N512 Diverse Populations & Health Care
Module 1 Assignment
Conduct an assessment of the health care environment where you work (i.e. health department, long-term care facility, specialty clinic, inpatient hospital, etc). Specifically, examine potential barriers that may exist for a member of a minority group that has a significant presence in your community (i.e. Native American, Cubans, Hmong). Using the criteria below (and explained in greater detail on pages 39 and 40), assess the potential organizational barriers to care in your work environment. Explore ways to decrease barriers to health care for this minority group so that your organization can strive for cultural competency. Write a 3-4 page APA essay, using two scholarly sources in addition to the textbook.
Availability
Accessibility
Affordability
Appropriateness
Accountability
Adaptability
Acceptability
Awareness
Attitudes
Approachability
Alternative practices and practitioners
Additional services
N512 Diverse Populations & Health Care
Module 2 Assignment
Conduct a cultural self-assessment. In order to understand culture and cultural diversity, it is important that you understand your own culture and heritage. Using the tables that are located throughout Chapter 2 of your textbook (one for each domain of the Purnell Model for Cultural Competence, Table 2-1 to Table 2-12), answer these questions as they relate to you. Remember, you are answering these questions from your personal perspective, so there is no right or wrong response. Explain why you do or do not adhere to the dominant cultural practices and beliefs of the ethnic group(s) with which you primarily identify. Although the information on this self-assessment paper is strictly confidential, if you do not wish to self-disclose a specific area from the Organizing Framework, indicate so instead of just not addressing it. You are not required to provide citations/references in this paper. Attention should be paid to grammar, spelling, and punctuation. Write a 3-4 page APA essay.
N512 Diverse Populations & Health Care
Module 3 Assignment
Complete the following Case Studies:
African-American case study #2
Appalachian case study #1
Write a 3-4 page APA essay, using two scholarly sources in addition to the textbook.
APPALACHIAN CASE STUDY #1
William Kapp, aged 55 years, and his wife, Gloria, aged 37, have recently moved from an isolated rural area of northern Appalachia to Denver, Colorado, because of Gloria?s failing health. Mrs. Kapp has had pulmonary tuberculosis for several years. They decided to move to New Mexico because they heard that the climate was better for Mrs. Kapp?s pulmonary condition. For an unknown reason, they stayed in Denver, where William obtained employment making machine parts. The Kapp?s oldest daughter, Ruth, aged 20, Ruth?s husband, Roy, aged 24, and their daughter, Rebecca, aged 17 months, moved with them so Ruth could help care for her ailing mother. After 2 months, Roy returned to northern Appalachia because he was unable to find work in Denver. Ruth is 3 months? pregnant. Because Mrs. Kapp has been feeling ?more poorly? in the last few days, she has come to the clinic and is accompanied by her husband, William, her daughter Ruth, and her granddaughter, Rebecca. On admission, Gloria is expectorating greenish sputum, which her husband estimates to be about a teacupful each day. Gloria is 5 ft 5 in. tall and weighs 92 pounds. Her temperature is 101.4°F, her pulse is regular at 96 beats per minute, and her respirations are 30 per minute and labored. Her skin is dry and scaly with poor turgor.
While the physician is examining Mrs. Kapp, the nurse is taking additional historical and demographic data from Mr. Kapp and Ruth. The nurse finds that Ruth has had no prenatal care and that her first child, Rebecca, was delivered at home with the assistance of a neighbor. Rebecca is pale and suffers from frequent bouts of diarrhea and colicky symptoms. Mr. Kapp declines to offer information regarding his health status and states that he takes care of himself. This is the first time Mrs. Kapp has seen a health-care provider since their relocation. Mr. Kapp has been treating his wife with a blood tonic he makes from soaking nails in water; a poultice he makes from turpentine and lard, which he applies to her chest each morning; and a cough medicine he makes from rock candy, whiskey, and honey, which he has her take a tablespoon of four times a day. He feels this has been more beneficial than the prescription medication given to them before they relocated. The child, Rebecca, has been taking a cup of ginseng tea for her colicky symptoms each night and a cup of red bark tea each morning for her diarrhea. Ruth?s only complaint is the ?sick headache? she gets three to four times a week. She takes ginseng tea and Epsom salts for the headache.
