216. Do a comment to each post with 2 references each. APA style, with citation and reference year not older than 2013. Post 1 For the record, MR is a 23-year-old Native American male who reports experiencing anxiety, smoking pot and drinking alcohol. MR reports a family history of diabetes, hypertension, and alcoholism. In addition, MR appears to be religious by his statement of being afraid that he will not get into Heaven if he persists with his behavior. According to Espey, Jim, Cobb, Bartholomew, Becker, Haverkamp and Plescia (2014), Native American has a history of discrimination and has received inadequate healthcare throughout the years. Tobacco smoking is extremely high in the Native American community. Native American had a higher rate of alcohol-attributable death in comparison to Whites (Yuan, Duran, Walters, Pearson & Evans-Campbell, 2014). According to Espey et al. (2014), there is a high heart disease mortality and diabetes mortality in the Native Americans community. Arm with the fact that there isnt a language barrier, the nurse introduces herself (Ball, Dains, Flynn, Solomon & Stewart, 2015). My name is Nurse Brown, the nurse says while quickly assessing the patient from head to toe. Patient (MR) appears jittery and appears diaphoretic. It is important to monitor patients behavior (Espey et al., 2014). The nurse asks targeted questions. What brings you to the clinic today? When was the last time you felt well? When did your symptoms start? What do you believe brought on this feeling? Was the symptoms the result of alcohol or smoking pot? The ethnic and racial differences in dealing with depression are rare amongst Black, Latino and Native American opposed to the White American who would readily address issues of depression (Ball et al., 2015). However, the nurse still exhibits sensitivity in approaching patient regarding his reporting of anxiety. The nurse has to determine whether it stems from something isolated or if there exists a family history of depression. Thus, the nurse will ask open-ended questions to ascertain a health history of patients family background (Ball et al., 2015). The questions will commence subtly and then gradually increase in intensity. Anyone in your family drinks alcohol? Anyone does drugs in your family? Are there any health issues such as heart disease, high blood pressure? Has he ever been admitted to the hospital? Has he had any blood transfusion? Who does life with? Are you working? Does he have a private doctor? When was the last time you saw your doctor? What do you do when you cant sleep? What is your religious background? Do you have any other concerns? You need to take into consider the person age, tone, be aware of your eye contact and give the patient time to think. If there is a language barrier, know how to secure an interpreter to translate. You must maintain a calm and cool demeanor. References Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2015). Seidels guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby. Espey, D. K., Jim, A. M., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health. 104(53). doi:2105/AJPH.2013.301798. Yuan, N., Duran, B. M., Walters, L.K., Pearson, R. C., & Evans-Campbell, E. T. (2014). Alcohol misuse and association with childhood maltreatment and out-of-home placement among urban two-spirt American Indian and Alska Native people. Intenational Journal of Environmental Research and Public Health. 11. 10462-10479. Doi: 10.3390/ijerph111010461 Post 2 Cultural Competence Cultural competence is a mindset to not just learn about other cultures, but to learn how to work with and care for patients from other cultures than ones own. As healthcare providers it is essential to be able to understand the beliefs in patients lives that affect their health and how they accept or refuse treatment recommendations. It becomes important to understand other alternative and complementary medicines that a patient may be using so as a provider one can help prevent adverse effects and interactions among treatments. This paper will share socioeconomic, spiritual, and lifestyle of an Asian male that can relate to health, it will also share issues that require sensitivity when interacting with the patient and why, provide five questions to ask in building a health history, and the assessment of health risks for this male patient. Socioeconomic, Spritual, and Lifestyle Effects on Health The health assessment of an 86 year old Asian male who is physically and financially dependent on his working single daughter (who also has children to care for) has hypertension (HTN), gastroesophageal reflex disease, b12 deficiency, and chronic prostatitis can require cultural competence while caring for this patient. One must determine socioeconomic status as this gives information about nutrition buying ability. Daines, Baumann, and Scheibel (2016) share assessing environmental concerns as they can affect health risks.Assessing if the patient has health insurance as this affects the purchase of medications. Spiritual beliefs of Asians (such as Japanese) hold Budhha as religious practice, and the belief in harmony and tolerance along with universal compassion per Clobert, Saroglou, Hwang, and Soong (2014). They further share there is less intolerance of others in this religion