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Assignment:

Complete the following:

• German case study
• Irish case study

GERMAN CASE STUDY  
Margaret Schmidt, a terminally ill 60-year-old American of German descent, was
recently admitted to a hospice service and is
receiving care at home. Diagnosed with
metastatic breast cancer, Margaret’s prognosis
is less than 6 months. Margaret’s cancer
has metastasized to her ribs and liver and
often causes intense pa
in. Although Margaret
speaks freely of her impending death, her family
has expressed their discomfort at her
decision to secure hospice care.
Over the last 10 years, Margaret, a nurs
e, has practiced homeopathy (for herself
and others) and consults frequently with a
medical intuitionist. She follows the medical
intuitionist’s recommendations to attenuate
her symptoms but avoids, when she can, the
traditional cancer pain
–management therapies.
Medical staff and her family have entere
d into continuous discussions with her
about her lack of acceptance of traditiona
l medical approaches. Margaret remains
unconvinced of their value within her scheme
of care. Margaret main
tains a strong belief
in an afterlife, believing that
she will be reunited with
her husband. Margaret meditates
daily, calling upon her spiritual guides and angels for strength and peace in the dying
process. She often asks those around
her to join her during this time.
Study Questions
1.
What experiences have you had with patients of German descent?
2.
How does Margaret’s German ancest
ry mold her beliefs about medical
treatment?

3.
What Western medicine concepts
complicate the staff and family’s
understanding of Margaret’s self
-prescribed medical regimen?
4.
How do you, as a health-care prof
essional, feel about the use of
homeopathic remedies?
5.
What is your view of the use of
medical intuitionists and other non-
Western health practices?
6.
How do Margaret’s health-care c
hoices differ or match your own?
7.
How do you deal with cultural health practices unlike your own?
8.
Discuss Margaret’s desire to contro
l her life even through terminal illness.
9.
Relate Margaret’s strong spiritual beli
efs in an afterlife to her ability to
cope with her impending death.
10.
Describe a plan of care that is cultu
rally sensitive to the patient and her
family.
11.
How can your knowledge of the German American culture positively
influence health outcomes for Margaret?
12.
Discuss the cultural filters you may
use as you assist Margaret in her
health-care decisions.
13.
Describe the enculturation you, as
a health-care professional, have
experienced and how this influences
your own health-care decisions.

RISH CASE STUDY  
The O’Rourke family lives on a small farm in Iowa and comprises David, aged 30; his
wife, Mary, aged 29; and two children: Bridge
t, aged 7, and Michael, aged 6. Both David
and Mary are second-generation Irish. Before
purchasing their farm 5 years ago, David
sold farm equipment in Ohio. The O’R
ourkes are Catholic; Mary converted to
Catholicism when they married.
David, who works long hours outdoors, is
concerned about profitability from
his corn crop because of the unpredictable size of the harvest, and thus, his income
varies depending on the weather. Mary di
d not work outside the home because she
wanted to be with their children until they started school. However, because both
children are now school age, Mary has discus
sed with David the possibility of working
part time to supplement the family income. He
would prefer that she stay at home, but
Mary is anxious to return to the wo
rkforce and believes the timing is right.
Both David and Mary are happy with ju
st two children and do not desire more.
They use the rhythm method for family planning.
Eating a healthy breakfast is important
to the O’Rourkes. Because eggs are
readily available on the farm, they have frie
d eggs with potato bread and juice at least
four times a week. Their main meal in the
evening usually includes meat, potatoes, and
a vegetable. David enjoys a
glass of beer with dinner.
David has been a little edgy lately becau
se of his concerns about the corn crop.
He admits to having some minor chest pain, wh
ich he attributes to indigestion. His last
visit to a physician was before their marri
age. Mary knows David is concerned about
finances and believes it would help if she had a job.

