Response 1

Scenario: JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter, a single-mother who has little time or money for her father’s health needs. He has a hx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10 mg QD, Prilosec 20 mg QD, B12 injections monthly, and Cipro 100 mg QD. He comes to you for an annual exam and states, “I came for my annual physical exam, but do not want to be a burden to my daughter.”

An assessment usually begins with the patient stating the reason for the visit (Ball, Dains, Flynn, Solomon, and Stewart, 2019). Birtwhistle, Bell, Thombs, Grad, and Dickinson (2017) suggest the annual exam is a long-established tradition in North America. It usually entails a review of health history, medications, allergies, and organ systems. It also includes a complete physical examination that may be followed by laboratory testing and discussion of health risks (Birtwhistle et al., 2017). Patient JC does not complain of any discomfort or pain, but he does state he is concerned with burdening his daughter. The patient will need a physical examination, a comprehensive geriatric assessment (CGA), and a thorough discussion regarding his feelings, fears, needs, as well as any threat of self-harm or feelings of depression.
When interacting with this patient, it is crucial for advanced practice nurses to be sensitive to specific issues. This patient has specific socioeconomic, spiritual, lifestyle and other cultural factors associated with his life. The socioeconomic issue related to this patient is that he is financially dependent on his daughter. We can assume because she is a single mother, that she is not financially stable enough to cover extreme health needs for her father. Therefore, the patient may be reluctant to tell providers exactly what issues he is having and whether he is experiencing discomfort or pain. He is also physically dependent on his daughter. Xie, Cheng, Tao, Zhang, Robert, Jia, and Su (2016) suggest it is widely common for children to take care of aging parents in the Chinese culture. Xie et al. (2016) suggest this is a value obligated by law as well as a foundation of Confucian teaching. The Asian culture values parental obedience, caring for family, and caring for the elderly have been established for over 2000 years (Xie et al., 2016).
Another important cultural factor related to this patient is effective communication. The most important part of this assessment is the conversation between the patient and the advanced practice nurse. When communicating with an elderly Asian patient, special considerations should be given. If not, this could create a huge barrier between the patient and provider. The elderly Asian population are highly influenced by traditional culture. An understanding of both verbal and nonverbal communication in the culture may help avoid barriers to effective communication.
There are at least five targeted questions that the patient should be asked to build his health history and to assess his health risks. They are:
1. What do you normally eat and drink for breakfast, lunch, dinner, and snacks daily?
2. Are you able to get your medications regularly and do you take your medications as prescribed?
3. Why do you state that you don’t want to be a burden to your daughter?
4. Have you ever harmed yourself or thought about harming yourself?
5. Do you feel you need help with basic daily needs such as dressing, bathing, and moving around the house?
The questions above allow providers to determine if specific support is needed for the patient. Identifying these problems or potential for similar problems allows the advanced practice nurse to obtain resources for the patient and for his family.

Response 2
The case study highlights an eighty-six-year-old Asian male who is financially and physically dependent on the daughter, a single mother with limited financial resources and time constraints to support the father’s health needs. The patient has a history of chronic prostatitis, GERD, HTN, and Vitamin B12 deficiency. The patient is currently taking vitamin B12 injections, Prilosec 20mg QD, Lisinopril 10mg QD, and Cipro 100mg QD. The patient is concerned about the burden on the daughter after reporting to the clinic for the annual physical exam. The discussion highlights spiritual, socioeconomic, and cultural factors that must be taken into consideration when building an effective history for patients from diverse backgrounds.

Socioeconomic, Spiritual, Lifestyle, And Other Cultural Factors
The APRN should evaluate many cultural aspects based on the information presented. When meeting someone from a different ethnicity or race, it is essential to consider language and communication (Dains, Baumann, & Scheibel, 2019). A translator may not be required because the patient appears to speak good English. However, additional communication concerns are essential. For example, making eye contact with authority figures or seniors is sometimes regarded as impolite and even provocative with various communities. This may be considered inappropriate for the 86-year-old patient JC of Asian descent. Many Asians avoid expressing, instead choosing silence or a head gesture to express misunderstanding or disagreement. Touching is also rare. Even if translation services are not needed, the physician may want one on hand for clarity (Office of Minority Health, 2022).

The patient’s connection with his daughter, on whom he is financially and physically reliant, and the presence of other supportive systems should also be addressed (Jazieh, Volker, & Taher, 2018). He says he doesn’t want to burden his daughter but is it his or her view? Traditionally, Asian households have been patriarchal, with males making decisions and women playing a supporting role. Also, children care for their parents till death. However, younger Asian Americans are abandoning traditional beliefs. They rely on friends and neighbors for day-to-day health requirements, with children stepping in when circumstances worsen, or the parents need aid. I’d also include spirituality and how it influences this patient’s healthcare views and behaviors. For specific ailments for the complete person, many Asians employ a traditional diet, herbal treatments, protective amulets, or procedures like acupuncture (Office of Minority Health, 2022). Clinicians should learn about Yin and Yang, heat and cold, and try to incorporate them into their treatment plans when possible.
Targeted Questions:
Do you need a translator today for the interview? The patient appears to be fluent in English. However, a translation may assist in clarifying meaning and words, as well as checking the patient’s understanding (Handtke, Schilgen, & Mösko, 2019).
Who decides on your family’s healthcare? This inquiry helps evaluate the patient’s rank and connection with his daughter, which helps estimate health care requirements.
Do you have health insurance? The patient says he doesn’t want to be a burden, and the scenario shows he is financially dependent on his daughter. Also, as a clinician, I must consider a patient’s financial situation while deciding on treatment choices and send them to social services or the local health department (Dains, Baumann, & Scheibel, 2019).
Have you tried or used any particular home remedies? Tell me about your day-to-day diet. Patients’ traditional beliefs and practices should be included in Western treatment if feasible. Patients comply better, and clinicians can uncover potential home remedy interactions with prescription treatments.
Is there anything I haven’t asked about that you feel I should know? Directing the interview and asking all critical questions is a common expectation among patients, especially at the first visit (Dains, Baumann, & Scheibel, 2019). This allows the patient to express any concerns in a safe atmosphere.