Disclosure of a Serious Diagnosis to the Patient

Nurse Practitioner Program

The ethnic and cultural backgrounds of patients are becoming increasingly diverse. Advanced practice nurses need to appreciate that patients’ cultural backgrounds impact how they view situations and actions. We cannot make assumptions about values, beliefs, and preferences based on cultural heritage, as individuals within a culture vary in their attitudes and values, and can change due to acculturation. However, advanced practice nurses need to understand how an individual patient is shaped by his or her culture. Open-ended questions help the healthcare provider to do this, regardless of the patient’s background.

Case Study

Disclosure of a Serious Diagnosis to the Patient

Background

Karen Gill is an acute care nurse practitioner. Karen is employed by the only group of pulmonologists in a medium-sized city in Texas. Karen sees patients in the office and rounds at a level 2 hospital where she was the first APRN granted privileges.

Mrs. Liu is a 72-year-old woman who moved to the United States from China 16 months ago after the death of her husband to live with her son and her daughter-in-law. Prior to immigrating, Mrs. Liu had complained of respiratory symptoms and consulted the village doctor, who diagnosed a minor ailment. Recently, her episodes of coughing, chest tightness, and wheezing worsened. After Mrs. Liu developed fever and weight loss, a chest X-ray ordered by her son’s family practice physician revealed a pulmonary mass. Mrs. Liu was referred to Karen’s practice, where she underwent a biopsy. The pathology report revealed pulmonary tuberculosis.

Mrs. Liu’s son asked that the diagnosis be withheld from his mother. He explained that in the rural area of China where his mom is from, tuberculosis is considered fatal, and to tell her would be like giving her “a death sentence.” He also said tuberculosis is considered “not a nice thing” to have.

Karen reviewed the literature on perceptions of tuberculosis in rural China and found considerable social stigma attached to the disease with loss of social connections common after the diagnosis. She knows that mandatory reporting must be done to the public health department within 24 hours.

In your initial post, select one of the five case studies provided. Please make sure that the title of your chosen case study is clearly listed so that others know which scenario you are posting about.

Answer the following questions for your selected case study:

• What should the advanced practice nurse know about the cultural issues in the case?
• How should the advanced practice nurse address these cultural differences in a respectful manner?
• What ethical action is required?
• What moral theories, ethical principles, or provisions of the ANA Code of Ethics impacted your decision?
• Are there clinical practice guidelines or legal implications that impacted your decision?

Post your responses to the forum below. End your post with two (2) thought-provoking follow-up questions designed to expand the discussion topic in new ways. Your post should be a total of 200–400 words. Reference three or more relevant, current, peer-reviewed journals (not a part of the assigned reading articles in the post), and incorporate assigned reading.

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