Question

CASE STUDY 1

Mr. Mendes

GENDER

DISABILITY

TO

Male

- Uses a wheelchair. Needs assistance with

activities of daily living (ADLs).

AGE

SOCIOECONOMIC

81

SETTING

Admitted from a rehabilitation health care center.

Hospital

SPIRITUAL/RELIGIOUS

ETHNICITY

Portuguese

PHARMACOLOGIC

CULTURAL CONSIDERATIONS

LEGAL

Language barrier

Use of a medical interpreter.

PREEXISTING CONDITION

ETHICAL

Peripheral vascular disease (PVD); type 1 diabetes; below the knee amputation (BKA, B-K amputation) of left leg two weeks ago

• Use of a medical interpreter.

ALTERNATIVE THERAPY

COEXISTING CONDITION

PRIORITIZATION

Left lower lobe pneumonia

COMMUNICATION

DELEGATION

Non-English speaking

THE SKELETAL SYSTEM

Level of difficulty: Easy Overview: This case challenges the nurse to identify strategies to help overcome a language barrier and form a therapeutic nurse-client relationship. Legal and ethical concerns regarding the use of an interpreter are considered. Stump care for the client with a recent amputation is discussed.

77

People who speak Portuguese:

People who speak Portuguese are generally from Portugal (in Europe by Spain) or from Brazil (South America). Portugal has a strong cultural past ruled by the Catholic Church and Southern European cultural norms, similar to Spain's culture in some ways. Non-immigrant people in Portugal are predominately from European descent. Brazil has a rich multiracial cultural past with traditions from all intertwining to become a unique culture on its own. People in Brazil are predominately of African and Native heritage and Portugal descent from Europe.

The bulk of the Portuguese population is nominally Catholic. A form of "pious" anticlericalism exists among the people who view the priest as a spiritual leader on the one hand and a man like every other man on the other. Catholics in Portuguese-speaking countries often develop personal relationships with particular saints who are never represented with the suffering and anguish that characterizes some Spanish representations.

Modern medical practice now reaches all sectors of Portuguese society. Few women, for

example, give birth at home today. Good health is often associated with what is natural, and changes in the diet (the consumption of unnatural and synthetic foodstuffs) are frequently cited as the cause of diseases such as stomach cancer. Folk medical practices are still prevalent in

rts of the country. Curers use a combination of prayer, religious paraphernalia, and traditional and modern medicines in their healing. Among some Azorean Portuguese at home and abroad there is a high incidence of Machado-Joseph disease. It is an inherited disorder of the central nervous system, colloquially known as the "stumbling disease" because the carriers demonstrate a staggering and lurching gait, spasticity, and uncoordinated body movements.

SU

Death is a fundamental part of Portuguese village life. Church bells toll to send the message that a neighbor (vizinho ) has passed away. In some parts of Portugal the gates and doors of the dead person's house are opened to allow anyone to enter, and relatives begin to wail around a body prepared for viewing. Burial is in local cemeteries, and family graves are well tended by living kin. Each village has several burial societies (confrarias) to which individuals belong in order to help defray the costs of a funeral and help pay for commemorative masses that continue for several years after death. All Saints' Day is an occasion for special reverence for those who have departed. Mourning is signified by the wearing of black for varying lengths of time depending on their age and relationship to the deceased. In cities, a network of spirit mediums who can contact the dead for the living has arisen.

1. After reading your case study and some characteristics of normative or traditional Portuguese

culture, what types of faith representative models/amulets would you not be surprised to see

in the patient's room? Candles for saints, medals, crosses, rosaries, saint figurines 2. If patient has traditional Portuguese culture and related faith, what practices would you

expect to see by patient and family members? prayer, black clothes, candle to 3. What type of food would the patient and family likely prefer in order to help healing?

Natural foods 4. Would you expect the family to accept traditional western medicine? Yes

a mixture of prayer traditional, t modern medicines 5. If patient has traditional Portuguese culture would the family accept herbal healing remedies? - Yes

6. What practices might you see if the patient should die?

Section 1.. Part 5

THE SKELETAL SYSTEM

Client Profile

Mr. Mendes is an 81-year-old man who speaks only Portuguese. He is quite frail, weighing only 110 pounds. He had a below the knee amputation of his left leg two weeks ago. Mr. Mendes has been admitted to the hospital from a rehabilitation center with an acute change in mental status and diminished lung sounds in the left base. Mr. Mendes is diagnosed with left lower lobe pneumonia and antibiotic therapy is prescribed. The nurse assigned to care for Mr. Mendes does not speak Portuguese.

Case Study

Mr. Mendes requires complete assistance with activities of daily living (ADL). A medical interpreter is not assigned to the nursing unit. If needed, the nurse can ask a Portuguese-speaking nursing staff member to help interpret what Mr. Mendes is trying to express. However, the nurse must develop a way of communicating with Mr. Mendes so the nurse can assess Mr. Mendes's level of comfort, provide care, and identify any needs.

Questions

1. Describe a therapeutic nurse-client relationship.

2. The nurse does not speak Portuguese. Discuss nonverbal strategies the nurse can implement to help develop a therapeutic relationship with Mr. Mendes

3. Provide the most likely explanation for why Mr. Mendes presented with an acute change in mental status.

Answer 1

1.Nurse- client relationship play a major role in treating the patients. The nurse establishes and maintains this important relationship by using her skills as well as painting her caring attitude and behaviour, dignity. Theraputic relationship between nurse and client will contribute to the clients health and well being. This theraputic relationship is mainly based on trust between he both, respect for each other, empathy ..

2. The strategies which and be implemented for nurse patient language barrier are. We can use translator in between nurse and the patient, who can speech bilingual or the staff can use one of the family member as translator who can translate in common language. The nurse can make use of professional interpreter service which can either be telephonic. The nurse can try out non verbal communication by using health care symbols, pain charts etc. As the technology has improvised so much these days, language translator applications are very much available and the language barrier can be managed with appreciate choice.

3.