Course material

1. advanced health assessment discussion response # 1
rubric:This criterion is linked to a Learning OutcomeFirst Response18 to >16.0
ptsExcellent“Response exhibits synthesis, critical thinking, and application to practice
settings. Provides clear, concise opinions and ideas that are supported by at least two
scholarly sources. Demonstrates synthesis and understanding of Learning Objectives.
Communication is professional and respectful to colleagues. Responses to faculty questions
are fully answered, if posed. Response is effectively written in standard, edited
English.descriiption:Respond on or before Day 6 on 2 different days to at least two of your
colleagues who were assigned a different patient than you. Critique your colleague’s
targeted questions, and explain how the patient might interpret these questions. Explain
whether any of the questions would apply to your patient, and why.Students paper to reply
to:Delphine SHello Dr. O and Class,TJ, a 32-year-old pregnant lesbianCultural competence
means that healthcare providers and institutions must respect the identities and practices
of their patients in order to give them proper care. The patient’s and their family’s values,
beliefs, culture, language, and socioeconomic status are all considered. Care that is both
culturally appropriate and focused on the patient’s needs has many things in common. For
example, it means giving care that respects and responds to each patient’s preferences,
needs, and values and ensuring that all clinical decisions are based on these values. Patient-
centeredness and cultural competence are needed to improve healthcare quality (Stubbe,
2020). When a nurse practitioner assesses a pregnant lesbian patient, she must consider the
woman’s values, sexual orientation, and other things that might affect her healthcare
decisions.When assessing this patient, the nurse practitioner/provider should have an open
mind, be considerate, and not be judgmental or discriminative. Instead of using cultural
knowledge as a foundation for making assumptions about the patient, it should guide in a
more productive questioning that avoids stereotyping (Ball et al., 2019). T.J. is a lesbian
easily discriminated against and judged for being pregnant. The provider is responsible for
making her feel comfortable and accepted so that she can open up and answer questions
without fear of stereotyping or being discriminated against. During the health assessment,
questions should be tailored to focus on her health and the well-being of the growing fetus.
The health assessment questions must be detailed without appearing judgmental or biased.
Being a lesbian does not negatively impact one’s health in and of itself, even though there
are physiological differences between lesbians and heterosexual women. However, lesbians
tend to engage in high-risk behaviors that can affect their access to healthcare and quality of
life (American College of Obstetricians and Gynecologists, 2018). As a nurse practitioner,

2. however, I have to determine whether or not the patient is engaging in any activities that
pose a danger to her unborn child or her pregnancy. Instead of making assumptions,
medical professionals can consider the patient’s cultural background and unique
circumstances when formulating a treatment plan.In order to create a treatment strategy
tailored to each patient’s specific needs, it is crucial to collect detailed information about the
patient’s background and current condition through a thorough history and physical
examination. The nurse practitioner and patient must establish a good rapport (Ball et al.,
2019). The nurse practitioner’s outward presentation should always be of respect, realism,
and pursuing patient-centered goals. As a nurse practitioner, I am responsible for adapting
to TJ’s unique situation to establish a rapport with her that will foster mutual trust between
us. Building trust will assist us in setting free of criticism.Potential Health Related
RiskWomen who are part of the LGBTQ community have always had to deal with many
problems regarding their health care, including but not limited to problems that affect their
privacy and confidentiality. Discriminatory attitudes and treatment from healthcare
workers, lack of access to health care and health insurance, and misunderstanding of health
risks (American College of Obstetricians and Gynecologists, 2019). Many women who
identify as LGBTQ have had to deal with prejudice and ostracism for decades. Because of the
Affordable Care Act and other recent changes, many LGBTQ people can now get health
insurance. They are legally recognized at the federal and state levels. However, these
discriminatory practices have persisted for decades, stigmatizing the target population. My
duty as a Nurse Practitioner is to ask her questions about her health insurance, plans for
postpartum care, her current relationship status to ensure emotional support, and her
financial situation.Individuals who identify as lesbian, gay, bisexual, or transgender (LGBT)
often report receiving poor care and a high level of discrimination from medical
professionals, leading them to avoid medical attention altogether (Nama et al., 2017). I will
also inquire about her mental health by asking if she is depressed if her family has a history
of mental illness, and if she has engaged in any risky behaviors related to her mental health
or the pregnancy. Patients should be evaluated for signs of abuse or self-neglect because
domestic violence, discrimination, and abuse are prevalent in this group, further with
pregnancy which may pull more attention. Also, the patient must be checked to see if she is
taking illegal or dangerous drugs due to the detrimental effects on the growing fetus.Legal
issues could also arise during and after childbirth in the areas of but not limited to, legal
questions such as who should be listed on the birth certificate as the “legal parents.” The
legal names of the child. For some LGBTQ parents, the question of who should have parental
rights can come up and should be discussed with social services. (Pharris, 2018). The nurse
practitioner can refer TJ to social services if need be. TJ needs the same care as any other
pregnant woman. Therefore, it is essential to evaluate her diabetes history, her reaction to
the news of her pregnancy, her family’s medical history, and her medical history to
determine potential health risks to her and her unborn child. Because diabetes runs in TJ’s
family, there is a high probability that she could get gestational diabetes, causing
complications of pregnancy/ birth like Fetal macrosomia (overweight baby).Targeted
QuestionDo you feel safe in your environment?How often are you seeing an obstetrician.?Do
you have sex with men, women, or both?Do you smoke, drink, or use the recreational

