John Green, the 33-year-old Caucasian male Diversity and Health Assessment Discussion
John was born as a female but identifies as male. He transitioned from being female to male two years ago and fully adapted to his new gender role socially and with his family last year. Recently, he moved back in with his parents and is currently without a job. He buys testosterone online and self-administers it. Apart from getting his hormone suppression drugs online three months ago, he hasn’t seen a healthcare provider since his transition. His medical history includes heavy smoking for the past decade, regular marijuana use, and bouts of depression. He’s been HIV-positive for three years but has been successfully controlling the virus for the last six months. Lately, he’s been feeling very weak, which led him to move back in with his parents. He takes a daily medication called Biktarvy for HIV, which he receives by mail for free, and injects 100 mg of testosterone every week. He has no significant past medical history, has never been married, and there are no notable health issues in his family. John is concerned that being unemployed and living with his parents will strain his family and worsen his health.
Consider the different factors in John’s life that could affect his health: his economic situation, his beliefs, his way of life, and any other aspects of his culture.
John Green, the 33-year-old Caucasian male Diversity and Health Assessment Discussion
Case Study 1
John Green, the 33-year-old Caucasian male, presents to the office to establish himself as a new patient. John’s natal sex is female, but he identifies as a male. He transitioned from female to male, 2 years ago. He has made a full transition with family and socially last year. He just moved back home and is unemployed at this time. He has obtained testosterone from the internet to give to himself. He has not had any health care since he decided to change other than getting his suppression medications through Telehealth 3 months ago. His past medical history includes smoking 2 packages of cigarettes per day for the last 10 years, smoking 3-6 marijuana joints every weekend (has an active green card), and does suffer from depressive episodes. He has been HIV-positive for the last 3 years. But remains viral suppression at his last blood draw 6 months ago. He has been feeling very weak over the last few weeks, which prompted him to move back home with his parents. He takes Biktarvy once daily which comes in the mail for free, tolerates it well, and 100 mg Testosterone IM every 7 days. His PMH is non-contributory. No past medical history. He has never been married. No significant family history. He is worried since moving back home and being unemployed, he will be a burden on his family, and he thinks his health may be declining.
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 of the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture?
When preparing a medical history for Case Study 1 Mr. J.G.
We’ll make sure to respect and support the gender identity of the patient. This means using the name and pronouns they prefer when we talk to them. It’s important for the patient to feel recognized and affirmed in their gender identity, as mentioned by Ball et al. (2019) in the Diversity and Health Assessment Discussion for week 2. During the physical exam, we’ll focus on the patient’s current anatomy and avoid making assumptions about their identity or body. Understanding the unique changes and challenges of hormone therapy and surgeries is crucial, so we’ll ask sensitive questions to gather this information. Mr. J.G. is a transgender man, which means he was assigned female at birth but identifies as male. As the healthcare provider, it’s important for me to ask respectful questions about Mr. J.G.’s sexual partners and practices, considering the increased risk of domestic violence among transgender individuals, as discussed in the article by Base and Nagy on Cultural Competence in the Care of LGBTQ Patients. We’ll also address his access to healthcare, financial worries, and support system since he returned home.
To gather Mr. J.G.’s health history and assess his health risks, we might ask:
1. How many sexual partners have you had?
2. What genders do your sexual partners identify as?
3. Are you currently sexually active?
4. When were you diagnosed with HIV?
5. What was your most recent CD4 count?
6. Have you used any illicit drugs in the past?
The gender-affirming approach would be prioritized. Ensuring the right name and pronouns are used during our interview. Affirmation of gender is necessary to confirm the manner in which the patient wishes to be identified in social interactions (Ball. J, et al, 2019) Diversity and Health Assessment Discussion week 2. Regardless of gender presentation, the physical examination should be pertinent to the existing anatomy and free of any presumptions about identity or anatomy. Cultural Knowledge related to comprehending the numerous and unique changes and peculiarities in the context of hormone therapy and surgical interventions, a sensitive history taking is necessary. Mr. J.G. is a transgender man. Transgender males are females who identify as males. As the provider, I will need to ask sensitive questions regarding Mr. J.G. Sex partners and sex practices. The article by Brittany Base and Hassan Nagy entitled “Cultural Competence in the Care of LGBTQ Patients”. Indicates that domestic violence is more frequent in transgender patients. Issues regarding domestic violence will need to be addressed. In addition, access to health care and financial concerns will need to be addressed. Also assessing his support system since he returned home.
