With the USA being arguably the most homogeneous community in the world, competence in healthcare, inter alia, means the competence to understand different cultural affiliations and substantively assist patients with those affiliations. Such competence also includes the avoidance of cultural generalizations such as African American or European American into a tangent understanding of cultural sub-classes such as German Americans, Irish Americans or Italian Americans, respectively. The case study involves a careful evaluation of patients of German and Irish descent, respectively. It is important to note that the concept of patient as used herein takes the extended care version that includes the patient's loved ones. Further, nursing takes the care-based interpersonal relationship approach that seeks to meet the holistic needs of the patient.
The German Case Study
1. My experience with German patients is among the more positive as these patients take their healthcare seriously and are also keep to follow prescriptions and related instructions (Purnell & Paulanka, 2013).
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2. As a German, Margaret believes that her health is her responsibility, and one that she must take very seriously. Contemporaneously, her family members also feel that they are obliged to cater to her good health (Purnell & Paulanka, 2013).
3. Modern western medicine is pure sciences which include tried and tested medicinal processes and clinical procedures. The need for scientific proof complicates the ability for the family and professionals to understand Margaret’s belief in an afterlife and also in homoeopathy.
4. My opinion of homoeopathy is conflicted. On the one hand, it enables peace of mind for patients who believe that something good is happening to their bodies and systems through the process. However, homoeopathy also gets in the way of clinically proven approaches to medicine and is thus a limitation for actual positive patient outcomes.
5. Medical intuitionists and other non-western procedures play a holistic role in providing some semblance of peace of mind for patients, more so terminal patients like Margaret. I, however, do not believe that intuitionist plays any clinical or substantive roles in healthcare.
6. Margaret’s healthcare choices differ exponentially from my own as I believe that a patient should allow those who are trained and licensed to cater for her health to do the same. This is what I do when I am unwell. Currently, Margaret is getting in the way of her medical team, something I would always aspire to avoid.
7. Professionally, a clinician should not seek to impose personal beliefs on the patient, based on the concept of patient autonomy. As a professional, I will advise the patient on available options and what I believe to be right, then proceed to respect the patient’s informed decision, even when it does not align with my advice.
8. A common prerequisite of Margaret’s heritage as a German American taking personal responsibility for her health both in terms of preventative and curative medicine (Purnell & Paulanka, 2013). The strong belief that Margret’s health is her responsibility pushes her to do what she can to make herself better, even if it means clinically unproven approaches such as homoeopathy.
9. Margaret’s belief in life after death is a positive attribute to her ability to cope with death (Keely & Generous, 2017). The fact that she has something to look forward to after she dies makes the prospect of death less frightening for her, a fact that aids her psychologically.
10. An effective treatment plan for Margaret is the one that incorporates pain management to homoeopathy. Instead of regular pain relief medication, medicine should be made available to Margaret with advice that pain means that her body is asking for some held and painkillers are the means to provide such help.
11. My understanding of German American culture will enable me to appreciate her reactions to what is happening, in turn, enabling me to develop effective interventions which will, in turn, improve her outcomes.
12. With regard to cultural filters, it is imperative to categorically avoid any suggestion that Margaret is wrong, or that her condition has worsened due to her choices or decisions. Alternatives must be offered in a manner that they do not sound like indictments to Margaret’s actions of beliefs.
13. Dealing with patients of a different cultural affiliation has enabled me to realize that cultural issues are not in black and white with some being wrong and others being right. My primary form of enculturation has been the development of a very open mind.
The Irish Case Study
1. The O’Rourke’s are a traditional nuclear family. David, the father, is the traditional provider while Mary, his wife, is the homemaker. The children, Bridget and Michael simply enjoy life and only chip in with minor chores when they want to.
2. The O’Rourke’s have been eating high protein food while contemporaneously eating enough carbohydrates hence creating the propensity for cholesterol accumulation and potential cardiovascular disorders (MFMER, 2019). Regular eating of potato bread also increases the propensity for developing diabetes.
