TYPE – Scholar Practitioner
1A. Using the National Center for Complimentary and Integrated Health (NCCIH) at https://nccih.nih.gov/, provide research about a complementary therapy. Provide a summary overview of the therapy. What evidence is there about providing care for patients of all cultures. Discuss how you would work with a patient to integrate the therapy into his/her care plan.

1B. Using transcultural care concepts, provide evidence based practice guidelines that illustrate how linguistic challenges interfere with culturally competent care. What are the safety concerns for APNP providers?

Students are expected to:

1. (From the professor)This is a topic near and dear to my heart! The focus of my private practice is CAM modalities. There are two distinct prompts that you need to construct a response for – complementary therapy and cultural care. Both of these discussions are directing you to use scholarly/credible resources. Be sure that you support your discussions and include the appropriate ‘in-text’ and corresponding reference citation
2. Post an initial substantive response of 250 words to each question
3. Respond to at least two other peer/student’s postings with substantive comments .
4. Substantive comments add to the discussion and provide your fellow students with information that will enhance the learning environment.
5. The peer postings should be at least one paragraph (approximately 100 words) and include references as indicated by the instructor.
6. References and citations should conform to the APA 6th edition.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Remember: Please respect the opinions of others, even if their views differ. In other words, disagree professionally and respectfully.

Plagiarism is never acceptable – give credit when credit is due - cite your sources.

PartB:Rebecca's Post:

Complementary Therapy

1A) One complimentary therapy that I believe is beneficial to many people of all cultures is chiropractics. Chiropractic is a health care profession that focuses on the relationship between the body's structure, mainly the spine, and its functioning. Although health care practitioners may use a variety of treatment approaches, they primarily perform adjustments to the spine or other parts of the body with the goal of correcting alignment problems, alleviating pain, improving function, and supporting the body's natural ability to heal itself (National Center for Complementary and Integrative Health, 2017). The chiropractic profession is the largest complementary and alternative medicine profession and one of the largest licensed health care professions in the United States. Chiropractic is considered to be a holistic and wellness-oriented profession, traditionally not using drugs or surgery to help patients maintain health, and has recently become more involved in public health activities. Chiropractic providers provide an extensive amount of care to underserved and rural populations. The United States is currently experiencing a shortage of physicians and it is anticipated that those citizens affected most severely by this understaffing will be vulnerable and underserved populations, a socially unjust situation. Therefore, doctors of chiropractic are now in an excellent position to be part of the solution to the current health care crisis and reduce the gap in health care providers, especially with providing conservative health care to underserved and diverse populations and cultures (Green, & Johnson, 2012).

One way I would work with a patient and integrate chiropractics would be if I had a patient who was in chronic pain from a motor vehicle accident. I would not only treat the patient with pain medications and anti-inflammatory, I would also recommend going to the chiropractor in order to help realign the patient’s spine. When a patient is involved in a car accident, micro-tears in the ligaments and muscles are a common injury. These tears in the muscles are the main reason patients wake up after a car crash in severe pain wondering what is wrong. A Chiropractic Doctor will use spinal manipulations to realign the spinal cord helping the body to release an anti-inflammatory that helps reduce inflammation and pain symptoms within the body. Another benefit of using a chiropractor with care is that chiropractors use a non-invasive approach. The non-invasive chiropractic adjustments realign the spine and joints significantly reducing pain and promoting healing without the need for surgery (Brown, 2017).

1B) APNPs today are providing care, education, and case management to an increasingly diverse patient population that is challenged with a triad of cultural, linguistic, and health literacy barriers. For these patients, culture and language set the context for the application of health literacy skills. APNPs are in an ideal position to facilitate the interconnections between patient culture, language, and health literacy in order to improve health outcomes for culturally diverse patients (Singleton, & Krause, 2009). Low health literacy, cultural barriers, and limited English proficiency have been described as the “triple threat” to effective health communication by The Joint Commission. APNPs, who work with patients from increasingly diverse cultural groups, experience daily how these three threats offer a challenge to the effective provision of care at the system, provider, and patient levels. At a practical level, APNPs must be aware that culture affects individual and collective experiences that are directly and indirectly related to health. Examples of cultural influences on patient health beliefs and behaviors can be found in patients' perceptions of control, preferences, communication norms, and prioritization of needs, as well as in their understanding of physical and mental illness and of the roles of the individual, family, and community (Singleton, & Krause, 2009).

