MR, a 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help himself too. He tells you he is afraid that he will not get into heaven if he continues in this lifestyle. He is not taking any prescriptions medications and denies 

drug use. He has a positive family history of diabetes, hypertension, and alcoholism. 

It is very important for healthcare providers to understand the culture of their patients in history taking and assessment. In the above scenario of a 23-year-old male, it is very important that the nurse practitioner be able to recognize different culture, values and biases in other to create an effective patient center communication (Ball, Dains, Flynn, Solomon, & Stewart, 2019). In other to provide culturally competent care, it is required that healthcare providers be sensitive to the patient’s heritage, sexual orientation, socioeconomic situation, ethnicity and cultural background (Ball et al., 2019). Healthcare professionals should avoid being stereotype base on patient culture but be able to recognize their limitations in knowledge about a patient culture and maintain an open mind on their cultures.

                                                     Socioeconomic, Spiritual, Lifestyle, and other cultural factors 

According to the scenario presented above, the 23-year-old does not have any socioeconomic factors affecting his health, but he has a spiritual and lifestyle factors that could affect his health. Culture, spirituality, and lifestyle is very important in the treatment of native Americans. The patient factor described above shows that the patient has factors like use of alcohol and drugs that may affect is health. Knowing these factors is very important in understanding the treatment approaches that are necessary to the particular individual (Indigenous Policy Journal, 2015). The patient also explains that he has anxiety about his drug use that could prevent him from reaching “heaven” when he dies In exploring this, the  nurse practitioner should be careful to not offend the patient but create rapport with the patient that can lead to a trustful one in other to implement treatment. Ask the patient to explain more about his specific beliefs and if he has a certain church or religion he follows and his thought about treatment options. I would also want to be careful when discussing his family’s medical history. Diabetes and hypertension are prevalent problems in the native community, partly due to the high rate of poverty and access to healthy foods (Struthers & Lowe, 2003). According Espey et al. (2014), there is increase mortality death rate in the native American population due to high incidence of diabetes, smoking prevalence, problem drinking, and social determinants. In this case a discussing patient perceived risk factors is a sensitive topic since patient already has anxiety because of his drug use. Proper assessment of the patient and good history taking to further find out what the patient could be more at risk for is important to provide better treatment and care. Other cultural factors that may affect the native American is that they mostly live in rural areas and are usually poor too making it difficult for them to get better healthcare. Even though not mention in the scenario above, the social determinant of the native Americans is that they are more likely than white to be poor, unemployed, and possess less education (Espey et al., 2014).

Sensitive Issues

The issues that the healthcare provider needs to be sensitive about when talking to the patient is the patient use of alcohol and recreational drugs.  The nurse practitioner will need to explore more by asking how often the patient drinks alcohol and uses recreational drugs. Patient also reported having anxiety. This could be from alcohol or the use of pot as mentioned. Native Americans are culturally sensitive to seek treatment for mental illness or drug/alcohol because of the stigma label on it. So, the nurse practitioner should be careful in suggesting treatment to patient. Nurse practitioner can start by asking the patient questions to find out patient stand regarding initiation of treatment (Ball et al., 2019).

                                               Targeted Questions

1. Do you smoke cigarettes, or are you around second-hand smoke?
2. What do you do for a living?
3. Within the last month has your anxiety impacted your daily living?
4. Have you tried any natural remedies to treat your anxiety?
5. On average, what is your daily/weekly alcohol intake?
6. Do you have a family or community support system?
7. Do you belong to any religious organization?

                                                                                        References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Espey, D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading Causes of Death and All-Cause Mortality in American Indians and Alaska Natives. American Journal of Public Health, 104(S3), S303-11. https://doi-org.ezp.waldenulibrary.org/10.2105/AJPH.2013.301798

Indigenous Policy Journal. (2015). Native American Indian Cultural Risk Factors – Contact to Termination. Retrieved from http://www.indigenouspolicy.org/index.php/ipj/article/view/338/325

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