Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.

Case Study Questions

1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
2. What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.

You should respond to both discussions separately–with constructive literature material- extending, refuting/correcting, or adding additional nuance to their posts. 

Minimum 150 words each reply. 

Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual).

Discussion 1:

Caring for African American, Mexican, and Navajo Populations

Importance of Folk Medicine Practices and Folk Healers to African Americans in Rural Settings

       Folk medicine still plays a crucial role in the lives of African Americans in rural areas as a culturally appropriate and accessible form of healing. A root doctor and a spiritual healer offer daycare therapies from African, Native American, and European cultures (Beasley et al., 2022). This study focuses on the fact that many African Americans with limited access to healthcare rely on these healers because of the historical lack of trust in mainstream medical facilities. Such mistrust resulted from past immoral medical experiments like the infamous Tuskegee Syphilis Study, which led to reluctance to use traditional healthcare services. They use herbs, prayer, and other rituals to treat illnesses while using biomedical methods. Nurses must learn about these customs and adapt treatment accordingly; cultural sensitivity is the best way to achieve this. Lack of recognition of the role of folk medicine may decrease patient satisfaction and adherence to prescribed treatments.

Cultural Imposition in Mrs. M.’s Case

        Cultural imposition occurs when a healthcare professional fails to respect a client’s values system and imposes their own. For instance, Mrs. M.’s nurse disregards her postpartum dietary restrictions without paying attention to her cultural norms as a Mexican American, which includes a traditional belief in the relationship between food consumption and health. For example, many Mexican Americans observe the so-called ‘hot’ and ‘cold’ foods, which can be traced back to humoral medicine and impacts food preferences, especially during pregnancy and breastfeeding, according to Häyry & Sukenick (2023). Some foods positively affect maternal and child health and well-being, while others are perceived to affect the woman or her baby adversely. The case of the nurse who compounds the problem by telling Mrs. M to eat all that she wants, regardless of her belief system, is an instance of cultural imperialism. Cultural values and belief systems in health care: Healthcare workers must understand cross-cultural treatment and care, work within patients’ frame of reference, and embrace their cultural beliefs. This way, nurses can address the patient’s beliefs while fostering compliance and buy-in to the recommended treatment plan (Giger & Haddad, 2021).

Communication Barriers for Non-Navajo Nurses Providing Care to Navajo Clients

      Research on Navajo client care revealed that non-Navajo nurses face communication challenges, which limit efficient care delivery. One potential issue is a lack of direct communication, which is restricted by hierarchy, bureaucracy, and cultural or language differences. According to Bennett & Paddock (2022), the Navajo people value telling stories and providing circumlocutions rather than giving straight answers. Some health practitioners may misinterpret this type of communication because they are not used to it and may think the patient is elusive or disobedient. Healthcare workers must use an understanding and gentle approach and ask the Navajo patients open-ended questions since they are accustomed to using storytelling to share their experiences.

      Another common barrier is eye contact avoidance, where people do not look directly into the eyes of the other. Eye contact is generally avoided with people in positions of authority, such as doctors and nurses, as opposed to prolonged eye contact, which may be seen as a sign of disrespect among the Navajo people (Bennett & Paddock, 2022). It may become particularly problematic for non-Navajo nurses, for they may perceive such behavior, including avoidance of eye contact, as a sign of their subjects’ disinterest or dishonesty. To enhance communication, nurses should understand the physical limits of the patient, refrain from forcing him/her to make eye contact, and instead make a head bow or a slight hand movement to show active listening. Using concepts from this inventory, such as appropriate touch, eye contact, and socio-centric language, healthcare professionals can restore the Navajo Nation people’s trust and improve their experiences with the healthcare system.

References

Beasley, E. A., Wallace, R. M., Coetzer, A., Nel, L. H., & Pieracci, E. G. (2022). Roles of traditional medicine and traditional healers for rabies prevention and potential impacts on post-exposure prophylaxis: A literature review. PLoS Neglected Tropical Diseases, 16(1), e0010087. https://doi.org/10.1371/journal.pntd.0010087Links to an external site.

