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You should respond to both discussions separately–with constructive literature material- extending, refuting/correcting, or adding additional nuance to their posts. 

Minimum 150 words. 

Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual).

Reply to discussion1:

One of the most fulfilling realities of nursing is the opportunity that it creates for life-long long learning. This endeavor to be competent extends beyond understanding advances in medicine and clinical skills, it involves a commitment to understanding our patients, specifically their culture. The concept of transcultural nursing includes a framework that describes six cultural phenomena that are present in all cultures. These phenomena include: communication, space, social organization, time, environmental control and biological variations.  

Communication focuses on both verbal and non-verbal cues. This would include selecting the appropriate language in which the patient feels most comfortable communicating in, even if that means using a translator. Special attention should be given to body language, and speaking clearly, as well as allowing for silence to give patients time to respond. Studies have shown that ineffective communication, specifically task-based care ,creates a barrier to patient centered care and communication. (Kwame & Petrucka, 2021) 

Space requires an understanding of how to appropriately use physical proximity. This includes awareness of preferences around comfort zones and personal space.  

Understanding the influence of social organization is important because degrees of involvement from the support system will vary greatly between cultures. Additionally, an understanding of the stake each member of the support systems has in the patient’s care can impact health outcomes. It’s been shown that increased social support yields favorable results such as increased self-management and increased medication adherence. (Shahin, Kennedy, & Stupans, 2021) 

A patient’s relationship with time can have significant implications in their care. An example of this would be their relationship with punctuality or time spent on activities related to their care.  

Environmental control is an important consideration as values and beliefs regarding the physical environment and its impact on health and recovery can vary greatly between groups. Respecting cultural practices and finding ways to honor or incorporate traditions in the treatment can be useful 

Biological variations impact susceptibility to disease and illness, genetic predisposition to disease, and response to certain treatment 

A nursing practice that is rooted in intention and desire to deliver culturally competent care implies a desire to improve health care quality, deliver individual care, and enhance equity in healthcare delivery & Stubbe, 2020).  It is estimated that by 2050, 50% of the population in the United States will be comprised of minorities, further highlighting the critical importance of this concept. (Nair & Adetayo, 2020). Having an awareness of these six cultural phenomena and understanding how to incorporate them in nursing practice is the responsibility of all nurses.  

References 

Kwame, A., Petrucka, P.M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward. BMC Nurs 20, 158. https://doi.org/10.1186/s12912-021-00684-2.

Nair, L., & Adetayo, O. A. (2020). Cultural Competence and Ethnic Diversity in Healthcare. Plastic and reconstructive surgery. Global open, 7(5), e2219. https://doi.org/10.1097/GOX.0000000000002219Links to an external site. 

Shahin, W., Kennedy, G. A., & Stupans, I. (2021). The association between social support and medication adherence in patients with hypertension: A systematic review. Pharmacy practice, 19(2), 2300. https://doi.org/10.18549/PharmPract.2021.2.2300 

Stubbe D. E. (2020). Practicing Cultural Competence and Cultural Humility in the Care of Diverse Patients. Focus (American Psychiatric Publishing), 18(1), 49–51. https://doi.org/10.1176/appi.focus.20190041 

reply to discussion2:

o provide culturally diverse nursing care, describe the six cultural phenomena that are evident in all cultural groups.   

There are six different cultural phenomena that are evident in all cultural groups. Those six cultural phenomena are space, communication, time, social organization, environment control and biological variations. These phenomena are there to understand how culture can impact the patient care and how they can clear any miscommunication and can improve patient care.

Communication is a very important factor in nursing for many different reasons. Communication is going to enhance quality of care to patients and it is going to effectively improve teamwork among other healthcare professionals that are involved in providing care for the patients. The patients are also to care for their own health and participate more if there is clear communication between the patient and the healthcare providers. There is a current problem in clear communication  due to a difference in culture and language as a barrier to health. There are many different cultures and many different religions and some of these patients are very unique and may come from many different cultures and religions. If there is a language or a culture barrier between the nurse and the patients, this can lead to an impaired healing process (Giger, 2021, pg. 20). It is very important for nurses to have effective communication not just with the patients but also with their family members and with other healthcare members that are involved in the patient’s care. This factor is very important because it help to educate the patient on their condition and their medication regimen. Clear and effective communication is going to enable nurses to care for their patients. Patients will be aware of their conditi0on and what interventions must be conducted to improve their health. The patients will also have a better understanding on how to administer their own medication at home (Wieke, 2021).

The second phenomena is space and this related to personal space and different levels of comfort with others. Personal space can also have a cultural variation. In many different cultures, personal space is very important and could mean different things for different cultures. Nurses have to be mindful and respectful in regards to personal space because it can be offensive in some cultures and it can be considered therapeutic in others (Roxberg, 2020). Biological variances is another factor that nurses should be aware of in order to understand the patient’s and their health. Understanding genetics and their ethnic background can also help to understand the patient’s condition and can aid in assessment. Environmental control is very important for the patient’s perception of their health and engagement in their health in terms of self-efficacy. Time is also very important when it comes to a patient’s health because they have to be mindful of their medication regimen and to take medication when it’s the appropriate time. The patients also have to be aware of their appointment times and to relay their availability to the healthcare providers for their check-ins. Social organization is also very important to understand for nurses because that can influence the patient’s behaviors and their belief. Because of certain conditions in patient’s they may need some social support and they may also have some spiritual needs as well.

Reference:

Giger, J. N., & Haddad, L. (2021). Transcultural Nursing: Assessment and Intervention (8th ed.).

Roxberg, Å., Tryselius, K., Gren, M., Lindahl, B., Werkander Harstäde, C., Silverglow, A., Nolbeck, K., James, F., Carlsson, I. M., Olausson, S., Nordin, S., & Wijk, H. (2020). Space and place for health and care. International journal of qualitative studies on health and well-being, 15(sup1), 1750263. https://doi.org/10.1080/17482631.2020.1750263

Wieke Noviyanti, L., Ahsan, A., & Sudartya, T. S. (2021). Exploring the relationship between nurses’ communication satisfaction and patient safety culture. Journal of public health research, 10(2), 2225. https://doi.org/10.4081/jphr.2021.2225

Assignment on ethical dilemma

Homework- Powerpoint

Homework

Compare the primary care NP role with other APN roles. What are the similarities among the roles, what are the differences, and how would you communicate the role to a healthcare provider and a consumer?

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 

Hematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.

Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.

Case Study Questions

1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
   In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
6. Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.

Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.

Case Study Questions

1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
2. What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.

Submission Instructions:

• Include both case studies in your post.
• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
• All replies must be constructive and use literature where possible.