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.
Main Discussion Post
Building EB’s Health History: Socioeconomic Background, Lifestyle, Spiritual and Culture
“EB is a 68-year-old black female who comes in for a follow-up of hypertension. She has glaucoma and her vision has been worsening during the past few years. She lives alone and is prescribed four hypertension medications (Hydralazine 50 mg PO Q8H, Metoprolol XL 200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily ). She brings in her medication bottles and she has some medication bottles from the previous year full of medications. She is missing one medication she had been prescribed and says she may have forgotten it at home. Her BP in clinic today is 182/99 with HR of 84.”
People come from all works of life with different lifestyles, cultures, and backgrounds, so to obtain useful information in an interview or an assessment, understanding a patient’s culture, religion, and beliefs is essential. According to Ball et al. (2019), define culture as a person’s behavior, beliefs, attitudes, morals, language, religion, sexual orientation, education, as well as life experiences. This post discusses a 68-year-old black female (EB) who comes to the hospital for a follow-up of her high blood pressure. She has glaucoma, and her vision had been worsening for the past few years. She lives alone and is prescribed four hypertension medications. She will be assessed based on her socioeconomic lifestyle, spiritual, and cultural background. Targeted questions will be posed about her health risk, challenges associated with communication, and strategies used to gather pertinent information will be addressed as well.
Building EB’s Health History: Socioeconomic Lifestyle, Spiritual And Cultural Background
Just every other human being, Ms. EB is unique; she should have experiences in life, so her assessment will take her socioeconomic spiritual, and cultural background into consideration. To tailor and provide a proper treatment plan and care to Ms. EB, as a nurse, I have to make her feel comfortable, listen carefully, and understand her culture and beliefs. Listening to her without being judgmental, without interrupting, and respecting her culture and beliefs will help build excellent communication while creating a good rapport. Creating a good rapport will lead her to open up about her social determinants and give me the necessary information needed for her treatment plan and care.
Another aspect of Ms. EB’s assessment that I have to pay great attention to when she responds to my questions is about her spiritual and religious life. According to Abel and Greer (2017), spirituality, and religion play a significant role in adhering to medication regimens. According to Williams and Anderson (2016), socioeconomic status determines variations in health outcomes throughout the world.
Addressing Ms. EB Sensitive Issues
As far as Ms. EB’s socioeconomic lifestyle, spiritual, and cultural background is concerned, many sensitive issues need to be addressed. As sensitive as it may sound, I will ask her without being judgmental if she drove herself to the hospital because she has glaucoma, and her vision has been worsening for the past few years. Since she lives alone, I will ask if she has children or family members or friends who come to see her or call to talk to her. I will ask about her community and religion/spirituality to identify if she belongs to a church group or club. I will ask her if she works, if not how she pays for her medications. She is on four hypertension medications, and some of the bottles of medicines presented are still full of drugs from the previous year. It is either she skips days, seldom takes them, or she is not medication compliant. I will ask why her bottles of pills are still full of drugs. I will not assume; I will ask about the last time she took her medications. If she had not been compliant, I would empathically ask if it is because of any side effects or if it is because she does not have food to eat before taking her medications. One of my patients who relapsed told me that his sister would not feed him at some so he would not take his medications. Some patients are not medication compliant because of their religious background.
For example, I had a patient from a 28-year-old Muslim Ethiopian male patient who was psychotic. He needed medications to help with “the voices” that he said he was hearing. He refused to take Haldol and Benadryl prescribed to him and said he would pray to “Alla to forgive my sins and cure me.” It was frustrating, too, because his parents had the same beliefs. Upon admission, his mother wanted to stay with him “because, in my culture, I must stay with him in the hospital and care for him.” It took lots of patience and explanation from me before she left and went home. My team of staff tried to work with the patient and his family to accommodate their cultural and spiritual beliefs. It got to the point that the patient had to be medication paneled because he became aggressive towards others. The patient’s parents finally agreed that their son would benefit from drugs. It was not easy because he had to be restrained to get injections. When his condition improved, he decided to take medications by mouth.