3. The family as a unit faces the two main risk factors of cardiovascular disease and diabetes. David’s main risk factors of depression and cardiovascular disorders, as evidenced by his chest pains. Mary might face depression due to being overly resilient and reproductive health risks factors for two early pregnancies followed by years of reproductive dormancy. Finally, the children’s main risk factor is obesity.
4. With regard to the non-communicable diseases, the Irish propensity of avoiding seeking medical attention until an ailment is debilitating can eliminate chances for timely mitigation. Conversely, the stress David is facing can drive him towards alcoholism, as he is already a habitual recreational drinker.
5. Every health risk that members of the family are facing can be mitigated through timely intervention and can become debilitating if such intervention does not happen. The primary health-promotion strategy needed by the family is an encouragement to seek the assistance of a healthcare professional, including a dietary expert.
6. The O’Rourke’s use the rhythm method for family planning, which can be effective but not definitively so. The method adheres to the traditional Catholic approach of absolute avoidance of any active contraception measures such as pills, Condoms or intra-uterine devices (Bayes & Tohidi, 2016).
7. The communication patterns in the family are extremely poor or ineffective at best. David aspires to rule his family with an iron fist and does not communicate about his fears. Mary is mentally assertive but does not communicate the same. The children have fears and worries, Bridget about her looks and Michael about his future career, but they do not open up about it.
8. The predominant health condition among the Irish is substance abuse, more so alcoholism due to drinking problems. Secondly, the Irish often suffer from debilitating chronic conditions as they ignore symptoms until the condition has developed to debilitating levels.
9. The Great Potato Famine pushed vast amounts of poor, unskilled and unprepared Irish immigrants to the USA. These immigrants faced discrimination for their poverty, lack of skills and Catholicism, a fact that drove many modern misconceptions about the Irish, some of which still prevail.
10. Irish descendants have a higher propensity for suffering galactosemia and cystic fibrosis (Croke, 2008).
11. Irish American Catholics observe fertility practices that engender an absolute and extreme avoidance of active contraception (Bayes & Tohidi, 2016). Many of their fertility practices include an element of sexual abstention.
12. The first source of strength for the Irish in time of illness of family support as their families is closely knit. Resiliency is another source of strength which limits the ability of the ailment to break the spirit of the invalid. Finally, a good diet that incorporates natural foods and vegetables help the Irish fight off communicable diseases.
13. Alcohol is a common home remedy used by the Irish and includes hot whiskey and Stout beer. Vegetable-based concoctions that include garlic and onions is another common home remedy. Finally, there are sugary products such as honey or sugary tea.
Conclusion
It is evident from the totality of the above that cultural affiliations are a critical bearing factor to the health of American patients. As bearing factors, cultural affiliations can play either a positive or negative health role both for the Irish and for the Germans as outlined above. Since nursing and caregiving is relational, it must delve deep into both the physiological and personal prerequisites of a patient. The personal attributes of a patient include, inter alia, the culture and social affiliations of the patient. A competent nurse should be able to integrate such cultural attributes to developing proper management regimens for individual patients.
References
Bayes, J., & Tohidi, N. (Eds.). (2016). Globalization, Religion and Gender: The Politics of Women's Rights in Catholic and Muslim Contexts . New York: Springer.
Croke, D. (2008). Diseases, genes and Irish population history. The Irish Naturalists' Journal, 29 , 117-125. Retrieved from http://www.jstor.org/stable/20764508
MFMER. (2019, February 23). High cholesterol. Mayo Foundation for Medical Education and Research . Retrieved from https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/symptoms-causes/syc-20350800
Purnell, L. D. & Paulanka B (2013). Transcultural health care: A culturally competent approach . (4 th Edition) Philadelphia: F.A. Davis.
Keeley, M., & Generous, M. (2017). Final conversations: Overview and practical implications for patients, families, and healthcare workers. Behavioral Sciences , 7 (2), 17.
