46 y/o African American male who recently was seen in the Emergency Department for alcoholic withdrawal seizures and released
NURS-6512 – Week 2 : Functional Assessments and Cultural and Diversity Awareness in Health Assessment – BUILDING A HEALTH HISTORY: COMMUNICATING EFFECTIVELY TO GATHER APPROPRIATE HEALTH-RELATED INFORMATION
Case Scenario
46 y/o African American male who recently was seen in the Emergency Department for alcoholic withdrawal seizures and released. Referred to 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.
Include the following:
- Explain the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Be specific.
- Explain the issues that you would need to be sensitive to when interacting with the patient, and why.
- Describe the communication techniques you would use with this patient. Include strategies to demonstrate sensitivity with this patient. Be specific and explain why you would use these techniques.
- Summarize the health history interview you would conduct with this patient. Provide at least five (5) targeted questions you would ask the patient to build their health history and to assess their health risks. Explain your reasoning for each question and how you frame each for this specific patient.
- Identify the risk assessment instrument/tool you selected, and then justify why it would be applicable to your assigned patient. Be specific. (Please make sure that it is a risk assessment screening instrument and or tool)
- References: This 46 y/o African American male who recently was seen in the Emergency Department for alcoholic withdrawal seizures and released paper should be in APA format with at least three references to support your posting. In-text citation should be used as well.
Building A Health History
Socioeconomic, Spiritual, Lifestyle, and Cultural Factors
The assigned patient faces multiple socioeconomic challenges. These challenges include homelessness, which significantly impacts his access to healthcare, medication adherence, and overall well-being. The patient also lacks financial resources and stable housing which inadvertently prevents him from consistently obtaining and taking his prescribed antihypertensive medication, Norvasc. With a long history of alcohol consumption and withdrawal seizures, this shows that the patient suffers from alcohol use disorder often exacerbated by stress and unstable living conditions (Dains et al., 2022). The observed current smoking habit suggests that it is a developed coping mechanism to help manage anxiety and cravings, which could further complicate his hypertension management. Culturally, African American men have historically faced disparities in healthcare access and outcomes, often due to systemic biases, mistrust in the medical system, and socioeconomic barriers. These factors may influence his willingness to engage in follow-up care and adhere to medical recommendations.
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Spiritual beliefs may also play a role in his health behaviors and coping strategies. Many African Americans incorporate faith and spirituality into their healing process, relying on religious communities for support. Understanding whether the patient draws strength from spiritual or religious beliefs could provide additional resources for motivation and adherence to health interventions. Lifestyle factors, such as dietary habits, physical activity, and stress management, must also be considered, as they may be influenced by cultural norms and current living conditions (Dains et al., 2022). Given his status in a homeless shelter, his diet is likely inconsistent and may include high-sodium processed foods, further exacerbating hypertension.
Sensitive Issues in Patient Interaction
When interacting with this patient, it is essential to approach him with empathy and cultural humility, acknowledging the multiple challenges he faces without judgment. Sensitivity is required in addressing his history of alcohol withdrawal seizures, as addiction carries significant stigma and may make him hesitant to disclose details about his past or current substance use. It is important to assess his readiness for change regarding smoking cessation without applying pressure or making him feel guilty, as smoking is currently one of his coping mechanisms. Additionally, discussions around homelessness should be handled delicately, ensuring that he does not feel marginalized or dismissed due to his living situation.
Trust-building is crucial, particularly because African American communities have historically experienced medical mistrust due to past injustices in healthcare. It is important to recognize and validate any concerns he may have about the medical system while providing transparent, patient-centered care (Ball et al., 2023). Furthermore, his financial constraints should be considered when discussing treatment options, ensuring that he has access to affordable or free resources for medication, smoking cessation programs, and hypertension management. By being sensitive to these issues, the patient may be more receptive to medical guidance and long-term health improvements.
Effective Communication Techniques
To foster a positive interaction, a patient-centered communication approach should be used, incorporating active listening, nonjudgmental language, and open-ended questions. Using motivational interviewing techniques can help the patient explore his own health goals and readiness for change. For example, asking, “What challenges have you faced in managing your blood pressure?” or “What strategies have worked for you in the past to stay healthy?” allows him to take an active role in his care. Reflective listening and affirmations, such as “I hear that quitting alcohol was a big step for you, and that’s a great accomplishment,” can help build rapport and encourage trust.