compared to Western religion that may be perceived as a way to maintain control among believers. Lifestyles of Asians may differ in that as one ages the family becomes the caring unit for the patient and includes many blended households. Talaie (2018) shares the Japanese healthcare system utilizes females as head of households and are responsible for caring for family members. He further shares this belief will cost Japan to have a shortage of caregivers of 370,000 workers as they do little to support the incoming of foreign care workers, and have stringent criteria these workers must pass testing wise to be caregivers that leave many without prospects in Japan. So Mr. JC understands the burden placed on his daughter with his comment of do not want to be a burden to my daughter. Many of these families do not put their loved ones in nursing homes. This authors spouse is Japanese/American and his mother lived with his sister after the fathers death until she also passed. She acquired dementia and oxygen but his sister continued to care for her at home. These issues of socioeconomic, spiritual, and lifestyle relate to health as not only his beliefs affect his healths but the behaviors of his daughter as well. JCs daughter being the financially responsible person, has the power of nutrition purchases, meal selections, and cooking. Lifestyle and meal selections can affect his blood pressure with the use of soy sauce, and other marinade sauces used in Asian cooking. JC may require options to alleviate these factors if his blood pressure is not controlled. Another thing these three have in common with cultural competence is for the provider to be aware of biases they may have in relation to single mothers, elderly without financial independence, differences in religious beliefs, and cultural differences. The United States Department of Human & Health Services (U.S. DHHS, 2016) shares providers can improve quality of health care services for diverse populations by learning to be aware of their own cultural beliefs and be more responsive to those of their patients. Issues Requiring Sensitivity While Daines, Baumann, and Scheibel (2016) share in the United States people tend to speak loudly and are direct in conversation the Japanese are the opposite use indirection, and place emphasis on attitudes and feelings instead. Being sensitive to the patients beliefs, and discretion it would be important to ask questions of health related treatments and if he would like his daughter involved. Assessing if there is anything to patient would not like to speak about in regard to his health would be beneficial as well. The health risk assessment would be helpful in determining the participation the patient has in his care. The United States DHHS (2016) shares healthrisks for Asians are gastric cancer, with Asians being two times as likely as non- Hispanic Whites and two times moer likely to die from complications of the disease. Another would be liver disease which is the fifth cause of death and Asians are two times as likely to die, while 50 percent are less likely to die of hear disease Mr. JC is on antihypertensives so adjusting his care is important as it may not follow recommended guidelines and patient centered care is recommended. Important for Mr. JCs age is immunizations such as the flu vaccine and pneumococcal the United States DHHS further shares 47 percent of Asians receive the pneumococcal vaccine while 72 percent recive the flu vaccine after the age of 65, it also shares suicide is the ninth cause of death in this population so more clarification needs to be sought to Mr. JCs comment about not being a burden. These subjects while important to address may present discomfort on the patients part if he does not have adequate finances to cover healthcare, medications, and dietary requirements for his HTN. It will also be important to address urinary problems related to the chronic prostatitis and if the patient is experiencing any difficulty. 5 Questions The five questions that may be beneficial would be: Tell me about your diet, what do you like to eat? What is your spiritual heritage? Do you participate in religious groups? Is there someone there you can talk to for support? Have you tried any other methods for your hypertension, gastroesophageal reflux, or prostatitis? Can you explain what you mean when you say you do not want to be a burden to your daughter? Summary In summary, cultural competence is important for advanced nurses to perfect, and when unsure to ask the patient rather than assume or stereotype populations. Some patients can be of another race, but have been born and raised in America without cultural influence, and assuming they follow the cultural norms can cause distrust and anger at excluding them from the American culture. When building a relationship with the patient it is important to address concerns of religion, socioeconomic status, religion, health risks, and preventions the patient may or may not participate in. Setting goals with the patient for his health promotion will help the patient buy into their care and help increase responsibility for their healthcare. Through the assessment of patients healthcare providers will have a better picture of health inequalities that can lead to addressing barriers to care.