21 Jun WHAT ARE SOME FOLK TREATMENTS FOR THIS CONDITION?
On her last visit to her physician a month ago, he referred her to a heart specialist at a medical center 50 miles from her home. He also wanted her to make an appointment with an arthritis specialist. So far, she has not made an appointment with either specialist because she does not know when one of her children will be available to take her to the medical center. Besides, she says, her children have their own families and jobs, and she does not like to bother them with her problems. In addition, she tells you that she is looking forward to her 16-year-old granddaughter, who is 3 months’ pregnant, coming to live with her in a couple of months. After all, she misses being a midwife. She admits not using the salve given to her by Dr. Adi because he told her to apply the salve according to the instructions on the jar. She has been drinking the brine from her home-canned pickles for her “low blood,” drinking ginseng tea for her arthritis, and applying a poultice made from bacon grease on the leg wound. She tells you that she does not want to return to Dr. Adi because she cannot understand him, he does not listen to her, and he did not help her when she last saw him. She explains that she is a good “Christianwoman,” has lived right all her life, and does not interfere with her neighbors’ lives. She rarely misses Sunday church services because all her neighbors go to the same Baptist church and she “allus” has plenty of volunteers to carry (take) her to the church. Study Questions 1. Why do the members of her community call Mrs. Sperry by the name Miss Leona? 2. What can the nurse do to assist Miss Leona to decrease the barriers to needed health care? 3. What might Dr. Adi do to ensure a more-trusting relationship with Miss Leona? 4. What historical precedence is there for distrust of “outsiders” in Appalachia? 5. What evidence do you see of the “ethic of neutrality” in this case study? 6. What is the difference between a minister and a preacher, as practiced by Baptists in Appalachia? 7. What do Appalachians mean by the term “low blood”? What are some folk treatments for this condition? 8. What advice would you give Miss Leona about her folk remedies? 9. What might you do to encourage Miss Leona to make appointments with the specialists recommended by Dr. Adi? 10. How might you help Miss Leona eat a more-nutritious diet? 11. What strategies might you encourage for Miss Leona to cope with her “heart problems” that began after her husband died? 12. What kind of prenatal advice would you give the granddaughter when she comes to live with Miss Leona? ARAB CASE STUDY Mrs. Ayesha Said is a 39-year-old Muslim Arab housewife and mother of six who immigrated to the United States from a rural town in southern Iraq 2 years ago. Her mother-in-law and her husband, Mr. Ahmed Said, accompanied her to the United States as participants in a post–Gulf War resettlement program, after they spent some time in a Saudi Arabian refugee camp. Their relocation was coordinated by a local international institution that provided an array of services for finding employment, establishing a household, enrolling the children in public schools, and applying for federal aid programs. Mr. Ahmed, who completed the equivalent of high school, works in a local plastics factory. He speaks some English. He plans to attend an English-language class held at the factory for its many Iraqi employees. Mrs. Ayesha, who has very little formal schooling, spends her day cooking and caring for her children and spouse, with the assistance of her mother-in-law. She leaves their home, a three-bedroom upper flat in a poor area of the city, only when she accompanies her husband shopping or when they attend gatherings at the local Islamic center. These events are quite enjoyable because most of those using the center are also recently arrived Iraqi immigrants. She also socializes with other Iraqi women by telephone. Except for interactions with the American personnel at the institute, Mr. Ahmed and Mrs. Ayesha Said remain quite isolated from American society. They have discussed moving to Detroit because of its large Arab community. Four of the Said children attend public elementary schools, participating in the English as a Second Language (ESL) program. Mr. Ahmed and Mrs. Ayesha are dismayed by their children’s rapid acculturation. Although Muslims do not practice holidays such as Halloween, Christmas, Valentine’s Day, and Easter, their children plead to participate in these school-related activities. Mrs. Ayesha is being admitted to the surgical unit after a modified radical mastectomy. According to the physician’s notes, she discovered a “lump that didn’t go away” about 6 months ago while breast-feeding her youngest child. She delayed seeking care, hoping that inshallah, the lump would vanish. Access to care was also limited by Mrs. Ayesha’s preference for a female physician and her family’s financial constraints—that is, finding a female surgeon willing to treat a patient with limited financial means. Her past medical history includes measles, dental problems, headache, and a reproductive history of seven pregnancies. One child, born prematurely, died soon after birth. As you enter the room, you see Mrs. Ayesha dozing. Her husband, mother-inlaw, and a family friend, who speaks English and Arabic and acts as the translator, are at her bedside. Study Questions 1. Describe Arab Americans with respect to religion, education, occupation, income, and English-language skills. Compare the Said family with Arab Americans as a group. 