Demonstrating cultural competence by acknowledging the patient’s experiences and tailoring recommendations accordingly is essential (Ball et al., 2023). For instance, instead of simply advising him to stop smoking immediately, a harm-reduction approach may be more effective, such as discussing nicotine replacement therapy options or behavioral strategies to gradually decrease smoking. According to Neufeld et al. (2021), providing information in an accessible and respectful manner, avoiding medical jargon, and ensuring he understands his treatment plan are also key components. If he expresses spiritual beliefs, integrating supportive community resources such as faith-based health programs may enhance adherence and support his overall well-being. By using these techniques, communication will be more effective, leading to improved patient engagement and health outcomes.
Health History Interview and Targeted Questions
To build a comprehensive health history, I would conduct a structured yet flexible interview, ensuring that I address the patient’s medical history, substance use, lifestyle factors, and social determinants of health. The questions would be framed in a nonjudgmental, open-ended manner to encourage honest responses.
- “Can you tell me about your experience managing high blood pressure? What challenges have you faced in keeping up with your medication?”
Reasoning: This question helps assess the patient’s awareness of his condition and barriers to medication adherence, such as financial constraints, forgetfulness, or lack of access to healthcare. - “You mentioned you are not drinking anymore. What support systems or strategies have helped you maintain sobriety?”
Reasoning: This question acknowledges his progress while assessing the stability of his sobriety and whether additional interventions, such as counseling or peer support, might be needed. - “I understand that smoking helps you cope. Have you considered any alternatives or strategies to reduce smoking?”
Reasoning: This nonjudgmental approach respects the patient’s current coping mechanisms while gently exploring harm reduction or smoking cessation options. - “Can you describe what a typical day looks like for you in terms of meals and access to food?”
Reasoning: Given his homelessness, understanding his diet helps in assessing his nutritional risks and developing realistic dietary recommendations for managing hypertension. - “Do you have any spiritual or community support that you rely on during difficult times?”
Reasoning: Many African Americans integrate spirituality into their coping mechanisms. Understanding this can help provide culturally appropriate resources and support systems.
Risk Assessment Tool Selection
A recommended risk assessment instrument for this particular patient is the Alcohol Use Disorders Identification Test (AUDIT) (Neufeld et al., 2021). The researchers wrote that the AUDIT instrument is ideal in this particular case as it is designed to address alcohol related elements for example the risk of relapse and alcohol dependence. The patient in the scenario has a long history of alcohol use disorder and other related conditions such as alcohol withdrawal seizures. Utilizing this tool will come in handy in informing the healthcare provider the likelihood, or risk for that matter, of the patient relapsing. What is more, the AUDIT tool will also help inform whether the patient has other lingering effects of alcohol use disorder. Writing in the importance and relevance of the AUDIT instrument, Arab et al. (2022) noted that it is a validated screening resource that aids in the evaluation of alcohol consumption patterns. More importantly, it also helps point out alcohol dependence symptoms for example underlying illnesses that are associated with alcoholism but which are clouded by the extended period of intoxication by an individual.
There are many advantages that the use of AUDIT screening resource will create most notably allowing for the provider to comprehensively, and in a structured manner, assess the patient’s past and present alcohol use. The value in this is allowing the provider to identify whether there are additional interventions that will be required in the course of treating the patient. In many cases, additional interventions that emerge include referral to addiction services. Arab et al. (2022) also commented on the importance of the AUDI screening tool citing its usefulness in primary care settings particularly among individuals with a history of heavy alcohol use. Interestingly, this instrument works in a very simple way. For example, if the results of an assessed patient turn out positive for continued alcohol-related risks, the provider triggers an immediate brief intervention for example connecting the patient to a community-based support service. Taking this initial step is necessary because it is appropriate for supporting the patient’s long-term recovery and health.
References
Arab, J. P., Izzy, M., Leggio, L., Bataller, R., & Shah, V. H. (2022). Management of alcohol use disorder in patients with cirrhosis in the setting of liver transplantation. Nature Reviews Gastroenterology & Hepatology, 19(1), 45-59. https://doi.org/10.1038/s41575-021-00527-0
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. (2022). Advanced Health Assessment & Clinical Diagnosis in Primary Care-E-Book: Advanced Health Assessment & Clinical Diagnosis in Primary Care-E-Book. Elsevier Health Sciences.
Neufeld, M., Bunova, A., Ferreira-Borges, C., Bryun, E., Fadeeva, E., Gil, A., … & Rehm, J. (2021). The Alcohol Use Disorders Identification Test (AUDIT) in the Russian language-a systematic review of validation efforts and application challenges. Substance abuse treatment, prevention, and policy, 16, 1-14. https://doi.org/10.1186/s13011-021-00404-8 46 y/o African American male who recently was seen in the Emergency Department for alcoholic withdrawal seizures and released
