question archive Case-Scenario Client Rose is a 65-year old who is a member of the Indigenous community
Case-Scenario Client Rose is a 65-year old who is a member of the Indigenous community
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Case-Scenario
Client
Rose is a 65-year old who is a member of the Indigenous community. Rose lives in a rural area in Northern Ontario.
Health History
Rose is a 65-year old with a history of gestational diabetes with her first pregnancy in her early twenties. She has had six pregnancies and with each pregnancy her diabetes became worse.
Present Health
Rose now has Type 2 Diabetes that is hard to control. She has had her right foot amputated
below the knee and has had a prosthesis since the age of 60. Rose is 175 cm tall. Rose weighs 110 kg. Rose also has a history of osteoarthritis, osteoporosis and high blood pressure.
Social situation
Relationships
Rose is a widow, her husband died in his forties as a result of uncontrolled diabetes and alcoholism.
Children
Rose was a single parent raising her children after her husband died and she raised them on social assistance. Two of Rose's children died, one in a car accident caused by drunk driving and one child died from suicide. Her other children except for one daughter left her and Northern
Ontario. They do not keep in touch and she does not see them. Rose is caring for her five grandchildren while her one daughter who stayed with her goes to a nursing school 400 km away.
Rose is fighting depression, is taking Prozac and sleeping pills and is struggling with alcoholism to help with her health and her situation. The anti-depression pills are not working.
Cultural History
Rose was taken from her community and was put in a residential school from the age of six until the age of 13. Due to this Rose is not as close to her community and culture as she might have been. She has had trouble relating to her community's culture, cultural values and spiritual beliefs.
Housing
Rose lives in a small, poorly insulated, mouldy, overcrowded two-bedroom house in a First Nations community in northern Ontario.
Present Situation
There is a new Community Health Center with a traditional circular healing room where traditional healers as well as a Nurse Practitioner, nurses, community health representatives, a nutritionist and a social worker are available. Rose has been coming to the health center on a more or less regular basis and has found herself drawn to the traditional healers. Rose has come to the health center because she is experiencing breakdown of her stump which is cracked, painful and is draining pus.
The Nurse Practitioner advised Rose that she may need to travel south to the hospital if the infection persists. Rose has no family members in the community and worries about who would care for her five grandchildren if she has to fly out of Northern Ontario for hospital care. Rose's granddaughter has come to the clinic with Rose. She is extremely overweight and given her family history is at high risk for diabetes.
Through her involvement at the Community Health Center and interactions with the traditional healers Rose has begun to become more active in the community and has joined a woman's drumming group.
She has found regular gatherings with her drumming group comprised of women of varying ages to be helpful with her struggle with alcoholism and depression.Her drumming group performed the opening welcome at an evening heart health talk held in her community for First Nations women and during that event, Rose discovered that diabetes is a major risk factor.
As a result of her experiences at the Community Health Center and in her drumming group, Rose has become involved in self-governance and has joined a group in the local band office particularly focusing on health issues such as diabetes, alcoholism and depression.
1.Using the nursing process develop a plan of care for Rose and her family.
2.Investigate how you would integrate Indigenous health beliefs into your nursing care plan for Rose and her family.
3.Investigate how you would integrate your knowledge of colonization and residential schools into the care for Rosa and her family.
4.Explore how you would integrate Rose's new appreciation of traditional healing into her care plan.
5.As a healthcare provider, what questions would you ask Rose about her family, community, and diabetes?
6.Identify Call to Action (s) needs for Rose and her community using the Call to Action Document
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Answer:
1. In developing a plan of care for Rose and her family, we must consider the nursing process as a client-centered approach which involves the following: assessment (subjective and objective data), nursing diagnosis based on the Maslow's hierarchy of needs, Planning (we formulate specific objectives that could impact the life of the patient and her overall life dimensions that would definitely change patient's condition), Interventions (here, we execute or apply specific actions that will improve patient's current condition) and lastly, is the Evaluation from which we reassess the patient and review the plan of care that we have formulated and if the outcome has been met or the patient's overall condition has improved.
2. It is unavoidable that in our pursuit for health care there will be encounters of patients having diverse culture. As an advocate for health, we must all be aware that traditional beliefs are part of the health care challenge. In this case, traditional healers are seemingly medically acceptable in the community where Rose resides, even present at the Community Health Center together with the licensed medical professionals. In developing nursing care plans for Rose and her family, we must acknowledge and be aware that such traditional health beliefs exist and it is imperative to establish a strong connection or rapport to them so to avoid conflict. Also, connections are built when we display interest by asking, listening actively and learning on their overall culture. Ultimately, we have to graciously share to them the accurate health information as their primary right in health care. Rose has a mental health condition and regular communication could help her be mentally resilient.
3. For Rose and her family, we must first investigate as to how long has traditional beliefs been ruling them and its extent as well. By that, we can begin to articulate all the truths in health care as knowledge is gained by a repetitive listening on medical truths thereby eventually eliminating their cultural beliefs that is considered a barrier to better health in communities.
4. Rose has a strong traditional beliefs and we must involve scientific evidences such as laboratory results that is obviously affecting her health. Here, we must emphasize to her that medical treatments should not be neglected. Be careful also to have a regular communication with Rose and family.
5. As a health care provider, part of the interests to Rose's family is their lifestyle and deep understanding of healthy living. That when body is abused prematurely and continuously, it gets into health collapse. In community, here we must take notice of the community's counterpart like assistance on the health of their constituencies. Lastly, diabetes has struck millions of individuals with this and part of the focus must be their level of knowledge pertaining to disease prevention and control.
6. In identifying call to action needs for Rose and family, we must focus on the following:
a. Diabetes awareness
b. Organizing a diabetic group
c. Healthy lifestyle activities
d. Means to visit Rose and family as patient is already a person with disability (amputated lower extremity)
e. Mental Health Awareness
f. How to gain medical assistance
g. Additional support from community.
h. Ensuring continues medical treatments
Step-by-step explanation
The entire scenario display the real health situation in the community where residents patronizes traditional healing over medical treatments. I focused on the existing social determinants of health and the possible actions that could bring a tremendous holistic impact to the patient. I used the nursing process: assessment, diagnosis, planning, interventions, and evaluation.
