CASE STUDY 1

John Green, a 33-year-old Caucasian man, came to the doctor’s office as a new patient. John was born female, but he identifies and lives as a man. He made this change 2 years ago and has fully transitioned in his family and social life, which was completed last year. Recently, he moved back in with his parents and is currently not working. He has been getting testosterone from the internet and giving it to himself. He hasn’t seen a doctor since he decided to transition, except for getting his suppression medications through Telehealth 3 months ago. His medical history includes smoking two packs of cigarettes daily for the past decade, smoking 3-6 marijuana joints every weekend (he has a medical marijuana card), and experiencing episodes of depression. He has been HIV positive for 3 years but his viral load was well controlled the last time he got blood work done 6 months ago. Lately, he has been feeling very weak, which led him to move back in with his parents. He takes Biktarvy once a day, which he gets delivered for free, and 100 mg of testosterone injections every week. His past medical history is not relevant, and he has never been married. There are no significant health issues in his family history. He is worried about being a burden on his family since moving back home and not having a job, and he is concerned about his declining health.

NURS-6512N WEEK 2 DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION POST

CASE STUDY 2

Shawn Billings, a 28-year-old African American patient, arrives at the clinic today. He has been labeled a “frequent visitor” by the clinic staff because he has been to the clinic last week and also 4 days ago due to a severe headache. On those occasions, he received a shot of Toradol and Ativan and was then sent home. Today, he is back again because his headache is extremely severe. He seems very upset. He is accompanied by his father and is worried that he won’t receive any medication.

John, aged 33, is a Caucasian man who is not married. He is a transgender individual experiencing depression and concerns about his declining health. John prefers to be addressed with he/him/his pronouns.

Socioeconomic StatusJohn is currently not working and hasn’t provided any more details about why he’s not working. He currently lives with his parents and relies on them for support. Because of what’s going on, it’s important for John to have a mental health checkup. He tells us that he feels like a burden and is unhappy with how things are going in his life right now. A depression check, like the PHQ-9, can help the doctor understand better how John is thinking and feeling by giving his thoughts and feelings a numerical value.

Studies have shown that many transgender adults have thought about or attempted suicide, way more than the average in the U.S. In 2015, 51% of transgender people tried to kill themselves, and it’s likely even higher now. So, it’s really important to check if a transgender person is feeling suicidal every time they come for a visit. This patient would benefit from talking regularly with a counselor or mental health expert who knows about LGBTQ patients.

Medical History

John has HIV and is sexually active. Right now, he’s transitioning from being a male to a female, although no surgery has been mentioned yet. But then it’s also said he’s transitioning from female to male. Other than that, there isn’t much to say about his medical past. John regularly gets treatment from a doctor for his HIV meds and overall care. But it’s a bit concerning that he’s getting testosterone from an online source. We need to know if he’s taking the right amount and if it’s safe since it might not meet FDA standards. Also, does this testosterone affect his Biktarvy medication for HIV? We need to check on his HIV status too, even though he had tests and saw a doctor about 6 months ago. But, as a healthcare provider, it’s crucial to gather a complete health history for him.

When it comes to John’s social life, there’s quite a bit to consider. He’s a heavy smoker, doing two packs a day for ten years. He also uses illicit drugs on weekends and lives with his parents. He recently came out as transgender to his family and publicly. As his provider, it’s important to dive deeper into each of these areas. Does he want to quit smoking? How much marijuana does he use and how often? Does he use any other drugs, and why does he use them?

Transgender people often face difficult situations, like sexual abuse or violence, especially after coming out. Half of transgender individuals have experienced violence from a partner after coming out. As a healthcare provider, building trust and making patients feel safe is crucial to talk about these issues. Providers can take training programs like Safe-Zone Training to better understand and support LGBTQ patients. It’s important to ask about sexual activity, partners’ genders, protection use, and if there’s any risk of pregnancy despite being biologically assigned female.