Mrs. Kapp is discharged with prescriptions for isoniazid, rifampin, and an antibiotic and with instructions to return in 1 week for follow-up based on the results of blood tests, chest radiograph, and sputum cultures. She is also told to return to the clinic or emergency department if her symptoms worsen before then. The nurse gives Ruth directions for making appointments with the prenatal clinic for herself and the pediatric well-child clinic for Rebecca.
Study Questions
1. Describe the migration patterns of Appalachians over the last 50 years.
2. Discuss issues related to autonomy in the workforce for Appalachians.
3. Identify high-risk behaviors common in the Appalachian region.
4. Describe barriers to health care for people living in Appalachia.
5. What might the nurse or physician do to encourage Mrs. Kapp to comply with her prescription regimen?
6. What would your advice be regarding each of the home remedies that Mrs. Kapp is taking? Would you encourage or discourage her from continuing them?
7. What might the nurse have done to help ensure that Ruth would make the appointments for herself and her daughter?
8. What advice would you give Ruth regarding the home remedies that she and her daughter are currently taking? Would you encourage or discourage their use?
9. Do you think Mrs. Kapp will return for her appointment next week? Why? What would you do if she did not return for her appointment?
10. Do you think that Ruth will make and keep appointments for herself and her daughter?
11. What would you do to encourage Mr. Kapp to consent to a health assessment?
12. What additional services could you suggest to assist the Kapp family at this time?
13. What additional follow-up do you consider essential for the Kapp family?
14. What advice would you give Ruth regarding her daughter?s frequent bouts of diarrhea?
AFRICAN AMERICAN CASE STUDY #2
Mr. and Mrs. Evans are an African American couple who retired from the school system last year. Both are 65 years of age and reside on 20 acres of land in a large rural community approximately 5 miles from a Superfund site and 20 miles from two chemical plants. Their household consists of their two daughters, Anna, aged 40 years, and Dorothy, aged 42 years; their grandchildren, aged 25, 20, 19, and 18; and their 2- year-old great-grandson. Anna and Dorothy and their children all attended the university. Mr. Evans?s mother and three of his nieces and nephews live next door. Mr.Evans?s mother has brothers, sisters, other sons and daughters, grandchildren, and great-grandchildren who live across the road on 10 acres of land. Other immediate and extended family live on the 80 acres adjacent to Mr. Evans?s mother. All members of the Evans family own the land on which they live. Mrs. Evans has siblings and extended family living on 70 acres of land adjacent to Mr. Evans?s family, who live across the road. Mr. and Mrs. Evans also have family living in Chicago, Detroit, New York, San Francisco, and Houston. Once a year, the families come together for a reunion. Every other month, local family members come together for a social hour. The family believes in strict discipline with lots of love. It is common to see adult members of the family discipline the younger children, regardless of who the parents are. Mr. Evans has hypertension and diabetes. Mrs. Evans has hypertension. Both are on medication. Their daughter Dorothy is bipolar and is on medication. Within the last 5 years, Mr. Evans has had several relatives diagnosed with lung cancer and colon cancer. One of his maternal uncles died last year from lung cancer. Mrs. Evans has indicated on her driver?s license that she is an organ donor.
Sources of income for Mr. and Mrs. Evans are their pensions from the school system and Social Security. Dorothy receives SSI because she is unable to work any longer. Mr. Evans and his brothers must assume responsibility for their mother?s medical bills and medication. Although she has Medicare parts A and B, many of her expenses are not covered.
Mr. and Mrs. Evans, all members of their household, and all other extended family in the community attend a large Baptist church in the city. Several family members, including Mr. and Mrs. Evans, sing in the choir, are members of the usher board, teach Bible classes, and do community ministry.
