My patient is a 32-year old lesbian who is having vaginal discharge on her annual exam. She has a family history of diabetes and received sperm from a local sperm bank without any complications thus far; this is her first pregnancy and has not given birth yet. Socioeconomic status (SES), spiritual, lifestyle, and other cultural factors all culminate to help better understand the patient and their history. These factors also provide trends on the way different populations seek medical care and how physicians treat them (Ball et al., 2019). Lower SES populations tend to have negative health and medical care, as poverty and inadequate education disproportionally affects this population (Ball et al., 2019). With this patient, there is not enough information to determine her SES, but the fact that she is arriving to her annual exam is positive.

The patient’s self-identity is the most important information to address because she is lesbian. The lesbian, gay, bisexual, and transgender (LGBT) community is at risk for numerous adverse health outcomes and discrimination (McEwing, 2020). This community has a higher rate of suicide, depression, HIV, STI, and mental health issues, which contributes to the many disparities that they may face just based on their lifestyle choices and self-identification (McEwing, 2020). Ball et al. (2019) argues that about 10% of patients that providers will see may not be heterosexual and it is important address them appropriately to gain respect throughout the exam. Respect and trust are important to gain upon assessments with patients because they must feel comfortable enough to confide in someone who is caring for them. It is important to be culturally competent and understand one’s views and feelings about heterosexism and homophobia that one may possess (Ball et al., 2019). Once one has a full understanding of their own views, it is important to not let these opinions affect the type of care they are providing, as this may have a negative effect on the patient’s plan of care.

To be culturally competent, it is important to understand the many facets that make up a patient, such as their health beliefs and practices, faith, language, communication, family roles, support systems, and dietary practices (Ball et al., 2019). When addressing the LGBT community, it is important to use the correct vernacular when addressing them (Aisner et al., 2020). Yes, this patient identifies as lesbian but they can further identify as asexual, gender fluid, gender nonconforming, nonbinary, pansexual, and queer (Aisner et al., 2020). Therefore, it is important to provide follow up questions to fully understand their background. Five potential questions are listed below.

Questions

How do you identify as?
How does your partner identify as?
Have you had sexual intercourse with more than one partner?
Do you have a history of HIV or any STIs?
Have you ever had sexual intercourse with an individual with confirmed HIV or STIs?
These five questions can help gain a better understanding of the patient and their sexual history. Additionally, it may help rule out any causes of the vaginal discharge the patient is experiencing.

Marcus Yee

Reference

Aisner, A. J., Zappas, M., & Marks, A. (2020). Primary care for lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) patients. The Journal for Nurse Practitioners, 16(4), 281-285.

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.

McEwing, E. (2020). Delivering culturally competent care to the lesbian, gay, bisexual, and transgender (LGBT) population: Education for nursing students. Nurse education today, 94, 104573.

rubric:
This criterion is linked to a Learning OutcomeSecond Response
17 to >15.0 pts
Excellent
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.

descriiption:
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.

discussion original assignment requirements that we are responding to:
Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
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?