2. Assess the Said family’s risk for experiencing a stressful immigration related to their isolated lifestyle. 3. Describe the steps you would take to develop rapport with Mrs. Ayesha and her family during your initial encounter. Include nonverbal behavior and social etiquette as well as statements or questions that might block communication. 4. Identify interventions that you would employ to accommodate Mrs. Ayesha’s “shyness” and modesty. 5. You notice that, although Mrs. Ayesha is alert, her husband and sometimes her mother-in-law reply to your questions. Interpret this behavior within a cultural context. 6. Although Mrs. Ayesha is normothermic and states her pain is “little,” Mr. Ahmed insists that his wife be covered with several additional blankets and receive an injection for pain. When you attempt to reassure him of his wife’s satisfactory recovery, noting as evidence of her stable condition that you plan to “get her up” that evening, he demands to see the physician. Interpret his behavior within a cultural context. 7. Discuss Arab food preferences as well as the dietary restrictions of practicing Muslims. If you filled out Mrs. Ayesha’s menu, what would you order? 8. When you give Mrs. Ayesha and her family members discharge instructions, what teaching methods would be most effective? What content regarding recovery from a mastectomy might most Arab Americans consider “too personal”? 9. Identify typical coping strategies of Arabs. What could you do to facilitate Mrs. Ayesha’s use of these strategies? 10. Discuss predestination as it influences the Arab American’s responses to death and bereavement. 11. Discuss Islamic rulings regarding the following health matters: contraception, abortion, infertility treatment, autopsy, and organ donation and transplant. 12. Describe the Arab American’s culturally based role expectations for nurses and physicians. In what ways do the role responsibilities of Arab and American nurses differ? 13. What illnesses or conditions are Arab Americans unlikely to disclose because of Islamic prohibitions or an attached stigma? 14. Compile a health profile (strengths versus challenges) of Arab Americans by comparing beliefs, values, behaviors, and practices favoring health and those negatively influencing health. BALTIC CASE STUDY Mr. Antanas Butkauskas, aged 61, and his wife, Birut, aged 58, live in an eastern suburb of Cleveland, Ohio. He works in a tool and die shop, and she works as a seamstress in a shirt factory. They have three grown children, none of whom live with them. They have lived in the United States since 1949, when they emigrated from Germany. They escaped from Lithuania just before World War II ended. Both lost touch with siblings who were deported to Siberia by the Soviets. Fearing for their own lives, Mr. and Mrs. Butkauskas took their then-small children and fled their country, leaving behind their farm and remaining relatives. Both Mr. and Mrs. Butkauskas worked hard, saved money for a small house, and put all three children through college. Mrs. Butkauskas has had arthritis in her hands and hip joints for a number of years and symptoms of congestive heart failure since her late 40s. Mr. Butkauskas has had high blood pressure for about 12 years. Both have been on medication for their physical problems. They were encouraged to diet, lose weight, and decrease their sodium intake. Mrs. Butkauskas has followed the medication regimen faithfully. She has decreased salt and fat intake and has lost about 15 pounds. Mr. Butkauskas initially lost 8 pounds but does not follow his diet closely. He eats salami and other salty foods for lunch when he is tired of what his wife prepares. The Butkauskas have a small backyard garden where they grow tomatoes, cucumbers, carrots, onions, beets, and beans. They enjoy being outdoors together in their small garden. They also enjoy listening to their ethnic music. Both are beginning to think about retirement and continue to be frugal, saving for their old age. This past winter, Mr. Butkauskas was laid off. Even though his foreman told him that this was temporary, Mr. Butkauskas is extremely worried about paying the bills and not being able to save as much as he wants. He has difficulty sleeping and is having tightness in his chest with pain radiating down his arm. He does not want to worry his wife, so he does not tell her about this until the pain and discomfort become severe. His wife takes him to their family physician, who has cared for him for years. Study Questions 1. Identify the cultural aspects of health to be considered for this family when performing a cultural health assessment. What physical symptoms need immediate attention? 