NURS 6512 Discussion: Diversity and Health Assessments
case study
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
Discussion post
It has been predicted that by 2050, 50% of the US population will consist of minorities and unfortunately, today’s model of healthcare has been noted to have persistent racial and ethnic discrepancies (Sharma et.al, 2016). Culturally competent patient care includes knowledge, attitudes, and skills that support caring for people across different languages and cultures. In healthcare, it is important to know how to provide quality patient care for all patients from different race’s, disability, socioeconomic status, sexual orientation, gender, nationality, education, religion, ethnicity, veteran status, and physical characteristics (Whitman, 2018). NURS 6512 Discussion: Diversity and Health Assessments
Assigned Case Study
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
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Assessment Needs
Lesbians and bisexual women face the same health issues as heterosexual women but there can be difficulty when accessing appropriate care (Carlson, (2020). An assessment for this patient is the same as it is for a patient that is not a lesbian. The assessment paperwork should have language about sexual orientation, sexual activity, relationship status, gender identity and sex assigned at birth included. All educational materials that are provided for patients should have inclusive images and languages for all ages, genders, races, sexual orientation, and literacy levels as well.
Quality patient care can be improved by recognizing any barriers that could exist for our patients so that we can create a therapeutic relationship with them by ensuring that an inclusive and nonjudgmental history is completed (Friedman, (2020). During the assessment process, it is always important to maintain a standard systematic inquiry that includes, social activities, surgeries, past medical history, current medications, vaccinations, etc. It is also important that patients are provided with privacy, removing distractions, communicate with patients with open-ended questions, and be prepared to provide clarification as needed. Enacting CORE communication with all of our patients will help to establish trust and transparency. CORE stands for Caring – feel and exhibit concerns for others, Open – desire to listen and receive information; and understand another person without prejudice and judgment, Respectful – treat others with consideration, courtesy and high regard and Empathetic – understand others experiences and communicate understanding (Friedman, (2020).
Risk Factors
Statistically, there is an elevated risk for stigmatization and discrimination that can pose to be a threat to this patient’s health and wellbeing which can lead to her being at a higher risk for suicide, becoming a victim of crime, substance use and participating in perceived culturally less accepted behaviors (Friedman, (2020). It is important to maintain positive interactions and be sensitive to our body language as we respect word choices to avoid creating any barriers that would hinder the patient’s transparency (Friedman, (2020).
This case study indicates that the patient is a lesbian and she is pregnant through donor insemination which is a fertility treatment using a sperm donor (American Pregnancy Association, 2020). It is important during the assessment not to assume anything. When asking the patient to tell her story it is important to inquire about her sexual history and sexual behavior that includes sexual safety practices, age of menarche and if the patient has any sexual concerns she would like to discuss. It is important to have the patient discuss who she is intimate with since it may not be congruent with sexual orientation or gender identity. We should not assume the parameters of sexual behavior based on the knowledge provided about the patient’s relationship status and identity.
Patient Complaints and Possible Diagnosis
This patient is complaining of having vaginal discharge. Inquiring when the discharge began, what it looks like if there is an odor, and if there are symptoms such as burning, itching or urinary frequency will help to narrow down the different causes and determine what tests may need to be completed and what treatments. There are several different causes for the discharge to explore. The number one cause that needs to be ruled out is related to the body’s natural response to the pregnancy. There is a normal vaginal discharge that can vary in consistency, thickness, frequency, and amount during pregnancy called leukorrhea (Healthline, 2020). Leukorrhea is thin, clear or milky white, and mild smelling and as the pregnancy progresses the discharge becomes more noticeable as it becomes heavier (Healthline, 2020). It is important to make sure that the assessment questions regarding the discharge characteristics are accurate since the abnormal discharged that could signal complications during pregnancy needs to be ruled out. For instance, if the discharge is bright red and exceeds an ounce it could indicate complications of the pregnancy such as placenta previa or placental abruption (Healthline, 2020).
There are other causes for an increase in vaginal discharge which can be explored such as Candidiasis (yeast infection), sexually transmitted diseases (STDs) like Bacterial vaginosis (BV), and Trichomoniasis). Yeast infections during pregnancy are not uncommon especially during the second trimester and can be caused by the hormonal changes that are occurring. It is difficult for the body to keep up with the chemical changes in the vagina as there is more sugar in the vaginal secretion where yeast can feed (American Pregnancy, 2020). Bacterial vaginosis (BV) is more common in lesbian and bisexual women than heterosexual women and frequently occurs in both members of lesbian couples (WebMed, 2020). When the normal bacteria in the vagina become out of balance BV can develop and present itself with or without symptoms. Symptoms can include vaginal discharge with a fishy odor and vaginal itching. BV can increase a woman’s chance of getting other STDs such as
HIV
,
chlamydia
,
gonorrhea
, and
pelvic inflammatory disease
(WebMed, 2020). Trichomoniasis is passed from one person to another during sexual contact but has a yellow, green, or gray vaginal discharge that is foamy and has a strong odor.
