Critique of the Discussion Essay
Critique of the Discussion Essay
The discussion in the provided case study demonstrates an awareness of the importance of considering cultural and linguistic factors when providing healthcare to a Spanish-speaking patient. Focusing on the patient’s background, cultural constructs, and the need for an interpreter shows sensitivity toward delivering appropriate care. However, there are a few points that could be critiqued and improved.
First, it is essential to avoid making assumptions based solely on the patient’s language and ethnicity. While the assumption that the patient is of Hispanic origin due to her Spanish-speaking ability might be a reasonable starting point, it is crucial to gather more information to understand her specific heritage and cultural background. Relying solely on assumptions can lead to misunderstandings and misinterpretations.
Additionally, the discussion mentions the patient’s potential religious preference, assuming she might be Catholic due to the high percentage of Latinos identifying as Catholic. As Dillard et al. (2021) assert, it is essential to note that religious preferences can vary widely within any ethnic or cultural group, and assuming a specific religion based on ethnicity can be misleading. It would be more appropriate to ask the patient about her religious beliefs if they are relevant to her healthcare.
Socioeconomic, Spiritual, Lifestyle, and Cultural factors
The patient’s socioeconomic status is unknown, but it can be inferred that she may face challenges, given that she receives care at a clinic. Hispanics in the United States have been reported to have a poverty rate of 17.0 percent, indicating a potential socioeconomic vulnerability. Socioeconomic factors are crucial in determining the patient’s access to healthcare. As McMaughan et al. (2020) highlight, the patient’s economic status can impact her ability to afford necessary medical care, such as regular check-ups and prescribed medications. She may be more likely to rely on over-the-counter medications and delay seeking medical attention if she has limited financial resources. Information about the patient’s health insurance coverage is also relevant as it can affect her ability to afford follow-up visits and diagnostic tests.
Additionally, the patient’s spiritual beliefs and practices may influence her approach to health and wellness. Understanding her religious or spiritual background can provide insights into her coping mechanisms, decision-making processes, and preferences for healthcare interventions (Swihart & Martin, 2022). Assessing the patient’s lifestyle habits is crucial in understanding her health status. Factors such as diet, exercise, substance use, and sleep patterns can contribute to developing or exacerbating abdominal pain.
Cultural factors also need to be considered when assessing the patient’s health. A language barrier exists as the patient primarily speaks Spanish, which could pose challenges during medical consultations. Effective communication is essential to properly understand the doctor’s instructions and recommendations (Kee et al., 2019). Furthermore, although not specified, the patient’s migration background could impact her access to healthcare, social support networks, and familiarity with the healthcare system in the new country.
Challenges Associated with Communication
Al Shamsi et al. (2020) highlight that communicating with patients from diverse populations presents various challenges. One significant challenge is the language barrier. The language difference may hinder effective communication in the case of the Spanish-speaking patient. This can lead to miscommunication, misunderstanding of symptoms, and inadequate provision of information. To address this challenge, employing the assistance of a professional interpreter who is fluent in both English and Spanish greatly facilitates communication. By utilizing an interpreter, nurses can ensure accurate transmission of information and enhance the patient’s understanding of their condition and treatment options.
Another challenge is the need for knowledge regarding the patient’s cultural background, including their lifestyle preferences, religious beliefs, and socioeconomic status. These factors can significantly influence a patient’s health beliefs, attitudes, and behaviors. To overcome this challenge, nurses should adopt a culturally sensitive approach. This involves recognizing and respecting cultural diversity, understanding the potential impact of cultural factors on healthcare decisions, and tailoring communication and care accordingly (Kaihlanen et al., 2019). Establishing a personal connection with the patient, acknowledging their cultural values, and demonstrating respect can help build trust and rapport. Additionally, seeking additional information from the patient’s daughter, who speaks English, may provide valuable insights into the patient’s background and cultural considerations.
Targeted Questions for Health History
The targeted questions for building a health history are appropriate for any patient experiencing abdominal pain. However, it is crucial to consider the patient’s cultural and linguistic background when formulating these questions. For example, in the first question, what brings you to the clinic today, and how can I help? This straightforward question allows the patient to express their visit’s reason and specific concerns. The patient would likely interpret this question as an invitation to share their symptoms and seek assistance.