Study Questions
1. Describe the organizational structure of this family and identify strengths and limitations of this family structure.
2. Describe and give examples of what you believe to be the family?s values about education.
3. Discuss this family?s views about child rearing.
4. Discuss the role that spirituality plays in this family.
5. Identify two religious or spiritual practices in which members of the Evans family may engage for treating hypertension, diabetes, and mental illness.
6. Identify and discuss cultural views that Dorothy and her parents may have about mental illness and medication.
7. To what extent are members of the Evans family at risk for illnesses associated with environmental hazards?
8. Susan has decided to become an organ donor. Describe how you think the Evans family will respond to her decision.
9. Discuss views that African Americans have about advanced directives.
10. Name two dietary health risks for African Americans.
11. Identify five characteristics to consider when assessing the skin of African Americans.
12. Describe two taboo views that African Americans may have about pregnancy.
N512 Diverse Populations & Health Care
Module 4 Assignment
Complete the following Case Studies :
Mexican case study #2
Puerto Rican case study #2
Write a 3-4 page APA essay, using two scholarly sources in addition to the textbook.
MEXICAN CASE STUDY #2
Pablo Gaborra, aged 32, and his wife, Olga, aged 24, live in a migrant-worker camp on the eastern shore of Maryland. They have two children: Roberto, aged 7, and Linda, aged 18 months. Olga?s two younger sisters, Florencia, aged 16, and Rosa, aged 12, live with them. Another distant relative, Rodolpho, aged 28, comes and goes several times each year and seems to have no fixed address. Pablo and Olga, born in Mexico, have lived in the United States for 13 years, first in Texas for 6 years and then in Delaware for 1 year, before moving to the eastern shore of Maryland 5 years ago. Neither of them have U.S. citizenship, but both children were born in the United States. Pablo completed the sixth grade and Olga the third grade in Mexico. Pablo can read and write enough English to function at a satisfactory level. Olga knows a few English words but sees no reason for learning English, even though free classes are available in the community. Olga?s sisters have attended school in the United States and can speak English with varying degrees of fluency. Roberto attends school in the local community but is having great difficulty with his educational endeavors. The family speaks only Spanish at home. Not much is known about the distant relative, Rodolpho, except that he is from Mexico, speaks minimal English, drinks beer heavily, and occasionally works picking vegetables. The Gaborra family lives in a trailer on a large vegetable farm. The house has cold running water but no hot water, has an indoor bathroom without a shower or bathtub, and is heated with a wood-burning stove. The trailer park has an outside shower, which the family uses in the summer. The entire family picks asparagus, squash, peppers, cabbage, and spinach at various times during the year. Olga takes the infant, Linda, with her to the field, where her sisters take turns watching the baby and picking vegetables. When the vegetablepicking season is over, Pablo helps the farmer to maintain machinery and make repairs on the property. Their income last year was $30,000. From the middle of April until the end of May, the children attend school sporadically because they are needed to help pick vegetables. During December and January, the entire Gaborra family travels to Texas to visit relatives and friends, taking them many presents. They return home in early February with numerous pills and herbal medicines.
Olga was diagnosed with anemia when she had an obscure health problem with her last pregnancy. Because she frequently complains of feeling tired and weak, the farmer gave her the job of handing out ?chits? to the vegetable pickers so that she did not have to do the more-strenuous work of picking vegetables. Pablo has had tuberculosis for years and sporadically takes medication from a local clinic. When he is not traveling or is too busy picking vegetables to make the trip to the clinic for refills, he generally takes his medicine. Twice last year, the family had to take Linda to the local emergency room because she had diarrhea and was listless and unable to take liquids. The Gaborra family subscribes to the hot and cold theory of disease and health-prevention maintenance.
Study Questions
1. Identify three socioeconomic factors that influence the health of the Gaborra family.
2. Name three health-teaching interventions the health-care provider might use to encourage Olga to seek treatment for her anemia.
