Health assessments are a vital part of healthcare provision and the inherent duty of most clinicians. However, in some cases, it may be challenging for patients and nurses to build a trusting relationship with each other. Many problems arise from cultural differences between the health provider and the client (Ball, Dains, Flynn, Solomon, & Stewart, 2015). For example, the presented case describes TJ, a 32-year-old lesbian, who is pregnant with her first child.
Here, some considerations should be taken into account – the patient’s sexual orientation and the way of conception should be acknowledged. Moreover, the woman’s partner should be considered in the health history, as well as the patient’s family history and current complaint. A nurse should focus on possible health risks such as the history of diabetes and reported vaginal discharge and treat the patient with understanding and openness, asking about her pregnancy and relationship.
Factors and Questions
The health of the selected patient can be evaluated from multiple points of view. While the ethnicity and socioeconomic status of the patient are not defined, one can discuss some aspects specific to her health. The patient’s family history of diabetes may put TJ at risk of gestational diabetes. A question, “Did you have a screening test for gestational diabetes during your first prenatal visit?” may reveal some additional information. It is important to note that some vaginal discharge is normal for pregnant women, but they also face a high risk of infections (Dains, Baumann, & Scheibel, 2016; Gandhi, Patel, & Jain, 2015).
Therefore, a question about the chief complain would be to “describe the vaginal discharge,” including color, smell, consistency, frequency, and other symptoms such as pain, bleeding, redness, and others. If the patient’s description differs from that of normal discharge, other factors may be considered.
One of the main lifestyle factors that impact the patient’s health is her sexual orientation. According to Workowski and Bolan (2015), homosexual women may be at increased risk of genital infection due to the lack of awareness about protection and testing. While many of the sexually transmitted diseases (STDs) are well-documented for heterosexual partners, less information is openly available to people in homosexual relationships.
Thus, some of the targeted questions for the patient should be, “In what types of sexual practices have you engaged in the last year?” and, “Which types of protection do you use during sexual intercourse?” Moreover, questions about testing such as, “Did you and your partner recently undergo screening tests for STDs?” may reveal the patient’s knowledge about testing and some possible causes of vaginal discharge.
Strategies
The language presented in the created questions shows how a nurse can move away from phrases that are centered on heterosexual relationships. Using such words as “partner” may outline the gender-neutral tone of the conversation (Pharris, Bucchio, Dotson, & Davidson, 2016). Furthermore, it is essential to include TJ’s partner in the pregnancy planning of the patient, as both women will be the parents of the future child. Nonetheless, one should also remember that homosexual couples often lack the necessary resources for adequate testing due to fear of facing negative stigma. Therefore, a nurse should openly discuss sexual practices and protection with such patients to foster a transparent communication and ensure that all actions are taken to provide the required care.
Conclusion
Cultural and lifestyle differences of patients pose a challenge to healthcare providers and require them to adopt an open-minded view of various concerns and beliefs that patients may have. In the case of homosexual relationships, it is vital for a nurse to ensure that the couple has the necessary access to resources that provide information and support. A nurse should ask TJ about her family history, partner, concerns, and plans and use inclusive language. An open dialogue about the patient’s sexual activities and testing may help her to discuss her health in detail.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Gandhi, T. N., Patel, M. G., & Jain, M. R. (2015). Prospective study of vaginal discharge and prevalence of vulvovaginal candidiasis in a tertiary care hospital. International Journal of Current Research and Review, 7(1), 34-38.
Pharris, A., Bucchio, J., Dotson, C., & Davidson, W. (2016). Supporting lesbian couples during pregnancy. International Journal of Childbirth Education, 31(3), 23-24.
Workowski, K. A., & Bolan, G. A. (2015). Sexually transmitted diseases treatment guidelines, 2015. Morbidity and mortality weekly report. Recommendations and reports, 64(RR-03), 1-137.