Providers today must offer gender-affirming care, which supports and respects a person’s gender identity while providing medical help without judgment. Many LGBTQ patients experience gender dysphoria, which is distress from a mismatch between their assigned gender and their identity.

John hasn’t mentioned his religious beliefs, which suggests he might not have strong ties to a religion. Despite increasing acceptance, over half of non-religious Americans think society hasn’t fully accepted transgender people. This highlights the need for supportive care for transgender patients.

Transgender adults often struggle to access healthcare due to discrimination, insurance issues, financial constraints, and healthcare providers’ lack of knowledge about transgender health. John might need help affording his meds and healthcare since he’s unemployed. He might also hesitate to seek care because of judgmental attitudes.

5 Targeted Questions for John

Evaluating the patients mental health is key. The following are a few questions to determine his suicide risk,.

• Have you wished you were dead or wished you could go to sleep and never wake up?
• Have you had thoughts of harming yourself?
• Have you ever attempted to harm yourself in the past, with the intent to end your life?

Other questions I would ask the patient may revolve around his sexual activity and history.

• Do you have sex with men, women, or both?
• Do you use condoms with both vaginal and/or anal sex?
• How many sexual partners have you had in the past year?

References

Boyle, P., & Writer, S. S. (2022, April 12). What is gender-affirming care? your questions answered. AAMC. Retrieved March 8, 2023, from https://www.aamc.org/news-insights/what-gender-affirming-care-your-questions-answered

Gerritse, K., Hartman, L., Antonides, M. F., Wensing-Kruger, A., de Vries, A. L. C., & Molewijk, B. C. (2018, November). Moral challenges in transgender care: A thematic analysis based on a focused ethnography. Archives of sexual behavior. Retrieved March 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245036/#:~:text=Six%20main%20themes%20of%20moral,6)%20decision%2Dmaking%20process.

Lipka, M., & Tevington, P. (2022, July 7). Attitudes about transgender issues vary widely among Christians, religious ‘nones’ in U.S. Pew Research Center. Retrieved March 8, 2023, from https://www.pewresearch.org/fact-tank/2022/07/07/attitudes-about-transgender-issues-vary-widely-among-christians-religious-nones-in-u-s/

Loyal |. (2020, April 9). Suicide thoughts and attempts among transgender adults. Williams Institute. Retrieved March 8, 2023, from https://williamsinstitute.law.ucla.edu/publications/suicidality-transgender-adults/

Office for Victims of Crime (OVC). (2014, June). The numbers. Sexual Assault: The Numbers | Responding to Transgender Victims of Sexual Assault. Retrieved March 8, 2023, from https://ovc.ojp.gov/sites/g/files/xyckuh226/files/pubs/forge/sexual_numbers.html

What is safe zone? ” The Safe Zone Project. The Safe Zone Project. (n.d.). Retrieved March 8, 2023, from https://thesafezoneproject.com/about/what-is-safe-zone/

response

This post is really informative, and I found it quite interesting. I’d like to build on what you’ve shared by discussing the specific questions you plan to ask your patients. Firstly, as a nurse, conducting a mental assessment is crucial because it helps us understand how patients are thinking about their problems. Your questions about suicidal thoughts aim to see if a patient might harm themselves. As a nurse, you could also ask about personal history, like work and marital status, current social life, and any issues with alcohol or drugs. Asking about suicidal thoughts is especially important because, in my recent interview with a patient, I noticed signs of depression, and addressing these thoughts could help prevent self-harm. These assessment questions play a vital role in making decisions and diagnosing conditions. Health providers, according to Aboraya et al. (2016), rely on patients’ responses to observe behavior and accurately diagnose signs and symptoms.