3. drug?The symptoms you are describing, are they new or worsening? Moreover, have you
had the symptoms before?What is your current job and income?Can you describe to me
your daily activities, sleep, and diet?Are you taking any over-the-county medications?What
are your expectations from your healthcare provider and my team?Are there any areas of
concern you and your partner would like to discuss?Challenges associated with the
communicationSome challenges include but are not limited to language barriers, beliefs,
cultures, clothing, diet, and sexuality. For the nurse practitioner, their personal beliefs
sometimes may prevent them from accepting or providing competent care to others. For
example, the catholic church does not accept the LGBT community; they believe it is sinful
(Houghton & Tasker, 2019)To be culturally competent, one must do more than merely
accept the cultural norms and customs of others. Instead of focusing on erasing differences,
it seeks to highlight them through the power of connection and individualized care.
Providing culturally competent care requires nurses to adopt a worldview encompassing all
peoples and communities. As a nurse, it is your responsibility to do your best to treat
patients with dignity regardless of their cultural background. It has significant effects on
your efficiency and output. You are accepting everyone without being judgmental or
discriminating and implementing the conduct of your profession across the board, being
empathetic, listening, understanding, and communicating effectively. No matter your best,
some patients will still not feel satisfied. Always ask questions and do your best to meet
their expectations. Seek and provide social services to the patient, including case
management.References:American College of Obstetricians and Gynecologists Guidelines
and Clinical Guideline Summaries. Guideline Central. (2020, June 19). Retrieved March 7,
2023, from https://www.guidelinecentral.com/guidelines/ACOG/Ball, W. J., Dains, J. E.,
Flynn, J. A., Solomon, B. S., & W. Stewart, S. R. (2019, January 1). Seidel’s Guide to Physical
Examination – 9th Edition – Elsevier. Retrieved February 28, 2023, from
https://www.elsevier.com/books/seidels-guide-to-physical-examination/ball/978-0-323-
48195-3Links to an external site.Houghton, M., & Tasker, F. (2019). Exploring lesbian and
bisexual Catholic Women’s narratives of religious and sexual identity formation and
integration. Journal of Homosexuality, 68(1), 47–69.
https://doi.org/10.1080/00918369.2019.1624455Pharris, A. (2018). Supporting LGBT
individuals and couples as parents. Counseling Couples Before, During, and After Pregnancy.
https://doi.org/10.1891/9780826166654.0009Nama, N., Sampson, M., & McMillan, H. J.
(2017). Medical students’ perception of lesbian, gay, bisexual, and transgender (LGBT)
discrimination in their learning environment and their self-reported comfort level for
caring for LGBT patients: A survey study. Medical Education Online, 22(1), 1368850.
https://doi.org/10.1080/10872981.2017.1368850Stubbe, D. E. (2020). Practicing cultural
competence and cultural humility in the care of diverse patients. FOCUS, 18(1), 49–51.
https://doi.org/10.1176/appi.focus.20190041