Health disparities affect just a segment of the population differently. Attitudes toward health care and treatment can also vary among different populations. Therefore, nurse practitioners, as well as medical professionals, need to provide custom care that acknowledges and recognizes these differences in order to serve its diverse patient population. Nurse practitioners becoming more self-aware of themselves can help them realize new things about their own culture which in turn, can open their eyes to appreciating cultural differences. NURS 6512 Diversity and Health Assessments Discussion Essay. Medical teams’ understanding of patients’ beliefs and values, will aid in providing a better care because when a patient cannot find providers that resemble them, their beliefs, their culture, or other facets of their life, it may delay or prevent them from seeking care. As a health care team, it is important that we are diverse in large part just like our patients are diverse. A lack of cultural understanding increases negative attitudes towards cross-cultural care and affects healthcare professionals’ perceived preparedness to take care of culturally diverse patients. Anxiety when combined with uncertainty, can further decrease effective communication leading to increased use of stereotypes. Nurse practitioners need to have an increased awareness about the sociocultural. NURS 6512 Diversity and Health Assessments Discussion Essay.
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I choose the case study number one; EB is a 68-year-old black female who comes in for 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) NURS 6512 Diversity and Health Assessments Discussion Essay. Poor adherence to antihypertensives has been shown to be a significant factor in poor blood pressure (BP) control. A good communication with patients about her medication-taking behavior may be central to improving adherence “A patient-centered approach in which the provider engages the patient in a process of shared decision making has been identified as an important factor in improving patient adherence” (Kaihlanen, Hietapakka & Heponiemi, 2019). Example, the use of “Open-Ended Strategies” and your patients feel comfortable and address them by their preferred names. Hypertension (HTN) affects more than 29% of the adult population and increases the risk for adverse outcomes. Poorly controlled or managed HTN can lead to stroke, kidney damage, vision loss, fluid in the lungs, memory loss, and erectile dysfunction (AHA, 2010) . Research studies have consistently shown that” most patients with established HTN have poorly controlled blood pressure (BP) and that 30% to 70% of patients do not take their BP medications as prescribed” as seen in the case of this patient (Bokhour, Berlowitz, Long & Kressin, 2006). NURS 6512 Diversity and Health Assessments Discussion Essay.
The nurse practitioner understanding that development of hypertension is related to both genetic and lifestyle factors such as genetic, age, gender, body shape, and family history, and lifestyle factors of excessive drinking, smoking, poor eating habits, and reduced physical activity will help in the management of this patient problems. As health care team, it is important that we are diverse in large part just like our patients are diverse “A lack of cultural understanding increases negative attitudes towards cross-cultural care and also affects healthcare professionals’ perceived preparedness to take care of culturally diverse patients” (Kaihlanen, Hietapakka & Heponiemi, 2019). Also, research shows that African Americans are genetically more at risk for glaucoma, making early detection and treatment more important. Early diagnosis and treatment and medication adherence are key in preventing vision loss from glaucoma “High BP could increase intraocular pressure (IOP) by increased production of aqueous humor by means of elevated ciliary blood flow and capillary pressure and decrease of aqueous outflow as a result of increased episcleral venous pressure” (Leeman & Kestelyn, 2019) NURS 6512 Diversity and Health Assessments Discussion Essay.
A low BP, whether spontaneous or secondary to antihypertensive therapy, can play a part in reducing OP intraocular pressure (IOP). Therefore, antihypertensive treatment has shown have a preventive effect on the development of glaucoma and both high BP and low BP having been associated with an increased risk of glaucoma (Leeman & Kestelyn, 2019). Patients with high BP should be screened for glaucoma, and patients with glaucoma should be screened for arterial hypertension. Patients with coexisting glaucoma and high BP should undergo closer ophthalmologic examinations. This patient requires close ambulatory BP monitoring be performed with the deterioration her vision and a referral to an eye doctor initial and then every six months subsequently will be recommended for treatment and management of her glaucoma.
In the case of this 68-year-old AA female who presented to the clinic with elevated BP in clinic with a BP of 182/99 with HR of 84. When developing strategic measures for medication adherence and planning for this patient findings suggestive should include barriers due to self-efficacy, time with hypertension diagnosis, medication inefficiency and age are critical factors to consider “Racial-ethnic minorities are less often engaged in decision on their treatment than white adults, which may be a contributing factor to lower adherence in the former” (Bokhour, Berlowitz, Long, & Kressin, 2006). Some patients do not accept the diagnosis, which is obviously a major impediment to adherence as well. Lack of knowledge about hypertension and its consequences are logically linked to suboptimal adherence. Diversity in health care goes far beyond a language barrier “It’s about understanding the mindset of a patient within a larger context of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities” (Bokhour, Berlowitz, Long, & Kressin, 2006).
