21 Jun DISCUSS THE ROLE OF THE NURSE AND THE IMPLICATIONS FOR CULTURALLY COMPETENT CARE WITH THIS COUPLE.
They never really approved of Julie’s living with Jean-Michel without being married. At first, Julie’s father didn’t like the fact that Jean-Michel was black, but now that he knows more about JeanMichel, he is more accepting of the relationship. Julie’s pregnancy is not planned. Julie and her partner have been using condoms for contraception. Thus, Julie is very surprised and does not understand how she became pregnant. Julie is anxious and worried; she has not said anything yet about the pregnancy to Jean-Michel. Julie is not sure if she is ready to become a mother. She doesn’t know if she wants the baby and is really confused. The couple has never discussed having a family since they have been living together. She doesn’t know what to do or what to say to Jean-Michel, or even whether she should tell Jean-Michel that she is pregnant. She walks into the clinic in an agitated state of mind. Study Questions 1. What are the major obstacles to health and well-being for this young couple? 2. Which of the transcultural domains are the most in jeopardy? 3. What are the major obstacles to independence/health? How do these differ from those that interfere with health and well-being? 4. How do the meanings people attach to health and well-being, the control they assume or wish to assume over their health, and the objective features of health reflect cultural differences in life? 5. Discuss the role of the nurse and the implications for culturally competent care with this couple. 6. What types of assistance and relationships between generations are most important in maintaining this family unit? 7. How important are kinship ties in minority settings with regard to the adjustment and morale? 8. Are cultural factors more important for young adults than for other age groups? Explain your answer. FRENCH CANADIAN CASE STUDY #2 Mr. Tremblay, a retired 63-year-old car dealer, lives with his wife, Aline, aged 58, in a nice suburban bungalow. The couple has five children, each of whom has their own family now, and no one is living close to them. Mrs. Tremblay has been a housewife since she married 40 years ago; she is not self-confident and is very dependent on her husband. Mr. Tremblay has always been the decision maker, but now he is not healthy and is tired of taking all the responsibilities. Mrs. Tremblay comes into the emergency room complaining of chest pain for 2 weeks. She describes the pain as burning and squeezing; it is steady and ends gradually. The pain started while she was raking the lawn. She didn’t say anything to her husband because he is an anxious man and she didn’t want to worry him. When her daughter, a nurse, came to visit them a week ago, she talked about her symptoms. Her daughter said she should see her family doctor as soon as possible because her maternal grandfather died of an acute myocardial infarction at the age of 59. Although Mr. Tremblay is completely bilingual, Mrs. Tremblay never mastered the English language further than necessary for the everyday needs of shopping. Mrs. Tremblay is hesitant to consult her family physician because he does not speak much French. She prefers to wait and see . . . until a stronger pain forces her to seek help. Study Questions 1. What are the major obstacles to health and well-being for this elderly couple? 2. Which of the transcultural domains are in the most jeopardy? 3. What are the major obstacles to the Tremblays’s independence and health? How do these differ from those that interfere with health and well-being? 4. How do the meanings people attach to health and well-being, the control they assume or wish to assume over their health, and the objective features of health reflect cultural differences in later life? 5. Discuss the role of the nurse and the implications for culturally competent care for this couple. 6. What types of assistance and relationships between generations are important in maintaining this family unit? 7. How important are kinship ties in minority settings with regard to the adjustment and morale of older adults? 8. Do cultural factors have a stronger impact on older adults than on those in other age groups? GERMAN CASE STUDY Margaret Schmidt, a terminally ill 60-year-old American of German descent, was recently admitted to a hospice service and is receiving care at home. Diagnosed with metastatic breast cancer, Margaret’s prognosis is less than 6 months. Margaret’s cancer has metastasized to her ribs and liver and often causes intense pain. Although Margaret speaks freely of her impending death, her family has expressed their discomfort at her decision to secure hospice care. Over the last 10 years, Margaret, a nurse, has practiced homeopathy (for herself and others) and consults frequently with a medical intuitionist. She follows the medical intuitionist’s recommendations to attenuate her symptoms but avoids, when she can, the traditional cancer pain–management therapies. Medical staff and her family have entered into continuous discussions with her about her lack of acceptance of traditional medical approaches. Margaret remains unconvinced of their value within her scheme of care. Margaret maintains a strong belief in an afterlife, believing that she will be reunited with her husband. Margaret meditates daily, calling upon her spiritual guides and angels for strength and peace in the dying process. She often asks those around her to join her during this time. Study Questions 1. What experiences have you had with patients of German descent? 2. How does Margaret’s German ancestry mold her beliefs about medical treatment? 3. What Western medicine concepts complicate the staff and family’s understanding of Margaret’s self-prescribed medical regimen? 4. How do you, as a health-care professional, feel about the use of homeopathic remedies? 5. What is your view of the use of medical intuitionists and other nonWestern health practices? 6. How do Margaret’s health-care choices differ or match your own? 7. How do you deal with cultural health practices unlike your own? 8. Discuss Margaret’s desire to control her life even through terminal illness. 9. Relate Margaret’s strong spiritual beliefs in an afterlife to her ability to cope with her impending death. 10. Describe a plan of care that is culturally sensitive to the patient and her family. 11. How can your knowledge of the German American culture positively influence health outcomes for Margaret? 