Develop five targeted questions you would ask the patient to build his or her health history and assess his or her health risks.
- How many sexual relationships have you had?
- What is the gender of your sex partners?
- Are you currently having sex?
- Can you tell me when you were diagnosed with HIV?
- What was your most recent CD4 count?
- What illicit drugs have you experienced?
- Diversity and Health Assessment Discussion week 2
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 pertinent information?
Cultural awareness is always important for me as a nurse practitioner (NP). Reflecting on my own beliefs and practices helps me provide care that respects and values each patient’s unique background. This means being nonjudgmental, respectful, and attentive to their needs and preferences. I believe in informing patients about their conditions and involving them in decisions about their care. It’s my responsibility to deliver high-quality care to all patients, practicing cultural humility.
Mr. J.G. faces potential stereotyping, judgment, or prejudice due to his immigrant status, being transgender, substance use, and history of HIV. It’s crucial not to overlook his health beliefs and cultural diversity, especially if someone involved in his care doesn’t respect these differences. This is why cultural competence is vital for me as a future NP. By understanding and respecting each patient’s concerns, I can help them make informed healthcare decisions without imposing my own biases.
In summary, as a nurse practitioner, it’s essential to employ all aspects of cultural competence when interacting with patients. This involves listening to their perspectives and supporting them in making choices that align with their cultural backgrounds and values.
Cultural awareness is always important for me as a nurse practitioner (NP). Reflecting on my own beliefs and practices helps me provide care that respects and values each patient’s unique background. This means being nonjudgmental, respectful, and attentive to their needs and preferences. I believe in informing patients about their conditions and involving them in decisions about their care. It’s my responsibility to deliver high-quality care to all patients, practicing cultural humility.
Mr. J.G. faces potential stereotyping, judgment, or prejudice due to his immigrant status, being transgender, substance use, and history of HIV. It’s crucial not to overlook his health beliefs and cultural diversity, especially if someone involved in his care doesn’t respect these differences. This is why cultural competence is vital for me as a future NP. By understanding and respecting each patient’s concerns, I can help them make informed healthcare decisions without imposing my own biases.
In summary, as a nurse practitioner, it’s essential to employ all aspects of cultural competence when interacting with patients. This involves listening to their perspectives and supporting them in making choices that align with their cultural backgrounds and values.
Cultural awareness is always necessary to gain a better understanding of my practice as an NP. Self-reflection allows me to provide patient-centered care that is nonjudgmental, respectful, and attentive to the patient’s concerns and preferences. This includes informing patients about their condition and allowing them to participate in their care. As a nurse practitioner, I am responsible for providing quality care to all patients under my care using cultural humility.
Mr. J.G has lifestyle can raise stereotypes judgments or prejudices against him, because he is an immigrant, transgender, substance abuse, and has an HIV status history. His health beliefs and cultural diversity can be overlooked if he has someone that does not respect his cultural differences. This is why it is important that I be culturally competent to avoid using judgment when caring for patients. As a future nurse practitioner, it is essential that all the dimensions of cultural competence be used with all patients. It’s working with patients to understand their concerns and helping them make health care choices
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.
Bass B, Nagy H. Cultural Competence in the Care of LGBTQ Patients. (Updated 2022 Oct 3). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Retrieve from: https://www.ncbi.nlm.nih.gov/books/NBK563176/ Diversity and Health Assessment Discussion week 2
