves as LGB” (Jarvis, 2016).

As nurses and future practitioners, we should be abreast of changes, especially when it comes to topics that affect the LGBTQ community. Alternative childbearing options have posed striking options to norms of human reproduction and the traditional notion of “family.”  Alternative family structures have been on the rise in the United States and other developed countries. In a recent research, it is estimated that there were 5 Million pregnant lesbian mothers in the United States (Gregg, 2018).  Given this information, one cannot assume that every pregnant woman walking into a practice is in a heterosexual relationship. Fewer Americans are choosing to get married, and there is also an increase in single mothers and fathers raising children (Livingston, 2018).Week 2 Main Discussion Post Essay.

It is important to recognize and be aware that lesbian, gay, bisexual, and transgender (LGBT) individuals have had to deal with discrimination, mistreatment, emotional, and physical abuse for many years.  According to Bolderston and Ralph, 2016, in many countries around the world, it is illegal to be gay to the extreme of being punished by death.  For reasons such as this, there is not a big selection of literature on childbearing lesbians as many do not disclose their sexual orientation to their healthcare providers. Unfortunately, even though many LGBT understand the need, to be honest with their providers, and they feel comfortable with being asked questions related to their sexual history and gender identity (Ball et al., 2019), many nurse practitioners are unaware of how to address the questions.  Manzer, O’Sullivan, and Doucet (2019) mention that one of the barriers lies in the documentation systems, which only provide options that are limited to binary answers.

In the case of TJ, it is essential to assess her relationship status and be sensitive when asking questions related to a partner.  LGBT patients have stated that a nurse practitioner that shows non-judgmental behaviors and facial expressions opens the door for a trusting patient-provider relationship (Manzer, O’Sullivan, & Doucet, 2019).  Even though LGBT wants to be respected, understood, and heard, they also want to be treated like anyone else; Manzer, O’Sullivan, and Doucet (2019). When building a health history and assessing TJ, it is vital not to make assumptions and ask questions that show respect and understanding of her sexual orientation.  It is important to include TJ’s partner if she does indeed have one and includes plans for the delivery.  Asking the following questions can open dialogue and build a good rapport.Week 2 Main Discussion Post Essay.

1. Are you currently in a relationship? (is it monogamous?)

2.Sexual history, how many partners? Use of protection for sexually transmitted diseases?

3. What do you do for a living?  (it is important to determine due to the vaginal discharge)
4. What kind of support do you currently have?
5. Knowing she does see an OBGYN regularly, we can assume that she has prenatal care, but we can ask about substance abuse even as simple as smoking and drinking habits.

Jarvis (2016), states that the same questions that one will ask of a heterosexual pregnant female should be asked to the lesbian female if the questions apply.  Just as the family history of diabetes would be an important aspect of a heterosexual mom to be, it is equally important on TJ’s health history and should be addressed.  Jarvis (2016) also mentions that state laws differ in terms of same-sex marriage and even the ability to add both partner names on the birth certificate. Thus, it is imperative to know the laws of one’s current state.

Before physically examining Tj it would be best to ask if I need to address the vaginal discharge or if this is something that was addressed with the obstetrician. If this was not addressed by the OBGYN and TJ would like me to address the situation, I would first question the patient before performing the physical exam and sending the discharge fluid to the laboratory. A physical examination would reveal color and consistency; however, questioning would identify if this is out of the norm for TJ (questioning as mentioned above about sexual behavior and partners would identify potential risk for STDs). Targeted questions would be:Week 2 Main Discussion Post Essay.

1. When did this discharge start?
2. Have you experienced this type of discharge before?
3. Do you have any associating symptoms such as itching or odor?
4. What is the amount of discharge? (small, moderate, large)?
5. What is the color of the discharge?

I would help TJ identify what is considered abnormal vs normal discharge during pregnancy. I would explore the strong family history of diabetes and evaluate if the obstetrician performed screening for gestational diabetes. Screening for gestational diabetes is usually done with the obstetrician; however, the physical will include a comprehensive metabolic panel, along with other laboratory testing that will give insight on overall health. I would send all reporting to TJs OBGYN upon receiving consent to do so.Week 2 Main Discussion Post Essay.

In conclusion, cultural norms are changing. Clinicians will be exposed to many different situations in which they will need to tailor questions in efforts to decrease assumptions and make patients feel at ease during visits. In as much as healthcare needs do not change because of one’s sexual preference thus everyone should be treated equally. Anyone seeking healthcare is entitled to culturally competent care that treats the patient as an individual and not a stereotype drawn from assumptions.Week 2 Main Discussion Post Essay.