To be health literate in the US, a patient needs to be able to effectively apply a variety of skills to accomplish health-related tasks that are often very demanding. Skills include reading and writing in English, speaking and listening in English, numerical computing, critical thinking, and decision making. Culture and language affect how patients acquire and apply these skills in health situations (Singleton, & Krause, 2009).APNPs need to understand that safety is of the upmost importance when it comes to patients who are unable to understand their health situation. Medication over doses and the inability to follow a medication regimen can be deadly. The APNPs need to make sure that their patients fully understand what is expected of them before discharge occurs.

References

Brown. (2017). 9 Benefits of Chiropractic Care After a Car Accident. Retrieved September 30, 2018, from https://www.arrowheadclinic.com/category/blog/bene...

Green, & Johnson. (2012). Diversity in the Chiropractic Profession. The Journal of Chiropractic Education, 26(1), 1-13

National Center for Complementary and Integrative Health. (2017, September 24). Chiropractic, Spinal Manipulation, and Osteopathic Manipulation. Retrieved September 30, 2018, from https://nccih.nih.gov/health/chiropractic

Singleton, & Krause. (2009). Understanding Cultural and Linguistic Barriers to Health Literacy. American Nurses Association, 14. Retrieved September 30, 2018.

Helen's Response:

1A. All of the following bulleted information is taken from the U.S. Department of Health and Human Services – National Institutes of Health (2018):

• Chronic pain can be disabling. Chronic pain may be defined as pain that last three months or more. The prevalence of chronic pain in the U.S. is close to 12% of the population has pain every day. Persons with severe pain account for about 17.6% of the population. Clients with severe pain are more likely to utilize healthcare and these clients are often disabled.
• A 2017 study investigated chronic pain complimentary approaches with the opioid crisis in mind. Evidence demonstrated that Tai Chi, yoga, relaxation techniques, and massage may have some benefits for chronic pain. However, acupuncture is the only complementary therapy that reduced the need for opioids.
• A clinical practice guideline from the American College of Physicians encourages the use of nonpharmacological therapies for chronic pain patients. They suggest the use of acupuncture, mindful stress management, yoga, and biofeedback. The American College of Rheumatology recommends complementary approaches for osteoarthritis of the knees or hips. They specifically recommend Tai Chi for knee pain.

In the U.S. the government developed National Standards for culturally and Linguistically Appropriate Services in health care to improve the care for all cultures (McCalman, Jongen, & Bainbridge, 2017). Inclusion of the client in decision-making is respectful to a patient of any culture and the client is more likely to be compliant with a mode of therapy if he or she chooses that therapy. In the last clinical, women’s health, video interpreters were used to communicate with persons from other countries when there were language barriers.

Incorporation into Plan of Care: For a patient with osteoarthritis: I make suggestions on complementary approaches such as Tai Chi and yoga. A discussion would ensue about all available forms of complementary treatment. The client would decide what mode of complementary therapy to perform.

1B. Cultural differences and language diversity make communication a challenge for NPs. Diverse cultures interpret healthcare in ways that stray from the traditional Western model (Nicholl et al., 2015). Language differences make it challenging to understand why the client is presenting for care. Safety becomes an issue because language barriers may make the client uncomfortable in reporting symptomology (Nicholl et al., 2015). NPs may be concerned that the whole picture is not available and that the client has a malady that is not being addressed.

References:

McCalman, J., Jongen, C., & Bainbridge, R. (2017). Organisational systems’ approaches to improving cultural competence in healthcare: A systematic scoping review of the literature. International Journal for Equity in Health, 16, 1-19. Doi: 10.1186/s12939-017-0571-5

Nicholl, B.I., Smith, D.J., Cullen, B., Mackay, D., Evans, J., Anderson, J., Lyall, D.M., Fawns-Ritchie, C….& Mair, F.S. (2015). Ethnic differences in the association between depression and chronic pain: Cross sectional results from UK Biobank. BMC Family Practice, 16, 1-10. doi: 10.1186/s12875-015-0343-5

U.S. Department of Health and Human Services – National Institutes of Health. (2018). Chronic pain: In depth. Retrieved from https://nccih.nih.gov/health/pain/chronic.htm#hed2