2. Identify this family’s expectation of care should Mr. Butkauskas need hospitalization. 3. List stress-management techniques appropriate for family members of this culture. How could they be used? 4. List alterations in diet and related interventions appropriate in this situation. 5. Discuss how the nurse might act with cultural sensitivity if Mrs. Butkauskas insists on doing the nursing for her husband while he is in the hospital. 6. Mrs. Butkauskas wants to bring in homemade wine one evening. How might the nurse intervene with cultural sensitivity? 7. Mrs. Butkauskas brings gifts of home-baked goods for the nursing staff each time that she visits. Discuss a culturally conscious response. 8. Identify two major health problems of Baltic Americans and how these relate to this particular family. 9. Discuss interventions appropriate to Mr. Butkauskas’s cardiac problems. 10. Identify strategies to reduce Mr. Butkauskas’s stress about being laid off that would be acceptable to him. CHINESE CASE STUDY #1 An elderly, Asian-looking man is admitted to the emergency room with chest pain; difficulty breathing; diaphoresis; vomiting; pale, cold, clammy skin; and apprehension. Three people, speaking a mixture of English and a foreign language to one another, accompany him. The nurse tries to speak English with the man, but he cannot understand anything she says. Accompanying the elderly man are two women (one elderly and very upset and one younger who stands back from the other three people) and one younger man. The younger man states that the elderly man, whose name is Li Ying Bin, is his father; the elderly woman, his mother; and the younger woman, his wife. The son serves as the translator. Li Ying Bin comes from a small village close to Beijing. He is 68 years old, and he has been suffering with minor chest pain and has had trouble breathing for 2 days. He is placed in the cardiac room, and the assessment continues. Mr. Li is on vacation, visiting his son and daughter-in-law in the city. His son and daughter-in-law have been married for only 1 year, but the son has lived in the West for 7 years. Mr. Li’s daughter-in-law looks Chinese but was born in the United States. She does not speak very many words of Chinese. Further physical assessment reveals that Mr. Li has a history of “heart problems,” but the son does not know much about them. Mr. Li had been to the hospital in Beijing but did not like the care he received there and returned home as soon as possible. He goes to the local clinic periodically when the pain increases, and the health-care provider in China used traditional Chinese medicine, herbs, and acupuncture. In the past, those treatments relieved his symptoms. Medications are ordered to relieve pain, and Mr. Li undergoes diagnostic procedures to determine his cardiac status. The studies reveal that he did sustain massive heart damage. Routine interventions are ordered, including heart medications, anticoagulants, oxygen, intravenous fluids, bedrest, and close monitoring. His condition is stabilized, and he is sent to the cardiac intensive-care unit. In the cardiac unit, the nurse finds Mrs. Li covering up Mr. Li until he sweats, and Mrs. Li argues with the nurse every time her husband is supposed to dangle his legs. She complains that he is too cold and brings in hot herbal beverages for him to drink. She does not follow the nurse’s and physician’s orders for dietary restrictions, and she begins to hide her treatments from the staff. Her son and daughter-in-law try to explain to her that this is not good, but she continues the traditional Chinese medicine treatments. Mr. Li is a very quiet patient. He lies in bed and never calls for help. He frequently seems to be meditating and exercising his arms. When he does talk to his son, he speaks of the airplane ride and the problems of being so high. He believes that may have caused his current heart problem. Mr. Li also wonders if Western food could be bad for his system. Mr. Li’s condition gradually deteriorates over the next few days. Nurses and physicians attempt to tell the family about his condition and possible death, but the family will not talk with them about it. Mr. Li dies on the 5th day. Study Questions 1. If you were to go to China on a business trip, how would you design your name card so that the Chinese would not be confused? 2. If you wished to have a meeting with a Chinese delegation of health-care providers, would you expect them to be on time? Why?
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