Assignment Part 1:
Mrs. C. is a 76-year-old Chinese American widow who lives in an apartment in the Chinatown section of San Francisco. She has lived within the same 1-mile radius since her parents brought her to San Francisco from Mainland China when she was 9 years old. All three of her children are married; two live about an hour away, and the other one lives on the East Coast. Although she can speak and read English, Mrs. C. prefers to use her native Chinese dialect, and all of her reading materials are in Chinese. She completed a high school education in Chinatown and married a Chinese immigrant when she was 19 years old. She served as her husband's primary caregiver after he developed lung cancer several years ago until his death last year.
Mrs. C. is enrolled in the On Lok Senior Health Program, a health maintenance organization that provides a wide range of health and social services. She attends a daily meal program and sees the nurse at the center for blood pressure checks every month. She has hypertension, arthritis, and coronary artery disease. Mrs. C. sees a local herbalist every few weeks to obtain the herbal medicines that will keep her yin and yang energies in balance, and she chooses foods according to their yin and yang characteristics. She periodically has acupuncture treatments when her arthritis bothers her. Although Mrs. C. believes she can control her heart problem and high blood pressure with herbs and diet, she takes her two medications as prescribed because the nurse at the On Lok clinic has emphasized that these pills are essential for keeping her energy in balance.
Mrs. C. recently had a stroke and received medical treatment and rehabilitation services. She is being discharged to her apartment with a referral to the On Lok home care services for skilled nursing and speech, physical, and occupational therapies. Discharge orders also include the need to instruct Mrs. C. in a low-sodium diet. In addition to having some aphasia and left-sided paralysis, Mrs. C. has some residual memory impairment from the stroke. Before discharge from the rehabilitation program, she said she would not need any home health aide assistance because she expected that her daughter and daughter-in-law would take turns coming over every day and that they would take care of her. You are the nurse assigned to do the initial assessment and your visit is scheduled for the day after discharge, when the daughter-in-law will be there. Although you have been a visiting nurse for several years, you have recently moved to San Francisco and you began working for On Lok 2 weeks ago
Part 1 Questions:
- What cultural factors might influence Mrs. C!'s acceptance of you, as the skilled care nurse, and of home care services in general?
- What would you do to gain skills in providing culturally appropriate care for Mrs. C. and other patients in the On Lok health care program?
- What are your specific health care concerns for Mrs. C., and what strategies would you use to develop an effective and acceptable care plan?
Assignment Part 2:
Mrs. A. is an 81-year-old African American who lives with her daughter, Mildred, and teenage great-grandson in a two-bedroom apartment in a large metropolitan area of Ohio. Mildred works as a nursing assistant in a nearby nursing home and often works double shifts. Mrs. A. was born in Alabama and lived there until 20 years ago, when her husband died and she moved in with her daughter (who lived alone at the time). Seven years later, Mildred took on responsibility for raising her infant grandson, who is now 13 years old. Mrs. A. has glaucoma, arthritis, and hypertension, and she had a stroke several years ago: She admits to having "a little problem with my memory," but Mildred says, "She remembers what she wants to remember." Mrs. A. takes an over-the-counter analgesic as needed for her arthritis and has two prescription medications for hypertension. She also uses prescription eye drops twice daily. Mrs. A. has her blood pressure checked by the parish nurse about once monthly; she sees a doctor and nurse practitioner at a neighborhood clinic for checkups about twice yearly. The parish nurse often tells her that her blood pressure is "a little on the high side" and encourages her to see her doctor, but Mrs. A. has difficulty getting appointments because she depends on Mildred to take her there. Mrs. A. is about 30 lb overweight, and she walks very slowly. When they go to church, Mildred provides a supportive hand to assist with steadiness and mobility. Mildred shops for groceries, but Mrs. A. prepares most meals for the family.
Part 2 Questions
- In what ways, both positively and negatively, might Mrs. A's living arrangements influence her health and functioning?
- What factors are likely to influence the kind of health care Mrs. A. receives?
- If you were the parish nurse, what actions would you take to decrease health risks and promote quality of life for Mrs. A.?
- What additional resources could be used to improve Mrs. A.'s situation?