Case Study Analysis

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 the clinic today is 182/99 with an HR of 84. 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.

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.
• 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 pertinent information?

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Solution

Patient on Follow-up of Hypertension

Patients have different lifestyles, cultures, religions, beliefs, and backgrounds and when carrying out their health assessment, it is important to obtain information based on their diversity (Purnell & Fenkl, 2019). Ms. EB may be of a low socioeconomic status since she does not live with anyone. Coming alone to the hospital could mean she lacks a strong support system.  Her non-compliance with medication may be a result of her belief system, financial constraints, or her current health status of not being able to see properly. Her race may also play a role in her current condition. According to (Foti et al., 2019), Americans of African origin have a much higher risk of hypertension compared to other racial groups.

To build the patient’s health history through interviews and assessments, I will make her feel comfortable and listen to her carefully. To build her confidence and good rapport, I will need to appear non-judgmental and respectful to her culture and beliefs as well as listen to her with minimal interruption. A good rapport will make her open up about her social determinants and this will give me the information needed for her treatment.

The issues that I will need to be sensitive to during Ms. EB’s assessment include her spiritual and religious life. Spirituality and religion play a significant role in a patient’s observance of medication instructions (Timmins & Caldeira, 2019). I will also need to be sensitive when inquiring how she managed to get to the hospital yet she has glaucoma and worsening vision. If not well asked, she may think I am doubting he medical condition. Her living alone creates the need to ask if she has children or family members or friends around her life. I will also ask if she has a job and if not, how she pays for her medications to see if I can refer her to social services. More importantly, I will seek to understand why her medicine bottles are still full of drugs and also ask about the last time she took her medications.

The targeted questions that I will ask the patient include:

  1. Who helps you with household chores?
  2. Do you belong to any social group or religious association?
  3. How do you have a job and how do you pay for your medications?
  4. Do you know the names of the medications you came with to the hospital?
  5. Do you have any challenges taking medication as prescribed?

Some of the challenges associated with communicating with patients from diverse populations include differences in language, patients’ level of education, gender differences, and difference in spiritual and religious beliefs (Miller& DiMatteo, 2020). As a nurse, the strategy that I would employ to enhance my competence in handling diverse populations is by improving cultural competence and sensitivity

 

References

Foti, K., Wang, D., Appel, L. J., & Selvin, E. (2019). Hypertension awareness, treatment, and control in US adults: trends in the hypertension control cascade by population subgroup (National Health and Nutrition Examination Survey, 1999–2016). American journal of epidemiology188(12), 2165-2174.

Miller, T. A., & DiMatteo, M. R. (2020). Physician-Patient Communication. The Wiley Encyclopedia of Health Psychology, 469-474.

Purnell, L. D., & Fenkl, E. A. (2019). Transcultural diversity and health care. In Handbook for culturally competent care (pp. 1-6). Springer, Cham.

Timmins, F., & Caldeira, S. (Eds.). (2019). Spirituality in healthcare: Perspectives for innovative practice. Cham: Springer International Publishing.

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