The biophysical factors operating in this situation are the age of the patient and the possible inheritance of breast cancer. The psychological factors are her mental health records and susceptibility to depression. The sociocultural factors are the influence of the public opinion on her gender, social stress, and prejudice resulting from her way of life. The behavioral factors include both the past and the current sexual behavior patterns.
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The health system factors are identifying and locating the establishments which have competence in dealing with reported issues (either cancer or depression) and are known to exhibit a readiness to provide their services to the lesbian and bisexual population.
Before receiving the patient, a nurse should facilitate a friendly and comfortable environment, including the appropriate visual aids (posters and brochures showing the diverse same-sex couples and highlighting the topics relevant for LGBT). Through the course of the meeting, the nurse should use appropriate terminology and language, such as “relationship status” instead of “marital status” and “partner” instead of “husband.” The sensitive questions, such as hormonal use or sexual behavior details need to be justified, and their intent explained.
Two major concerns of Betty are the depression she is currently suffering from and the possibility of cancer. The latter is especially alarming as she is exhibiting a poor understanding of the matter. The fact that lesbians do not face the threat of cervical cancer is a common misconception that is still responsible for the low rates of early detection of cancer among the lesbian community (Davey, 2016).
Thus, the community health nurse needs to inform Betty on the matter and provide her with guidelines for further actions. The information needs to be presented as non-alarmingly as possible to avoid aggravating the current disturbing emotional and psychological condition of the patient.
In the case when evidence exists of the correlation between different population groups and the HIV incidence rate, the problem should be addressed on two levels. First, the campaign of raising awareness must be initiated, including meetings and educational events. Also, HIV testing capabilities need to be provided to the population. Second, the setup suggests the high probability of stigmatization.
Thus, the stigma-reduction and prevention programs are advised, including the new policies that will protect the target population’s rights and ensure their privacy and non-discrimination. The education programs have also proven to yield successful results in reducing stigma, so their introduction would be desirable.
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However, before making conclusions from the obtained data, additional information needs to be collected. First, other possible causes of disparities need to be checked. The differences in HIV rates often occur based on cultural background, which may only partially coincide with the ethnic profile of the population (Gari et al., 2013). In this case, the low disparity between different ethnic groups compared to the generally high rate among the gay men suggests the relatively minor influence of race and may lead to wrong conclusions.
The most obvious segments of the community that will be helpful for the intervention are other LGBT activist groups. They often have access to the same resource bases and organizations, so the organizational side of the event will be easier to handle. Additionally, human rights activist groups will likely help provide efficient educational activities. The most important, however, is the detection of cultural or other groups associated with the disease. Once such groups are detected, they will provide additional information regarding the ways the intervention should be conducted and the weak points in the current situation among the risk group (which may or may not be gay African Americans).
Barriers to Cultural Competence
While it is tempting to state that I have overcome most of the barriers to cultural competence, this probably is not the case. While certain aspects, such as demonstrating patience and respect, are intuitive and well-understood practices, I still fall short on considering such details as the role of familism (Wilson, Durantini, Albarracín, Crause, & Albarracín, 2013). It is a fact that in certain cultures the opinion of other family members, possibly even one patriarchal figure, plays a decisive role in many questions, including the treatment. I will thus need to study the relevant literature to time determine and prevent possible misunderstandings.
However, this solution brings up another barrier. Basing a conclusion regarding the cultural background on the visual clues and background information may as well lead to improper decisions. The recommended procedure to avoid this issue is asking questions about the patient’s cultural practice. To avoid being offensive, the questions must be structured in a non-intrusive and professional manner and should be justified by the nurse’s intention.
However, the exact line between the assumption and the need for a follow-up question is unclear and context-sensitive. What’s more, the current literature has little to offer on the matter (Singleton & Krause, 2009). What I think would be a possible solution for overcoming this barrier is organizing educational events and dedicated meetings. As there are many nuances to this question, experienced staff members are more likely to provide additional insights and useful details on the matter, so the horizontal involvement is desirable to overcome this barrier.
Davey, M. (2016). ‘Urban myth’ that lesbian women don’t need pap smears is a health risk – study. Web.
Gari, S., Doig-Acuña, C., Smail, T., Malungo, J. R., Martin-Hilber, A., & Merten, S. (2012). Access to HIV/AIDS care: a systematic review of socio-cultural determinants in low and high income countries. BMC Health Services Research, 13(1), 198-211.
Singleton, K., & Krause, E. M. (2009). Understanding cultural and linguistic barriers to health literacy. Kentucky Nurse, 58(4), 4-6.
Wilson, K., Durantini, M. R., Albarracín, J., Crause, C., & Albarracín, D. (2013). Reducing cultural and psychological barriers to Latino enrollment in HIV-prevention counseling: Initial data on an enrollment meta-intervention. AIDS care, 25(7), 881-887.