Shawn Billings, a 28 year-old African American patient


Shawn Billings, a 28 year-old African American patient comes in to the clinic today. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and 4 days ago with a migraine, given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache. He is very agitated today. He is here with his father and worried that he will not get any medication.

To prepare:

  • Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
  • By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
  • Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
  • Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
  • Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?


Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Main Post

     Frequent flyers can be defined as “patients who have been admitted at least four times in 12 months” (Huang et al., 2020, para 7). This phenomenon can be considered indicators of the patient’s less than optimal mental, social, and physical daily living conditions. 


     Reducing health disparities is a key factor in improving patient outcomes and overall health for diverse backgrounds. Persistent health disparities have prevented certain populations from receiving the quality healthcare they deserve. These health disparities are commonly seen in individuals from low socioeconomic classes who have limited healthcare resources available to them. A study by (O’Rourke & McDowell, 2018) concluded that, “many African Americans experience healthcare disparities that result in limited access to healthcare, the underutilization of healthcare services, quality of care received, and having inadequate health insurance coverage” (para. 3). Another study by (Hostetter & Klein, 2021) found that, “African Americans are consistently underrated for pain relative to white patients; one revealed half of medical students and residents held one or more false beliefs about supposed biological differences between Black and white patients, like the former have higher pain tolerance than the latter” (para.3). These socioeconomic factors and health disparities can explain why Shawn Billings and his father are worried he might not receive the proper medication he needs. 

     A non-biased approach is necessary when interacting with patients from diverse backgrounds. With Shawn, it is important to take into consideration; race consciousness, educational levels, health literacy, religious beliefs, and family history. When a patient feels like they are being heard and treated as an equal, they are more likely to be utilize healthcare resources to engage in their healthcare in the future. 

Five target questions that would be appropriate to ask are:

  1. What causative or environmental factors seem to initiate or exacerbate these migraines? 
  2. Have you been diagnosed with any conditions previously?
  3. What is your day to day routine like?
  4. How has your mental health been recently? Any depression, anxiety, nervousness, or irritability?
  5. What is your usual diet like?


Hostetter, M., & Klein, S. (2021). Understanding and ameliorating medical mistrust among Black Americans. Commonwealth Fund. Retrieved March 8, 2023, from to an external site.

Huang, M., Van der Borght, C., Leithaus, M., Flamaing, J., & Goderis, G. (2020, September 7). Patients’ perceptions of frequent hospital admissions: A qualitative interview study with older people above 65 years of age. BMC geriatrics. Retrieved March 8, 2023, from’frequent%20flyers’%20can%20be,%25)%20%5B7%2C%208%5DLinks to an external site..

O’Rourke, M., & McDowell, M. (2018). Providing culturally competent care for African Americans . AANA. Retrieved March 8, 2023, from


  • Hi xx

    Very informative post. Yes, you are right about the health disparities among African Americans. The role of mistrust is one important aspect in their experience of medical care. Distrust itself contributes to racial disparity in health outcomes. Moreover, they receive disparate care for several conditions and most caregivers are oblivious to such disparate care differences. They are often deprived of medical treatments as well. (Eiser & Ellis). Due to these reasons, this patient is worried that he will not get any medication. So, in this case, to prevent such concerns, the provider can try history collection by greeting them respectfully through body language, avoiding inappropriate familiarity but encouraging friendly discourse, acknowledging patient’s emotions, and using nurses or staff who are familiar to patient’s ethnicity for communication and education. Cultural competence training should also be given to the health care providers to improve treatment outcomes among them. Also, medications do not act same in all patients. Special attention to be taken when prescribing medications to different ethnic groups.(Eiser & Ellis). You are right about the target question about mental health, stress, anxiety, irritability et al. as mental health has a major role in headache. The serum serotonin levels are usually high early in the migraine and alcohol and smoking are important triggers for migraine. So, history of alcoholism, smoking and drug use should also be collected.(Dains et al.)


    Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care. (5th ed.). St. Louis, MO:

    Elsevier Mosby

    Eiser, A. R., & Ellis, G. (2007). Viewpoint: Cultural competence and the African American experience with

    health care: The case for specific content in cross-cultural education. Academic Medicine, 82 (2),

    176-183. Doi:10.1097/ACM.0b013e31802d92ea