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Reflect on your experience as an advanced practice nurse and on the information provided in the Week 1 Learning Resources on building a health history and the Week 2 Learning Resources on diversity issues in health assessments. By Day 1 of this week, your Instructor will assign a case study for this Assignment. Note: Please see the Course Announcements section of the classroom for your Case Study Assignment.

Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of your assigned patient. Consider how you would build a health history for the patient. What questions would you ask? How might you target your questions based on the patient’s social determinants of health? How would you frame the questions to be sensitive to the patient’s background, lifestyle, and culture?

Identify any potential health-related risks, based on the patient’s age, gender, ethnicity, or environmental setting, which should be taken into consideration. What risk assessment instruments would be appropriate to use with this patient? What questions would you ask to assess the patient’s health risks? Select one (1) risk assessment instrument discussed in the Learning Resources, or another tool with which you are familiar, related to your selected patient. Develop five (5) targeted questions you would ask the patient to build their health history and to assess their health risks.

Think about the challenges associated with communicating with patients from a variety of specific populations. What communication techniques would be most appropriate to use with this patient? What strategies can you as an APRN employ to be sensitive to different cultural factors while gathering the pertinent information? For your assignment, you will work on this case: 46-year-old African American male who recently was seen in the Emergency Department for alcoholic withdrawal seizures and released. Referred to the clinic for follow-up on his hypertension history.

He ran out of the Norvasc prescription given by the Emergency Department. He is living in a homeless shelter now. He states not drinking anymore but needs to smoke cigarettes to calm down and function.

Sample Paper For Above instruction

Introduction

Effective health assessment relies heavily on understanding the multifaceted social, cultural, and behavioral factors that influence patient health outcomes. As advanced practice registered nurses (APRNs), our role extends beyond clinical knowledge to encompass cultural competence, sensitivity, and tailored communication strategies. This paper explores the process of building a comprehensive health history for a homeless African American male with a history of hypertension, recent alcohol withdrawal, and current lifestyle challenges, emphasizing cultural awareness, risk assessment, and communication techniques.

Understanding the Patient Context

The patient is a 46-year-old African American male experiencing homelessness, who recently presented with alcohol withdrawal seizures and is now on follow-up for hypertension management. His current social circumstances significantly influence his health risks and care needs. Living in a homeless shelter suggests instability in basic needs, limited access to consistent healthcare, and high vulnerability to environmental risks such as exposure to infectious diseases, poor nutrition, and stress-related health issues.

Given his history of alcohol withdrawal seizures, substance use remains a pertinent concern. The fact that he has discontinued alcohol but still relies on cigarettes to function underscores the importance of addressing behavioral health within cultural and social contexts. The loss of his prescribed medication and his housing instability are critical social determinants of health, impacting his ability to adhere to management plans.

Building the Health History with Cultural Sensitivity

In collecting the health history, questions should be framed to acknowledge and respect his circumstances and cultural background. For example, questions about substance use, stress management, and social support should be open-ended to foster trust.

Questions might include:

• Can you tell me about your current living situation and how it affects your health?
• What challenges do you face in managing your health and taking medications regularly?
• How do you usually cope with stress or difficult feelings?
• Are there cultural or personal beliefs that influence how you manage your health or medications?
• What support systems or community resources do you utilize?

By targeting questions around social determinants of health—such as housing, economic stability, and social support—the nurse can better understand the patient’s unique context and tailor interventions appropriately.

Identifying Potential Health Risks and Risk Assessment Tools

The patient's age, history of hypertension, recent alcohol withdrawal, and current smoking status are notable risk factors. He is at increased risk for cardiovascular events, respiratory illnesses, and recurrent substance use issues. Environmental factors associated with homelessness elevate his risk for infectious diseases like tuberculosis and hepatitis.

Choosing an appropriate risk assessment instrument is essential. The Framingham Risk Score, for example, can estimate the risk of cardiovascular disease based on age, gender, blood pressure, cholesterol levels, and smoking status. Given his current circumstances, a screening for social risk factors and behavioral health issues using the AUDIT-C (Alcohol Use Disorders Identification Test - Consumption) is also appropriate.

Targeted questions for assessing health risks include:

1. Have you experienced any chest pain or shortness of breath recently?
2. When was the last time you checked your blood pressure?
3. Do you smoke cigarettes daily? How many per day?
4. Have you experienced any symptoms of depression or stress lately?
5. Do you have access to regular healthcare or medications?

These questions facilitate assessment of cardiovascular, respiratory, mental health, and medication adherence risks, enabling personalized care planning.

Communication Strategies and Cultural Competence

Effective communication with this patient requires sensitivity to cultural background, social circumstances, and health literacy levels. Strategies include adopting a respectful, nonjudgmental demeanor, employing open-ended questions, and ensuring a comfortable environment for discussion.

Techniques such as motivational interviewing can foster trust and promote behavior change, especially when addressing substance use and lifestyle modifications. Using plain language, providing visual aids, and confirming understanding through teach-back methods enhance clarity and engagement.

As an APRN, understanding the cultural significance of smoking within the community or personal history, and acknowledging barriers such as homelessness, social isolation, and mistrust in healthcare, helps tailor interventions that are culturally appropriate and more likely to succeed. Collaboration with community resources, such as housing programs and social services, further supports comprehensive care.

Conclusion

Building a culturally sensitive health history, assessing risks accurately, and employing effective communication techniques are foundational to providing equitable, patient-centered care. For the homeless African American male with hypertension and behavioral health needs, integrating social determinants of health with clinical assessment ensures a holistic approach to improve health outcomes and foster therapeutic relationships.

References

• Centers for Disease Control and Prevention. (2021). Cultural competence in health and human services. https://www.cdc.gov
• U.S. Department of Health & Human Services Office of Minority Health. (n.d.). A physician's practical guide to culturally competent care. https://minorityhealth.hhs.gov
• Coleman, D. E. (2019). Evidence-based nursing practice: The challenges of health care and cultural diversity. Journal of Hospital Librarianship, 19(4), 330–338.
• Pirhofer, J., Bà¼kki, J., Vaismoradi, M., Glarcher, M., & Paal, P. (2022). A qualitative exploration of cultural safety in nursing: Perspectives of advanced practice nurses. BMC Nursing, 21, 178.
• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel's guide to physical examination: An interprofessional approach (10th ed.). Elsevier Mosby.
• Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). Elsevier Mosby.
• i-Human Patients. (2023). Case manual download. Kaplan.
• National Prevention Information Network. (2021). Cultural competence in health and human services. https://npin.cdc.gov
• American Psychological Association. (2019). Guidelines for culturally sensitive health care. APA Publications.
• World Health Organization. (2020). Social determinants of health. https://www.who.int