Part 1: Assessment
Alex Williams is a 45-year-old African American male adult who is hospitalized in the Johns Hopkins Hospital in the United States. He is a married lawyer and a father of two daughters. He was diagnosed with type 2 Diabetes one year ago and started Metformin medication. Besides having type 2 diabetes, he also has other comorbidities such as hypertension and dyslipidemia. His wife and children have no health problems. Alex William’s medication and health history data were collected through a face to face interview technique. The assessment approach used was Giger and Davidhizar’s Transcultural Assessment tool. The tool is used to help assess the cultural values of patients in relation to their health and disease behaviors and their outcomes.
Communication is an important aspect. Communication entails the whole world of human interaction and behavior. It provides a sense of commonality among diverse cultures and provides room for more comfortable sharing of information, passing messages in the form of ideas and feelings. Through communication, culture is shared. In different cultures, both verbal and nonverbal communications are shared. The major elements of communication include vocabulary, volume, style, and context of the speech, rhythm, use of touch, body posture, and kinesics. Alex William’s family has no language or dialect distinction. He speaks English fluently, hence, eased the communication between him and the nurse. Alex had no difficulties in letter pronunciation. He does not use body language regularly but mostly uses body language to express pain. His voice tone is high, and the voice tone declines when he is in pain and when he talks about his disease. He describes his condition and the pain he feels in different words and phrases. He does not use silence as his way of communication; instead, he maintains eye contact expressing his pain and disease.
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A culturally unique individual is essential. Patients may be of different cultures and from different countries. Alex is an African American who lives in the United States, but his home country is Nigeria. He is currently a lawyer working at a corporate law firm, Jones Day. Alex was born in Abuja in the year 1974. His parents are both Nigerian citizens. Alex's wife is also an African American from Ghana. She is currently employed in the United States as a journalist. His parents are both Nigerian citizen. Alex follows his Nigerian culture, and he expects his culture to be respected. He is also a religious man; therefore, he takes religion very seriously.
Space is essential. It is the intimacy and distance measures used when associating verbally or non-verbally to other people. Effective communication happens in the aspect of space. There are various zones of interpersonal space which include personal, intimate social and consultative and public. Personal space varies from culture to culture. Space, territorially, is described as the feeling and attitude towards one private environment. Disrespecting the patient’s intimate and personal space may bring about discomfort, hence, causing patients to refuse treatment or even refusing to come back for more care. Alex Williams speaks and expresses himself within personal space during the interview. He refused to be touched and requested the nurse to maintain his personal space. He is seen to be more comfortable having his personal space during communication. His body movement showed his comfort in having his own personal space. He is also observed to be more comfortable when close to his wife and children.
Biological variations are also known as the biological differences matters in different cultures. Different cultures focus on biological variations mainly growth and development patterns, body systems, genetic mutations, skin and hair physiology, disease prevalence and resistance to diseases. Genetic variations to diabetes were detected in the family. One of Alex's daughters was found to have gene mutations which leads to a higher risk of diabetes. Alex’s family is one of the families known to have diabetes history. Alex’s father was also diagnosed to have diabetes. Alex' children have some similar body characteristics as their father. They both have dark hair and dark skin color just like their father. In addition, Alex expresses various psychologic traits such as extroversion, neuroticism, and extraversion. He has the ability to cope with the disease, and he is willing to accept the treatment process. However, he gets upset and anxious whenever he is not attended to the right time. Alex consumes a lot of carbohydrate meals. He also prefers consuming more vitamin foods.
Environmental control is the effort of a person to manage nature and to determine and plan factors in the environment that affect them and their surroundings. There are different cultural practices. There is a cultural group that has less believes in internal control and others which have less believes in external control. Culturally, these beliefs are essential to the people; however, this believes may be seen as useless because it has not been medically proven. Alex Williams frequently prays and uses a rosary even during the treatment process. He believes in giving thanks to God if he gets to heal. He believes that his disease is God's way of strengthening his faith. He values religion especially since he is a Catholic. Alex's family believe in praying during sickness and other challenging situations. The diabetes symptoms have affected the family relationship and peace. Also, the disease has challenged Alex's food beliefs and practices. The family dietary intake may have also contributed to the increase in Alex's symptoms. Also, the need for care for Alex and the disease management has affected the established family roles and responsibility.
Time is an essential aspect according to culture. Cultural groups are divided into the past, present, and the future. Some people look back at the past and try to provide tradition and have less motivation for implementing future goals. Other people focus on the present time and believe that it is essential. The people in cultures that are future-time oriented, plan the current activities to achieve their future plans. Preventive medication requirements require future time orientation since a future reward motivates preventive techniques. Cultures also describe time as clock time or social time. Alex believes that one day he will get healed by God. He claims he doesn't know Gods timeline, but he is sure that he will get healed one day in the future. He also believes in spending time with his family even though he is a hospital. He believes in focusing on the present since he makes no plans regarding the future. Alex is comfortable having social time. He spends most of his time with his family. He believes that social time helps him cope with the medication process of his disease. He respects the working time of the nurses. He fully cooperates during assessment and diagnosis done by his healthcare providers.
