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N512 Diverse Populations & Health Care

Module 5 Assignment

Complete the following Case Studies:

Amish case study

Jewish Case study #1

Write a 3-4 page APA essay, using two scholarly sources in addition to the textbook.

AMISH CASE STUDY

Elmer and Mary Miller, both 35 years old, live with their five children in the main house on the family farmstead in one of the largest Amish settlements in Indiana. Aaron and Annie Schlabach, aged 68 and 70, live in the attached grandparents’ cottage. Mary is the youngest of their eight children, and when she married, she and Elmer moved into the grandparents’ cottage with the intention that Elmer would take over the farm when Aaron wanted to retire. Eight years ago, they traded living space. Now, Aaron continues to help with the farm work, despite increasing pain in his hip, which the doctor advises should be replaced. Most of Mary’s and Elmer’s siblings live in the area, though not in the same church district or settlement. Two of Elmer’s brothers and their families recently moved to Tennessee, where farms are less expensive and where they are helping to start a new church district.

Mary and Elmer’s fifth child, Melvin, was born 6 weeks prematurely and is 1 month old. Sarah, aged 13, Martin, aged 12, and Wayne, aged 8, attend the Amish elementary school located 1 mile from their home. Lucille, aged 4, is staying with Mary’s sister and her family for a week because baby Melvin has been having respiratory problems and their physician told the family he will need to be hospitalized if he does not get better within 2 days. At the doctor’s office, Mary suggested to one nurse, who often talks with Mary about “Amish ways,” that Menno Martin, an Amish man who “gives treatments,” may be able to help. He uses “warm hands” to treat people and is especially good with babies because he can feel what is wrong. The nurse noticed that Mary carefully placed the baby on a pillow as she prepared to leave. Elmer and Mary do not carry any health insurance and are concerned about paying the doctor and hospital bills associated with this complicated pregnancy. In addition, they have an appointment for Wayne to be seen at Riley Children’s Hospital, 3 hours away at the University Medical Center in Indianapolis, for a recurring cyst located behind his left ear. Plans are being made for a driver to take Mary, Elmer, Wayne, Aaron, Annie, and two of Mary’s sisters to Indianapolis for the appointment. Because it is on the way, they plan to stop in Fort Wayne to see an Amish healer who gives nutritional advice and does “treatments.” Aaron, Annie, and Elmer have been there before, and the other women are considering having treatments, too. Many Amish and non-Amish go there and tell others how much better they feel after the treatments.

They know their medical expenses seem minor in comparison to the family who last week lost their barn in a fire and to the young couple whose 10-year-old child had brain surgery after a fall from the hayloft. Elmer gave money to help with the expenses of the child and will go to the barn raising to help rebuild the barn. Mary’s sisters will help to cook for the barn raising, but Mary will not help this time because of the need to care for her newborn. The state health department is concerned about the low immunization rates in the Amish communities. One community-health nurse, who works in the area where Elmer and Mary live, has volunteered to talk with Elmer, who is on the Amish school board. The nurse wants to learn how the health department can work more closely with the Amish and also learn more about what the people know about immunizations. The county health commissioner thinks this is a waste of time and that what they need to do is let the Amish know that they are creating a health hazard by neglecting or refusing to have their children immunized.

Study Questions

1. Develop three open-ended questions or statements to guide you in your understanding of Mary and Elmer and what health and caring mean to them and to the Amish culture.

2. List four or five areas of perinatal care that you would want to discuss with Mary.

3. Why do you think Mary placed the baby on a pillow as she was leaving the doctor’s office?

4. If you were the nurse to whom Mrs. Miller confided her interest in taking the baby to the folk healer, what would you do to learn more about their simultaneous use of folk and professional health services?

5. List three items to discuss with the Millers to prepare them for their consultation at the medical center.

6. If you were preparing the reference for consultation, what would you mention about the Millers that would help to promote culturally congruent care at the medical center?

7. Imagine yourself participating in a meeting with state and local health department officials and several local physicians and nurses to develop a plan to increase the immunization rates in the counties with large Amish populations. What would you suggest as ways to accomplish this goal?

8. Discuss two reasons why many Old Order Amish choose not to carry health insurance.

9. Name three health problems with genetic links that are prevalent in some Amish communities.

10. How might health-care providers use the Amish values of the three-generational family and their visiting patterns in promoting health in the Amish community?

11. List three Amish values to consider in prenatal education classes.

12. Develop a nutritional guide for Amish women who are interested in losing weight. Consider Amish values, daily lifestyle, and food production and preparation patterns.

13. List three ways in which Amish express caring.

JEWISH CASE STUDY #1

Selecting a “typical” Jewish client is difficult. An ultra-Orthodox Jew has a particular set

of special needs. Yet, it is more common to see a Jew who is a middle-of-the-road

Conservative.

Sarah is an 80-year-old woman who is a first-generation American. She was

raised in a traditional Conservative home. Her husband died after 50 years of a strong

marriage. She has three children. Although her home is not kosher, she practices a

variation of kosher-style eating, avoiding pork and not making dishes that combine

meat and milk.

