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CASE STUDY Paloma Hernandez, a 26-year-old Spanish-speaking patient, has presented to the clinic for the last two days in a row, complaining of abdominal pain that is getting worse

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CASE STUDY

Paloma Hernandez, a 26-year-old Spanish-speaking patient, has presented to the clinic for the last two days in a row, complaining of abdominal pain that is getting worse. On the first visit, the staff relied on her younger bilingual daughter to translate. She was treated with Omeprazole and encouraged to take OTC medication. Today she presents with the same problem. Her daughter states it is the same problem but worse today.

 

POST A

The assigned case study involves a clinic visit from a 26-year-old female, Spanish speaking, with complaints of abdominal pain. However, this is the second visit by the patient for the same health complaint, but they reported increased abdominal pain severity. During the initial visit, the patient was accompanied by her youngest daughter, who acted as her interpreter. The patient was treated and sent home with omeprazole.

Unfortunately, the lack of effective communication between the provider and the patient during the initial encounter because of the language barrier, failed to provide the patient with quality care. Squires (2018) discussed the Affordable Care Act restrictions against using family members as qualified healthcare interpreters. Also, the 1964 law protects patients' right to access quality healthcare no matter the language the person speaks; healthcare organizations must provide interpreter services suited for each communication barrier to enhance quality care. Nevertheless, as language is part of the culture, providers can use the opportunity to inform themselves about the patient's interests, beliefs, ways of living, and perception of health to build rapport and establish patient-centered care (Ball et al., 2019).

Making up approximately seventeen percent of the total U.S. population, the Latino community is the largest minority group. Hence, the healthcare system must implement strategies to address health risks and preventive care (Gast et al., 2017). Based on the spiritual belief of fatalism, the Latino community believes less in medical practices that aim toward disease treatments and prevention. Moreover, due to fatalism attitudes, there is a lack of health education, early screenings, and health insurance, and a higher prevalence of potentially fatal diseases that could have otherwise been preventable (Gast et al., 2017). American Heart Association (2022) explained the family role of Hispanic mothers as heads when it came to raising children, also consisting of sixty-one percent of the U.S. workforce, posed challenges in balancing family responsibilities, and caring for their health. In fact, women of Hispanic and Black origins are often found to develop high blood pressure at a younger age (AHA, 2022).

Furthermore, among Hispanics, it is vital to consider morbidity over mortality. The perception of well-being/health in a family or individual is influenced by the social determinants of health, including income, environment, education, and health behaviors (Valderrama, 2021). The impact of the language barrier and lack of online resources supporting Hispanic heritage is seen in the increase in non-insured patients (Nagle, 2021). The lack of insurance, especially for undocumented immigrants, has forced many patients not to seek medical services on time for meaningful and successful care to ensure cure and prevent readmissions.

Sensitive and meaningful issues to discuss with the patient would include the patient's status on health insurance coverage and income, as these two factors determine the availability and access to quality care. Other sensitive social issues discussed include access to nutritious food, personal safety, sleep patterns, physical fitness, sexual education, contraceptives, women's health, and formal education.

To build a thorough health history and assess health risks, I will inquire if the patient had a primary doctor and determine the last history and physical to evaluate the patient's condition before the illness. The interview will include the date of last menstrual, history of unprotected sexual activities, dietary habits, family history, especially in cancer and diabetes diagnoses, bowel patterns, pain nature, and patterns.

 

POST B

Cultural Diversity and Cultural Competence

Population diversity is rising in the United States, which has created challenges for healthcare providers and the patient population. Areas of concern are the communication styles, cultural differences, explanatory styles, and interpreter services in meeting the needs of the diverse population. Young and Guo (2019) cited the U S Census Bureau (2007), stating that twenty (20%) percent of the people in the United States spoke a language other than English in their different homes. As a result, diversity and linguistic challenges become incredibly complex. Organizations, especially healthcare, expect professionals to be culturally competent and demonstrate behaviors, attitudes, and structures that will enhance cross-cultural effectiveness (CDC, n. d.) by managing the dynamics of difference, valuing diversity, and adapting to diversity and cultural contexts. Young and Guo (2019) suggested that healthcare professionals be proficient in knowledge, skills, and tools to practice and provide culturally competent care to our culturally diverse population. There is a direct correlation between healthcare professionals' level of cultural competence and their ability to provide culturally competent healthcare. Cultural competence is essential in delivering culturally appropriate care to cross-cultural populations (Campinha-Bacote, 2002).

Case Study

Paloma Hernandez, a 26-year-old Spanish-speaking patient, has presented to the clinic for the last two days in a row, complaining of abdominal pain that is getting worse. On the first visit, the staff relied on her younger bilingual daughter to translate. She was treated with Omeprazole and encouraged to take OTC medication. Today she presents with the same problem. Her daughter states it is the same problem but worse today.

Healthcare professionals must recognize their knowledge and cultural perspective limitations and be open to others' perspectives (Ball et al., 2019). Language differences created a communication barrier between the patient and the healthcare provider. Using the patient's daughter as an interpreter did not help, as the daughter could not interpret effectively to convey her mother's care needs. It is essential to understand the patient's care needs by utilizing a professional, competent interpreter to help communicate the patient health care needs. The federal government mandated that we provide Paloma Hernandez with language assistance at no cost to her to facilitate timely access to healthcare needs and health history building. It is forbidden to utilize an untrained individual or a minor as an interpreter (Think Cultural, n.d.). Besides making this patient comfortable and building trusting relationships, ensuring that the patient is understood and her needs are met to alleviate her fear and anxiety.

Questions to help build a health history

I will maintain a non-judgmental attitude towards the patient and eye contact to ensure a continuous trusting relationship. To ensure that she is free to express herself, I will find out if she is comfortable having her daughter in the interview room. With a competent professional interpreter, Ms. Paloma will be asked the following questions: Tell me about what brought you here today. This open-ended question will allow the patient to narrate her story without interruption in a free and respectful atmosphere. To get a specific answer to a question, I will employ the patient to tell me where it is hurting, place her finger where it hurts, and if the pain radiates to any other adjacent or surrounding location.

 Is this the first time you have experienced this kind of pain?

What interventions have you attempted in the past that worked?

When was the last time you ate, and what did you eat, any nausea or vomiting?

Was the pain worst after eating?

When was the last time you had a bowel movement, and what was the color if you saw it?

When was your last menstrual period, and was it regular?

Are you pregnant?

I hope this approach helps dig out the cause of her visit to the clinic and her accurate health history to ensure appropriate clinical action.