WK 1 Discussion – 40-year-old black recent immigrant from Africa without health insurance
My patient is a 40-year-old black recent immigrant from Africa without health insurance. The challenge here lies in the fact that this patient’s English fluency is not indicated. I would begin my interview by offering a friendly smile to make the patient feel comfortable and introduce myself. I would then ask some basic questions such as name, age, and where the patient resides to assess the patient’s language competency. If necessary, I may require the assistance of an interpreter, perhaps a software tool to help with translating if an interpreter is not available. Whereas some African nations do communicate in English, this is not the case for all African nations. Thus, a language assessment is imperative in obtaining this patient’s comprehensive health history 40-year-old black recent immigrant from Africa without health insurance.
After addressing any communication challenges, I would focus on obtaining basic information such as age, gender, marital status, and occupation. Thereafter, I would proceed towards obtaining a thorough health assessment by asking specific questions. The aim of obtaining a high-quality comprehensive patient health history is to identify symptoms that represent a range of pathologies; even by itself, the assessment is a powerful instrument (Diamond-Fox, 2021). Specifically, I would ask the below five basic questions:
What is the reason for your visit today? By asking this, I would assess the patient’s unexpressed fear or concern.
When did you first begin to feel your symptoms? This question is asked to assess the chronological order of events, as I assess the patient’s most recent state of health prior to the current condition.
Can you describe your symptoms, giving the location, duration, aggravating and alleviating factors, onset, and duration? This inquiry is for symptom analysis.
Do you have any medical conditions, or are you taking medications for any condition? Perhaps here I can also ask of any childhood illnesses or injuries that may be pertinent to the patient’s chief complaint. Assessing the patient’s past history helps practitioners assess the present issue and also formulizes a risk assessment of their health.
Towards the end, I would like to summarize the data collected with my patient by repeating the information and asking “Am I missing anything? or “Is this information correct?” This is to correct any errors and ensure that I have in fact obtained the most accurate health history for the patient that can now be established in his chart/profile 40-year-old black recent immigrant from Africa without health insurance.
As a provider, I must remain aware of cultural sensitivities to ensure my actions or wording will not be misinterpreted. Immigrants from Africa in particular faces challenges from the US healthcare system, including the lack of culturally sensitive care and hostile provider attitudes that reinforce their lack of trust in the healthcare system (Omenka et al., 2020). For this reason, it is crucial that I remain empathetic, courteous, and ensure comfort in order to develop a bond of trust. A useful tool that can be applied here is I.C.E. (ideas, concerns, expectations.) This ensures that the provider listens actively, is aware of proper body language, empathizes with the patient, and focuses on the patient’s ideas, concerns, and expectations of healthcare by directly asking the patient “what are your concerns?” (Desai, MD, 2018).
The fact that my patient is an immigrant places him at a greater risk of psychological health problems due to both pre-migration risk factors such as previous traumatic experiences along with post-migration factors such as culture shock, low socioeconomic status, and a possible void in the emotional family/support system (Adu-Boahene et al., 2017). And for this reason, I would add a mental health component in my interview to check for any signs of depression, anxiety, trauma, sleep disturbance, eating disorder, or substance abuse. There are many tools for mental health that can be utilized such as the PTSD checklist for DSM-5, or an anxiety checklist that gives the provider a general idea of the stress level patient is currently experiencing.
As a provider, I would take all such factors into consideration when developing an appropriate care plan. An added degree of empathy is required in the assessment of this patient due to the fact that the patient is in a foreign land, dealing with culture shock, communication barriers, and not having health insurance. This assessment will most likely be a bit longer than the usual admitting patient because of these factors, and this patient will need to be referred to a social worker for assistance in obtaining proper care although uninsured. In the end, I would hope to have provided comfort and empathy and developed a bond of trust with this patient, in addition to providing proper medical care 40-year-old black recent immigrant from Africa without health insurance.
Adu-Boahene, MPH;, A. B., Laws, PhD, MA, M. B., & Dapaah-Afriyie, MD, MBA, K. (2017, January). Health-Needs Assessment for West African Immigrants in Greater Providence, RI. Rhode Island Medical Journal. https://www.rimed.org/rimedicaljournal/2017/01/2017-01-47-cont-adu-boahene.pdf
Desai, MD, R. (2018, October 19). Clinician’s Corner: Taking a good patient history [Video]. Osmosis. https://www.youtube.com/watch?v=4wfjSfoHwl4
Diamond-Fox, S. (2021). Undertaking consultations and clinical assessments at advanced level. British Journal of Nursing, 30(4), 238-243. https://doi.org/10.12968/bjon.2021.30.4.238
Omenka, O. I., Watson, D. P., & Hendrie, H. C. (2020). Understanding the healthcare experiences and needs of African immigrants in the United States: A scoping review. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-019-8127-9
Discussion: Building a Health History
Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.
For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor 40-year-old black recent immigrant from Africa without health insurance.
Photo Credit: Sam Edwards / Caiaimage / Getty Images
With the information presented in Chapter 1 of Ball et al. in mind, consider the following:
By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
How would your communication and interview techniques for building a health history differ with each patient?