Two months ago, she was diagnosed with pancreatic cancer. Surgery was

attempted, but the cancer was already in an advanced stage. Chemotherapy was started,

but the cancer has progressed and is not responding to the medications. She is having

difficulty eating because of the pressure of the tumor on the gastrointestinal tract.

Discussions are being held to determine whether or not treatments should be stopped

and whether hospice care should be initiated.

Her hospital room is always filled with visitors.

Study Questions

1. What must you anticipate in discussing with Sarah her wishes regarding the continuation of medical care?

2. How would you respond to her initial decision to have surgery and initiate chemotherapy?

3. What questions do you need to ask in the initial patient interview to assess her degree of religious practice? How will you determine her spirituality needs?

4. What is your understanding of the reason she has so many visitors in her room?

5. Is hospice care appropriate for this patient?

6. Sarah dies with her family at her bedside. What interventions can you take at the time of death to demonstrate religious sensitivity to the family? What questions do you need to ask the family?

7. Describe three genetic or hereditary diseases common with Ashkenazi Jews.

8. Describe Jewish burial rituals and grieving process.

9. Discuss the laws of Kashrut in regard to food practices for observant Jewish clients.

10. What should the health-care provider keep in mind when entering a Jewish home to provide care?

11. Distinguish between the terms Sephardic and Ashkenazi.

12. How might a non-Jewish and a Jewish coworker share holidays in the workforce?

13. What is the official language the Jewish people use for prayer?

N512 Diverse Populations & Health Care

Module 6 Assignment

Complete the following Case Studies:

Chinese case study #1

Japanese case study #1

Write a 3-4 page APA essay, using two scholarly sources in addition to the textbook.

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?

3. If the meeting included a meal with Chinese food, what kinds of food would you expect to be served? How would it be presented? If something were served that you do not like, would you eat it anyway?

4. Compare and contrast the Chinese meaning of life and way of thinking with the Western meaning of life and way of thinking.

5. What are the common health risks for the development of chronic obstructive pulmonary disease among Chinese people?

6. What are some of the reasons that Mr. Li waited so long to enter the hospital?

7. Mr. Li did not complain of chest pain in the cardiac intensive-care unit. Is this a common behavior? Why?

8. True or False: The Chinese family will expect health-care providers at the hospital to provide most of the care for Mr. Li.

9. Why must the physician be careful with the amounts of medication ordered?

10. Mrs. Li is curt, demanding, and disagreeable toward her daughter-in-law. Why does she act this way?

11. Explain why Mr. Li blames the airplane ride and the Western food for his heart attack. Why does he meditate and do exercises?

12. Is Mr. Li’s stoicism during dying surprising? Why do the family members refuse to discuss his health and possible death?

13. What is the preferred method for handling the remains of a deceased Chinese person?

14. Describe common mourning rituals for the Chinese.

15. Describe bereavement in a Chinese family.

16. Describe a common view of death among Chinese.

JAPANESE CASE STUDY #1

This case study is a composite of actual situations. Marianne, who is American, and Ken Shimizu, who is Japanese, have worked in Tokyo for over 30 years as Methodist missionaries. They have annual furloughs and occasional sabbaticals, during which they visit relatives and sponsoring organizations and engage in continuing education in the United States. They met as college students in the United States, and their three grown children have established their own careers in the United States. Ken’s 98-year-old mother resides with Marianne and Ken. She is not Christian

but has always been extremely supportive of Ken and Marianne’s work. Ken teaches at a large Christian university, whereas Marianne has served in various church-related positions over the years. As missionaries, they live in ubsidized post–World War II housing near Ken’s university. Marianne has been a frugal housewife, preparing local foods in the Japanese style for her family. Ken, who is nearly 60, recently learned that he has glaucoma. By the time it was discovered, he had lost a significant amount of peripheral vision. Although Marianne delivered all three children at a Christian hospital in Tokyo, she gets her annual physical examination when visiting relatives in the United States. She has never believed that the Japanese health system is as proactive as that in the United States. On her most recent visit to the United States, Marianne learned that she has hypertension. Her physician prescribed a medication that is readily available in Japan, but the physician was concerned about the level of stress in Marianne’s life. Mother Shimizu is quite confused and requires considerable care, but it is unthinkable for Ken, the only child, to put his mother in a long-term-care facility. Even if he would, the quality of facilities in Japan leaves much to be desired. Most of the responsibility for Mother Shimizu falls on Marianne, in addition to her work. Marianne’s relatives are urging her to consider placing Mother Shimizu in a church-related life-care community near Marianne’s family in the United States, where Marianne and Ken would like to retire. Marianne’s own parents lived in this facility at the end of their lives. She is considering these issues as she returns to Tokyo.

Study Questions

1. Identify some of the cultural issues that may lead to conflict in this international family.

2. What are the family resources for this international family?

3. What factors within the Japanese health system may account for the late diagnosis of Ken’s glaucoma?

4. What practical issues might arise for the Shimizus if Mother Shimizu were placed in a long-term-care facility in the United States?