In the second targeted question, “I am concerned that this is your second visit for abdominal pain. Can you start by explaining when, how, and why you think the pain started?” This question seeks to gather more detailed information about the onset and nature of the pain. The patient would interpret this question as an opportunity to provide a chronological account of their symptoms, allowing the nurse to better understand the context and possible causes.
In the third question, “Where exactly is the pain (can you show me)? Are there any associated symptoms?” By asking the patient to locate and describe the pain, the nurse aims to gather specific information about the pain’s location and accompanying symptoms. The patient would interpret this question as a request to demonstrate the area of discomfort and provide additional details about related symptoms.
In the fourth question, “Can you describe the character of the pain? Does it radiate? Is it localized, severe or dull?” This question reveals the pain’s characteristics, such as intensity, quality, and radiation. The patient would interpret this question as an opportunity to describe the pain and help the nurse assess its severity and potential underlying causes.
Finally, the question, “What makes the pain worse/better?” This question seeks to identify any factors that exacerbate or alleviate the pain. The patient would interpret this question as an invitation to provide information about triggers or relieving factors, which can assist the nurse in formulating an appropriate diagnosis and treatment plan.
Al Shamsi, H., Almutairi, A. G., Al Mashrafi, S., & Al Kalbani, T. (2020). Implications of language barriers for healthcare: A systematic review. Oman Medical Journal, 35(2). https://doi.org/10.5001/omj.2020.40
Dillard, V., Moss, J., Padgett, N., Tan, X., & Kennedy, A. B. (2021). A cross-sectional survey study of attitudes, beliefs, and behaviors of religiosity, spirituality, and cultural competence in the medical profession. PLOS ONE, 16(6), e0252750. https://doi.org/10.1371/journal.pone.0252750
Kaihlanen, A.-M., Hietapakka, L., & Heponiemi, T. (2019). Increasing cultural awareness: Qualitative study of nurses’ perceptions about cultural competence training. BMC Nursing, 18(1), 1–9. https://doi.org/10.1186/s12912-019-0363-x
Kee, J. W. Y., Khoo, H. S., Lim, I., & Koh, M. Y. H. (2019). Communication skills in patient-doctor interactions: Learning from patient complaints. Health Professions Education, 4(2), 97–106. https://doi.org/10.1016/j.hpe.2017.03.006
McMaughan, D. J., Oloruntoba, O., & Smith, M. L. (2020). Socioeconomic status and access to healthcare: Interrelated drivers for healthy aging. Frontiers in Public Health, 8(231). https://doi.org/10.3389/fpubh.2020.00231
Swihart, D. L., & Martin, R. L. (2022, November 14). Cultural religious competence in clinical practice. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493216/
Critique the discussion below about the 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 #3 involves a 26-year Spanish-speaking patient who has visited the clinic on 2 consecutive days for abdominal pain. We have no information on the patient’s background, where she migrated from, and when she arrived. We do know that her daughter speaks English, but we do not know the age of her daughter. After the initial visit, the patient was sent home with Omeprazole and encouraged to take over-the-counter meds. Today (day 2) she presents with worsening abdominal pain per her daughter.
We can assume that she is of Hispanic origin. Per Funk & Lopez, (2022) the US Census Bureau reported that the Hispanic population reached 62.1 million in 2020, accounting for 19% of all Americans and making it the nation’s second-largest racial or ethnic group, behind White Americans and ahead of Black Americans.
According to Gonzalez-Barrera, (n.d.), about half of Hispanic adults say they most often describe themselves by their family’s country of origin or heritage, using terms such as Mexican, Cuban, Puerto Rican, or Salvadoran, while another 39% most often describe themselves as “Hispanic” or “Latino,”. Based on 2020 census data the Hispanic population reached 62.1 million, thirty-six percent of Hispanics are first-generation immigrants based on the same data. Culturally it would be difficult to define Paloma’s heritage unless her daughter was able to share that information. As indicated earlier we assume she is Hispanic due to the language she speaks.
We have no information on her lifestyle preferences, her religious preferences, or her socioeconomic status. If we assume that she is Hispanic we can consider that her religious preference might be Catholicism since “fifty-five percent of Latinos in America identify as Catholic” (Author, 2014).
