Instructions:
Discuss your proposal change project with your classmates, including brief information about the process, the results obtained, and your experience completing it.
End-of-life care becomes an issue at some point for elderly patients. Discuss the difference between palliative care and hospice care programs. Discuss what you can do as a nurse to support your patients regarding end-of-life care in accordance with their wishes. Explain the use of advance directives versus Physician Order for Life Sustaining Treatment (POLST) and their legal implications when providing care for elderly patients.
Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format.
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:
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.
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
Instructions for Completing the SOAP Note
1. Review the SOAP note resources provided in the course content.
2. Read the Case Study: Begin by carefully reading the case study provided below. Pay close attention to the patient’s background, medical history, and presenting complaint.
3. Download the SOAP Form: Access the attached SOAP form. This form will serve as your template for documenting the patient encounter.
4. Complete the SOAP Form: Using the information from the case study, fill out the SOAP form to the best of your ability. Ensure that you provide details for each section: Subjective, Objective, Assessment, and Plan. Any part of the assessment not mentioned in the case study is considered normal.
5. Thoroughness is Key: Aim to complete each section of the SOAP form as comprehensively as possible. Include relevant information obtained from both the patient’s subjective account and objective observations.
6. Submit Your Completed SOAP Note: Once you have filled out the SOAP form, submit your completed document according to the instructions provided by your instructor. Include at least 2 reference.
CASE STUDY: Fever, Sore Throat, Fatigue
History
A.J. is a previously healthy 17-year-old female who presents to her primary care office due to fever, sore throat, fatigue, and cervical lymphadenopathy. Symptoms started 5 days ago and have been increasingly worse. She has been taking ibuprofen 200 mg every 6 to 8 hours which she states improves the fever and sore throat. She rates her current pain as 8/10. She reports that her brother had similar symptoms about 1 month ago. She denies weight loss, night sweats, other sites of lymph node enlargement, cough, rhinorrhea, abdominal pain, diarrhea, constipation, or rash. She has allergic rhinitis and takes Loratidine 10 mg PO daily. She has no drug allergies. She had a tonsillectomy at age 8. She has no significant family history. She denies smoking, recent travel, exposure to cats, or IV drug use. She is not sexually active and denies ever having intercourse. She is a high school student who is currently running track. She has had to miss practice due to illness.
Physical Examination
She appears ill. Her temperature is 101.8°F (38.7°C). Her pulse is 93 and her respirations are 18. Her weight is stable based on her previous visit. On physical examination, the clinician finds anterior cervical, posterior cervical, and axillary lymphadenopathy. Lymph nodes are bilateral, soft, mobile, and tender to palpation. The size of lymph nodes is estimated at 8 to 10 mm. She has no other superficial lymphadenopathy or splenomegaly on examination. Her posterior pharynx is erythematous without exudate. Tonsils are surgically removed. Her skin is clean, dry, and intact without any rashes, abrasions, or signs of infections. Heart rate and rhythm are regular and lungs are clear to auscultation bilaterally.
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.
Community health nurses work with populations that
vary from country to country, and to serve them
appropriately requires an understanding of the ways in
which the context in which they are located interacts
with their health status and health histories. Student
nurses are spending a month in Africa reviewing global
health and international community health nursing.
1. The student nurses are required to examine the
population in Africa to assess the kinds of health
conditions the population experiences. What is the
context and framework for delivering community-
based nursing within the context of global health?
2. The student nurses are examining the impact of
disease patterns on the health of the population of
Africa. What is the demographic transition theory,
and what demographic trends should the student
nurses expect to find in Africa based on this
theory?
3. The student nurses are exploring the social
determinants of health in Africa and how these
affect the global burden of disease in these
countries. What is the global burden of disease,
and how would the student nurses go about
calculating this metric for the countries in Africa
they are studying?
Describe your clinical experience for this week
must be on Geriatrics patient
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