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.
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.
This week, you will consider the impact of functional assessments, diversity, and sensitivity in conducting health assessments.
• 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
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
• Chapter 1, “The History and Interviewing Process” (pp. 1-20)
This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients.
• Chapter 2, “Cultural Competency” (pp. 21–29)
This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
• Chapter 2, “Evidenced- Based Health Screening” (pp. 6-9)
Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2014). 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
The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma.
Centers for Disease Control and Prevention (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence
This website discusses cultural competence as defined by the Center for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website.
United States Department of Human & Health Services. Office of Minority Health. (2016). A physician’s practical guide to culturally competent care. Retrieved from https://cccm.thinkculturalhealth.hhs.gov/
From the Office of Minority Health, the Website offers CME and CEU credit and equips health care professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.
Espey, D., Jim, M., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health, 104(S3), S303-S311.
The authors of this article present patterns and trends in all-cause mortality and leading cause of death in American Indians and Alaskan Natives.
Wannasirikul, P., Termsirikulchai, L., Sujirarat, D., Benjakul, S., Tanasugarn, C. (2016). Health literacy, medication adherence, and blood pressure level among hypertension older adults treated at primary health care centers. Southeast Asian J Trop Med Public Health., 47(1):109-20.
The authors of this study explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving health care services at Primary Health Care Centers.
Discussion: Diversity and Health Assessments
In 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).
Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the health care field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and health care 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.
JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. He has a hx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter.”
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 Tylenol over the counter for aches and pains on occasion. She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.
MR, a 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle. He is not taking any prescriptions medications and denies drug use. He has a positive family history of diabetes, hypertension, and alcoholism.
• Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
• Select one of the three case studies. Reflect on the provided patient information.
• Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
• 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?