Module Seven: Presenting Social Science Concepts And Researc ✓ Solved

Module Seven Presenting Social Science Concepts And Research

Considering multicultural issues related to end-of-life concerns is important while working with clients/patients and their families. An expanded multicultural population in the United States increases the opportunity for human service professionals to work with individuals with different cultural origins. The beliefs and values that these individuals have are greatly influenced by their culture; this means that many clients/patients may have different meanings and traditions for the end of life and its care.

The following case gives you an opportunity to think about cross-cultural issues that case managers may face when working with end-of-life care. Utilize your chapters 3 and four readings to complete this assignment. Part One: Read the first part of Wilma’s case and then answer questions 1-3.

Wilma Martinez, a 67-year-old Spanish-speaking woman, has congestive heart failure due to inoperable coronary artery disease. She has been hospitalized three times during the past six months, even though she has reliably taken five medications daily. She seems distressed when her physician discusses advance directives and encourages her to designate a health care proxy. She says she wants “everything” done to help her survive. The patient’s daughter usually accompanies her to clinic appointments and serves as translator. A few months after the discussion about advance directives, the physician asks more specifically about Mrs. Martinez’s preferences of end-of-life care. This time, Mrs. Martinez’s daughter expresses a strong desire that her mother not receive mechanical ventilation or cardiopulmonary resuscitation. It is unclear whether this represents a change in the patient’s preferences or reflects the daughter’s wishes.

The physician comes to you as the case manager for Mrs. Martinez to ask several questions. Respond as best as you can. Part Two: Read the second part of Wilma’s case and then answer question 4 (This is a 2-part question).

Wilma Martinez, a client introduced in Part One, moved from El Salvador to the United States to live with her daughter. Mrs. Martinez speaks only Spanish. Through her daughter’s translations, the patient appears to comprehend details of her illness and treatment. When asked if she understands what the doctor is saying, she invariably nods affirmatively. During a clinic visit when the patient’s daughter is not present, the physician arranges for a trained medical interpreter to be present. When the physician discusses end-of-life preferences, the interpreter reports that Mrs. Martinez thought that ventilator support and cardiopulmonary resuscitation would hasten her death. Later, the interpreter explains that Mrs. Martinez could not understand why staff were insistent that she, rather than her daughter, make decisions. Mrs. Martinez stated, “In my country, the family decides.” Assuming that her daughter would make decisions for her, she saw no reason to sign forms. She worried that signing forms would cause legal problems because of her immigration status.

The interpreter also suggests that Mrs. Martinez’s nodding indicates politeness and respect for the physician, not assent. The physician arranges for a trained interpreter to be present at subsequent clinic visits. By probing—for example, asking, “Tell me what you believe is going on in your illness”—the physician ascertains that Mrs. Martinez does not expect to survive her illness. By asking, “How would you like decisions to be made about your medical care?” the physician confirms that Mrs. Martinez wants her daughter to make decisions for her. Rather than assuming that Mrs. Martinez’s nods signify assent, the physician asks her specifically whether she has any questions or disagreements with the care plan.

Paper For Above Instructions

The case of Wilma Martinez exemplifies the complex interplay of culture, language, and healthcare decision-making, particularly in the context of end-of-life care. Understanding Mrs. Martinez's wishes requires a careful examination of her cultural background, family dynamics, and the implications of her communication style. As a 67-year-old Spanish-speaking woman, Mrs. Martinez brings specific cultural values that shape her views on health and family roles in decision-making. Her preferences for end-of-life care, as expressed through her statements and her daughter's responses, paint a picture of her desire for life-preserving interventions, despite the discussions around advance directives.

1. Mrs. Martinez's wishes center around receiving aggressive medical treatments to prolong her life. She articulates a desire for “everything” to be done for her in terms of medical interventions. This reflects a common cultural value where life is highly valued, and there is often resistance to discussions about death or limitations in care. The fact that she becomes distressed when advance directives are mentioned indicates a struggle between her cultural beliefs and the medical system’s emphasis on autonomy and informed consent.

However, an important nuance emerges when interpreting her daughter's later expression of desire for no mechanical ventilation or cardiopulmonary resuscitation. This raises the question of whether Mrs. Martinez's preferences have changed, or if her daughter is advocating based on her understanding of her mother's best interests. It is essential to investigate whether Mrs. Martinez is truly aware and in agreement with her daughter's wishes, providing an opening for further dialogue and clarification.

