Discussion: Diversity and Health Assessments

May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your instructor will assign a case study to you for this Discussion.

To prepare:

Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.

By Day 1 of this week, you will be assigned a case study by your instructor. 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 the patient assigned to you.

Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

By Day 6 of Week 2

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.


Case study:  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 ahx 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.


When treating a patient, we need to treat them with a holistic approach. Holistic health is treating the patient’s mind, body, spirit, and social needs rather than just focusing on physical health (Holland, 2018). The socioeconomic status of this patient could negatively impact his health. He is an elderly patient that is dependent on his daughter for financial stability, and his daughter is a single mother who is financially unstable herself. The patient’s financial hardships can make it hard to seek medical attention when needed, maintain a well-balanced diet, and participate in other activities that could improve his quality of life. The patient has not discussed any spiritual background but may be lacking the spiritual guidance that could improve his health and quality of life. Studies show that patients that are spiritual are better at coping and making important medical decisions (Spiritual Care, 2020).


It is a belief among Asian-Americans that if you seek mental health or discuss any mental health issues you are facing, you are considered to be crazy (Tanap, 2019). Their culture also believes that the men should be providers, J.C. is dependent on his daughter which is a strain on his mental health because he may believe he is failing by not being the provider. He also expresses stress about not wanting to burden his daughter. It is crucial to express the importance of good mental health to the patient and remind him that there is no shame in seeking help.


The physician needs to be culturally competent and sensitive to the patient’s socioeconomic situation, ethnicity, and cultural background when communicating with the patient. A provider should ask a patient what exactly they mean when they need clarification as a provider, and they also need to continue to ask the patient if they understand or need clarification. If a provider is not sensitive to these items, communication and trust can be lost (Ball et al., 2019). The Asian culture relies more on body language than actual words for effective communication, good posture, tone of voice, and gestures are important when communicating with this specific patient. In the Asian culture, they may smile a lot when they are uncomfortable or do not understand, this is a que that we as providers need to clarify the information we just provided (Pier, n.d.).

5 Targeted Questions

  1. How are you feeling in general about your health? What is concerning you about your health recently?
  2. Have you ever considered looking into resources in the community that could help with managing your health?

3.Do you have trouble affording your medications or are you ever worried you will not be able to afford groceries?

  1. What do you typically eat in a day?
  2. Do you feel safe at home? 6. Do you have any trouble performing daily activities such as bathing, feeding yourself, or getting dressed?
  3. Do you feel sad or depressed? If so, How many days a week would you say that you feel sad?

Colleague 2

Week# 2 Discussion Post.

Case study:   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 ahx 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.


The scenario selected for this week’s discussion post is number one: Our patient is an “Asian male 86 years old that presents for his annual physical exam. The patient has a health history of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. The patient is taking Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Ciprofloxacine 100mg QD to control those. The patient expressed concern about the actual economic family situation because he is living with his daughter, a single mother without money or time to face her father’s health care necessities, and he states he doesn’t want to be a burden for her”. This post aims to examine the cultural, spiritual, socioeconomic, and lifestyle factors that can interfere with his health care necessities. The analysis of sensitive issues during the patient interview and the targeted questions will build the health history and help identify patients’ risk in a culturally competent environment. A culturally competent service can improve the quality of care and patients’ health care outcomes (Temkin-Greener, Mao, McGarry, Zimmerman, & Li, 2021).

Patients’ factors

It is clear is almost impossible to know everything about each culture. However, as providers, we need to develop communication skills and techniques to take clinical history from the patient that can help to sort these sensitive issues (Health Policy Institute, 2019). Based on the presented information is necessary to consider multiples cultural factors in this patient

The first factor is language and communication barrier, in this case does not exist reference to direct communication problems ,but still corporal communication like eye contact should be considered because in Asian culture eye direct contact with elders or persons of authority can be regarded as disrespectful (Park, Chesla, Rehm, & Chun, 2011).

The second factor is socioeconomic; the patient is dependable, financially, and physically, in his daughter, and he intends not to be a “burden” for his daughter. Asian culture promotes a patriarchal structure where the man is the head of the family and its principal provider. Psychologically it is hard for him to rely on his daughter’s care, even more when the economic foundation of this family relay only on her as main provider. This situation represents a limitation for the acceptance of required services, and the provider needs to be trained in how to provide empathy, respect, and humility to provide the services in a culturally competent manner (Jayaram, 2020).

The third aspect to consider is patient believes and spirituality concepts. This aspect is critical in how the patient accept the diagnosis and can participate in their care. Many Asian use traditional medicine that can interfere with occidental schedules of treatments. As a provider is important to address culture and be familiar with the concepts of Yin- Yang in the Asian culture, the important relation between hot/cold beverages to treat different illnesses, and the importance to include this cultural element on the patient plan of care (Park, Chesla, Rehm, & Chun, 2011).

Sensitives issues

Due to special cultural considerations for this patient a sensitive assessment and clinical interview is necessary inquiry is aspect about high blood pressure control their response to western medications. the management of sensitive issues and allowing sufficient time for interview provide comfort for this patient like talking about his prostatitis with a provider of the opposite sex because for Asian patients sharing very sensitive ,intimate and personal information with outsiders take time (Working with Asian American patients, n.d.).

Targeted questions.

Would you like to have a translator today to assist with your interview?

Beside the fact that patient look like can speak English another important action can be done for a translator because knowing the language and culture .he can assess the level of patient language comprehension, clarify language typical phrases, or help the provider to empathize with the patient.

What kind of medical insurance do you have?

This question allow the provider to identify why the patient state he does not wants to be a burden for his daughter, and because the scenario indicate the patient in dependable on her is important to identify if the patient is uninsured , how he will think to cover the treatment or necessary medical expenses and on this way the patient if in need can be referred to social services or general welfare assistant services for health care assistance.

  1. Tell me about all-natural remedies or herbs that you are actually using?

With this question, providers can identify possible natural remedies that can interact with prescribed medication to alert the patient about the interaction. This aspect is also critical because considering these remedies and incorporating those on the patient’s treatment plan; the provider can gain adherence to treatment and patient respect.

What support network in families or friends do you have?

Because the Asian culture is patriarchal , fathers consider providing for the family even when the children are adults. With the acclimatization of the Asian immigrant to the United States elderly are now living more independent from their children, and they rely more on friends or another family members for daily needs or health care necessities and allowing children to intervene only in difficult or exceptional situations (Li, McLaughlin, & Zhang, 2020).

  1. Is there any aspect that I have not asked you and you want to discuss with me?

This question opens the opportunity for the patient to bring up any concern that the provider has not considered yet. This question opens the communication channel between the provider and the patient in a safe environment and allows the patient to speak freely (Jayaram, 2020).