We have no information on her socioeconomic status, we do know that she is receiving care at a “clinic”. Shrider, Kollar, Chen, & Semega, (2021) indicate that in 2020 Hispanics had a poverty rate of 17.0 percent.
Based on all of the previous information presented it is understood that knowledge of cultural, lifestyle, religious, and socioeconomic factors of individuals and groups be integrated into standards, policies, practices, and attitudes throughout the healthcare sector (Centers for Disease Control and Prevention, 2021). Research suggests that this inclusiveness will increase the quality-of-service delivery and influence better outcomes (Nolan, Alston, Choto, & Moss, 2021).
Due to the patient’s presentation and being that this is the 2nd visit within 2 days, it is of prime importance that the clinic staff attempts to use an interpreter. Magaña, (2020) asserts that structural issues in the healthcare delivery system can disproportionately affect language-minority patients who require interpretation services.
We cannot be certain that the daughter of unknown age other than “younger” is clearly communicating the patient’s issues to the provider or that she is communicating the treatment back to her mother. The use of a Spanish-speaking interpreter and more time with the provider falls aligns with Latino cultural constructs of confianza (trust), familismo (family orientation), personalismo (friendliness), respeto (respect), and simpatia (kindness) (Magaña,2020).
Issues that I would be sensitive to when interacting with the patient.
- Language barrier: from personal experience, I feel that using an interpreter to inform the line of questioning does align with the Latino cultural constructs outlined above. When we take the time to acknowledge that assistance is required to provide the most optimum patient experience it may allow the patient to be more open to providing information and can foster a sense of reassurance. Miscommunication such as language barriers can create obstacles to treatment adherence (Magaña,2020)
- Being sensitive to an unknown socioeconomic status, living situation, and ability to procure medications, I would attempt to make a personal connection with the patient. The Latino cultural construct of personalismo(friendliness) indicates that making an interpersonal connection before an institutional relationship is important. This may allow me as the provider to acquire additional information that could assist with diagnosis. Patients benefit when providers are culturally and linguistically competent and a perceived lack of personalismo can negatively impact Latino patients’ satisfaction and follow-up care (Magaña,2020).
Five targeted questions to build a health history.
- What brings you to the clinic today and how can I help?
- I am concerned that this is your second visit for abdominal pain can you start by explaining when, how, and why you think the pain started?
- Where exactly is the pain (can you show me)? Are there any associated symptoms?
- Can you describe the character of the pain, does it radiate, is it localized, is it severe or dull?
- What makes the pain worse/ better?
Author, N. (2014, May 7). Chapter 1: Religious Affiliation of Hispanics. Pew Research Center’s Religion & Public Life Project. https://www.pewresearch.org/religion/2014/05/07/chapter-1-religious-affiliation-of-hispanics/
Centers For Disease Control and Prevention. (2021, September 10). Cultural Competence | National Prevention Information Network. Cdc.gov. https://npin.cdc.gov/pages/cultural-competenceLinks to an external site.
Funk, C., & Lopez, M. H. (2022, June 14). A brief statistical portrait of U.S. Hispanics. Pew Research Center Science & Society. https://www.pewresearch.org/science/2022/06/14/a-brief-statistical-portrait-of-u-s-hispanics/Links to an external site.
Gonzalez-Barrera, A. (n.d.). The ways Hispanics describe their identity vary across immigrant generations. Pew Research Center. Retrieved June 6, 2023, from https://www.pewresearch.org/short-reads/2020/09/24/the-ways-hispanics-describe-their-identity-vary-across-immigrant-generations/
Magaña, D. (2020). Local Voices on Health Care Communication Issues and Insights on Latino Cultural Constructs. Hispanic Journal of Behavioral Sciences, 42(3), 073998632092738. https://doi.org/10.1177/0739986320927387Links to an external site.
Nolan, T. S., Alston, A., Choto, R., & Moss, K. O. (2021). Cultural Humility: Retraining and Retooling Nurses to Provide Equitable Cancer Care. Cjon.ons.org, 3–9. https://doi.org/10.1188/21.CJON.S1.3-9Links to an external site.
Shrider, E. A., Kollar, M., Chen, F., & Semega, J. (2021, September 14). Income and Poverty in the United States: 2020. The United States Census Bureau; United States Census Bureau. https://www.census.gov/library/publications/2021/demo/p60-273.html