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Health and human service organizations are recognizing the need to enhance services for culturally and linguistically diverse populations (CDC, 2020). The dynamic nature and cultural diversity in the healthcare sector require nursing acculturation to promote quality and patient-centered care. Nurse practitioners cannot effectively play an advocate role to patients without being culturally aware of their own cultural beliefs and biases, must be culturally sensitive, culturally flexible, and respect each patient as an individual. Cultural competence is designed for practitioners to treat and care for the patient in a manner that promotes quality of care. Implementing cultural competency strategies while dealing with diverse patients can be an accessory to the quality improvement process. The cultural competence framework requires that the practitioner comprehend, respect, and acquire knowledge and skills needed to treat patients from diverse cultures (Ball, 2019). In the case scenario provided, 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.”. In caring for this patient, the nurse practitioner would consider the communication techniques, family dynamics, health beliefs, and the use of herbal medicines. Asians are known for their strong family values, traditional, cultural, and religious beliefs. In caring for this patient, I would rule out any communication barrier that may impact this encounter. If the patient speaks fluent English, then no translator or interpreter would be needed. While maintaining eye contact is positively evaluated by Western Europeans, it is not the case with people of East Asian cultural backgrounds (Uono & Hietanen, 2015). The sensitive issue, in this case, would be to avoid eye contact during my interaction with the patient. Maintaining eye contact with this population while communicating is a sign of rudeness or disrespect (Ball et al., 2019).Low socioeconomic status is one major barrier to preventing Asian Americans from accessing health insurance. The way Asians deal with the disease process is different from the general population. Older Asians living in America often experiencesocial isolation, inadequate community outreach, and limited English proficiency play a large role in low socioeconomic status(Zhang,2021). Considering the socioeconomic factor, the patient lives with the daughter who is responsible for his upkeeps. Asian American seniors, especially foreign-born seniors, are likely to receive much less Social Security benefits because they tend to earn less and over fewer years during their working years in the United States (Zhang, 2021). As a result of the financial status, this patient depends on the daughter for the majority of his financial needs. Another factor to consider is the patient’s spirituality and how it impacts his health. I have elderly Asian patients whose family brings traditional medicine from time to time based on their belief system. In this case, the nurse has to inform the primary physician who would authorize the herbal medicine to be added to the patient’s list of medications. The physician would have the pharmacy review patient’s medications to ensure no adverse effect would result from adding herbal medicine to the current list of medications. Many Asians are known to use herbal or traditional medicine to treat one ailment and the practitioners should be conversant with the basic remedies in this population and incorporate them into the treatment plan as appropriate
Questions to ask my assigned patient
To conduct a comprehensive health history on my patient, I would start with an open-ended question to enable my patient to speak freely and voice his concerns. By so doing, the patient would reveal as much information as possible. My first question would be, what health concerns do you have? This would enable the patient to share pertinent information. I would also use this opportunity to discuss his current health condition and the medication to ensure he understands how to manage his medications and his medical conditions. Secondly, what are your food choices? this question is important since the patient has B12 deficiency and may need education on food choices to supplement for B12 deficiency. Thirdly, I would ask the patient about his physical activity. This is important because of his age and other comorbid conditions. Physical inactivity in Asian American adults has been recognized as a high-risk factor for disease (Zhy & Sun, 2016). Fourthly, I would ask the patient, do you feel depressed? This is important since the patient is dependent on his daughter. Also, living with chronic health conditions can be depressing. Lastly, I would ask the patient about who makes health care decisions and if he does have health insurance. This question is important since he is depending on the daughter financially and he had stated that he did not want to be a burden to the daughter.
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.
Uono, S & Hietanen (2015). Eye contact perception in the West & East: A cross-cultural study.Plos One,10(2). Doi: 10.1371/journal.pone.0118094
Zhang, N. (2021). Why income inequality is growing at the fastest rate among Asian Americans. Retrieved from https://www.cnbc.com/2021/05/26/why-income-inequality-is-growing-at-fastest-rate-among-asian-americans.html
Center for Disease Control and Prevention(2020, October 21). Cultural competence in health and human services. Retrieved from https://npin.cdc.gov/pages/cultural-compe-tence
Zhu, W., Chi, A., & Sun
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