Cultural Awareness
Ms. Jackson is a 44-year-old overweight woman who was diagnosed with diabetes 2 years ago and is now insulin dependent. In 2012 the company she worked for downsized, and Ms. Jackson lost her job. As a result she was unable to pay her mortgage and became homeless. Since then she has been staying with various family members and friends because she has not been able to afford her own apartment. She has been working as an office temp from time to time but has not been able to find full-time work. She arrived at the emergency department (ED) with a blood sugar of 322 (normal range is 80 to 120) and a hemoglobin A1C of 11% (normal is approximately 5%).
Sam is a 23-year-old nursing student assigned to care for Ms. Jackson. After Sam reads Ms. Jackson's chart, she notices that she has come to the ED on several occasions over the past 6 months with the same issue. She also notices that health care providers who took care of Ms. Jackson during the previous visits documented that she verbalized an understanding of how to manage her diabetes but has been nonadherent with her treatment plan.
After Sam conducts a cultural assessment using an explanatory model with questions, she learns that Ms. Jackson fears that she will eventually die because her mother died of diabetes. She also learns that Ms. Jackson cannot get her medications filled because she doesn't have health insurance. After obtaining this information, Sam consults with a social worker, who tells Sam about a community health center within eight blocks of the place where Ms. Jackson is currently living. This health center has a diabetes management program and can offer ongoing support to Ms. Jackson. Sam spends time with Ms. Jackson explaining that people do not die from diabetes if they manage it effectively. Sam also discusses with Ms. Jackson some realistic ways to manage her diabetes given her challenging circumstances. In addition, she escorts Ms. Jackson to the social worker's office so they can discuss possible housing and unemployment resources. Sam realizes that there is an opportunity for her to learn more about the social determinants of health that affect Ms. Jackson's ability to manage her care. She also realizes that by gaining skills in cultural competence she will be more confident in providing culturally competent care to her patients.
1. List some of the social determinants of health that Sam most likely discovered while conducting a cultural assessment with Ms. Jackson.
2. On the basis of a cultural assessment, Sam discovers that Ms. Jackson believes that she may die. Select the C-LARA communication mnemonic listed in this chapter and plot a discussion that might help Ms. Jackson understand that diabetes is a manageable chronic illness that does not have to result in death.
3. Ms. Jackson is discharged and returns to the ED several months later because she is having difficulty managing her diabetes again. You are assigned to care for her. How will her weight, history of nonadherence, and past visits to the ED possibly affect your treatment? How could these factors trigger biases and assumptions that will get in the way of providing quality care? How could self-awareness help you reduce the effect of bias on the quality of care you provide?
1. Ms. Jackson lost her employment and home. She is currently destitute and does not have medical coverage. This implies she needs stable lodging and sufficient money related assets to guarantee great personal satisfaction. It is likewise conceivable that she doesn't have an essential consideration supplier. Given Ms. Jackson's restricted access to financial assets, Sam may likewise discover that there are constrained alternatives for getting solid nourishment in her neighborhood. Ms. Jackson's unsteady lodging circumstance might hinder planning dinners that would enable her to all the more likely deal with her diabetes. At long last, since she is overweight and seen as non-follower, Ms. Jackson might encounter "implicit" or "explicit" inclination from her health insurance suppliers. Her race and ethnicity could likewise affect how her medicinal services suppliers see her.
2. C-LARA: was created by the association "Love Makes a Family," the "C" for check your heartbeat was included by the association "nonviolent Peaceforce." C-LARA represents:
C-alm- - Calm yourself down, take a full breath, and check your heartbeat
L-isten- - Listen to patient's and patient's family viewpoint
A-ffirm- - Affirm or express association with something that was shared: an inclination, viewpoint, guideline.
R-espond- - Respond to information exchanged. Answer the inquiry.
A-dd- - Add or offer extra data for the patient as well as family to consider.
In this stage an attendant can teach.
Test DISCUSSION:
Sam: Ms. Jackson, I see here in your outline that you have a past filled with diabetes in your family.
Ms. Jackson: Yes I do. My mom had diabetes.
Sam: You said "had diabetes." It sounds like your mother is no longer with us.
Ms. Jackson: Yes, my mother passed on quite a long while prior from diabetes.
Sam: I am sorry to learn that. Losing a parent is never simple. (certification)
Ms. Jackson: No, it's definitely not. I miss my mother, particularly after I lost my home. I realize she would have bailed me out on the off chance that she were near. She was constantly ready to fix everything...— well, everything with the exception of her wellbeing.
Sam: I can just envision. ... Ms. Jackson, I'm considering how your mother's battles with diabetes influence the manner in which you consider your diabetes. It must be alarming to believe that you have a similar disease that prompted her passing. (insistence)
Ms. Jackson: Yes, I stress over it constantly. Each time I end up in the crisis office, I have an inclination that I'm en route to her.
Sam: That sounds good to me. (confirmation) Diabetes is a difficult condition; and, as you most likely are aware, it can result in numerous issues, including passing (insistence). In the meantime, I know beyond a shadow of a doubt that individuals with diabetes can carry on with a long and beneficial life (reaction). I might want us to invest some energy discussing approaches to deal with your diabetes all the more viably (include). After I ask you a couple of more inquiries, I'd like to acquaint you with our diabetes instructor. He is magnificent and will almost certainly take a seat with you and conceptualize answers for a portion of the difficulties you're confronting. We're getting down to business with you to get this diabetes leveled out. I am certain that we can do that together. (include)
3.All people have generalizations, inclination, and partiality about human practices. Sadly Heath insurance suppliers are not insusceptible to them. You are particularly powerless against the impact of your generalizations and predisposition when you are feeling the squeeze and experience high pressure. "Cultural competence" signifies promise to revealing predispositions and generalizations that are a piece of your reality see. Despite the fact that you undoubtedly can never be predisposition or generalization free, you can expand your self-information and capacity to see when they ring a bell. You would then be able to see them, be interested about them, and choose not to follow up on them. Moving toward every association with an expectation to regard a patient as a one of a kind individual and pledge to mindfulness enables you to give socially applicable and quality consideration to all patients, paying little heed to their experience.
Hope you find this helpful thankyou ☺️
Cultural Awareness Ms. Jackson is a 44-year-old overweight woman who was diagnosed with diabetes 2 years...
Ms. Jackson is a 44-year-old overweight woman who was diagnosed with diabetes 2 years ago and is now insulin dependent. In 2012 the company she worked for downsized, and Ms. Jackson lost her job. As a result she was unable to pay her mortgage and became homeless. Since then she has been staying with various family members and friends because she has not been able to afford her own apartment. She has been working as an office temp from time...
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