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).Photo Credit: Getty ImagesRandall’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?BELOW IS THE QUESTION————————-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.BELOW IS THE REQUIRED READING————————————-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.Chapter 1, “The History and Interviewing Process” (Previously read in Week 1)This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients.Chapter 2, “Cultural Competency”This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.Chapter 2, “Evidenced-Based Clinical Practice Guidelines”Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2014). Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis. Journal of Asthma, 51(7), 703-713. doi:10.3109/02770903.2014.906605Credit Line: Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis by Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J., in Journal of Asthma, Vol. 51/Issue 7. Copyright 2014 by Taylor & Francis, Inc. Reprinted by permission of Taylor & Francis, Inc. via the Copyright Clearance Center.The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma.Centers for Disease Control and Prevention. (2020, October 21). Cultural competence in health and human services. Retrieved from https://npin.cdc.gov/pages/cultural-competenceThis website discusses cultural competence as defined by the Centers for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website.United States Department of Human & Health Services. Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent care. Retrieved June 10, 2019, from https://cccm.thinkculturalhealth.hhs.gov/From the Office of Minority Health, this website offers CME and CEU credit and equips healthcare professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.Coleman, D. E. (2019). Evidence based nursing practice: The challenges of health care and cultural diversity. Journal of Hospital Librarianship, 19(4), 330-338. https://doi.org/10.1080/15323269.2019.1661734Young, S., & Guo, K. L. (2016). Cultural diversity training. The Health Care Manager, 35(2), 94-102. https://doi.org/10.1097/hcm.0000000000000100PLEASE FIND BELOW THE CASE STUDY————Shawn Billings, a 28-year-old African American patient comes in to the clinic today. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and 4 days ago with a migraine, given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache. He is very agitated today. He is here with his father and worried that he will not get any medication..Please make sure to add 4 references not more than 5 years old , with APA format 7th edition.Please make sure to go through the rubic, case study very well and make sure to use headings to answer all the question.Please make sure to read the instruction very well and go through the rubic like I said earlier. CORE SKILL: separating CULTURE from STRUCTURE — and recognizing that the Randall article is a piece of evidence to be analyzed, not a truth to be endorsed or condemned.
THE ARGUMENT: Randall claimed that cultural attitudes among Black women support body sizes above the clinical healthy range. The debate it sparked is the assignment. A strong post neither uncritically accepts nor dismisses it — it INTERROGATES it.
THE CRITIQUE YOU SHOULD BE ABLE TO MOUNT: attributing obesity disparities to CULTURAL PREFERENCE risks individualizing a STRUCTURAL problem and shades into victim-blaming. The structural determinants have strong evidence behind them: FOOD DESERTS and food swamps (differential access to affordable fresh food); RESIDENTIAL SEGREGATION and its downstream effects on the built environment (fewer parks, unsafe streets, no sidewalks — so “just exercise” is not a neutral prescription); wage and wealth gaps; food marketing targeted at Black and Latino communities; occupational and time constraints; healthcare access; and WEIGHT STIGMA in clinical settings, which measurably reduces care-seeking and worsens outcomes. Also, ALLOSTATIC LOAD and the WEATHERING HYPOTHESIS (Geronimus): the cumulative physiological cost of chronic exposure to discrimination, which is independently associated with cardiometabolic disease. That is a mechanism through which racism becomes biology, and citing it lifts a post considerably.
THE COUNTER-CONSIDERATION, stated fairly: cultural body-image norms DO vary and are documented in the literature, and some evidence suggests more positive body image among Black women — which has a protective association with lower eating-disorder rates. Culture is not nothing. The sophisticated position is that culture and structure are ENTANGLED, and that cultural preference cannot bear the causal weight Randall placed on it.
THE MEASUREMENT POINT worth making: BMI is a crude population-level instrument with known limitations — it does not distinguish fat from lean mass, and its risk cut-points perform differently across ancestry groups (which is why some bodies recommend lower thresholds for South Asian populations). Building a health assessment around BMI alone is itself a form of imprecision.
FOR THE HEALTH ASSESSMENT PORTION: socioeconomic, spiritual, lifestyle, and other cultural factors that shape THIS patient’s presentation; sensitive, non-judgmental, non-assumptive questions; and the CULTURAL HUMILITY frame (Tervalon & Murray-García) — lifelong self-critique and redress of power imbalance — rather than “cultural competence” as a body of facts about groups. State the corollary explicitly: within-group variation exceeds between-group variation, so this patient must be asked, not assumed.
USEFUL TOOLS: Kleinman’s explanatory model questions; the DSM-5-TR Cultural Formulation Interview; teach-back; trained interpreters. And check your own implicit bias — the IAT and the literature on provider bias in pain treatment are directly relevant.

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