Case Summary
Patients’ race, ethnicity, culture, spirituality, and socioeconomic status may impact their health and their access to treatment. For many patients from minority groups, the relationship with clinicians is strained due to the various stigmas assigned to them. In the present case, the 28-year-old African-American man comes to the office with a concern about a migraine. His frequent visits to the clinic have led to the patient being referred to as a “frequent flyer,” which carries a negative meaning among the nurses. It is vital to build the patient’s history and ask questions about his health and environment to determine the cause of his condition.
Patient Background Considerations
When considering a specific patient, the nurse has to be attentive to their personal characteristics. The patient in the chosen case is a young African-American man, and his race and ethnicity may be a cause of mistrust in the nurse-patient relationship. A history of mistreatment and poor handling of people of color by clinicians has caused minority groups to avoid visits to the doctor (Coleman, 2019). Moreover, African Americans continue to experience health disparities – they are less likely to access the necessary treatment or be diagnosed than white people (Centers for Disease Control and Prevention (CDC), 2021). While not much is known about the socioeconomic status of the patient, his being worried about not getting medication may be a sign of fear of poor medical treatment in the past.
Furthermore, the patient appears to have strong familial connections, as his father has come with him to the clinic. The nurse must acknowledge the presence of family members and discuss whether the patient wishes to be seen alone or with the father present. There are no apparent spiritual or lifestyle factors in the case, so additional questions are necessary to make the patient feel comfortable. It is possible that the patient’s lifestyle, such as stressful or dangerous work or substance use, affects his health.
Assessment Questions
To build a patient’s history, the nurse must ask questions while using cultural competence during communication. This means that one must assess and value the cultural beliefs of patients, recognizing that each person requires an individualized approach tailored to their specific needs. For example, it is crucial to ask the patient whether they are comfortable with medical terms or prefer simple language for easy understanding (Office of Minority Health, n.d.).
Next, the questions should be unbiased and avoid making assumptions to build trust with the patient. For instance, the status of a “frequent flyer” is a negative description that may disrupt the patient’s treatment and place some stigma on his medication needs. The following five questions can be asked to start creating a patient history:
- When did you first start experiencing headaches?
- Please describe the headache: Which parts of your head usually hurt, and how would you describe the pain? How long does your migraine usually last?
- Do any of your family members experience or have experienced similar migraines?
- What do you usually take or do to alleviate the pain, including medications and non-drug treatments?
- Do you have any types of stress in your daily life? If you do, can you tell me more about them?
The five target questions presented above cover the initial stages of discussing the patient’s migraines with him. First, it is vital to understand whether the patient’s headaches are recent or not. If they have been occurring for a long time, the nurse may ask in-depth questions to see why the patient does not have a diagnosis.
Next, the nurse must learn about specific symptoms to determine the potential cause or other symptoms related to the condition. Questions about migraines can also include descriptions of symptoms, such as sharp or dull pain, pressure, and tension in specific areas, among others. Family history is another crucial factor that can help one understand the patient’s background. The question about pain relief may indicate the patient’s access to medication outside of the office and suggest whether non-traditional treatments are used at home. Finally, the question about stress has the potential to reveal any causes of migraines or cultural factors that lead to a strained relationship with healthcare.
Patient-Nurse Communication Barriers
When communicating with patients, nurses may encounter various challenges. The language barrier is one of the most apparent problems that can be addressed by using simple language and asking the patient which terms they prefer (Dains et al., 2019). Another issue that may arise is the lack of transparency or detailed answers – patients may be hesitant to answer or provide explanations if they are scared, unsure of their opinions, or suspicious of the nurse. In this case, the nurse should focus on learning and providing the patient with as much information as possible to ensure that the patient understands the problem (Young & Guo, 2020).
Furthermore, if mistrust persists, the professional can collaborate with community specialists to foster effective communication (CDC, 2021). The nurse should also learn about the patient’s specific culture and consider how people in the community typically communicate, convey news, and offer or receive advice (Ball et al., 2023). Asking the patient directly or using evidence-based practice guidelines and literature can help the clinician stay informed.
References
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.
Centers for Disease Control and Prevention. (2021). Cultural competence in health and human services.
Coleman, D. E. (2019). Evidence based nursing practice: The challenges of health care and cultural diversity. Journal of Hospital Librarianship, 19(4), 330-338.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care(6th ed.). Elsevier Mosby.
Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent care. United States Department of Health & Human Services.
Young, S., & Guo, K. L. (2020). Cultural diversity training: The necessity of cultural competence for health care providers and in nursing practice. The Health Care Manager, 39(2), 100-108.