The Cultural Part

Nursing homework help: Given the information regarding the two patients below please answer the following questions. Please be specific, give examples in the cultural part and do not write intellectual. Just be simple and direct. Please note each questions should be answer for both patients.
1. What is the Reason for Services and the Presenting Problem
2. Be very detailed and give specific examples. What are your cultural identities? At How are your identities similar or different from the client or system you are engaging? What assumptions or biases may you need to be aware of? How might culture and identity impact the power dynamics in your relationship with this client? Be very detailed here.
3. What do you think the client might be thinking or feeling?
4. What is your Impressions/Assessment of the patient during the session/s?

INTERN DEMOGRAPHICS: The therapist is a 31-year-old married heterosexual colored immigrant male (Caribbean culture) who resides in Brooklyn, New York. He is educated stable housing, is middle class, does not have any kids and is able-bodied.

PATIENT #1 DEMOGRAPHICS: The patient is a 86-year-old single white American female who currently resided in a shelter in Brooklyn New York. She lost her apartment in Queen, New York because of a building fire. She spent most of her life in Queens, New York, and her friends reside in Queens New York. Her diagnosis is a generalized anxiety disorder, and severe pain that results in her needing to use a rollator to ambulate. She needs total replacement surgery, but she is unable to obtain this due to not having stable housing and adequate resource for recovery. She is unable to use public transportation and uses Access-a-ride to travel. However, this is time-consuming and not always reliable. She is Christian and attends church every Sunday along with church activities. She needs a home attendant but is unable to obtain one due to the shelter not allowing visitors. In addition, the patient does have two nieces in PA but there are distant and career-oriented. She is not technology savvy, and she gets irritable when it requires something to do with technology. VERY IMPORTANT: In this therapy session the therapist is using Cognitive Behavior Health Therapy to indicate how her anxiety impacts daily functioning and mood.

Patient 1 Encounter.
Primary PST interventions used in today’s session:   Assisted patient in brainstorming solutions to identified problem, Collaborated with patient to identify possible solutions, Evaluated, with patient, the feasibility of solutions identified, Assisted patient in choosing a solution.
Patient response to PST interventions:   The intern addressed the termination and referral out process due to him ending his internship on 05/05/2022. The patient provided the information that she would like to continue her services but at a new felicity. The patient was provided with the pros and cons of starting her treatment at a new facility rather than continuing her treatment at the same location but with a different therapist. Some of the pros the patient suggested are starting over with a new therapist, appointment reminders, providing her with a notice when an appointment is scheduled, and finding a clinic that can assist with her needs. The con the patient mentioned is her charts would not be accessed internally. Since the patient’s pros outweigh the con, the patient declined to continue services at the same facility and explained that she would like a therapist at a new facility and someone who is preferable much older. The patient explained that she feels alone and lonely and that her friends and family members do not reach out to her. Also, if she does not call, it would be months that would pass by, and no contact has been made. She feels that if she does not attempt to call these individuals, she would not hear from them. For example, she reached out to her cousin who lives in Florida, and she responded back via text saying she was busy. It has been approximately two weeks since the call and her cousin did not return her call. The patient explained that at some point a return call would have been appreciated and it is a common courtesy thing to do. This contributes to the patient’s anxiety and make her feel she does not have any support. The patient explained that people are so consumed with their lives that they forget about friends and family even though they are aware of her struggles and living in the shelter. She feels distant because she does not interact with her loved ones except if she contacts them. The patient explains that she cares and because of their history she feels obligated to call them. She wants her friends and family members to make the same effort regarding communication. The patient was encouraged to express her concerns to her loved ones. Also, set up conference calls with her friends and family at a time that is convenient for both parties. The patient expressed that she agreed to the recommendation. The patient even suggested that she can set up a zoom call between her friends. She explained that she used zoom calls for several meetings with her church before but was always invited to the call. The patient expressed her technology barriers/disparities due to age and needing to rely on people to set up the call. The patient was advised to ask someone to create the video call invite, or he can assist. The patient provided the information that she will provide the intern with the date and time of the meeting, and she asked the intern to assist with creating the zoom call link. In addition, the patient was encouraged to set up live dates with her friends. Also, the patient can contact 311 for local social daycare to interact and socialize among individuals to help reduce loneliness. The patient agreed with the recommendations and she will contact 311 for addition assistance.

Assessments
1. GAD (generalized anxiety disorder) – F41.1 (Primary)
2. Other specified problems related to psychosocial circumstances – Z65.8
3. Living in shelter – Z59.01

Patient 2 Demographics:

The patient is a 24-year African American Bisexual female who currently resides with her 2-year-old son, mother, and older brother in a private residence in Queens, New York. She currently freelances as a makeup artist mostly on the weekends. She is seeking behavioral health services because of recent abortion (March 2022) and relationship issues.

Patient 2 Encounter

PATIENT PRESENTATION TODAY: 
The patient was calm, open, and cooperative during the session. She expressed her frustration and difficulties in maintaining stable relationships, especially with her son’s father. She explains that this relationship impacts her mood and triggers her anxiety because it usually more conflict than resolution.

TRAUMA HISTORY 
Chronological breakdown of patient traumatic events (limit to sexual/physical/verbal abuse/assault, severe neglect, unexpected death, witness of violence, etc):   The patient did not identify any trauma and this section is not applicable to her.
Additional difficult/stressful events patient reports experiencing (eg, divorce, etc):   None
Patient readiness to address traumas:   No trauma reported.
Identify probable course of treatment:   Not applicable since the patient denies experiencing any traumatic events that warrants treatment.
TREATMENT PLANNING 
Identify initial treatment modality and why:   The intern will use Cognitive behavioral therapy to address the patient’s anxiety. The patient’s difficulty of maintaining stable relationships with her mother and son’s father impacts the patient’s anxiety. This causes her to not be motivated and having difficulties navigating life which makes her feel irritable. CBT will help with managing symptoms, decreasing anxiety, and improving problem-solving for impairments/struggles.

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