will take on the role of an APRN who is building a health history for a particular patient assigned by your instructor. You will consider how social determinants of health and specific cultural considerations will influence your interview and communication techniques as you work in partnership with the patient to gather data for an accurate health history.
Case Study
SD is a 37 y/o healthy Hispanic female seen in the Emergency Department with bruises and an
arm laceration after a fall. Her husband is at the bedside. This is her second time in the last 6
months coming to the Emergency Department for care. She is undocumented and waiting for
residency to come through after marrying her current husband.
Building a Health History With Cultural and Diversity Awareness
Include the following:
• Explain the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Be specific.
• Explain the issues that you would need to be sensitive to when interacting with the patient, and why.
• Describe the communication techniques you would use with this patient. Include strategies to demonstrate sensitivity with this patient. Be specific and explain why you would use these techniques.
• Summarize the health history interview you would conduct with this patient. Provide at least five (5) targeted questions you would ask the patient to build their health history and to assess their health risks. Explain your reasoning for each question and how you frame each for this specific patient.
• Identify the risk assessment instrument you selected, and then justify why it would be applicable to your assigned patient. Be specific.
Full Answer Section
- Spiritual Factors: Understanding SD's religious beliefs and cultural practices can inform her approach to healthcare. For example, her faith may influence her views on health, illness, and treatment.
- Lifestyle Factors: SD's lifestyle may include factors such as diet, exercise, and exposure to environmental hazards, which can affect her overall health and risk for certain diseases.
- Cultural Factors: Cultural beliefs and values can influence health behaviors, attitudes towards healthcare providers, and communication styles. In this case, understanding Hispanic cultural norms can help to establish rapport and build trust with SD.
Addressing Potential Issues
When interacting with SD, it is essential to be sensitive to the following issues:
- Language barriers: If SD does not speak English fluently, it is crucial to use a qualified medical interpreter to ensure effective communication.
- Fear of deportation: Undocumented immigrants may fear being deported or facing legal consequences if they seek healthcare. It is important to create a safe and welcoming environment that fosters trust and confidentiality.
- Cultural differences: Understanding and respecting cultural differences can help to build rapport and avoid misunderstandings. For example, SD may have different expectations regarding patient-provider relationships or the role of family in healthcare decisions.
Communication Techniques
To effectively communicate with SD, I would use the following techniques:
- Use clear and simple language: Avoid medical jargon and complex terms that may be unfamiliar to SD.
- Use an interpreter: If necessary, a qualified medical interpreter should be used to ensure accurate communication.
- Show empathy and understanding: Demonstrate that I am aware of the challenges SD may be facing and that I am committed to providing culturally sensitive care.
- Active listening: Pay close attention to SD's responses and ask clarifying questions to ensure that I understand her concerns and needs.
- Respect cultural differences: Avoid making assumptions about SD's beliefs or values. Instead, ask open-ended questions to learn more about her cultural background and preferences.
Health History Interview
To assess SD's health history and identify potential risk factors, I would ask the following targeted questions:
- Past medical history: "Have you ever been diagnosed with any chronic conditions, such as diabetes, high blood pressure, or heart disease?" (This question helps to identify potential underlying health conditions that may be contributing to SD's symptoms.)
- Family history: "Does anyone in your family have a history of chronic diseases or genetic disorders?" (Family history can provide clues about SD's risk for certain conditions.)
- Medication history: "What medications are you currently taking, including over-the-counter medications and herbal supplements?" (This information is essential for identifying potential drug interactions or allergies.)
- Allergies: "Are you allergic to any medications, foods, or environmental substances?" (Identifying allergies can help to prevent adverse reactions.)
- Social history: "Can you tell me about your daily activities, diet, and exercise habits?" (This information can help to identify potential risk factors for health problems.)
Risk Assessment Instrument
A suitable risk assessment instrument for SD would be the
Domestic Violence Screening Tool (DVST). This tool is designed to identify individuals who may be at risk for domestic violence. Given SD's undocumented status and potential for experiencing abuse, the DVST would be appropriate for assessing her risk and providing appropriate support and resources.
Sample Answer
Socioeconomic, Spiritual, Lifestyle, and Cultural Factors
SD, a 37-year-old Hispanic female, presents to the emergency department with injuries sustained from a fall. Her undocumented status and recent immigration from a Spanish-speaking country significantly influence her socioeconomic circumstances, cultural beliefs, and potential barriers to healthcare access.
- Socioeconomic Factors: As an undocumented immigrant, SD may face financial challenges and limited access to resources. These factors can impact her ability to seek regular healthcare, adhere to treatment plans, and afford medications.