Scenario

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 a hx 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.”

Understanding the Culture

In this case, an 86-year-old Asian man who relies on his daughter financially and physically states at his annual exam that he is here but does not want to burden his daughter. First and foremost, understanding the Asian culture may help understand why the patient feels this way (Lee, 2017). Asian’s mental health may be impacted by cultural components such as language barriers if they are immigrants, gender, and age, to name a few (Kramer et al., 2002). In the Asian culture, family is of high importance, and each member has a role and position in the family they are supposed to abide by and cater to the more significant needs of the family (Kramer et al., 2002).  When it comes to receiving health care, the Asian population may feel ashamed or judged for seeking help (Kramer et al., 2002). Due to this stress, they often present with mental health issues but physical complaints (Kramer et al. 2002). The annual exam assessing his mental status will be included (Ball et al., 2019). Also, to help understand the caregiver’s role, it is necessary to understand their cultural values, immigration history, and family expectations within the Asian culture (Lee, 2017).

Socioeconomic

Acknowledging his concern is a priority as he states that right away (Ball et al., 2019). Using RESPECT as a tool to help speak with the patient and close the cultural gap to improve cross-cultural communication may be beneficial in this scenario (Ball et al., 2019).  The tool RESPECT stands for rapport, empathy, support, partnership, explanations, cultural competence, and trust (Ball et al., 2019). Addressing socioeconomic factors may cause discomfort for the patient as he knows his daughter is his financial source. As part of respect in the Asian culture, adult children take care of their elder parents (Lee, 2017). After creating rapport and trust with the patient would be an excellent opportunity to offer other resources and support to the patient and daughter to help relieve some of the stress.

Spiritual Needs

It is essential to know what religion they follow (Carnes, 2021). Some follow Christianity, Hinduism, Buddhism, Islam, Sikhism, Jainism, Zoroastrian, and more (Carnes, 2021). Speaking with the patient’s family and daughter, the care provider, may aid in assessing family relationship history and cultural beliefs (Ball et al., 2019).

Five Targeted questions

1. Do you have the medications you need? Do you take them as prescribed?
2. Do you need any assistance with taking your medications and injections?
3. Are you able to make your meals? What do you typically eat and drink in a day?
4. Are you able to dress? Get around independently?
5. Do you feel sad? Depressed?

Conclusion

            In conclusion, cultural competence is learned over time through education on cultural concerns, biases, and understanding (Ball et al., 2019). Different methods of communication may be used to meet a patient’s needs (Ball et al., 2019). This may include language translation, facial expressions, body language, and eye contact (Ball et al., 2019). Moreover, being aware of cultural differences is essential when caring for others of different cultures.

References

Carnes, T.  Asian American Religions. Oxford Research Encyclopedia of Religion.

Retrieved 7 Sep. 2021, from

https://oxfordre.com/religion/view/10.1093/acrefore/9780199340378.001.0001/acrefore-9780199340378-e-502.

Kramer, E. J., Kwong, K., Lee, E., & Chung, H. (2002). Cultural factors influencing the mental

health of Asian Americans. The Western journal of medicine, 176(4), 227–231.

Lee J. (2017). ASIAN AMERICAN ADULT CHILDREN AS CAREGIVERS FOR THEIR

AGING PARENTS: A PUBLIC HEALTH PERSPECTIVE. Innovation in

Aging, 1(Suppl 1), 915. https://doi.org/10.1093/geroni/igx004.3277

response

I like that you begin your discussion by talking about understanding different cultures. There are countless different customs in the world, and all have their own methods of communication, health beliefs, diets, and relationships (Ball et al., 2019). Asian Americans often face healthcare disparities and challenges when accessing care. Many are not born in the United States and are unfamiliar with the language and Western medicine. They frequently view mental illness as a personal weakness and manifest psychological distress in physical symptoms (National Institute on Minority Health and Health Disparities, 2016). Nurse practitioners need to be aware of common cultural practices to treat their patients best. It can also be beneficial to have experts in certain cultures available to navigate a patient’s treatment plan. For example, the hospital I work for serves a sizeable Korean community in the area. Most of the physicians and healthcare workers in the facility are not Korean, so we have a designated department to serve this group. This population can receive care from providers who understand their language and culture, which increases their likelihood of coming to the facility for care and trusting those who are taking care of them.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

National Institute on Minority Health and Health Disparities. (2016). The center for Asian health engages communities in research to reduce Asian American health disparities. Retrieved from https://www.nimhd.nih.gov/news-events/features/training-workforce-dev/center-asian-health.html