As a future nurse practitioner, I can empower this patient to take her medications as Prescribed by doing effective two-way communication to doubles the odds of taking her medications properly. Try to understand the barriers and address them honestly to build that trust. I will develop simple method and directions to help improve medication adherence by simplify the regimen. Talk to her, show empathy and address her concerns or fears. Encourage the use of adherence tools, like day-of-the-week pill boxes or mobile apps such that will work to match the action of taking medications on daily routine example, mealtime or bedtime. To help impart knowledge, I will write down prescription instructions clearly, and reinforce them verbally. Modify patients’ beliefs and behavior by providing positive reinforcement such as offering incentives when medications are taken successfully. Always ask for patients’ input when discussing recommendations and making decisions and remind patient to call the office with any questions or concerns “Interventions to promote adherence require several components to target these barriers, and health professionals must follow a systematic process to assess all the potential barriers” (Burnier & Egan, 2019). Also, a healthy lifestyle modification example, healthy eating habits, engaging in enough physical activity, abstaining from tobacco use, and limiting alcohol intake can help with blood pressure control.
Using multiple strategies, the nurse practitioner can assess the patients’ medication-taking behavior, and to identify potential reasons for the lack of BP control, and plan intervention accordingly. NURS 6512 Diversity and Health Assessments Discussion Essay
What Are Your Medical and Surgical Histories?
What Prescription and Non-Prescription Medications Do You Take? …
What Allergies Do You Have? …
What Is Your Smoking, Alcohol, and Illicit Drug Use History?
Did you take all your pills?
When was the last time you see eye doctor?
Socioeconomic, lifestyle, religion and other cultural factors especially religious doctrine among African American community has a lengthy traditional belief. This is because, spiritual or religious experiences of African Americans may shape beliefs about the causes of illness, as well as treatment decisions. There is also a tendency for religious faith and prayer to be having substantial potential for healing and may serve as an alternative to medical care for serious illnesses. Among African Americans, it is generally expected that family members, including extended family members, will play an important role in treatment decisions. With this patient, it is critical to increase family education about disease states and the benefits of compliance in achieving successful outcomes (Purnell, & Fenkl, 2019).
Patient poor adherence may be partially due to problems of access and cost of medication, however, patients’ beliefs about HTN and medication may also play a significant role. Not all patients treated for hypertension follow their health care professional’s advice especially when it comes to long-term medication therapy. Medication adherence is very important and non-adherence increases patients risks for death. Most patient stooped taking their prescription drugs they believed that they were cured or thought that they had been advised to stop by their provider. Some nonadherence to medications has been attributed to both intentional meaning a conscious decision not to take medications and unintentional, a failure to take medications due to poor understanding or forgetfulness. Socioeconomic, lifestyle, religion and other cultural factors especially religious doctrine among African American community has a lengthy traditional belief. This is because, spiritual or religious experiences of African Americans may shape beliefs about the causes of illness, as well as treatment decisions. Medical teams understanding of patients belief and values, will aid in providing a better care because when a patient cannot find providers that resemble them, their beliefs, their culture, or other facets of their life, it may delay or prevent them from seeking care.
Bokhour, B. G., Berlowitz, D. R., Long, J. A., & Kressin, N. R. (2006). How do providers assess antihypertensive medication adherence in medical encounters? Journal of General Internal Medicine, 21(6), 577-583. doi:10.1111/j.1525-1497.2006. 00397.x
Burnier, M., & Egan, B. M. (2019). Adherence in Hypertension. Circulation Research, 124(7), 1124-1140. doi:10.1161/circresaha.118.313220
Kaihlanen, A., Hietapakka, L., & Heponiemi, T. (2019). Increasing cultural awareness: Qualitative study of nurses’ perceptions about cultural competence training. BMC Nursing, 18(1). doi:10.1186/s12912-019-0363-x
Leeman, M., & Kestelyn, P. (11 mar 2019). AHA, 73, NO. 5. doi: https://doi.org/10.1161/HYPERTENSIONAHA.118.11507
Purnell, L. D., & Fenkl, E. A. (2019). Barriers to Culturally Competent Health Care. Handbook for Culturally Competent Care, 19-26. doi:10.1007/978-3-030-21946-8_3 NURS 6512 Diversity and Health Assessments Discussion Essay