How might you target your questions for building a health history based on the patient’s social determinants of health?
What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history 40-year-old black recent immigrant from Africa without health insurance.
By Day 3 of Week 1
Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6 of Week 1
Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:
Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
Suggest additional health-related risks that might be considered.
Validate an idea with your own experience and additional research.
Thank you for sharing your informative discussion post. I agree with your assertion that you should offer a friendly smile to make the patient feel comfortable and introduce yourself to warm up the encounter before engaging in any further action(s). According to Omenka et al. (2020), many African immigrants already have substantial health vulnerabilities when they arrive in the United States, which will only worsen if they don’t have access to good treatment. For this reason(s), the practitioner must determine the patient’s needs, establish a suitable treatment plan, obtain reliable information via history collection and a physical examination (Ball et al., 2019). Furthermore, Communication is a two-way process to exchange meaning. As clinicians, we must evaluate the patient’s appearance, exposure or experience, language skills, tone of voice, listening ability, cultural practices/beliefs, and body language to collect the necessary information or create a therapeutic alliance. Furthermore, patient-centered care based on the patient’s knowledge necessitates the use of a unique technique. In an immigrant, the communication tactics should focus on chronic illness, migratory trauma, and socioeconomics to the best of their knowledge. The provider must address the language barrier if applicable in the case of the immigrant and any access to available resources. Although some African countries use English, the majority speak French or dialects. Conscious awareness and ongoing examination of all communication process components can help improve diagnostic abilities and patient compliance 40-year-old black recent immigrant from Africa without health insurance.
According to Ball et al. (2019), Structuring a health history is critical for accurately diagnosing and treating patients. Firstly, I will agree with you to evaluate the patient’s mastery of English and a language interpreter used in a language barrier to facilitate this encounter and after that. Healthcare practitioners must accept patient variations or backgrounds (considering that this immigrant’s values may vary from U.S. values) and views to make this process comfortable and trustworthy. Also, the patient may be suffering the usual obstacles of cross-continental or geographical travel, such as not finding work. The practitioner, in this instance, must assess the patient’s emotional and psychological well-being as adaptation has been linked to mental illness. Isasi et al. (2016) also notes that, conditions regarding immigration and cultural adaptation also appear to be linked to mental health among immigrants.
Applying I.C.E. (ideas, concerns, expectations.) in your care of this patient and other patients is an excellent tool in achieving excellent care. Incorporating cultural sensitivity into our practice as practitioners increase efficiency in reaching many different groups of people and giving a non-biased approach to care, leading to more valuable services and outreach.
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.). Mosby.
Isasi, C. R., Rastogi, D., & Molina, K. (2016). Health Issues in Hispanic/Latino Youth. Journal of Latina/o psychology, 4(2), 67–82. https://doi.org/10.1037/lat0000054
Omenka, O. I., Watson, D. P., & Hendrie, H. C. (2020). Understanding the healthcare experiences and needs of African immigrants in the United States: a scoping review. BMC public health, 20(1), 27 40-year-old black recent immigrant from Africa without health insurance. https://doi.org/10.1186/s12889-019-8127-9
You made so many great points and hit so many things, I can already tell you will be a very empathetic practitioner. I like how you included ICE (ideas, concerns, and expectations) in your assessment. I also like your five questions. I haven’t really thought about all the issues that can occur with a patient who is an immigrant where language barriers might be a factor and also when they do not have insurance. It is very sad that some people are unable to receive the same care that others are afforded. Suzanne et al. (2019) agree that ethnic minorities, and those from other countries, are vulnerable and are at a social disadvantage. Many scams are also out there with healthcare letting some believe they will cover things and getting them hooked into paying for insurance that they can’t afford or don’t need. Dagmar Dzúrová et al. (2014) point out that many immigrants just don’t know what to do in order to get healthcare.
I can see how uninsured patients a problematic issue might be so I would make sure to have pamphlets available for the patients about other insurance options. I would also see the need to address as many issues as possible in one visit for the patient because due to the lack of insurance, they might be as willing to return to the office. Radoslaw et al. (2018) point out that those with no insurance or high deductibles have a lower life expectancy than those with insurance. I would try to get as good of a health history as possible so I could see determining factors leading up to the reason for the visit. If possible, I would suggest that the patient get bloodwork to ensure they are healthy. Everything costs money though, and the patient may just need an acute need met rather than a comprehensive exam 40-year-old black recent immigrant from Africa without health insurance.
In the end, you brought some good points at the challenges in helping those that are unaware or unable of the best type of healthcare needed. This is something that will not go away and we will always have challenges how to help all those that need care. To help the patient feel comfortable, I would hope that there is a family member or friend that could come to the appointment to help with translation if needed. I also realize it might be a good idea to invest in a good translation app as language barriers might happen often. I truly believe mental health could be a potential problem with some immigrants depending on the support they have so I think asking mental health questions, or including a mental health questionnaire to be answered if possible would be a great option as well.