References

Aboraya, A., Nasrallah, H., Muvvala, S., El-Missiry, A., Mansour, H., Hill, C., … & Price, E. C. (2016). The Standard for Clinicians’ Interview in Psychiatry (SCIP): A Clinician-administered Tool with Categorical, Dimensional, and Numeric Output—Conceptual Development, Design, and Description of the SCIP. Innovations in clinical neuroscience, 13(5-6), 31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5077257/

Välimäki, M., Lantta, T., Lam, Y. T. J., Cheung, T., Cheng, P. Y. I., Ng, T., & Bressington, D. (2022). Perceptions of patient aggression in psychiatric hospitals: a qualitative study using focus groups with nurses, patients, and informal caregivers. BMC psychiatry, 22(1), 344.https://link.springer.com/article/10.1186/s12888-022-03974-4Links to an external site.

NURS-6512N WEEK 2 DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION Case Study

Patient History

John Green, 33 year-old Caucasian male, presents to the office to establish as a new patient.

John was born as a girl, but now he feels like he’s a boy. He made this change two years ago and completed it fully last year, telling his family and friends. Right now, he’s moved back in with his parents and doesn’t have a job. To continue his transition, he’s been buying testosterone online and giving it to himself. He hasn’t seen a doctor since deciding to transition, except for getting some medications online three months ago. John has a history of smoking heavily for ten years, using marijuana regularly, and dealing with episodes of feeling really sad. He’s been living with HIV for three years, but his last blood test six months ago showed that the virus was under control. Lately, he’s been feeling very tired, which is why he moved back home. He takes a medication called Biktarvy every day, which he gets in the mail for free, and injects 100 mg of testosterone into his muscle every week. He doesn’t have any other significant medical history, hasn’t been married, and doesn’t have any major illnesses in his family. John is worried about being a burden on his family now that he’s back home and doesn’t have a job. He’s also concerned that his health might be getting worse.

When looking at John’s situation, there are many things that could affect his health. Being transgender, he might face discrimination and judgment from others. Also, not having a job and relying on his family for support can make him feel stressed and upset. His smoking, marijuana use, and struggles with depression are also important factors in his health. Plus, being HIV positive and not getting regular medical care could have serious effects on his physical well-being.

It’s really important for healthcare providers to understand a patient’s background and experiences, especially when they first meet them. To learn more about John’s health, I would ask him sensitive questions about his gender identity and how it’s affected his health. Then, I’d ask about his smoking, marijuana use, depression, and how he’s managing his HIV.

There are five targeted questions that would aid me on this and these are;

1. Tell me about your gender identity and how it has affected your healthcare experiences?
2. How long have you been smoking cigarettes, and how many do you smoke per day?
3. Describe your marijuana use, including how often you use it and how it affects you?
4. How do you manage your depression episodes, and have you sought any treatment?
5. How have you been managing your HIV status, and have you had any recent blood draws to check your viral load?

Communicating with patients from diverse cultural backgrounds often present challenges for nurses and a key strategy is to approach patients with an open mind and a willingness to learn about their culture and beliefs (Seelman et al., 2017). When need be, nurses can use the services of and to promote effective communication. Importantly, it is essential to avoid making assumptions and to ask open-ended questions that allow patients to share their experiences and concerns.

  References

Hines, D. D., Laury, E. R., & Habermann, B. (2019). They just don’t get me: A qualitative analysis of transgender women’s health care experiences and clinician interactions. The Journal of the Association of Nurses in AIDS Care, 30(5), e82. https://doi.org/10.1097/JNC.0000000000000023Links to an external site.

Seelman, K. L., Colón-Diaz, M. J., LeCroix, R. H., Xavier-Brier, M., & Kattari, L. (2017). Transgender noninclusive healthcare and delaying care because of fear: connections to general health and mental health among transgender adults. Transgender health, 2(1), 17-28. https://doi.org/10.1089/trgh.2016.0024Links to an external site.

Truong, M., Paradies, Y., & Priest, N. (2018). Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC health services research, 14(1), 1-17. https://doi.org/10.1186/1472-6963-14-99Links to an external site.

