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.

When a 54-year-old man presents to the clinic, the nurse pays attention to the following: first, he is homeless; second, he has a history of substance abuse and withdrawal symptoms. Both these features have profound socioeconomic, spiritual, and cultural implications. Patients who are homeless are more likely to be suffering from multiple acute and chronic conditions, because of their lifestyles, and because they lack access to primary and preventive care (Asgary et al., 2016). According to Astroth et al. (2019), their health needs are usually more complex than those of the general population. They are poor and know the taste of isolation and violence. Because of high levels of systemic prejudice in the healthcare system, homeless individuals often have negative experiences of primary care (Jones et al., 2017). As a result, nurses may find it difficult to communicate with them in a manner that promotes trust and transparency.

Despite these difficulties, I would have to build a health history for the patient. I would have to create an atmosphere of trust; this is the only way that can encourage the patient to provide truthful information about his health. I would greet the patient and begin with general questions about how he is feeling (Ball et al., 2014). I would ask the patient about his cardiovascular and withdrawal symptoms in a manner that he can understand. I would use a tone of warmth and compassion, to make sure that there is no confrontation on the patient’s side. I would have to remember that living in the street might have an impact on how the patient reacts to stiffness and tone-deafness. Therefore, I would use my active listening skills to identify the cues that would guide the interviewing process.

Among others, I would ask the following questions.

1. Did you have any headaches in the past few days?
2. Did you have any of the following symptoms – dizziness, blurred vision, chest tightness, weakness?
3. How many cigarettes do you smoke every day?
4. How many meals a day do you have, and what type of food do you eat?
5. Do you have any health problems beyond high blood pressure?

Communicating with a homeless patient can be a challenge for several reasons. First, the patient may be reluctant to share the full story (Ball et al., 2014). Second, he may have concerns about the cost of care, which is why he may not provide enough information to complete history (Ball et al., 2014). My task is to maintain an optimal balance of trust and compassion that will encourage the patient to provide enough information that will be used to develop a plan of care for him.

References

Asgary, R., Sckell, B., Alcabes, A., Naderi, R., Schoenthaler, A., & Ogedegbe, G. (2016).

Rates and predictors of uncontrolled hypertension among hypertensive homeless adults using New York City shelter-based clinics. Annals of Family Medicine, 14, 41-46. https://doi.org/10.1370/afm.1882

Astroth, K.S., Jenkins, S.H., Kerber, C., & Woith, W.M. (2018). A qualitative exploration of

nursing students’ perceptions of the homeless and their care experiences. Nursing Forum, 53(4), 489-495. https://doi.org/10.1111/nuf.12276

Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2014). Seidel’s guide to

physical examination. Elsevier Health Sciences.

Jones, A.L., Hausmann, L.R., Haas, G.L., Mor, M.K., Cashy, J.P., Schaefer, J.H., & Gordon,

A.J. (2017). A national evaluation of homeless and non-homeless veterans’ experiences with primary care. Psychological Services, 14(2), 174-183. https://doi.org/10.1037/ser0000116

 

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

I enjoyed reading your post. You asked great questions. Were you also aware homelessness exists when individuals lack safe, steady and suitable spots to live. Sheltered and unsheltered individuals are destitute. Individuals living in crowed everyday environments or lacking monetary assets are remembered for this definition, just like those living in tents (Psychosocial Factors and Homelessness, n.d.). The main socioeconomic factors that are impacting this patient include his Current lifestyle and state of homelessness. Also, homelessness is related to health inequalities, including shorter life, higher morbidity, and more prominent use of intense emergency clinics. People experiencing homelessness are less likely to access primary and preventive health services resulting in increased risk for later-stage diagnosis of disease, poor control of manageable conditions, and hospitalization for preventable conditions. Without a doubt, in individuals who are homeless, the social determinants of vagrancy and health disparities are frequently entwined, and long-haul vagrancy further worsens unexpected frailty (Stafford & Wood, 2017). It appears several possible scenarios could have led this patient to his current situation. His level of education or previous employment status is unknown. Because his current employment status is likely contributing to his present income, employment information can be gathered, and his current level of ability to work. He may have been laid off from a well-paying position with an established company due to his prior substance use. The powers which influence homelessness are unpredictable and frequently intuitive in nature. Social issues, for example, addictions, family breakdown, and psychological instability are intensified by auxiliary controls, absence of accessible ease lodging, poor monetary conditions, and lacking emotional well-being administrations. Together these elements sway levels of homelessness through their dynamic relations (Mago et al., 2013).