12. Discuss the cultural filters you may use as you assist Margaret in her health-care decisions. 13. Describe the enculturation you, as a health-care professional, have experienced and how this influences your own health-care decisions. GREEK CASE STUDY Mr. Glinatsis is a 76-year-old immigrant from Athens, Greece. In 1940, at the request of his father, Mr. Glinatsis migrated to Chicago, Illinois. Greece had just entered World War II, and the father wanted Mr. Glinatsis to “earn some money for the family.” In fact, Mr. Glinatsis believes that his father sent him away so he would not have to enter the war as a soldier. Avoiding conscription in the Greek military was somewhat of an embarrassment. So Mr. Glinatsis moved to Chicago to the home of his mother’s sister and, then, after a short time, to the Quad Cities between Iowa and Illinois to be near two of his father’s brothers. For a number of years, Mr. Glinatsis worked as a waiter and later as a manager of his uncle’s business. On three occasions, he took second jobs to send extra money home. When possible, Mr. Glinatsis traveled to Greece to see his family. After he became a U.S. citizen, he married a woman from Athens and she joined him in Davenport, Iowa. There they raised a family of four, and shortly after the second child was born, Mr. Glinatsis went into the wholesale pharmaceutical distribution business and became very successful. Shortly after the death of his wife, Mr. Glinatsis retired. At the age of 75, he sold his business to a nephew, because all his children went to college and received graduate professional degrees unrelated to his business. Although financially able to live alone, he lives with his eldest son’s family in Moline, Illinois. His son is an engineer and owns his own firm. Both Mr. Glinatsis and his son are financially able to manage Mr. Glinatsis’s health-care needs. The rest of Mr. Glinatsis’s children also live in the area. He has a rich social life, centered around the Greek Orthodox Church. Mr. Glinatsis visited the Family Health Medical Clinic in October complaining of headaches and lightheadedness. His son said that he had been irritable. Some days ago, he had a dark urine stream. A health history further uncovered that he was sure it was not what he called matiasma. Unusual in his history is that he reported never going to a physician until this time. He began to feel ill only recently, diagnosing his condition as arthritis and taking “several pills a day” for the last few weeks. Nothing else in the history was remarkable. A urine culture was negative. However, a preliminary diagnosis of urinary tract infection was made, and Mr. Glinatsis was sent home with sulfisoxazole (500 mg four times a day). Mr. Glinatsis appeared in the emergency room complaining of severe abdominal and back pain and weakness several days after the clinic visit. He appeared in distress. Additional health data obtained in the emergency room indicated that Mr. Glinatsis consumes approximately two glasses of wine and an after-dinner drink each evening, has a 50-pack-per-year history of smoking, and has been relatively compliant on the antibiotic medication prescribed during his clinic visit. Clinical laboratory results indicate severe anemia. A subsequent laboratory analysis for glucose-6-phosphate dehydrogenase (G-6-PD) deficiency indicates that Mr. Glinatsis has this deficiency. He is treated for anemia, and the sulfa drugs and aspirin are removed from his therapy. He remains in the hospital for only 2 days. The illness and hospitalization are hard on Mr. Glinatsis, and one social worker recommends that he be discharged to an intermediate-nursing facility for recovery. On the evening before his discharge, he had an argument with his son and his daughter-in- law over whether Mr. Glinatsis should continue to reside in their home. Mr. Glinatsis is discharged to home with an instruction to no longer treat his self-diagnosed and unconfirmed arthritis. Study Questions 1. List some social values presented in the case that are common to members of the Greek community. 2. The migration of Mr. Glinatsis to the United States served as both an obligation and a source of shame. How might this be explained? 3. In what ways was Mr. Glinatsis’s immigration pattern similar to that of other people of Greek heritage? 4. U.S. immigration laws in the early half of the 20th century instituted quotas for Greek immigrants. Examining the basic values of Greek immigrants, how might you explain the shift to U.S. citizenship by Greek residents? 5. From a clinical perspective, the influence of the two drugs aspirin and sulfisoxazole uncovered a hereditary medical problem, G-6-PD. Discuss that problem. 6. What reasons might account for the fact that the disease did not occur until late in life? 7. How does Mr. Glinatsis’s pattern of family life demonstrate core cultural values of Greeks in America? 8. What is the folk illness in this case? Why did Mr. Glinatsis think it might be important? 9. How does Mr. Glinatsis’s health-seeking pattern fit with Greek values? 10. One issue in this case is where Mr. Glinatsis will reside. Discuss this issue in the context of family and residential preferences of older Greek Americans based on their heritage. HAITIAN CASE STUDY #1 Marie-Jose Paul is a 76-year-old Haitian woman who lives alone in a two-bedroom apartment in an enclave in East Hollywood, Florida. She has five children: one girl and four boys. According to Mrs. Paul, her youngest son died at the age of 23 in New York, from a policeman’s bullet. Her daughter, Marie-Nicole Joseph, lives with her family in an apartment next door to her mother. Mrs. Paul, born in Haiti, has been in the United States for 22 years, living first in New York and then in Florida. She is a legal resident, and because she had worked for 11 years as a hotel maid, she receives a monthly Social Security check for $450.00. She also receives Medicaid and food stamps. Mrs. Paul completed a sixth grade education in Haiti. She is functional linguistically and is able to sign her name. She primarily communicates in Creole. Although she understands English, since her retirement, she sees no need to communicate in English. Her children take care of her and are able to function within the American bureaucracy. Her apartment costs $455.00 per month. Her children help with the apartment rental and provide her meals and other basic necessities. She looks after her grandchildren when their parents are at work, a task that is becoming more difficult since she lost her vision.
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