NR 305 Week 6 Discussion – Providing Culturally Competent Nursing Care
The first thing I would do upon receiving Amira in the Emergency Room is to get a set of vital signs & perform a rapid assessment to figure out where the general direction of the bleeding is coming from & if she is still currently bleeding. It’s important to stabilize the patient prior to doing a full physical assessment& health history. Since Amira speaks limited English, it’s extremely important to find a way to communicate with her to gather more information as well as explain to her what you are going to do & why. It’s important to find a translator or utilize a translating resource in the hospital when there is a language barrier, especially in this urgent situation. After establishing a means of communication, I would perform a more thorough physical assessment of Amira. I would listen to her heart, lung & abdominal sounds. I would then palpate the abdomen for any tenderness or pain. It’s important to consider urgent conditions such as pelvic inflammatory disease, appendicitis, ruptured ovarian cysts, or ovarian torso, which may indicate the need for a transvaginal ultrasound (Jarvis, 2016, p 741). I would ask her questions about when the bleeding & abdominal pain started when was her last menstrual period if she thinks she could be pregnant, if she was sexually or physically assaulted by someone, & if she has any other new health conditions, diseases, or problems. I would also inquire about collecting lab work, including a pregnancy test, CBC, BMP, type & screen, occult blood sample & UA with culture to rule out any issues contributing to or as a cause of her recent bleeding & abdominal pain.
It’s important to take Amira’s culture into account when performing any kind of assessment or physical examination. She may only want to be treated by female employees. She may follow a special diet that the homeless shelter could not provide or even be fasting as a part of her religion, which may have been the reason she wasn’t eating. It’s important to protect her modesty during the physical examination. She may not be open to questions or discussions regarding certain sensitive issues, particularly those pertaining to sex or sexual problems (CDC, 2016, p 5).
NR 305 Week 6 Discussion – Providing Culturally Competent Nursing Care
It’s possible that since Amira is a refugee that her current condition is a direct cause of her not receiving the medical attention she needed. It was reported that she was seen not eating & didn’t look well for a couple of days, but nothing was done until it was a more urgent situation presented itself. It’s also possible that Amira was sexually or physically assaulted, which would then require further investigation into her situation. Since Amira is homeless & a refugee, she most likely does not have access to the medical attention that she needs or insurance to cover any expenses. I’m sure she’s terrified enough already being a refugee & residing in a homeless shelter which may have caused her not to reach out for help herself.
References
Jarvis, C. (2016). Physical examination & health assessment (7th ed.). St. Louis, MO: Elsevier.
U.S. Department of Health & Human Services/Centers for Disease Control & Prevention/National Center for Emerging & Zoonotic Infectious Diseases/Division of Global Migration & Quarantine. (2016). Syrian Refugee Health Profile. Retrieved from https://www.cdc.gov/immigrantrefugeehealth/pdf/syrian-health- profile.pdf
Amira is a 27-year-old Syrian refugee who has been residing in a local homeless shelter since her arrival here in the United States 4 weeks ago. She was brought into the emergency room this morning via squad after being found by a shelter employee sitting in a pool of blood on the bathroom floor, crying & holding her abdomen. Due to her limited English speaking abilities, she is unable to provide specific details as to her complaints but the shelter employee states that she has recently stopped eating & has not looked well for the past couple of days.
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Question 
NR 305 Week 6 Discussion – Providing Culturally Competent Nursing Care
Based on the limited information provided, please answer the following questions.
How will you prioritize your case of Amira, what assessments will you complete, & in what order? Please provide a rationale for choosing this order.
Are there any cultural beliefs/practices that must be considered when planning her case?
Considering her symptoms of abdominal pain & bleeding, is it possible that her status as a homeless refugee is a causative or contributing factor to her illness? Please provide a rationale for your response.
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