Social orientation is how or the way a cultural group organizes itself in a family group. A family is the most critical group in different cultures. The family organizations and structure, values and beliefs, religion and the role assignment, are all related to ethnicity and culture. Alex's family is a Catholic religious family. Alex believes his sickness to be God`s will. Alex’s family pray together and support since family comes first according to his culture. Alex’s family support shows the importance of social support to the patient’s outcome. Alex shows adherence to the recommended medication. The family support made Alex have a positive perception of life, and his depression levels were reduced. Also, the family support ensured that Alex facilitates better access to medication and utilization of healthcare. The family support reduces Alex stress and fear hence improving his psychological, nutritional, neuroendocrine and immunologic functioning.
Part 2: Care Plan
i) Nursing Diagnoses
Alex showed symptoms such as increased thirst, hunger, blurred vision, frequent urination. He also had poor wound healing. Also, Alex had other comorbidities such as hypertension and dyslipidemia. Type 2 diabetes has many causes. Genetics and lifestyle are the most crucial one studied to cause type 2 diabetes (American Diabetes Association, 2015). Combining both genetics and lifestyle may create insulin resistance when the body is not using insulin effectively as it should. Therefore, insulin resistance is the primary cause of type 2 diabetes. According to research, genetics also has a significant role in causing type 2 diabetes. This is because type 2 diabetes may be inherited. Poor lifestyle may contribute to type 2 diabetes. Choices made by individuals may affect their health. The poor life choices which may lead to type 2 diabetes include lack of exercise, overweight or obesity, and unhealthy eating. (American Diabetes Association, 2015) Individuals involving themselves in physical activities help avoid type 2 diabetes. Also, there are several risk factors for acquiring type 2 diabetes. They include high blood pressure, high alcohol intake, ethnicity and aging.
Excessive thirst is also known as polydipsia. It is one of the first noticed symptoms of diabetes. It is associated with great dryness of the mouth. In most individuals, thirst develops slowly hence making it hard to notice until other symptoms begin to show. Excessive thirst comes about when the glucose level increases significantly in the bloodstream. This level is often about 200mg/dl; however, this level differs from person to person. The kidney fails to absorb glucose from the water. In normal situations, almost all glucose is taken out of urine and incorporated back in the body. In this case, the body is unable to pull glucose from the water in the kidneys making the osmotic pressure increase. The osmotic pressure greatly increases; hence the water cannot be absorbed back to the bloodstream and instead absorbed out of the blood.
Blurred vision is a common symptom for people with type 2 diabetes. With long periods of high levels of glucose in the blood, the water in the body is pulled to the lenses hence swelling of the lens. It takes about six weeks for the swelling to stop after the blood sugar levels are almost normal. There may be damage to the retina. This is when there is severe damage to the blood vessels in the retina. With years of having high blood sugar levels, the walls of the blood vessels present in the retina get weaker and thinner. The vulnerable areas budge out forming micro-aneurysms. The weak, thin areas may leak a fatty protein. If the fatty protein leaks into the center of the retina, it leads to swelling hence causing difficulty in seeing.
Frequent urination is among the common symptom of type 2 diabetes. With type 2 diabetes, when high levels of glucose are present in blood, the kidneys respond by pulling glucose out of blood and into the urine. This causes increased production of urine and the frequent urination hence providing a high risk of urinary tract infections in men and women. Individuals having type 2 diabetes have a high chance of getting urinary tract infection more than the people without it. The risk has been proven to be high in women than men.
Hunger is also a common sign and symptom of type 2 diabetes. Patients with type 2 diabetes have insulin resistance which is described to be the body inability to utilize insulin the way it should to get glucose into the cell. Therefore, in patients with type 2 diabetes, insulin is not used effectively in muscles, fats and other tissues hence forcing the pancreases to put out more insulin to compensate. The insulin level in the body will, therefore, be high. The high insulin levels in the body thus send signals to the brain that the body requires food making the patient always hungry.
Poor wound healing is another symptom of type 2 diabetes. All wounds, especially to individuals with diabetes, should be a serious concern which needs immediate attention. This is because the wounds may not be noticed until when it’s too late making it hard to heal. Internal wounds may lead to tissue breakdown hence increasing high chances of infection. This can be explained because patients with type 2 diabetes have difficulties in maintaining an optimal blood sugar level. Diabetes does not give the body a chance to handle glucose effectively. High levels of glucose in blood damages many body systems. High glucose levels cause stiffening of arteries, narrows blood vessels and diabetic neuropathy described as the nerve damage all over the body especially the limbs. Therefore, this causes a high risk of wounds and other complications in diabetic wound healing.
