Case Study: MR, a 23-year-old Native American- How long have you been having episodes of anxiety? 

Case Study: 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 prescription medications and denies drug use. He has a positive family history of diabetes, hypertension, and alcoholism. 

Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you. 

According to the U.S. Census Bureau, the current total population of Native Americans in the United States is 6.79 million, which is about 2.09% of the entire population. There are about 574 federally recognized Native American tribes in the U.S (2021).  The 2018 Bureau of Labor Statistics data reported that the unemployment rate among Native Americans was 6.6%, aligning closely to the percentage of African Americans at 6.5% (2019). The American Indian and Alaska Native people have long experienced lower health status when compared with other Americans. Lower life expectancy and the disproportionate disease burden exist perhaps because of inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences. These are the broad quality of life issues rooted in economic adversity and poor social conditions (2019). Spirituality varies some between tribes and nationalities but they all share common values for morals, values, and beliefs.  some tribes share spiritual connections with animals or nature and others have a belief in one God. Native Americans have a long-standing history of distrust with American medicine which has added increased strain on health care disparities of Native Americans.  

Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture?  

As I would begin the interview with a proper introduction and question the young man on his background and language of choice. If the preferred language were not English then I would obtain an interpreter. I would ask open-ended questions and allow time for the patient to reflect and respond. Silence although sometimes uncomfortable for many of us, affords patients who are Native American time to think; the response should not be forced and quiet time should be expected (Ball et al,2019). I would ensure privacy for the patient and make sure that the young man was comfortable discussing concerns with a female. I  would ask about the spirituality of the patient and be engaged with the conversation and listen without casting judgment.  I would limit eye contact but remain respectful towards the patient but ask direct questions to elicit responses that will educate the provider on the patient’s background and current health issues.   

Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks. 

How long have you been having episodes of anxiety? What brings on the anxiety?  

How much alcohol do you drink each day? How much pot is smoked daily? 

Is there anyone in your community whom you would feel safe talking to about your anxiety and spirituality?  

Have you ever thought about hurting yourself?  

Does anything else help relieve your anxiety? Such as talking, music, or prayer.  

 What strategies can you as a nurse employ to be sensitive to diverse cultural factors while gathering the pertinent information?