NURS-6512N WEEK 2 DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION  CASE STUDY 2

Initial Post:

Specific Socioeconomic, Spiritual, Lifestyle, and Other Cultural Factors Associated With the Patient

The person I’m helping today is 28 years old and comes from the African American community. He’s come to the clinic feeling really bad with a really bad headache and he’s also very agitated. He was here at the clinic just last week and also four days ago because of a migraine. Last time, the doctors gave him Toradol and Ativan before he left. Today, he’s here again, and he’s come with his dad. He’s worried that he won’t be able to get any medicine this time. Maybe he’s thinking this because he’s been coming to the clinic a lot, or he’s not sure if he can afford the treatment, or he had a not-so-good experience with the clinic staff before. My job today is to listen carefully, understand what he’s going through, and give him the best care I can.

Studies have shown that minority groups, like African Americans, don’t always get the same good healthcare as others. The Centers for Disease Control and Prevention said in 2017 that African Americans often have more problems with money or society that can affect their health compared to white people. For example, more African Americans might not have jobs, might be poor, or might have obesity, which can all make their health worse. Today, I’ll try to find out as much as I can about what’s going on with him and work together to make a plan for treatment that matches what he wants and needs.

How I’ll Learn About His Health

To understand what’s happening with my patient’s health, I’ll act calmly and professionally. I’ll make sure to look him in the eyes and really listen when he talks so he feels comfortable telling me everything. If he mentions something I don’t know about, like a type of treatment that’s common in his culture, I’ll ask him to explain. Since his dad is here with him today, I’ll ask if he wants his dad to stay or leave while we talk and I examine him. Doing these things will help us have a good conversation and make sure he feels respected and cared for.

Targeted Questions to Ask to Build His Health History and Assess His Health Risks

• What are your goals for this visit? (e.g., pain relief, discovering the cause of the headaches, or finding ways to prevent headaches)
• Have you had any recent major life changes? (e.g., loss of employment, income, housing, relationship status change, or serious illness or loss of a close relative or friend)
• What are your usual diet and sleep patterns?
• I know your father is with you, what other sources of support do you have?
• Do you have any specific values or beliefs related to your health such as traditional vs. modern medicine?

Strategies to Employ to be Sensitive to Different Cultural Factors 

According to Young and Guo (2020), cultural diversity variables can increase the opportunity for miscommunication with our patients. Providers need to be culturally competent, adaptable, and genuinely curious about their patient’s culture, beliefs, and values to foster a trusting relationship (Ball et al., 2019, p. 22). As practitioners, we need to approach each person as an individual. One model we can utilize in our interactions with patients is the RESPECT Model which is patient-centered and includes rapport, empathy, support, partnership, explanations, cultural competence, and trust (Ball et al., 2019, p. 31). This model can assist us with better understanding patients from different cultures and treating them as individuals.

 References:

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (Eds.). (2019). Cultural competency. Seidel’s guide to physical examination: An interprofessional approach (9th ed., pp.22-31). St. Louis, MO: Elsevier Mosby.

Centers for Disease Control and Prevention. (2017, July 3). African American Health. Centers for Disease Control and Prevention. https://www.cdc.gov/vitalsigns/aahealth/index.htmlLinks to an external site.

Young, S., & Guo, K. L. (2016). Cultural diversity trainingLinks to an external site.. The Health Care Manager, 35(2), 94–102. https://doi.org/10.1097/hcm.0000000000000100Links to an external site.

NURS-6512N WEEK 2 DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION SAMPLE POST 2

Cultural Competence

Understanding and improving communication between different cultures is the first step in being good at providing healthcare. This means thinking about how people from different backgrounds might talk and act, and finding ways to make sure they feel comfortable and understood when they come for medical help. One way to do this is by using something called the RESPECT model, which helps healthcare providers make sure their patients are at the center of their care. RESPECT stands for Rapport, Empathy, Support, Partnership, Explanations, Cultural Competence, and Trust. It’s important for healthcare providers to be aware of their own ideas and biases about different cultures when using this model.

Let’s look at a case study of a 28-year-old African American man who often visits the hospital because of his migraines. Even though he’s been there many times before, it’s crucial to build a good relationship with him each time. We shouldn’t assume things about him just because he comes in a lot, but treat him with respect and without judging him.

