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Holistic Nursing Approach
Holistic Nursing Approach
The matriarch of the Garcia family is Mercedes Garcia, she 70 years old. She as one child, Geraldo and is currently unemployed, and a native of Cuba. She is 5’2”, and weighs 140lbs. Mercedes have no known allergies. Mercedes lives with her son and her family, because of her age within the hispanic culture, should not be addressed by her first name. Mercedes as presented to the clinic numerous occasions, always for the same reoccurring issue, hypertension and pain. Mercedes main complaint of generalized joint pain, patient refuses intervention, states, “she can handle the pain.” Her blood pressure is 136/92, remaining vital signs are unremarkable. Mercedes is ESL, English Second Language, and as difficulty issues conveying her needs. This places her at a significant disadvantage, in getting the care and understanding the care she needs or requires .Because family plays a vital role in the Garcia family, the plan of care will be provided respecting her wishes, being receptive to feedback and most of all culturally appropriate, including her family present. Hispanics perceive illness as a physical state of illness and their approach to health is usually holistic, in Mercedes circumstances, it is important to assess this more in-depth. Also some cause of illness in Hispanic culture, is categorized as “hot and cold” illness.
Hot and cold illness from the Hispanic cultures can be defined an imbalance between the natural and the supernatural. Hypertension is believed to be a hot illness/disease in the Hispanic culture. A Spanish speaking interpreter is another must have it enables all present to receives the necessary information without impedance. Studies have shown that the lack of a medically trained interpreter or healthcare providers sometimes leads to family members or friends being used in this role and can lead to personal biases if not worst. Providing a comprehensive holistic and culturally appropriate care is vital, especially with language limitations. Teaching Mercedes how to take better care of herself, not only applies to the present, but also for the future. Incorporating comprehensive complementary alternative medicine modalities can be integrated in her care.
In treating the Mercedes we not only treat her as the patient, her family and also the community they serve. Utilizing evidence based practices such looking at dietary modification to better maintain and manage Mercedes weight, stress and hypertension. The DASH diet can be useful because of it employs reduction of the amount of sweets,fats,red meats and sugared bevererages, and emphases nuts fish, poultry and whole grain. When talking to Mercedes always maintain cultural competency by facing her, be warm, friendly, and lean forward when actively listening or speaking. Dietary modifications may includes a reliance on beans, rice, and tortilla and a change in others—such as reduced consumption of high-fat dairy products, sodium and less use of fat in cooking.
Geraldo is the son of Mercedes, his wife is Lourdes, and his only child is Angelo. Geraldo is Mercedes son. Geraldo was born in Cuban, now living in the United States. He is 47 years old, a successful business man. Geraldo is 5’6” and weighs 180lbs, he has no known allergies. His medical history comprise of smokes three pack of cigarette per day for the last 15 years. Geraldo as presented at the clinic once, with continuous cough for “several weeks” with discolored sputum. He states that he continues to smoke about 3 packs per day, the cough has made him exhausted because he cannot sleep at night and states that it,” is unacceptable”. Geraldo he is the main breadwinner for his family and must work at least 50-60 hours per week to keep his job and to pay the household bills in this tough economy.
Nevertheless, is interesting to know if the underlying cause of Geraldo’s stress is work related, personal or family stress. Gerald needs to foster relationships within the workplace, the community and his family. Geraldo is provided information on smoking cessation including family involvement in the process, discussion on the various risk factors of smoking such as pneumonia, COOD, bronchitis etc. Although, it culturally the norm to smoke in the Hispanic culture some preventative and curative factor is much needed, eg smoking cessation patches or gums. Regarding possible stress factors, discuss with him on one and one basis management, and how to decrease further pathologies and personal antidotes to further compliance. manage and maintain her BP, pain, weight and possible stress and depression.
Mercedes and family with receive outpatient and patient teaching at home to facilitate long term compliance, and care. Spirituality and religion plays a major part in this culture, ceremonies are sometimes held to relieve symptoms and remove the cause of the illness. Dance therapy would also provide Mercedes with the added benefit of bone strengthen, socialization decreasing possible depression, self healing with cultural herbs and oils , including conventional medical therapy for her pain management secondary to osteoporosis.
Lourdes is a 45 years old female, she is a native of Cuba. She is 5’3” and weighs 135lbs, with no known allergies. Lourdes is a publisher of historic novels, and works for home. Her only health history is controlled hypertension. Lourdes as only visited the clinic once; this is for a routine physical and the cause of her hypertension.
