question archive Centennial College IEPN 223 CREATING A "CULTURALLY SAFE PLAN OF CARE" ADVOCATING FOR THE USE OF INDIGENOUS HEALTH Instructions Part A Read the case-scenario below
Centennial College IEPN 223 CREATING A "CULTURALLY SAFE PLAN OF CARE" ADVOCATING FOR THE USE OF INDIGENOUS HEALTH Instructions Part A Read the case-scenario below
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CREATING A "CULTURALLY SAFE PLAN OF CARE" ADVOCATING FOR THE USE OF INDIGENOUS HEALTH
Instructions
Part A
Read the case-scenario below.
Review and use the nursing process to assess, diagnosis, plan, implement and evaluate a Culturally Safe Plan of Care for your client using the template provided.
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.
Coping
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.
Critical Thinking questions to brainstorm together
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 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, her community and her diabetes?
6. Identify Call to Action (s) needs for Rose and her community using the Call to Action Document.
Task :Create Culturally safe nursing Care plan for Rose and her family
Client's Priority Need or Nursing Diagnosis ( From NANDA)
Emotional Nursing Diagnosis:
Planning/Outcomes:
Implementation/
Rationale
Evaluation
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Answer:
Emotional Nursing Diagnosis: Ineffective coping
Planning/Outcomes:
- the patient will be able to communicate needs and negotiate with others to meet them.
- the patient will be able to identify personal strengths and accept support to solve weaknesses.
Implementation/
Rationale
1. Assess for the influence of norms, cultural beliefs, and values on the patient's perceptions of effective coping. The patient's coping behavior could be based on cultural perceptions of abnormal and normal coping behavior.
2. Observe for causes of ineffective coping such as grief, poor self-concept, lack of problem-solving skills, lack of support, or recent change in life situation. Situational factors must be recognized to gain an understanding of the patient's current situation and to help patient with coping effectively.
3. Identify specific stressors. Appropriate appraisal can facilitate development of accurate coping strategies. Just because a patient has an altered health status does not mean the coping difficulties she exhibits are only related to that. Persistent stressors may drain the patient's ability to maintain effective coping.
4. Evaluate support systems and resources available to the patient. Patients may have support in a single setting, like during hospitalization, yet lack sufficient support in the home setting.
5. Assess for suicidal tendencies. Refer for mental health care immediately if indicated. Identify an emergency plan if the patient becomes suicidal. A suicidal patient is not safe in the home environment unless supported by professional help.
6. Set a working relationship with the patient through continuity of care. An ongoing relationship establishes trust, decreases the feeling of isolation, and may facilitate coping.
7. Provide chances to express fears, concerns, feeling, and expectations. Verbalization of perceived or actual threats can help reduce anxiety and open doors for ongoing communication.
8. Avoid false reassurances. Convey feelings of acceptance and understanding. An honest relationship facilitates problem-solving and successful coping. False reassurances are never helpful to the patient. It would only serve to relieve the discomfort of the care provider.
9. Encourage the patient to identify her own abilities and strengths. During crises, patients may not be able to recognize their strengths. Fostering awareness can expedite use of these strengths.
10. Provide information about diabetes and how to manage it. Do not give more than the patient can handle. Patients who are coping ineffectively have reduced ability to absorb information and may need more guidance initially.
11. Help the patient with problem-solving in a constructive manner. Constructive problem solving can promote sense of autonomy and independence.
12. Point out signs of positive change or progress. Patients who are coping ineffectively may not be able to assess their progress toward effective coping.
13. Use distraction techniques during procedures. Distraction is utilized to direct attention toward a pleasurable experience and block the attention of the feared procedure.
14. Respect patient's belief about existential issues. Nurses can promote traditional healing by actively engaging themselves during the rituals and by praying with the patients, if only they were asked to.
Evaluation
- the patient was able to describe and initiate effective coping strategies.