Thanks for your post, it opened my eyes and brought many things to light that I didn’t think about before when giving healthcare. I live in Arizona and just started working as a nurse at a prison and I didn’t realize how many people are in the prison that do not speak English. The prison has invested in an interpreter service that we can call with a telephone that really helps when delivering healthcare.
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Dagmar Dzúrová, Petr Winkler, & Dušan Drbohlav. (2014). Immigrants’ Access to Health Insurance: No Equality without Awareness. International Journal of Environmental Research and Public Health, 11(7), 7144–7153. https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph110707144
Suzanne G. M. van Hees, Timothy O’Fallon, Miranda Hofker, Marleen Dekker, Sarah Polack, Lena Morgon Banks, & Ernst J. A. M. Spaan. (2019). Leaving no one behind? Social inclusion of health insurance in low- and middle-income countries: a systematic review 40-year-old black recent immigrant from Africa without health insurance. International Journal for Equity in Health, 18(1), 1–19. https://doi-org.ezp.waldenulibrary.org/10.1186/s12939-019-1040-0
Radoslaw Panczak, Viktor von Wyl, Oliver Reich, Xhyljeta Luta, Maud Maessen, Andreas E. Stuck, Claudia Berlin, Kurt Schmidlin, David C. Goodman, Matthias Egger, Kerri Clough-Gorr, & Marcel Zwahlen. (2018). Death at no cost? Persons with no health insurance claims in the last year of life in Switzerland. BMC Health Services Research, 18(1), 1–8. https://doi-org.ezp.waldenulibrary.org/10.1186/s12913-018-2984-2
sample response 3
I enjoyed reading your post. As I read through your post, I can identify as that 40-year-old immigrant, and I can correctly validate some of the ideas here in your post. You did a great job by stressing the importance of obtaining a health history and health assessment. You also touched on mental health, which in most African countries, residents still see mental illness as an omen or taboo.
Africa is a continent that is reached in culture. I agree with you 100% that as a provider, you must remain aware of cultural sensitivities to ensure your actions or wording will not be misinterpreted 40-year-old black recent immigrant from Africa without health insurance.
Adequate or appropriate assessment of an African patients would be dependent on how culturally competent and sensitive the provider is.
The provider might be the brightest of all providers, but if not culturally aware of Africans, there would always be a barrier in communication. Most countries in Africa are either Anglophone (English speaking) or francophone (French-speaking) countries, depending on the colonized country in Europe. A 40-year-old from an English-speaking country should have at least a high school diploma. The ability to understand the patient’s accent and be understood by the patient is a big challenge. Sometimes the interpreter is not the solution.
The interview technique would entail speaking slowly, and sometimes, when words are written out, it helps to understand some phonetics.
Smiling at a new patient may mean different things in different cultures. A handshake is always a welcoming and friendly gesture rather than a smile. Lack of eye contact during the interviewing process is not derogatory or bad for this 40-year-old man. Asking about what brought a forty-year-old man to the US is irrelevant to him, but he would appreciate you asking about his goals in American and whom he left behind. This question would guide the provider to recommend the proper health promotion for this immigrant man. These questions are not intrusive, but rather, they help the man open up and tell you more stories about his life and living conditions.
The United States has done so well in health history taking and documentation for the future. The new technological systems have made it easier to keep patient records from birth to old age. Unlike most countries in Africa, there are gaps in medical journals if at all they are found. The life expectancy of a Nigerian male is 60 years compared to a US male of 78-year-old (Varrella, 2021). Social determinants of health are rampant in most African families, such as poor housing conditions, food scarcity, and lack of healthcare. A provider must assess and address which factors impact the patient’s health (Ball et al., 2019). Family health history would be necessary to make a presumptive diagnosis for diabetes, hypertension, and heart disease.
The Center for Disease Control and Prevention (CDC) has a screening tool for new refugee immigrants for providers and clinics to use. This tool is termed the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards) (Center for Disease Control and Prevention CDC, 2020). It is recommended that care providers obtain this tool to appropriately provide that clinical care, address language and cultural barriers that patients may experience (CDC, 2020) 40-year-old black recent immigrant from Africa without health insurance.
Some critical questions recommended by CDC are centered around the following during a new immigrant clinic visits includes:
Key Considerations and Best Practices
General and optional laboratory tests
History and Physical
Nutrition and Growth
Sexual and Reproductive Health
Viral Hepatitis (CDC, 2020)
It is crucial to assess immunization. Ask questions about the last time the patient saw a health care provider and for what reason. The average person has no health insurance in most countries in Africa, so dental checkup is almost nonexistent.
Ball, J., 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: Mosby.
Center for Disease Control and Prevention (CDC). (2020, November 06). Refugee Domestic Screening Guidance: Key Considerations and Best Practices. Retrieved from https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/screening-guidance.html 40-year-old black recent immigrant from Africa without health insurance
Varrella, S. (2021, February 12). Nigeria: Life expectancy, by gender. https://www.statista.com/statistics/1122851/life-expectancy-in-nigeria-by-gender/ 40-year-old black recent immigrant from Africa without health insurance
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