To build rapport with him, we should ask questions like when his migraines started and how long they’ve been happening. We should also ask him to tell us about his experiences with migraines and treatments so far.

Empathy is important because he’s in pain and seeking help. Just acknowledging that he’s going through a tough time can show him that we understand and care. His agitation might be because he hasn’t felt taken seriously before.

Support is crucial too. He’s worried about not getting the right medications and feels like his trip to the hospital might be pointless. Understanding what he thinks is stopping him from getting better can help us figure out how to help him. Asking him directly about what has been difficult in the past can guide us in his treatment today.

Partnership means showing him that we’re working together as a team to find a solution. We can ask him what he thinks might help his migraines or what has worked for him before. It’s important for everyone involved to understand what they expect from the treatment.

Explanations are important too. We should check in with him often to make sure he understands what’s going on. Using his own words and making sure he understands everything as we go along can make him feel listened to and cared for.

NURS-6512N WEEK 2 DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION

Understanding and being respectful of different cultures is a part of the RESPECT model that some healthcare providers might feel unsure about because it involves talking about sensitive topics. When healthcare providers ask personal questions, it can feel uncomfortable for both them and the patient. Different cultures have different levels of openness about personal matters, so it’s essential to approach each person with respect for their cultural background. For instance, in some cultures, it’s not polite to look someone directly in the eyes while talking, so healthcare providers need to be aware of these cultural differences, especially when asking sensitive questions. Questions should focus on understanding any cultural, lifestyle, spiritual, religious, or economic factors that could affect the patient’s care, and they should be asked respectfully while putting aside any biases the healthcare provider may have.

Certain things like stress, lack of sleep, and specific foods can trigger migraines. Cultural practices, such as dietary habits, work routines, and sleep patterns, can also influence migraine triggers. Asking questions like “what have you been eating regularly lately” can help identify possible triggers. Another important question is whether the patient has tried any other treatments for their migraines, including alternative or herbal therapies. Asking sensitive questions like “what was your gender assigned at birth” can provide valuable information, as migraines are more common in women, especially around menstrual cycles. For transgender individuals, hormone levels and stress related to gender identity can also play a role in migraine frequency. Additionally, exploring psychiatric conditions like anxiety and depression, which are more prevalent in sexual minority groups, can offer insights into migraine patterns.

Trust is the final step in the RESPECT model, and it’s crucial for building a strong relationship between patients and healthcare providers. When patients trust their healthcare providers, they’re more likely to share information openly. However, if trust isn’t established, it might be necessary to acknowledge that the partnership isn’t working and involve another healthcare provider in the patient’s care.

Cultural competence is an ongoing process that requires healthcare providers to continuously learn and adapt their practices. One essential way to do this is by listening to and learning from our patients. Gathering feedback on how patients perceive their visits can help healthcare providers improve their cultural understanding and humility.

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.). Elsevier.

Befus, D. R., Irby, M. B., Coeytaux, R. R., & Penzien, D. B. (2018). A Critical Exploration of Migraine as a Health Disparity: the Imperative

of an Equity-Oriented, Intersectional Approach. Current Pain and Headache Reports, 22(12), 79. https://doi.org/10.1007/s11916-018-0731-3

McCance, K.L. & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children, (8^th ed.). Elsevier.

Pace, A., Barber, M., Ziplow, J., Hranilovich, J. A., & Kaiser, E. A. (2021). Gender Minority Stress, Psychiatric Comorbidities, and the

Experience of Migraine in Transgender and Gender-Diverse Individuals: a Narrative Review. Current Pain & Headache Reports, 25(12), 1–9. https://doi.org/10.1007/s11916-021-00996-7

Rosenthal, L.D. & Burchum, J.R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants, (2^nd ed.) NURS-6512N WEEK 2 DIVERSITY AND HEALTH ASSESSMENTS DISCUSSION .