Five Targeted Questions Asked To Build EB’s Health history And Assess Health Risks.
What is your understanding of high blood pressure and the last time/dose of medication taken?
What are your diet and nutritional practices, and was the last time you ate some food?
What are your beliefs about taking medication and the importance of taking prescribed medications?
Why are three bottles of your medications still full of drugs; do you feel sick when you take them?
Do you think a weekly pillbox will remind and help you keep your medication regimen on track?
Challenges Associated With Communicating and Strategies Used To Gather Pertinent Information
With Ms. EB’s condition, no matter how challenging sensitive it may seem, questions must be asked when communicating to understand and help her situation. A sensitive aspect of Ms. EB’s background will be about her level of education because her health literacy needs to be assessed. Melton et al. (2015), state that African Americans are more likely to have low health literacy due to education, culture, and the healthcare system. Thus, asking some questions about Ms. EB’s level of education to assess her health literacy is essential to make sure she understands her illness and recommendations made. Ball et al. (2019), allude that it is vital to be aware of these statistics yet not stereotype someone based on race. Explain the complications of not complying with the treatment regimen with the medicine (CDC, 2015).
One should not assume that Ms. EB is not educated because she is an African American. She should be assessed as a unique individual based on her socioeconomic lifestyle, spiritual, and cultural background. This moment will be an excellent opportunity to educate Ms. EB about her health. While using simple terms, she should be educated about high blood pressure, glaucoma, and the importance of taking her medications. The education provided should be done in such a way that she will not feel uncomfortable and ashamed. Before concluding my conversation with Ms. EB, I will make sure that I ask her to restate in her owns words the education she got from me so that I can be sure that she received the information I provided to her.
References
Abel, W.M., & Greer, D.B. (2017). Spiritual/Religious Beliefs & Medication Adherence in Black Women with Hypertension. Journal of Christian Nursing: A quarterly publication of Nurses Christian Fellowship, 34(3), 164-169. https//doi-org.ezp.waldenulibrary.org/10.1097/CNJ0000000000000333
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.
Centers for Disease Control and Prevention. (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence
Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2015). Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis. Journal of Asthma, 51(7), 703-713. doi: 10.3109/02770903.2014.906605
Williams, D.R. Priest, N., & Anderson, N.B. (2016). Understanding associations among race, socioeconomic status, and health: Patterns and prospects. Health Psychology, 35(4), 407-411. https://doi-org.ezp.waldenulibrary.org/10.1037/hea0000242
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.
response
Thanks for bringing up vital points. For this patient, culture, socioeconomic status, and religion are critical factors to consider. Generally, African Americans are regarded as one race, suggesting that they are of the same origin, with the same culture and religion. However, black Americans constitute a heterogeneous group, and they differ in culture, heritage, and health beliefs and practices (Watts, 2003). Therefore, establishing a rapport and asking questions to gain substantial insight into the patient’s culture, religion, and health beliefs, is an excellent way to start the interview.
Also, I would ask specific questions regarding medication nonadherence as it appears from the scenario that the patient is not taking her medications as prescribed. Hugtenburg et al. (2013) described adherence as the degree to which patients follow treatment recommendations. They also pointed out that medication nonadherence is multidimensional and can occur for various reasons. The causes of medication nonadherence include, but not limited to, cost, lack of symptoms, side effects, and patient’s cognition. In this scenario, the patient may not have been taking medications due to worsening vision or possible side effects. The patient may be experiencing cough from Lisinopril or dizziness and lightheadedness from a combination of the medications. Inquiring about medication nonadherence can assist in creating an individualized treatment plan for the patient, which will improve adherence and, consequently, the patient’s state of health.
References
Hugtenburg, J. G., Timmers, L., Elders, P. J., Vervloet, M., & van Dijk, L. (2013). Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions. Patient preference and adherence, 7, 675–682. https://doi.org/10.2147/PPA.S29549
Watts, R. (January 31, 2003). Race Consciousness and the Health of African Americans. Online Journal of Issues in Nursing, 8(1), Manuscript 3. www.nursingworld.org//MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume82003/No1Jan2003/RaceandHealth.aspx