Conclusion
Making sure that the assessment is thorough and all bases are covered will help to ensure that the patient is properly cared for and her pregnancy continues without complications. Providing the patient with appropriate outside support if deemed necessary through the assessment and making sure all paperwork and materials are supportive and compatible with her needs will ensure patient confidence and transparency in the care that is being provided.
Reference
American Pregnancy Association (2020). Yeast Infections During Pregnancy.
https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/yeast-
infections-during-pregnancy-.
Carlson, K. (2020). Cultural Competence and the Nursing Care of the LGBTQ Community.
Nursing CE. https://www.nursingce.com/cultural-competence-and-the-nursing-care-of-
the-LGBTQ-community/
Friedman, J. (2020). Caring for the Health of Lesbians and Bisexual Women.
https://www.uclahealth.org/womenshealth/workfiles/2017/LBWHCTraining/Workingwit
hlesbianandbisexualwomen12142017.pdf
Healthline (2020). Vaginal Discharge During Pregnancy: What Is Normal?
https://www.healthline.com/health/pregnancy/vaginal-discharge-during-pregnancy
University of California
Sharma K, Grant D, Parikh R, Myckatyn T. (2016), Race and Breast Cancer Reconstruction: Is
There a Health Care Disparity?
Plastic Reconstruction Surgery.
138(2):354-61. http://doi:
10.1097/PRS.0000000000002344. PMID: 27465159.
Smith, T. (2016). LGBTQ family building: What physicians need to know.
American Medical
Association.
https://www.ama-assn.org/delivering-care/population-care/lgbtq-family-
building-what-physicians-need-know
WebMD (2020). Women’s Health: Lesbian Health.
https://www.webmd.com/women/lesbian-
health#1
Whitman, S. (2018). The Importance of Diversity in Nursing; Breaking down stereotypes and
inclusivity barriers.
MedPage
.https://www.MedPage today.com/nursing/nursing/76623
Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment
Diversity is not about how we differ. Diversity is about embracing one another’s uniqueness.
—Ola Joseph
Countless assessments can be conducted on patients, but they may not be useful. In order to ensure that health assessments result in the necessary care, health assessments should take into account the impact of factors such as cultures and developmental circumstances.
Learning Objectives
Students will:
Analyze diversity considerations in health assessments
Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment
Learning Resources
Required Readings
(click to expand/reduce)
Required Media
(click to expand/reduce)
Discussion: Diversity and Health Assessments
May 2012, Alice Randall wrote an article for
The New York Times
on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).
Photo Credit: Getty Images
Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.
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?
By Day 3 of Week 2
Post
an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
Note:
For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on
Submit!
Read
a selection of your colleagues’ responses.
By Day 6 of Week 2
Respond on or before Day 6
on 2 different days
to at least
two
of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.
NURS_6512_Week_2_Discussion_Rubric
Grid View
List View
Excellent
Good
Fair
Poor
Main Posting
Points Range:
45
(45%)
– 50
(50%)
“Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
Points Range:
40
(40%)
– 44
(44%)
“Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
Points Range:
35
(35%)
– 39
(39%)
“Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.
Points Range:
0
(0%)
– 34
(34%)
“Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
Points Range:
10
(10%)
– 10
(10%)
Posts main post by Day 3.
Points Range:
0
(0%)
– 0
(0%)
N/A
Points Range:
0
(0%)
– 0
(0%)
N/A
Points Range:
0
(0%)
– 0
(0%)
Does not post main post by Day 3. NURS 6512 Discussion: Diversity and Health Assessments
First Response
Points Range:
17
(17%)
– 18
(18%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.
Points Range:
15
(15%)
– 16
(16%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.
Points Range:
13
(13%)
– 14
(14%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
Points Range:
0
(0%)
– 12
(12%)
“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited. NURS 6512 Discussion: Diversity and Health Assessments
Second Response
Points Range:
16
(16%)
– 17
(17%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.
Points Range:
14
(14%)
– 15
(15%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.
Points Range:
12
(12%)
– 13
(13%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
Points Range:
0
(0%)
– 11
(11%)
“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation
Points Range:
5
(5%)
– 5
(5%)
Meets requirements for participation by posting on three different days.
