Introduction  One of the goals of the Affordable Care Act (ACA) was to increase the practice of preventive medicine (Obama, 2016). As preventive care is less common in the health care industry in the U.S. than is the practice of treating patients after they have already become ill (McGlynn, Asch, Adams et al., 2003), this study aims to increase preventive care among nurses through the application of health literacy, which can raise patients’ awareness of potential health problems that may be associated with their lifestyles.

Problem Statement

The specific health problem that this report focuses on is heart disease and the need to reduce the risk of its development in patients. As Torpy, Burke and Glass (2009) report, heart disease is the biggest cause of mortality among people in the U.S. As a preventive measure, nurses can use health literacy to raise awareness among patients about the risk factors associated with heart disease and prevention plans that can be adopted in order to mitigate the risk of heart disease becoming a problem for them.

Theoretical Approach

The two nursing theories that will be used to develop this case report are the theory of transcultural nursing and the theory of personal system empathy. Obtaining and utilizing a cultural competency can help one better implement a health literacy initiative in preventive care, according to Lie, Carter-Pokras, Braun and Coleman (2012). Cultural awareness and personal empathy are tools that nurses can use to identify the best ways to approach patients about issues that might be sensitive to their feelings or that might involve long-held beliefs or ideas about health, personhood, and life orientation. A nurse who can identify a patient’s cultural background, proceed with the practice of using health literacy so as to raise awareness about taking preventive steps to reduce the risk of heart disease, and help the patient to obtain a greater quality of health is a nurse who will address the issue of heart disease by focusing on one of the critical goals of the ACA, as proposed by President Obama.

Literature Review

The Framingham Heart Study identified the main risk factors associated with heart disease to be (Torpy et al., 2009):

· Men over the age of 40; women over the age of 45

· Family history of heart disease

· Smoking

· High blood pressure

· Diabetes

· Obesity

· Lack of exercise

· High cholesterol

· Excessive fat in the abdominal area

Preventive care associated with reducing the risk of heart disease includes: cessation of smoking, 30 minutes of exercise per day, obtaining medical treatment for hypertension (high blood pressure), a healthier diet (high-fiber, low animal fat—lots of fruits, vegetables and whole grains), watching blood sugar levels, and lowering one’s intake of high-cholesterol foods.

As Hruby and Hu (2015) point out, however, preventing the onset of heart disease might be easier said than done for many patients, who may not even realize they are at risk for this problem. For instance, patients may present for an unrelated (or seemingly unrelated issue) and a nurse could see after assessing the patient that the individual is indeed at risk for developing heart disease. One of the reasons that so many patients are presenting with these signs is that “with few restrictions on access to or availability of food, the prevalence of overweight and obesity in the USA climbed virtually unmitigated over the last 50 years” (Hruby & Hu, 2015, p. 674). In other words, the environment and customary ways of eating that have been ingrained in people in the U.S. over the past few decades are perfect for elevating risks for heart disease.

Presenting this information to patients can be particularly difficult, especially if patients are unaware of their condition or take offense to the impression that they are not being healthy in their lifestyle. A nurse must be careful to approach the issue with empathy and with cultural sensitivity so that the patient does not feel like he or she is being attacked or treated unfairly. Empathy is described as the ability to put oneself in another person’s shoes (Wiseman, 1996) and can be a strategic tool that empowers a nurse to approach a patient with social and emotional intelligence so that the right kind of preventive care can be delivered to the patient to help the patient address risk factors that could later lead to major harm (Tshuldin, 1989).

Approaching the patient with cultural sensitivity via the transcultural nursing model can also be helpful in helping patients to understand the risks...

The goal of the transcultural model is to give the patient quality care from within the patient’s own cultural framework (Maier-Lorentz, 2008). By showing knowledge of a patient’s cultural background and beliefs and approaching those beliefs empathetically, the nurse can help to establish a strong relationship with the patient, which will support the nurse’s efforts to practice preventive care (Che, Barret, Velez et al., 2014).
Nursing constitutes a succession of methodical steps aiming to offer excellent care. Its five stages are: assessment, diagnosis, planning, adoption and appraisal (Edwards, Staniszewska & Crichton, 2004). Using empathy and the transcultural model can help nurses to plan a preventive care approach, encourage the patient to adopt it, and assist in the appraisal of the intervention.

Health literacy can be used in preventive care as it works to raise the awareness of the patient about risks and to lean about procedures that can be implemented as a matter of daily habit in order to prevent disease from occurring (White, Chen & Atchison, 2008). Through the application of health literacy, using materials such as pamphlets and fliers that can be obtained from sources online as well as from organizations like the IOM or CDC, nurses can intervene with health literacy while adopting the empathetic and transcultural nursing approaches to ensure that respect for the patient is shown at the same time that important knowledge is conveyed and preventive care is delivered.

Case

The example case for this study would be an Indian patient who presents for a broken foot. The nurse notices that the patient is overweight, has excessive fat around the abdominal region, and upon further questioning the patient reveals that he does not exercise, smokes every day, and eats a high-cholesterol American diet of fast food with sugary drinks like soda and sweetened tea. The patient is a male of 45 years of age. The patient has not been checked for diabetes and it is not known whether there is a family history of heart disease. Upon checking the patient’s blood pressure, it is revealed to be high. Thus, 7 of 10 risk factors for heart disease are identified by the nurse. Though the patient has presented for a broken foot, the nurse immediately realizes that this would be a perfect opportunity to practice preventive care.

The preventive care that could be implemented here is first for the nurse to schedule a test for diabetes. The nurse should use the transcultural model and the empathetic approach to next discuss with the patient some of the patient’s lifestyle choices, such as smoking, diet and exercise habits. The transcultural model is applied by considering the following aspects (Giger & Davidhizar, 2002):

· Time

· Space

· Social organization

· Communication

· Environmental control

· Biological variation

Being aware of these indicators will provide the nurse with useful information about the best way to approach the patient. How the patient uses space to keep distance, how the patient displays a sense of time (have they been waiting long, not long at all, do they feel neglected—and so on), how the patient views his or her biology, how the patient communicates (openly or in a closed manner)—all of these variables will contribute to the cultural lens that the nurse uses to obtain information from the patient before engaging in preventive care through the application of health literacy.

Transcultural nursing can allow the nurse to apply cultural competency to the task of practicing preventive care by using practical steps to indicate respect for the patient. These steps can include being mindful about how the nurse stands, the proximity to the patient as treatment plans are discussed, the tone of voice that the nurse employs, how the nurse makes suggestions regarding care options (whether the nurse includes the patient in the process of making decisions vs. the nurse adopting an arbitrary tone and an isolating approach to the patient’s inputs). The point of this mindfulness is that how a nurse presents him or herself to the patient conveys meaning, depending on that patient’s cultural background. A nurse who is culturally aware, will understand the right signals to send through both verbal and non-verbal communication techniques so that the nurse demonstrates both empathy for the patient and support for the patient’s well-being. The patient should perceive that the nurse really has the patient’s best interests at heart and is approaching the patient’s health like a true friend.

Giger and Davidhizar (2002) make the important point…