References

Mago, V. K., Morden, H. K., Fritz, C., Wu, T., Namazi, S., Geranmayeh, P., … Dabbaghian, V. (2013). Analyzing the impact of social factors on homelessness: a Fuzzy Cognitive Map approach. BMC Medical Informatics and Decision Making, 13(1). doi: 10.1186/1472-6947-13-94

Psychosocial Factors and Homelessness. (n.d.). Retrieved from https://www.apa.org/pi/ses/resources/publications/homelessness-factors

Stafford, A., & Wood, L. (2017). Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants. International Journal of Environmental Research and Public Health, 14(12), 1535. doi: 10.3390/ijerph14121535

 

 

response 2

Thank you for your presentation. You made pertinent arguments. Please see my input as follows:

Critique of Targeted Questions

The questions you asked patient AG are appropriate. The first and second questions are necessary because the provider must assess any symptoms of the patient’s need for immediate care. Patient AG presents many factors that support a potential need for emergent care. First, the patient is establishing care following a recent hospitalization after having a seizure related to alcohol withdrawal. Second, the patient is out of his blood pressure (BP) medication. Third, AG has a history of alcohol and cocaine abuse. Lastly, he uses smoking to abstain from alcohol and cocaine. According to the University of Wisconsin Health (2020), not taking your blood pressure medicines properly or using illegal drugs, such as stimulants like cocaine, can lead to a hypertensive emergency, which may cause symptoms of or result in a heart attack or stroke. The third question about the quantity of daily cigarette consumption could help the nurse practitioner (NP) identify the patient’s level of nicotine dependence. Getting a complete smoking history is a critical part of the intake and assessment process, for it can help providers determine the patient’s health care risks and treatment options (Substance Abuse and Mental Health Services Administration & Office of the Surgeon General (2016).

The fourth and fifth questions about diet intake and other pre-existing medical conditions would help the practitioner assess further risk factors for AG’s hypertension and identify appropriate approaches to improve patient’s control of high BP. Suliburska et al. (2015) found that incorrect dietary intake among patients with hypertension often related to the coexistence of co-occurring conditions such as being overweight and obese. Also, the Center for Substance Abuse Treatment (2016) highlighted that people who abuse substances present with medical conditions in advanced stages or a medical crisis. Moreover, co-occurring mental disorders also are likely to be exacerbated by substance abuse (Center for Substance Abuse Treatment, 2016). In this regard, the NP must investigate both co-occurring medical and psychiatric conditions that can significantly affect patient AG’s overall well-being. Hence, some questions could have specifically targeted the patient’s substance use and mental health issues. For example, the NP should investigate about patient’s anxious state, which may relate to many factors. The patient may be experiencing possible withdrawal or craving from alcohol and substance or suffering from mental health problems. Also, patient AG’s safety needs may be a burden, such as finding resources to help refill his medication and more health care program and services the patient may need.

Patient’s Interpretation of Questions

Regarding the patient’s perception of questions asked, effective communication is vital. As you mentioned and evidence by Hashim (2017), creating an atmosphere of trust, building a rapport with AG, being non-judgmental, and providing truthful information about the patient’s health can lead to an open conversation between the NP and patient AG. Also, using appropriate health literacy can help the patient be more receptive to the provider (Dains, Baumann, & Scheibel, 2019). According to Hersh, Salzman, and Snyderman (2015), screening patients for health literacy has not been shown to improve outcomes and is not recommended. Hersh et al. (2015) argued that multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. For instance, avoiding medical jargon, breaking down information or instructions into small concrete steps, limiting the focus of a visit to three key points or tasks and assessing for comprehension, printing information at or below a fifth- to sixth-grade reading level, using visual aids, graphs, pictures, or concrete presentation of numerical information are some techniques that can enhance patient understanding of health information and improve quality of care (Hersh et al., 2015).

Relevance of Questions to Case Scenario #3

Your patient case presents some similarities to mine because of underlying mental health needs. While your adult patient already identifies with a history of substance use, my patient, an adolescent, obese, presenting with new onset of mood disturbance and whose mother is a drug addict and currently incarcerated, could be at risk using drugs. Though your targeted questions do not directly assess the patient’s mental health needs, questions about diet intake and other pre-existing medical conditions apply to my patient. As evidenced by John Hopkins (2020), many medical illnesses (including cancer, injuries, infections, and chronic diseases) can trigger mental health disorders. Hence, inquiring about diet and existing medical condition and diet are appropriate for my patient. Such background information would help the NP identify and prioritize patient health issues and health goals.

References

Center for Substance Abuse Treatment. (2016). Detoxification and substance abuse treatment. Retrieved from https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/books/NBK64105/

John Hopkins. (2020). Mood disorders. Retrieved June 11, 2020, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/mood-disorders

Hashim, M. J. (2017). Patient-centered communication: Basic skills. Retrieved from https://www.aafp.org/afp/2017/0101/p29.pdf

Hersh, L., Salzman, B., & Snyderman, D. (2015). Health literacy in primary care practice. Retrieved from https://www.aafp.org/afp/2015/0715/p118.html

Substance Abuse and Mental Health Services Administration, & Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Retrieved from: https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/books/NBK424848/

Suliburska, J., Bogdanski, P., Duda, G., Pupek-Musialik, D., Piatek, J., Zukiewicz-Sobczak, W., & Krauss, H. (2015). An assessment of dietary intake and state of nutritional in hypertensive patients from rural and urban areas of Greater Poland. Annals of Agricultural and Environmental Medicine, 19(3), 339–343

Wisconsin Health. (2020). Hypertensive emergency. Retrieved June 11, 2020, from https://www.uwhealth.org/health/topic/special/hypertensive-emergency/zp3151abc.html