3. Identify strategies to help improve communications in English for the Gaborra family.
4. Identify three health-teaching goals for the Gaborra family.
5. Name three interventions Olga must learn regarding fluid balance for the infant, Linda.
6. Discuss three preventive maintenance?teaching activities that respect the Gaborra family?s belief in the hot and cold theory of disease management.
7. Identify strategies for obtaining health data for the Gaborra family.
8. Identify four major health problems of Mexican Americans that affect the Gaborra family.
9. If Olga were to see a folk practitioner, which one(s) would she seek?
10. Explain the concept of familism as exhibited in this family.
11. Distinguish between the two culture-bound syndromes el ataque and susto.
12. Discuss culturally conscious health-care advice consistent with the health belief practices of the pregnant Mexican American woman.
13. Discuss two interventions to encourage Mexican American clients with tuberculosis to keep clinic appointments and to comply with the prescribed medication regimen.
14. Identify where the majority of Mexican Americans have settled in the United States.
PUERTO RICAN CASE STUDY #2
Carmen Medina, aged 39, lives with her husband, Raúl, aged 43, who works as a mechanic in a small auto shop. Mr. Medina has worked in the same place since he and his wife came to the United States from Puerto Rico 15 years ago. The Medinas have a 4-year-old son, José; a 16-year-old daughter, Rosa; and an 18-year-old son, Miguel. The Medinas both attended vocational school after completing high school. Mrs. Medina is employed 4 hours a day at a garden shop. She stopped working her full-time job to care for her ill mother and aged father, who do not speak English and depend on government assistance. The family income last year was $28,500. The family has health insurance through Mr. Medina?s job. They live in a threebedroom apartment in a low-income Illinois community. Miguel works in a fast-food store a few hours a week. Because Rosa has responsibilities at home, the Medina?s do not allow her to work outside the home. She is very close to her grandmother but avoids talking with her parents. Both Rosa and Miguel are having difficulties in school. Rosa is pregnant and the family does not know. She is planning to drop out of school, get a job in a beauty shop, and leave home without telling the family. Miguel frequently comes home late and, on occasion, sleeps out of the home. He is beginning college next semester and has plans to move out of the house during the summer. The family is having difficulty dealing with Rosa?s and Miguel?s developmental and behavioral challenges. Although Mrs. Medina is outspoken about these concerns, Mr.Medina is quiet and not actively involved in the discussion. He is more preoccupied with the family?s financial situation. Mrs. Medina?s parents are encouraging them to return to Puerto Rico.
Mr. Medina was diagnosed with hypertension 2 months ago, when he went to the emergency room for a respiratory infection. He smokes cigarettes and drinks two to three beers every evening after work. He has not followed up on his blood pressure treatment. Miguel is beginning to smoke, but not at home. José has had frequent colds and sinus allergies. He has been to the emergency room three times during the past year for respiratory infections. Mrs. Medina?s last physical examination was after she had José. She is experiencing insomnia, tiredness, headaches, and gastrointestinal problems. She is very concerned about Rosa and Miguel, her parents, and the family?s finances. Mrs. Medina is Catholic and recently has been visiting her church more often. Study Questions
1. Explain Mrs. Medina?s attitude in her relationship with her adolescent daughter.
2. Identify strategies to ensure that Rosa seeks prenatal care.
3. Identify barriers to accessing health care for the Medina family.
4. What are the high-risk behaviors exhibited by this family?
5. What communication barriers exist in this family that affect care delivery?
6. Discuss gender and family roles in the context of traditional Puerto Rican culture.
7. Identify socio demographic factors affecting the physical- and mental health well-being for this family.
8. Identify Puerto Rican folk practices appropriate for this family.
9. If the Medina family chose to visit a folk healer, which one(s) do you think they might visit? Why?
10. If Mrs. Medina?s parents visit a health-care provider, what might they expect?
11. Identify culturally congruent interventions to ensure compliance with Western health prescriptions for Mr. Medina.
12. Discuss the importance of respeto and familism in the Medina family.
13. Identify culturally congruent interventions for Rosa?s pregnancy.
14. Identify health-promotion and disease-prevention interventions needed for José.
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?