Bridget and Michael spend
a lot of time outside playing and doing some minor
chores for their parents. Both children
enjoy school and are looking forward to
returning in the fall. Bridget is starting to
show concern over her appearance. She does
not like her red hair and all the freckles on he
r face. Her teacher has noted that Bridget
has trouble reading and may need glasses.
Michael wants to be a farmer like his Dad
but worries about his Da
d being tired at night.
The O’Rourkes have not taken a vacati
on since they were married. They go to
the state fair in the summer, which is the extent of their trips away from home. They
are active in the church and
attend services every Sunday.
Study Questions
1.    Describe the O’Rourke family st
ructure in terms of individual roles.
2.    Identify two potential health problems re
lated to the O’Rourke
’s dietary practices.
3.    Identify potential health-risk
factors for the O’Rourkes as a family unit and for each
family member.
4.    Explain the relationship be
tween risk factors a
nd ethnicity specific
to the O’Rourke
family and their Irish heritage.
5.
Describe culturally competent health-promotion strategies for the identified risk
factors for the O’Rourke family.
6.    Describe the O’Rourke family’s fertility
practices. Are they congruent with their
Irish background and religious beliefs?
7.
Describe the O’Rourke fam
ily’s communication patterns. 

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8.
  What are the predominant health
conditions among Irish immigrants?
9.    Explain the significance of the Great
Potato Famine for Irish Americans.
10.   Name two genetic diseases common among Irish Americans.
11.
Identify accepted fertility practices
for Irish American Catholics.
12.   Identify three sources of strength for
the Irish American in times of illness.
13.   Identify traditional home remedies commonly used by Irish Americans.

ITALIAN CASE STUDY #1
Rosa and Mario Gianquito live on the ground fl
oor of a three-family house in Brooklyn,
New York. Although they completed only gram
mar school in Italy, they speak English
and have little difficulty understanding mo
st verbal communication. They have a
daughter, Lucia, aged 25, and a son, An
thony, aged 28, who were born in this
neighborhood but now live in Manhattan. Both
children speak fluent Italian. Anthony is
an attorney and does not visit with his si
ster very often. Luci
a is a grammar school
teacher, married to an Italian man, Guido
Venetto, who recently immigrated from
southern Italy and is 10 years older than Lu
cia. Guido speaks mostly Italian at home but
does speak broken English. In addition to sm
oking two packs of cigarettes a day, Guido
is emotionally abusive to Lucia. He is ve
ry jealous and does not want Lucia to go out
after work with her friends or
to spend much time visiting with her parents. Lucia has
allergies, and the last time she visited the docto
r, he told her that her blood pressure was
elevated. She has noticed lately that, after st
anding all day at work, she often has swollen
ankles and leg pain.
Lucia’s husband works 12 hours a day as a construction worker and expects her
to cook Old-Country–style Italian food, which re
quires that she use a great deal of salt.
She is often depressed and feel
s isolated and powerless. She has been trying to have a
baby for 3 years.
Rosa comes to visit her daughter wh
en she can. She often brings homemade
manicotti or tortellini when she comes. She
is very concerned about Guido’s behavior
toward her daughter but does not feel that
she can challenge Guido because he is the
capo di famiglia
. Rosa is concerned about Lucia’s
swollen feet and suggests that she

drink red wine and eat more garlic and dandeli
ons. She tells Lucia to pray to the Virgin
Mary to ask for help in conceiving a ch
ild and to make Guido treat her better.
Lucia and Guido attend the neighborhood Catholic Church on Sunday. Lucia
always wears the
cornicelli
around her neck that her mother gave her to protect her
from
il mal occhio
. Lucia says her faith and her fa
mily help her cope with life
challenges with
pazienza
.
Study Questions
1.    Identify three problems and a
related plan of care for Lucia.
2.
  Identify two health-teaching goals for this family that are congruent with family
order and rituals.
3.
  Identify three socioeconomic factors that in
fluence the health of the Venetto family.
4.
How might the health-care provider involve
Lucia in a mutual-planning process for
her holistic health-care needs,
including mind, body, and spirit?
5.    Knowing that many first-generation Italia
ns generally mistrust health-care providers,
how would you encourage Lucia to enga
ge in health-promotion behaviors?
6.    Discuss at least two preventive health
maintenance–teaching activities that respect
the folk practices used to treat illness in this family.
7.    Define the Italian’s unique relationship w
ith food and discuss implications this could
have on the health of the Venetto family, particularly Lucia.
8.
Discuss the status and role of elderl
y Italians in the extended family.  

