Week 2 Main Discussion
Diversity and Health Assessment
Patient: TJ, a 32-year-old pregnant lesbian being seen for an annual exam.
As future nurse practitioners, we will be providing care to patients with diverse backgrounds. Diversity means every one is unique and has individual differences in relation to race, ethnicity, gender, sexual orientation, socio-economic status, age, physical abilities, religious beliefs, political beliefs, or other ideologies (Queensborough Community College, 2018, para. 1). It is important for clinicians to understand that when caring for diverse patients, we must provide acceptance and respect so that a good ‘relationship’ can form, and optimal health care can be provided to that patient.
Week Two Patient- TJ
Exam Notes- (Focused for Week 2 Discussion)
TJ is a 32-year-old Caucasian female
CC: Presents for an annual wellness exam. She is currently 24 weeks pregnant G1:P 0: Ab 0 and is receiving care from an obstetrician. Pt received sperm from a local sperm bank.
HPI: Unremarkable; however, patient states she started having thick white, itching, slightly foul-smelling vaginal discharge one week ago. Pt denies current feelings of depression or anxiety.
Current Medications: Prenatal vitamins and acetaminophen PRN for aches and pains
Allergies: NKDA, no food or Latex allergy
Social HX: Pt attended graduate school and is currently is an attorney for a large local firm practicing family law. Pt states she has “good health insurance” and is “very financially secure” at this time. Pt states she has a partner, DR, who is currently living separately from the patient. TJ lives in a large single-family home 10 minutes outside of the main city of Boise. The patient has one dog and no other pets including cats or exotic animals. The patient states they are planning on living together in her home after the baby arrives. TJ states she is in a monogamous relationship with DR and believes that her partner is monogamous as well. The pt. states she and her partner mutually chose the donor sperm, and her partner was present for the IVF procedure. This was her second attempt at conceiving a child and both are very excited about expecting a child. TJ states she and her partner attend all scheduled prenatal appointments and they are looking forward to attending parenting classes specially focused on lesbian mothers-to-be later that month. The patient states that she feels “very safe” in her relationship with her partner. Pt denies current or past illicit drug, prescription drug, alcohol, tobacco, or nicotine use. Pt states she is not exposed to second-hand smoke or other chemicals at home or work. Pt states she is religious and that she was raised Catholic; however, she has not affiliated anymore with the church since her announcing she was a lesbian to her friends from church. She felt ostracized immediately after her disclosure and she has not attended a church of any type since. Pt states that she “still has faint in God” and “does not need a building to pray and have Him hear her”. Pt has one sister, Anne, who she is close to and says Anne is supportive of her lifestyle and her pregnancy. Pt states her mom lives in another state and is supportive to the patient as well but “not as much as my sister is”. Pt further states she has two close friends from college who are also very supportive to her.
Family Hx: Strong family history of diabetes. Mother still alive and healthy. Father passed away from diabetes-related complications at the age of 53. Sister –hx. type 2 diabetes and obesity.
Target Questions:
Some target questions I would ask to obtain an initial health history from TJ are:
(not necessarily in this order).
1. What name do you go by?
2. Do you have any religious or cultural concerns you would like to discuss during this visit?
3. What gender do you identify with?
4. What sexual orientation do you associate with?
5. What is your current living situation?
6. Are you in a relationship?
7. Is the relationship monogamous or polyamorous? (to assess for potential STD risk)
8. Do you feel safe in this relationship? (screen for intimate partner violence)
9. Do you have a support system?
10. What is your occupation?
11. Do you currently have any financial concerns regarding your health care and pregnancy?
12. Are you keeping all scheduled and required OB appointments?
Nurse Practitioner Sensitivity
According to the National LGBT Health Education Center (2016), lesbian, gay, bisexual, transgender (LGBT) patients have reported that health care providers have: used excessive precautions or refused to touch them (11%), blamed them for their health status (12%), or used harsh or abusive language (11%) during health exams (National LGBT Health Education Center, 2016, p. 10). It is because of negative experiences and interactions with the health care system that lesbian women do not obtain the necessary health care, including preventative care, that they need (Gregg, 2018, p. 42). Because my patient is a lesbian, I would be mindful in delivering culturally sensitive care to her. I would utilize terms and pronouns appropriate to the patient, and if I were to inadvertently use the wrong ones, or make the patient feel uncomfortable, I would promptly apologize and state I did not mean to be disrespectful.
Unfortunately, LBGT patients have difficulty finding health care providers where they feel accepted, understood, and do not fear discrimination, and many will intentionally seek out care from practitioners who are familiar with this health population (Landry, 2017); therefore, I would make every attempt to create an environment that displays concern, inclusiveness, and respect and obtain further education and training focused on this patient population. I would also incorporate the RESPECT model in my care of diverse patients such as TJ. The RESPECT model stands for Rapport, Empathy, Support, Partnership, Explanations, Cultural Competence, and Trust and can help a clinician remain effective with communication and in providing patient-centered care (Ball, Dains, Flynn, Solomon, & Stewart, 2019, p. 31). I believe that LGBTQ patients deserve the same level and quality of care as heterosexual patients, and I personally will do everything in my power to ensure that they receive it.
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.
Gregg, I. (2018). The health care experiences of lesbian women becoming mothers. Nursing for Women’s Health, 22(1), 41-50. https://doi.org/10.1016/j.nwh.2017.12.003
Landry, J. (2017, May). Delivering culturally sensitive care to LGBTQI patients. The Journal for Nurse Practitioners, 13(5), 342-347. https://doi.org/https://doi.org/10.1016/j.nurpra.2016.12.015
National LGBT Health Education Center. (2016). Caring for LGBT people: Improving communication; creating an inclusive and welcoming environment. Retrieved from http://www.ncfh.org/uploads/3/8/6/8/38685499/fenway-adelante_-_lgbt_inclusive_care_-_2016.pdf
