Diversity and Health Assessment

Huang et al. (2020) conducted a qualitative study to understand the patients’ perceptions who had frequent readmissions. In their study, Huang et al. (2020) found that physical, mental, and social deprivations at their home contribute significantly to their frequent admission. Sometimes, frequenters in hospital settings are colloquially referred to as ‘frequent flyers.’

Diversity and Health Assessment

My assigned case for this week’s discussion is about a 28-year-old African American female who was seen in the clinic last four days ago with a migraine and was discharged on medications – lorazepam and ketorolac. Today, she presents again with severe headaches, but she is concerned that she may not get any medications.

She is accompanied by her father. In this discussion, I attempt to explain the socioeconomic, spiritual, lifestyle, and other cultural factors that might be associated with this patient and explain issues that I would be sensitive about when building her health history.

Socioeconomic Factors

The social and economic determinants of health care contribute to care quality and access. Readmissions in the hospital may reflect the health disparities among populations or races (Dains et al., 2019; Centers for Disease Control and Prevention, 2022). Poverty, lower educational level, and low income are some of the critical factors for readmission and care access.

While this patient was prescribed ketorolac and lorazepam, the chances are that she could not afford these medications; thus her primary condition was not fully treated, and she had to seek care again with the hope of other medical alternatives and medications.

A population-based study by Murray et al. (2021) reported that social, economic, and demographic factors are associated with 30-day readmission rates and thus should be considered during the medical interventions patients receive. Proper discharge planning must consider these factors to reduce the chances of readmission.

Spiritual Factors

Whether physical or mental, illness stirs up feelings that reflect our position in the wellness-illness continuum. The fear of death or outcomes of illness makes us spiritual, and this impacts how we perceive and respond to uncomfortable physical or psychological states. According to Ball et al. (2022), faith contributes to the success of the management plans.

Therefore, caution is necessary when tackling faith-based issues in health as they impact the patient’s perspective. Spirituality and sensitive issues such as drug use, alcohol, and sex. This patient’s perception of her illness would explain her revisit in anticipation of similar illness or experiences.

Lifestyle Factors

Sometimes, unplanned revisits to the hospital are due to factors outside the institution’s control. Lifestyle factors are some of the modifiable patient factors that lead to them seeking care for the same reasons. Zhao & Yoo (2021) advocated for customized readmission prevention interventions based on patient lifestyle factors.

It can be suspicious that this patient was prescribed a benzodiazepine and a pain reliever but returned four days later with anxiety. Her cause of anxiety is that she may miss medications. This could be suggestive of a drug use problem that would require further investigations. Lifestyle factors such as diet, alcohol, smoking, physical fitness, and drug use can lead to readmission.

Other Cultural Factors

Cultural practices and beliefs are shared among populations with particular social or demographic characteristics (Centers for Disease Control and Prevention, 2020). Ethnically, various studies have reported that African Americans have higher readmission rates than other races.

In most states, African Americans are a minority population and may be at risk of hospital readmission due to various cultural factors such as religion and family as the basic social unit (Basu et al., 2018). Religion and family have played an important role in health-seeking behavior and perception of health. Culture may have a significant role in these health outcomes, but other noncultural disparities such as income and education have been reported.

Sensitive Issues

Sensitive issues that I will pay attention to when building a health history for this patient include but are not limited to religion, drug use, sex, domestic violence, and alcohol. Understanding these sensitive issues will direct the identification of the cause of the persistence of her headache even after medical interventions. Religion would determine the perspective of contemporary interventions and thus adherence.

Drug use and addiction are likely causes for her revisit bearing in mind that she has been on a benzodiazepine for her anxiety disorder. Violence leading to trauma and headache needs to be ruled out. Alcohol and cigarette use are sensitive topics that require trust with the patient. She is within the reproductive age bracket, and thus we need to rule out reproductive health illness.

Targeted Questions

Some of the questions that I will ask this patient will include:

  1. Have you missed any dose of the previously prescribed medications?
  2. It seems that you are anxious about the possibility of missing to get medications for your headache. How has your faith influenced how you cope with your anxiety?
  3. Has anyone assaulted you psychically or threatened to harm you?
  4. Have you felt that you need more Ativan to feel better?
  5. Tell me about your source of income
  6. Who do you live with at home?

References

  • Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., Stewart, R. W., & Monahan, F. D. (2022). Student laboratory manual for seidel’s guide to physical examination: An interprofessional approach (10th ed.). Elsevier – Health Sciences Division.
  • Basu, J., Hanchate, A., & Bierman, A. (2018). Racial/ethnic disparities in readmissions in US hospitals: The role of insurance coverage. Inquiry: A Journal of Medical Care Organization, Provision, and Financing55, 46958018774180. https://doi.org/10.1177/0046958018774180
  • Centers for Disease Control and Prevention. (2022, October 21). Cultural competence in health and human services. Cdc.Gov. https://npin.cdc.gov/pages/cultural-competence
  • Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment & clinical diagnosis in primary care (6th ed.). Mosby.
  • Huang, M., van der Borght, C., Leithaus, M., Flamaing, J., & Goderis, G. (2020). Patients’ perceptions of frequent hospital admissions: a qualitative interview study with older people above 65 years of age. BMC Geriatrics20(1), 332. https://doi.org/10.1186/s12877-020-01748-9
  • Murray, F., Allen, M., Clark, C. M., Daly, C. J., & Jacobs, D. M. (2021). Socio-demographic and -economic factors associated with 30-day readmission for conditions targeted by the hospital readmissions reduction program: a population-based study. BMC Public Health21(1), 1922. https://doi.org/10.1186/s12889-021-11987-z
  • Zhao, P., & Yoo, I. (2021). Potentially modifiable risk factors for 30-day unplanned hospital readmission preventive intervention—A data mining and statistical analysis. Health Informatics Journal27(1), 146045822199523. https://doi.org/10.1177/1460458221995231

Diversity and Health Assessment Instructions

NURS 6512 Health assessment Week 2
Discussion 2: Diversity and health assessments

CASE STUDY AG is a 54-year-old Caucasian male who was referred to your clinic to establish care after a recent hospitalization after having a seizure related to alcohol withdrawal. He has hypertension and a history of alcohol and cocaine abuse. He is homeless and is currently living at a local homeless shelter. He reports that he is out of his amlodipine 10 mg which he takes for hypertension. He reports he is abstaining from alcohol and cocaine but needs to smoke cigarettes to calm down since he is not drinking anymore

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?