Points Range:
0
(0%)
– 0
(0%)
N/A
Points Range:
0
(0%)
– 0
(0%)
N/A
Points Range:
0
(0%)
– 0
(0%)
Does not meet requirements for participation by posting on three different days.
Total Points: 100
Name: NURS_6512_Week_2_Discussion_Rubric
Scenario: 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
Diversity is the description of patient population characteristics that refers to a combination of certain dimensions of differences such as socioeconomic, spiritual, lifestyle, and other cultural factors (Celik et al., 2008). TJ represents a diverse population as the National Survey of Family Growth statistical data suggests that 1.1% of women identify as lesbian (Martos, et al., 2017). During this healthcare appointment, since it is helpful and important to recognize the client as a unique individual, and respect their diversity, I would build a health history by focusing questions without bias and framing them to be sensitive to the patient’s background, lifestyle, and culture (Saha, 2014). It is important to recognize that barriers in communication or feelings of discrimination already exist within this diverse population (Martos et al., 2017). and current healthcare practices are structured in ways that support the neutral approach and keep dimensions of diversity invisible and hidden but acknowledging that differences matter can have clinical implications that are immensely helpful to patient outcomes (Celik et al, 2008). Some diagnosis gets missed based on the lack of identifying that differences matter, and overall, the most important concern is the patient’s healthcare.
As a clinician, I would be kind and compassionate and create a comfortable interview environment for TJ noting that this diverse patient population already has a higher level of unpredictable social stress than are others because of the stigmatization of homosexuality in American culture (Mays & Cochran, 2001). Additionally, being in a healthcare exam is already incredibly stressful enough (Ball et al., 2019). My questions would tailer around comfort and unbiased care and concern to identify and treat the patient’s concerns. Since this is an annual physical exam, and she is followed closely with obstetrics, I would focus on her needs that she currently discusses and ask her five basic questions that would help in this area. NURS 6512 Discussion: Diversity and Health Assessments
1. How would you prefer to be addressed (Ball et al., 2019)?
2. Are there any concerns that you want me to focus on that will help you today? I noticed you identified that you have been having vaginal discharge, can you tell me more about this (de Fonseca et al., 2013)?
3. Tell me about your support system for your pregnancy (Appelgren et al., 2018)?
4. Do you have any health problems or medical conditions not related to pregnancy?
5. Are you eating well and exercising to maintain mental and physical health for you and the baby (Weiss & Elmore, 2017).
Diversity care is associated with communicating with patients from a variety of specific populations will be sensitive to different cultural factors when gathering pertinent information (Laureate, 2019). By being able to fully communicate the issues of this patient and ask non-bias questions, but aware of cultural sensitivity to come up with the best plan for this patient. NURS 6512 Discussion: Diversity and Health Assessments
References
Appelgren Engström, H., Häggström-Nordin, E., Borneskog, C., & Almqvist, A. L. (2018).
Mothers in Same-Sex Relationships Describe the Process of Forming a Family as a Stressful Journey in a Heteronormative
World: A Swedish Grounded Theory Study.
Maternal and child health journal
,
22
(10), 1444–1450.
https://doi.org/10.1007/s10995-018-2525-y
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.
Celik, H., Abma, T. A., Widdershoven, G. A., van Wijmen, F. C., & Klinge, I. (2008).
Implementation of diversity in healthcare practices: barriers and opportunities.
Patient
Education and counseling
,
71
(1), 65-71.
da Fonseca, T. M., Cesar, J. A., Mendoza-Sassi, R. A., & Schmidt, E. B. (2013). Pathological
Vaginal Discharge among Pregnant Women: Pattern of Occurrence and Association in a Population-Based Survey.
Obstetrics and gynecology international
,
2013
, 590416.
https://doi.org/10.1155/2013/590416
Laureate Education (Producer). (2019). Advanced health assessment and diagnostic reasoning
[Video file]. Baltimore, MD: Author
Martos, A. J., Wilson, P. A., & Meyer, I. H. (2017). Lesbian, gay, bisexual, and
transgender (LGBT) health services in the United States: Origins, evolution, and contemporary landscape.
PloS one
,
12
(7), e0180544.
https://doi.org/10.1371/journal.pone.0180544
Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination
among lesbian, gay, and bisexual adults in the United States.
American journal of public
health
,
91
(11), 1869-1876.
Saha, S. (2014). Taking diversity seriously: the merits of increasing minority representation in
medicine.
JAMA internal medicine
,
174
(2), 291-292.
Weis, K. L., & Elmore, K. O. (2017). Military Prenatal Intervention Models.
Perinatal Mental
Health and the Military Family: Identifying and Treating Mood and Anxiety Disorders
, 151. NURS 6512 Discussion: Diversity and Health Assessments