Jessica Black Week 2 discussion
Introduction
Primary care practitioners face many scenarios when providing care to the public. One of the challenges associated with the job is providing proper and culturally competent care to all patients. In addition to cultural competency, the practitioner must also communicate clearly and ensure the information is understood. Health literacy (HL) is important for optimal health outcomes, older adults with low HL levels often have a hard time understanding and acting upon health information resulting in noncompliance to medical instructions. One cause of a low HL is a language barrier (Wannasirikul, et al., 2016). When the practitioner interviews a patient of another culture there are many factors to consider. In the case of 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 in today for an annual exam and states I came for my annual physical exam, but do not want to be a burden to my daughter.”
Cultural Factors
There are several specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with JC. Being a competent practitioner in cross-cultural functioning requires learning new patterns of behavior and applying them effectively in appropriate settings. For JC, the practitioner should understand multigenerational cohabiting and how the elderly are cared for. The food that the patient consumes is important in determining nutritional status and health goals. Patients from a different culture may have a negative perception of the food thinking that eating healthy means they have to give up their traditional foods. Providing education on healthier modifications of traditional foods can help to encourage positive changes in dietary habits (Wagle, Gokul & Sucher, 2009). Understanding that cultural differences and attitudes toward animals helps to influence the health of elderly people can make a difference for the patient. The animal-human bond, in the Asian culture is strong and those patients without pet companions may have a lower self-perceived health and self-esteem than those with pet companions (de Guzman, et al, 2009).
Sensitive Issues
When interacting with the patient, for treatment to succeed, the emotional needs must be let and matters involving ethnicity, socioeconomic status (SES), sexual orientation, age, or gender must be sensitively addressed. Knowing the patients culture in respect to provider gender, touch for communication and eye contact is essential to not offend the patient (Wannasirikul, et al., 2016). Asian grandparents often play an important role in raising their grandchildren. They are often involved in caring for the children together with parents due to the high rate of grandparent co-residence (Luo, et al., 2020). When talking about the patients residence and family, it must be handled sensitively so the patient does not feel offended.
Five Targeted Questions
1. What language is spoken in the home?
2. Do you understand your medical conditions and treatment?
3. Do you feel safe and well cared for at home?
4. Are you actively helping to raise your grandchildren?
5. How is your food prepared and consumed?
These five questions will help the practitioner understand the patients HL and home life. These questions will help to identify areas to focus on for the patient and the need for Bureau of Adult and Elderly Services (BEAS) involvement.
References:
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.
de Guzman, A., Cucueco, D., Cuenco, I. B., Cunanan, N. G., Dabandan, R., & Dacanay, E. J. (2009). Petmanship: Understanding elderly Asians self-perceived health and self-Esteem captured from their lived experiences with pet companions. Educational Gerontology, 35(11), 963989.
Luo, N., Van Heel, M., & Van Leeuwen, K. (2020). Perspectives of early adolescents, parents, and grandparents on parenting behaviors in China. Journal of Early Adolescence, 40(8), 12441274. =true&db=eric&AN=EJ1265204&site=eds-live&scope=site
Wagle, A., R. Gokul, K. Sucher. (2009). Attitudes and behavior of elderly Asians towards health and the impact of nutrition education program on dietary knowledge and behavior,
Journal of the American Dietetic Association, 109(9), 81. .
Wannasirikul, P., Termsirikulchai, L., Sujirarat, D., Benjakul, S., & Tanasugarn, C. (2016). Health literacy, medication adherence, and blood pressure level among hypertensive older adults treated at primary health care centers. Southeast Asian Journal of Tropical Medicine and Public Health, 47(1), 109-120. Retrieved from Fwww.proquest.com%2Fscholarly-journals%2Fhealth-literacy-medication-adherence-blood%2Fdocview%2F1799913077%2Fse-2%3Faccountid%3D14872
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Diversity and Health
Formulation of an appropriate patient management plan often revolves around the diagnosis and medical or surgical aspects patient to patient care. Most health care professionals forget that for a patient to effect the recommended treatment plan, one must consider a patients social determinants of health ranging from economic, cultural, religious and level of education. These factors influence both the health seeking behavior of an individual as well as their implementation of suggested treatment plans (Muntaner & Navarro, 2020). The patient in the case scenario involves an 86-year-old Asian male named JC who is currently financially dependent on his daughter. The daughter is a single mother who has little time or money for her fathers health needs following previous diagnosis of hypertension, gastroesophageal reflux diseases, vitamin B12 deficiency and chronic prostatitis He currently has a prescription of lisinopril 10mg, Omeprazole 20mg, vitamin B12 monthly injections and occasional ciprofloxacin 100m for recurrent urinary tract infections. He comes in for his annual physical examination and states that he does not want to be his daughters burden. The patients dependence on his daughter creates a financial constraint which may impair his compliance to the current medication regimen leading to disease progression and resultant multisystemic complications. The patients sociocultural background also reveals that the patient is of Asian descent making it pertinent that racial and ethnic sensitivity be considered when managing the patient. Different individuals have diverse sociocultural norms ranging from feeding habits to health beliefs that may affect their compliance or health seeking behavior. A competent health practitioner should employ the relevant communication skills to unearth any practices that the patient may be inclined to which comprehensively impair treatment. Dietary habits are pertinent when managing JC as he has a prescription of ciprofloxacin 100mg which should not be taken together with milk (Hughes et al., 2021). Dairy products are known to chelate ciprofloxacin thus reducing its absorption in the gastrointestinal tract. JC is also seen to have vitamin b12 deficiency commonly found in meat and known to curb vegetarians without adequate information on nutrition. The patients presence of B12 deficiency and his Asian descent renders importance to inquiry of dietary practices as part of the relevant health determinants (Sakkas et al., 2020).
JC would like to not be a burden to his daughter both financially and physically which requires that a professional nurse practitioner educate the patient on the various interventions that are geared toward independence in health care. Explaining the various health insurance plans available for the patient alongside other finance options should be explored by the nurse practitioner for elimination of the pill-cost burden as well as ease of future medical bills coverage.
Five targeted questions
- Do you comply to your medication regimen? IF not, do financial constraints have a part to play in non-compliance?
- Do you partake in any substance abuse such as alcohol consumption or cigarette smoking? If yes, what is the frequency and type of substance consumed?
- What is the content of your weekly dietary plan and how frequently do you feed in a given day? Does your diet regularly contain meat or any animal products?
- Have you had any signs or symptoms of an adverse drug reaction originating from the currently prescribed regimen?
- Do you currently have a health insurance cover plan?
References
Hughes, S., Heard, K., Mughal, N., & Moore, L. S. (2021). Burden of enteral supplement interactions with common antimicrobial agents: A single-centre observational analysis. European Journal of Hospital Pharmacy, ejhpharm-2020-002445. doi:10.1136/ejhpharm-2020-002445
Muntaner, C., & Navarro, V. (2020). Conclusion: Political, economic, and cultural determinants of population healthA research agenda. Political and Economic Determinants of Population Health and Well-Being, 551-556. doi:10.4324/9781315231068-52
Sakkas, H., Bozidis, P., Touzios, C., Kolios, D., Athanasiou, G., Athanasopoulou, E., Gartzonika, C. (2020). Nutritional status and the influence of the vegan diet on the gut microbiota and human health. Medicina, 56(2), 88. doi:10.3390/medicina56020088
2 sources for each discussion.