Alex has shown various signs and symptoms of type 2 diabetes and high blood pressure which may have been caused due to his lifestyle choices. The diagnosis done will have cultural implications for the patient. This is because Alex will be forced to change his diet and his lifestyle choices which may be against his cultural practices.
ii) Client Outcomes
CVD has been researched to be a higher cause of death and disabilities in individuals with type 2 diabetes hence accounting for 52% of death among individuals with type 2 diabetes (Huang et al., 2017). Individuals with type 2 diabetes also have a high risk of experiencing a stroke within the first five years of diagnosis. Excessive thirst and increased urination may lead to body dehydration. If blurred vision goes untreated, the patient may experience vision problems, and if the problem progresses, it may lead to vision loss and blindness. Slow healing of wounds is also a major concern. It may decrease the body's ability to fight infection thus providing a high risk of infection which may lead to some organs and body parts being amputated.
iii) Interventions
The nurse has to determine the patient’s factors that may have caused unstable blood sugar levels. The nurse should also identify the patient’s cultural and religious factors that influence the patient’s dietary intakes. (Jutterstrom et al., 2016) The nurse should advise the patient about the importance of balancing food diets and improving physical activities. This will help prevent increased levels of glucose in the blood. The nurse should advise the patients to increase carbohydrate intake since the blood glucose level depends highly on carbohydrate intake. The patient should understand the importance of monitoring and controlling carbohydrates when stabilizing high blood sugar levels. (Jutterstrom et al., 2016) The nurse should explain to the patient how the anti-diabetic medication works and the importance of inspecting the patient’s insulin medication. The nurse should also check for necrotic tissues around clients wound and test and document the skin condition around the wound. To reduce the risk of infection, the nurse has to clean and dress the wound, advice the patient on the necessity of adhering to prescribed diabetic treatment and also administer and monitor the medication regime.
Part 3: Personal Reflection
I have learned that in a health care setting, patients may come from the different cultural backgrounds. The knowledge obtained from this assignment is essential for providing culturally appropriate care. The Giger and Davidhizar’s transcultural model is beneficial since I will be able to understand a patient's cultural heritage believes, values and behaviors. I have learned how to assess patients who are culturally adverse to provide culturally nursing care. This shows the importance of respecting and trying to determine the different cultures in a healthcare setting. Interviewing and assessing patients has to been done with care and keenness so that one may not feel that their cultural practices have been disrespected. It is essential to focus on the six cultural phenomena which include communication, space, biological variations, environment control, time and social orientation. The six cultural phenomena have to be taken into consideration especially when assessing and treating a patient from a different culture from your own. Alex showed different qualities in his response. He maintained his space and communicated effectively using less non-verbal gestures to demonstrate his pain. As a nurse, I would maintain space so as to prevent causing discomfort to the patient. I will also communicate clearly and effectively to ensure that the patient understood well. Alex does not believe in future plans since he believes in religion. He believes that God is going to heal him. According to me, as a nurse, time can be explained by the outcomes of the diagnosis. With the right medication, proper diet and exercise, the server outcomes will be reduced buy it may be worse if treatment is not done. Alex also believes that his disease is a way of God strengthening his faith. According to me, Diabetes is caused by different possibilities which include, genetic variation and lifestyle.
My response may influence my interaction with the patient. By observing the six cultural phenomena, a nurse may be able to fully interact with patients hence leading to an excellent nurse-patient relationship. Accepting their values and believes is important especially when assessing and treating their patients. It is also important to advise and educate the patients on the importance of ensuring their medication is taken effectively. My response to the patients will be polite and in a caring manner to hence providing a safe environment for the patient to the full understanding of the information. My response will positively influence my interaction with the patient because accepting their cultural beliefs is important as well as letting them fully understand the importance of medical treatments and procedures. In the future practice, as a care provider, I will use the Giger and Davidhizars transcultural model to assess and treat patients from widely differing cultures hence providing meaningful and beneficial care to all patients. I will be able to recognize and appreciate the diverse cultures in the healthcare values, believes and customs. In conclusion, from this assignment, I have benefited from the model hence making cultural assessment easier.
References
American Diabetes Association. (2015). Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical Diabetes: A Publication of the American Diabetes Association, 33(2), 97.
Huang, C. T., Ho, T. W., Ruan, S. Y., Lai, F., & Yu, C. J. (2017). A103 COPD: Disease Progression and Prognosis: The Prognostic Role of Type 2 Diabetes in Patients with Chronic Obstructive Pulmonary Disease. American Journal of Respiratory and Critical Care Medicine, 195.
Jutterström, L., Hörnsten, Å., Sandström, H., Stenlund, H., & Isaksson, U. (2016). Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes—A randomized study. Patient Education and Counseling, 99(11), 1821- 1829.
