Question

Holistic Health Assessment The home care nurse is seeing a 68-year-old Vietnamese woman for an initial visit. The patient was discharged from the hospital with a diagnosis of congestive heart failure (CHF). The home health nurse notices the patient's blood pressure is elevated, and the patient has a productive cough. The patient speaks very little English. However, the patient's daughter is present and able to interpret. The nurse completes a full health assessment, including a review of medications, and notes that the patient was prescribed a diuretic and a beta-blocker for blood pressure regulation. The daughter shares with the nurse that her mother does not like taking medications and chooses to take herbal remedies instead. Upon assessment, the patient's vital signs are: T 98.6 P 76 R 20 BP 160/80, 02 saturation 94%. The patient's lungs are positive for scattered rhonchi in the upper bases, clear in the lower bases, rhonchi clears with cough. The patient's heart rate is regular with no audible murmurs, +2 edema bilateral in the lower extremities. The patient denies pain (Jarvis, 2012). The nurse understands that culture and alternative medicine are playing a role in the patient’s current health and health decisions; however, the nurse is hesitant about asking further questions because he does not want to offend the family. • Identify and describe at least two priority areas of a holistic health assessment the nurse must consider when planning the patient interview. Provide a rationale for your choices. • How can the healthcare provider show respect for the patient’s culture and health beliefs while working toward resolution of her health issues? Provide a rationale for your decision. • Should the patient be encouraged to take the prescribed medication? Why or why not? • When considering the holistic model how does the family play into your assessment and the care that you provide. Provide a clear rationale for your steps to include or not to include the family.

Answer 1

1. Two priority areas of holistic health assessment that the nurse must consider when planning the patient interview are :

1. Cultural assessment : It is important to know the patient's cultural beliefs in order to plan care that is sensitive and supportive of their cultural issues. The fact that the patient prefers herbal remedies to medications points to the fact that the patient has strong cultural beliefs. hence it is important that the nurse explores the cultural values, family dynamics, traditions and beliefs of the patients that might have an impact on their response to their diet and adherence to the therapeutic regimen.
2. Developmental assessment : The patient is a 68 year old woman and hence through developmental assessment , the nurse can gain information regarding her social and cognitive developmental stage and coping mechanisms. these factors have an impact on how the patient perceives their health condition and how they respond to their present health status which in turns affects their adherence to the care plan. The questions for the interview can be based on the Erik Erikson's psychosocial development theory and Piaget's cognitive development theory.

2. showing respect to the patient's cultural and health beliefs while working towards resolution of the health issue:

• Communicate to the patient respectfully about their health beliefs and gain information through cultural assessment. Eg: Do you have any particular dietary restrictions that you want me to consider when planning the diet for you?
• Get information about what the patient thinks with regards to their illness and present health status.
• provide culturally appropriate information and suggestions to persuade her to take the prescribed medications.
• Educate and explain about the complications that may arise due to non compliance to the medication.
• you may also involve a family member or a member of the cultural / religious organization to talk to the patient and persuade her to take the medications and follow the plan of care.

3. Should the patient be encouraged to take the medication?

Yes, the patient must be persuaded in a culturally sensitive manner to take the medication because the patient's B.P is elevated and she also has edema and ronchi . If she does not take her beta blocker and diuretics it could lead to life threatening complications. Although the patient does not like taking medications and prefers herbal remedies, it is important that she takes these medications. alternatively , the nurse can talk to the treating physician for substitute medications that may fulfil the patient's requirement.  

4. Family plays an important role in the assessment and planning of care.

• physical and medical care : The family is to be involved in monitoring the health status of the patient. Providing physical assistance, medications and monitoring the progress of the treatment may be done by the caregiver.
• Coordination and advocacy : A family member can act as a coordinator and help the patient get health and social services that they are eligible for. family members can act as advocates for the patient.
• family members can act as surrogate decision makers and take decisions on behalf of the patient when the patient is unable / incapable to do so.
• The family can play an important part in the care planning by providing their inputs during the assessment and planning phase . This will also ensure that they carry out the patient's care plan diligently.
• Family can provide the much required emotional support to the patient.