9.     Identify two practices common among Ital
ian women that might affect conception
and pregnancy.
10.   Name two dietary health-car
e risks and two dietary health
-care assets for Italians.
11.   What are some of the primary religious
practices and use of prayer for Italian
people?
12.   Define the terms
capo di famiglia
,
il mal occhio
, and
pazienza
.

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Case Studies Activity Instructions

Case studies are stories. They present realistic, complex, and contextually rich situations and involve problems to solve and/or questions to answer. Thoroughly read the case studies below and answer the questions presented in each. Your responses to the questions must be detailed and include information supported by academic sources (textbook, .gov, and .edu webistes). Do not use .com, .net, .org, or blog websites. All sources must have been published within the last 5 years.

Please complete all 3 case studies. Your case study responses must follow current APA format and include in-text citations for any resources you use to support your answers. You must also include a separate reference page. The Case Studies Activity must be submitted as a Microsoft Word document.

This assignment is due by 11:59 p.m. (ET) on Monday of Module/Week 2.

Case Study 1

Mrs. Jones, who is 80 years old, presents to ABC Medical Associates today for her annual wellness visit. She was last seen 6 months ago by a doctor in the practice for a bout with influenza.

In today’s visit, the patient will receive her annual gynecological evaluation in addition to a general maintenance examination. She will also have blood work done to evaluate her hypertension, hypothyroid, and type II diabetes.

Mrs. Jones is covered by Medicare and AARP Medigap insurance.

Based on the information in this case study, determine if this is a new or established patient. Then, describe what information you will need to collect from the patient and what steps you must take to ensure the services being rendered will be covered by insurance. Determine which insurance policy is primary.

Case Study 2

Mr. Jones is seen in the ER at Grand Valley Hospital for chest pain. He is from another state and is visiting family. He has never been to Grand Valley Hospital previously.

While in the ER, it is determined that the patient needs a cardiac catheterization done before discharge. This procedure is performed by Dr. Lindsay.

Mr. Jones serves in the National Guard and has been covered by TRICARE since 1989. He is also covered by his employer’s health plan, Blue Cross Blue Shield, and has been covered by this health plan for the past 2 years.

Based on the information in this case study, determine if this is a new or established patient. Then, describe what information you will need to collect from the patient and what steps you must take to ensure the services being rendered will be covered by insurance. Determine which insurance policy is primary.

Case Study 3

Jack Minnow, a 4-year-old boy, presents to Valley Allergy practice because of a recent allergic reaction to a bee sting. He has never had a reaction previously. Jack’s primary care physician Dr. Zane is referring him to Dr. Shelby, an allergist, for a consultation. Jack is accompanied by his mother who is the custodial parent.

During the visit, Dr. Shelby performs a series of allergy tests that identify not only an allergy to bees, but also to animal dander and grass.

Jack is covered by both his mother’s and his father’s employers’ health plans. His parents are divorced. His mother went back to work after the divorce 1 year ago and enrolled Jack under her health plan due to some concerns about whether Jack’s father would keep his job. However, his father is still employed with the same company and has worked there for the past 3 years.

Based upon the information in this case study, determine if this is a new or established patient. Then, describe what information you will need to collect from the patient/guarantor and what steps you must take to ensure the services being rendered will be covered by insurance. Determine which insurance policy is primary.

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Read the following case study and answer the questions below. Response should be at least 75 to 100 words.

Wayne is a public health/community nurse who lives in South Texas. During the summer, Wayne’s community experienced uncontrollable wildfires that devastated the area. Because he lived in the area, Wayne was called upon to help triage and care for victims of the fires. Many of the wildfire victims were Wayne’s family, personal friends, and work colleagues.

1. After the fires were controlled and the most critically ill residents were transported to the hospital, Wayne began recovery efforts. What is Wayne’s priority recovery goal for this population? What steps should Wayne take to reach this goal? 
2. Wayne performs psychosocial assessments on the wildfire victims. Which victims are more likely than others to need crisis intervention? 
3. Wayne is worried about the major health concerns after a disaster and how they may affect his community. What are some of these major health concerns? What can Wayne do to improve the health concerns? 

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