5. What dietary factors may contribute to Marianne’s hypertension?

6. In what ways might you consider Ken to be countercultural as a Japanese man?

7. What social pressures might Marianne have faced, given some of her choices, as a housewife in Japan?

8. What pressures will Ken likely experience as he considers how to meet the needs of both his mother and his wife?

9. Compare and contrast the fertility and mortality rates of Japan and the United States.

10. Do the traditional Japanese maintain sustained eye contact with strangers? Why or why not?

11. To which drugs might Japanese people have greater sensitivity than that of white ethnic populations?

12. How do most Japanese people meet their need for calcium?

N512 Diverse Populations & Health Care

Module 7 Assignment

Complete the following Case Studies:

German case study

Irish case study

Write a 3-4 page APA essay, using two scholarly sources in addition to the textbook.

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.

IRISH CASE STUDY

The O’Rourke family lives on a small farm in Iowa and comprises David, aged 30; his wife, Mary, aged 29; and two children: Bridget, aged 7, and Michael, aged 6. Both David and Mary are second-generation Irish. Before purchasing their farm 5 years ago, David sold farm equipment in Ohio. The O’Rourkes are Catholic; Mary converted to atholicism when they married. David, who works long hours outdoors, is concerned about profitability from his corn crop because of the unpredictable size of the harvest, and thus, his income varies depending on the weather. Mary did not work outside the home because she wanted to be with their children until they started school. However, because both children are now school age, Mary has discussed with David the possibility of working part time to supplement the family income. He would prefer that she stay at home, but Mary is anxious to return to the workforce and believes the timing is right.

Both David and Mary are happy with just two children and do not desire more. They use the rhythm method for family planning. Eating a healthy breakfast is important to the O’Rourkes. Because eggs are readily available on the farm, they have fried eggs with potato bread and juice at least four times a week. Their main meal in the evening usually includes meat, potatoes, and a vegetable. David enjoys a glass of beer with dinner. David has been a little edgy lately because of his concerns about the corn crop. He admits to having some minor chest pain, which he attributes to indigestion. His last visit to a physician was before their marriage. Mary knows David is concerned about finances and believes it would help if she had a job. Bridget and Michael spend a lot of time outside playing and doing some minor chores for their parents. Both children enjoy school and are looking forward to returning in the fall. Bridget is starting to show concern over her appearance. She does not like her red hair and all the freckles on her face. Her teacher has noted that Bridget has trouble reading and may need glasses. Michael wants to be a farmer like his Dad but worries about his Dad being tired at night.

The O’Rourkes have not taken a vacation since they were married. They go to the state fair in the summer, which is the extent of their trips away from home. They are active in the church and attend services every Sunday.

Study Questions

1. Describe the O’Rourke family structure in terms of individual roles.

2. Identify two potential health problems related to the O’Rourke’s dietary practices.

3. Identify potential health-risk factors for the O’Rourkes as a family unit and for each family member.

4. Explain the relationship between risk factors and ethnicity specific to the O’Rourke family and their Irish heritage.

5. Describe culturally competent health-promotion strategies for the identified risk factors for the O’Rourke family.

6. Describe the O’Rourke family’s fertility practices. Are they congruent with their Irish background and religious beliefs?

7. Describe the O’Rourke family’s communication patterns.

8. What are the predominant health conditions among Irish immigrants?

9. Explain the significance of the Great Potato Famine for Irish Americans.

10. Name two genetic diseases common among Irish Americans.

11. Identify accepted fertility practices for Irish American Catholics.

12. Identify three sources of strength for the Irish American in times of illness.

13. Identify traditional home remedies commonly used by Irish Americans.

N512 Diverse Populations & Health Care

Module 8 Assignment

Signature Assignment

A nurse educator is preparing an orientation on culture and the workplace. There is a need to address the many cultures that seek healthcare services and how to better understand the culture. This presentation will examine the role of the nurse as a culturally diverse practitioner.

Choose a culture that you feel less knowledgeable about

Compare this culture with your own culture

Analyze the historical, socioeconomic, political, educational, and topographical aspects of this culture

What are the appropriate interdisciplinary interventions for hereditary, genetic, and endemic diseases and high-risk health behaviors within this culture?

What are the influences of their value systems on childbearing and bereavement practices

What are their sources of strength, spirituality, and magicoreligious beliefs associated with health and health care?

What are the health-care practices: acute versus preventive care; barriers to health care; the meaning of pain and the sick role; and traditional folk medicine practices?

What are cultural issues related to learning styles, autonomy, and educational preparation of content for this culture?

This PowerPoint® (Microsoft Office) or Impress® (Open Office) presentation should be a minimum of 20 slides, including a title, introduction, conclusion and reference slide, with detailed speaker notes and recorded audio comments for all content slides. Use at least four scholarly sources and make certain to review the module’s Signature Assignment Rubric before starting your presentation. This presentation is worth 400 points for quality content