30.2: Chapter 5

Unfolding Case Study

1. A. Rationale: The patient appears to be stable currently. The nurse should recognize the need for an interpreter as the priority to improve communication because the patient does not speak English.

2. C. Rationale: Pain is whatever the patient says it is. In this case, it is likely that the patient’s culture processes pain and the meaning of pain differently than what the nurse expects to see. In some cultures, it is common to remain stoic, regardless of how severe the pain is. This highlights the importance of obtaining a thorough history and assessment so that cues are not missed.

3. Health disparities are health outcomes that are worse in certain populations. The social determinants of health are external factors such as the neighborhood people live in or access to health care and have a direct impact on health disparities. In this particular case, the patient reports that income is inconsistent, likely classifying the patient as from a low socioeconomic status, which is a social determinant of health. Having a limited (or inconsistent) amount of income directly impacts the patient’s ability to provide for her family and obtain healthcare services, both of which contribute to the development of health disparities.

4. First, the nurse should attempt to obtain more information about the patient’s situation. This needs to be done with care as this can be sensitive to talk about. In this case, the nurse also needs to request assistance from the interpreter because the patient does not speak English. Once more information about the patient’s finance and home situation obtained, the nurse can initiate appropriate referrals. Often this includes a referral to a social worker or counselor who can assist the patient in finding community and other resources to address economic or social needs.

5. First, the nurse will determine what the patient considers to be the problem and what they call it. In this case, the nurse may ask the patient, “What do you call your illness?” or “What does your illness mean to you?” Second, the nurse should ask the patient what they think caused the illness. In some cultures, it is believed that illness is caused by imbalances in the body or is a punishment from God. The nurse should accept the patient’s answer without judgment, even if it does not align with the nurse’s personal beliefs. Next, the nurse should ask what the patient is doing to cope with the problem. The nurse should take note of any cultural differences in the way the patient handles the illness, such as use of folk remedies or nontraditional healers, which could impact the patient’s care plan. Last, the nurse will ask the patient how concerned they are about the illness. Some cultures view illness as “God’s will” and are not concerned, while others express more concern. In this case, specifically, the nurse may also want to ask how concerned the patient is about their finances and access to health care as it has been determined that the SDOH are likely impacting the patient’s overall health.

6. Many times, nurses provide patients with resources and referrals while in the hospital but then have no idea if they followed through and got the assistance they needed. To combat this, the nurse can do a few different things. First, the nurse should work closely with the social worker to ensure that appropriate resources are available and that the patient’s contact information is provided and all follow-ups are scheduled. This helps ensure that contact with the patient is not lost after discharge. Additionally, the nurse should continuously assess the patient’s social needs while they are in the hospital, initiating appropriate referrals as needed. In many cases, nurses and patients build a rapport during the hospital stay which allows the patient to confide in the nurse and allows the nurse to assist the patient with resources. The nurse can ask the patient questions such as “Did I address all of your concerns?” or “Is there anything you are worried about that we haven’t talked about yet?” to determine whether the patient’s social needs have been completely addressed.