Bennett, E. C., & Paddock, E. (2022). Subtle approach to the mores of the Navajo nation. In Difficult decisions in surgery: an evidence-based approach (pp. 273–304). https://doi.org/10.1007/978-3-030-84625-1_20Links to an external site.

Giger, J. N., & Haddad, L. (2021). Transcultural nursing: Assessment and intervention (8th ed.). St. Louis, MO: Elsevier.

Häyry, M., & Sukenick, A. (2023). Imposing a lifestyle: A new argument for antinatalism. Cambridge Quarterly of Healthcare Ethics, 33(2), 238–259. https://doi.org/10.1017/s0963180123000385Links to an external site.

Discussion 2:

• In rural African Americans, and especially the elderly, indigenous healing practices and folk medicine are important components of health and wellbeing. The practices have their origins in African folk medicine and have been handed down from one generation to another (Giger & Haddad, 2021). Indigenous healing is critical for rural African Americans to deal with both physical and psychological distress as a cornerstone of wellness and a strategy to respond to life challenges.

Several factors can be attributed to the importance of folk medicine and healers in rural African American communities.

These are cultural heritage: they are deeply rooted in African American culture, derived from various African healing traditions combined during slavery.

A holistic approach: African American indigenous healing takes into account the connection between body and mind in treating the physical and emotional sides of health.

Folk healers: Many folk healers are respected members of the community who will deliver culturally familiar and accessible care (Giger & Haddad, 2021).

Spiritual component: A large number of healing practices contain a spiritual component that coincides with the high religious beliefs in the African American communities.

Intergenerational knowledge transfer: Cultural wisdom of healing skills and knowledge are usually inherited from older generations and more especially from mothers to their daughters.

• The cultural imposition scenario is shown in the Mrs. M. scenario. The nurse is creating their own culture beliefs about postpartum diet and not acknowledging the cultural practices and family traditions of the patient. However, this method is not aware of the significance of cultural beliefs in healthcare decisions and may result in a loss of trust and acceptance in medical instructions (Mayo Clinic, 2022).
• There are several communication barriers that non-Navajo nurses may experience when giving care to Navajo clients.

Language differences: There are many Navajo patients who, especially elders, can only speak their native language and therefore it can be challenging for a nurse who is not a Navajo speaker to communicate with them.

Navajo culture respects indirect communication and may interpret direct eye contact as disrespectful. Because they are not Navajo nurses, they might misinterpret lack of eye contact or long pauses in conversation as disinterest or noncompliance (Keeler, 2018).

Cultural beliefs about health and illness: Navajo patients may have different ideas on the causes and treatments of illnesses from what we would consider Western medicine.

Dignity of elders and traditional healers: Navajo patients place more emphasis on advice from family elders and traditional healers than that of healthcare professionals which can lead to conflicts in treatment plans.

Healthcare professionals need to be aware of these barriers and try to comprehend and respect the culture of patients’ beliefs and practices to provide culturally congruent care. Using this approach can improve patient outcomes and satisfaction in the context of cross cultural healthcare (Giger & Haddad, 2021). It can also be stated that cultural sensitivity training in nursing schools can create a bridge in the gaps and promote a more inclusive healthcare environment.

References

Giger, J. N., & Haddad, L. (2021). Transcultural nursing: Assessment and intervention (8th ed.). Elsevier.

Keeler, J. (2018, September 13). Why Navajo hair matters: It’s our culture, our memory, and our choice. ICT News. https://ictnews.org/archive/why-navajo-hair-matters-its-our-culture-our-memory-and-our-choice

Mayo Clinic. (2022, September 15). Addressing health care barriers during Hispanic Heritage Month [Video]. YouTube. https://youtu.be/7kpAmYI3MX4

Case Study: JE is a 38-year-old white woman with a 6-year history of psoriasis. Her family history includes allergies, asthma, and her mother with psoriasis. JE returns to the clinic today reporting an increase in symptoms and expresses a desire to improve the appearance of her skin.

• Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
  • Describe one source of big data that you are likely to use in your future advanced practice nursing role.  
  • Identify the types of information that can be obtained from this source.  
  • Examine three ways data from this source can be used to impact client care. 
  • Discuss the role of the advanced practice nurse in data stewardship.