Lourdes being an intelligent woman appears to be doing the right things with regards to managing her diet, taken her prescribed medications as stated. There are possibilies that Lourdes may have also researched the cause and effects of hypertension, and is now looking for some more specific information on further management of her hypertension for the long term. Lourdes as also accompanied her mother-in-law to the clinic, this increases her knowledge base not only for herself, but she may also serve as a resource for Mercedes. Lourdes appears to be in the developmental stage Middle Adulthood: Generatively vs. self absorption. According to Erickson,” Strength comes through care of others and production of something that contributes to the betterment of society, which Erikson calls generatively, so when we’re in this stage we often fear inactivity and meaninglessness…”.
Lourdes as certainly exemplified herself since migrating to the U.S, and is certainly adapting to her physiological and developmental stages. In my holistic approach with Lourdes, I would recommend she meets with a cardiologist, and a dietician, to a provide healthy and effective Hispanic dietary resources, recipes etc, with reduction in fats, and increase fiber. Incorporating all family members in relaxation and meditation therapy is also adapted. Relaxation relieves muscle tension and facilitates inner peace. With group participation it encourages family bonding, and the means to optimizes health. Exercise provides Lourdes an outlet to interact with her community and facilitates socialization especially because she works from home.
Angelo is the son of Geraldo and Lourdes. He is 25 year old, he was born in America. He has unremarkable health history, drug allergy is sulfa. He presents to the clinic for two visits, first for a routine visit, in which we learnt of his homosexual life style, he is in a monogamous relationship that may be ending soon. It is unclear whether this was by his choice or otherwise. We also learnt that although his mother was more accepting of his sexuality, than his father whom continues to struggle with it. On his second visit he complaint of a cough, sore throat and ear ache. Strep culture was complete and pending. He weighs 185 lbs, with height of 5’10”and he also exercises on a regular basis. By profession he is a physician’s assistant, this may affect the holistic approach strived for in an holistic approach, healthcare providers generally are always the lest at compliance with therapy. Angelo in the stage of Erikson’s developmental stage of Young Adulthood, Intimacy and Solidarity vs. Isolation, is certainly having some conflicts. According to Erikson, (n.d) “it is the initial stage of being an adult. We seek one or more companion s and love……if negotiating this stage is successful we experience intimacy on a deep level, if not successful isolation”.
Being an only child, and being male in the Latino/ Hispanic/Cuban culture the expectations are to provide grandchildren, and also some of the older generation frown on the homosexual ideology’s and tendencies. Gerald’s dreams or expectations for Angelo may be dashed as a result of his sexuality. Angelo being in his early 20’s may or may not want to be in a monogamous relationship. And may want to see other people, Angelo’s sexuality is a proving to be significant impact on the Garcia family on a whole. It is like the elephant on the table, and I believe it is a major contributing stress factor for Geraldo also. Asessment of family based I believe all the family should sit down and have a heart to heart about, Angelo’s sexuality, its impact on the family now and in the future. And counseling to repair the relationship between father and son relationship, how to communicate effectively and meet each others needs. And a neutral party should be privy to the meeting, with approval of all members of the family. Has a result of his professional knowledge, is quite aware of the statistics regarding the impact of AIDS, HIV on the Hispanic/Latino and African American communities not only on the individuals involved but also their caregivers.
For Geraldo, I would recommend a peer group therapy for him regarding his father’s denial of his sexuality, and for the family I would also recommend, Impact for Gays, Lesbian and Transgender families. According to the CDC, HIV/AIDS in the Hispanic /latino men who have sex with men represents a 72%of the new infections…. It is the sixth leading cause of death among Hispanic/Latinos aged 25-34 in the US, Hispanics/Latinos were reported to have the highest rates of unprotected male-to-male sexual contact. ” The holistic approaches that are appropriate for Angelo are mainly prevention, communication between partner and potential partners about HIV/AIDS status, condom usage, and other exposure to other STD’s and IV drug usage.
In conclusion, the Garcia family is undergoing some physiological, spiritual, emotional transitioning through various stressors and enculturation is one of the many. With a connectivity, and family dynamic, which is quite evident throughout, they will rise to the occasion with the various modalities we have set forth. They are unique individuals and cultural appropriate intervention, assessment, implementation and evaluation is a necessity. According to Flowers, pg 51 (2004), the increasingly diverse population in U.S is offering new challenges in the provision of culturally competent care….” There with that in mind, we all have to rise to the new challenges each culture brings and learn from it. Cultural holistic approach for the Garcia’s will embrace their cultures nuances and respectful guide self care, while enabling knowledge.
Retrieved, Nov 30, 2010
Flowers, D., RN, PhD (2004). Culturally competent nursing care, a challenge for the 21st century.
Retrieved from http:// reserves.uah.edu/eres/download.aspx?docID=2665
Harder, A., (n.d). The developmental stages of Erik Erickson Retrieved from http://www.learningplaceonline.com/stages/organize/Eriksonhttp://www.ahna.org/AboutUs/WhatisHolisticNursing/tabid/1165/Default.aspx
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