2. The daughter’s response could be influenced by her understanding of both her mother's condition and the cultural shift that occurs when individuals migrate. In many Hispanic cultures, family plays a crucial role in medical decisions; thus, the daughter may feel responsible for advocating for her mother's wellbeing. Additionally, her desire to limit aggressive treatments might reflect an understanding of the quality of life implications inherent in Mrs. Martinez's medical prognosis. This context highlights the daughter's potential conflict between respect for her mother's wishes and her interpretations of what her mother truly desires based on her own experiences and beliefs.

3. Several cultural considerations must be explored in this case. Firstly, the belief systems and values of the family significantly shape their perceptions of healthcare. In many Latin American cultures, there is a strong emphasis on family involvement in medical decisions. The notion that "the family decides" is prevalent; hence, the daughter’s role as a translator can introduce complexities around communication and understanding consent. Language barriers compound this issue by adding layers to Mrs. Martinez's comprehension of her medical choices. Notably, assumptions about nodding as an affirmative response can mislead healthcare providers about patient understanding or agreement.

Furthermore, cultural norms around end-of-life care differ widely and can impact how patients feel about discussions of death, medical interventions, and autonomy. For instance, Mrs. Martinez's concern that signing forms might lead to legal complications owing to her immigration status showcases the intersecting issues of cultural identity, legal status, and healthcare access. Exploring these dynamics with cultural competence allows professionals to navigate the sensitive terrain of end-of-life decisions effectively.

4. As society diversifies, human services professionals will encounter more clients facing end-of-life decisions influenced by cultural factors. Ethical, legal, and clinical dimensions become paramount in appropriately supporting these individuals. Ethically, practitioners must balance respect for cultural values while advocating for patient autonomy. This requires sensitivity and vigilance to ensure that clients do not feel coerced into decisions that negate their cultural beliefs.

Legally, understanding patients' rights and the implications of advance directives in various cultural contexts is critical. Clinicians must navigate laws concerning healthcare proxies and informed consent while being attuned to cultural norms. Clinically, involving skilled interpreters to facilitate accurate communication and understanding ensures that clients are making informed choices about their care.

My personal values shape my view on end-of-life decisions. I believe in the importance of autonomy and informed consent but also recognize that cultural traditions may dictate a collective decision-making process within families. This duality may impact my ability to assist clients as I strive to respect their cultural beliefs while advocating for their individual rights. Awareness of my biases can help me provide compassionate and culturally sensitive care, acknowledging that each patient's story is unique.

References

• Alvarez, V. (2019). Cultural Competency in End-of-Life Care. Journal of Healthcare Management, 64(5), 321-336.
• American Association of Colleges of Nursing. (2017). The Essentials of Baccalaureate Education for Professional Nursing Practice. Retrieved from www.aacnnursing.org
• Baxter, B. (2020). Ethics in End-of-Life Care: A Cultural Perspective. Health Affairs, 39(3), 450-456.
• Cruz, I., & Silva, A. (2018). Family Dynamics and Decision-Making in Healthcare among Hispanic Families. Social Work in Health Care, 57(8), 634-650.
• Fitzgerald, D. (2021). Adapting End-of-Life Care to Diverse Populations: Challenges and Recommendations. Journal of Social Work, 12(4), 455-477.
• Gonzalez, M. (2019). Cultural Beliefs and Practices in End-of-Life Decision Making. Journal of Palliative Medicine, 22(1), 42-48.
• Jones, A. R., & Williams, H. (2022). Understanding Patient Autonomy in Multicultural Contexts. Bioethics Quarterly, 35(1), 5-19.
• Smith, L. (2020). The Role of Communication in Patient Decision-Making. American Journal of Psychology, 133(2), 150-162.
• Thomas, G. (2019). Legal Aspects of End-of-Life Decisions: A Guide for Clinicians. Journal of Medical Ethics, 45(6), 367-373.
• Wilson, T., & Martinez, S. (2021). Family Involvement in Healthcare Decision-Making: Cultural Insights and Implications. Health Care for Women International, 42(12), 1320-1340.