NR 222 Week 4 Cultural Assessment Paper Example

Cultural Assessment: One Ethiopian Orthodox Household, Two Fast Days a Week and a Grandfather on Insulin, Asked Rather Than Assumed

Student Name

College of Nursing, Chamberlain University

NR 222: Health and Wellness

Instructor Name

Month Day, Year

Cultural Assessment: One Ethiopian Orthodox Household, Two Fast Days a Week and a Grandfather on Insulin, Asked Rather Than Assumed

Locating the Household

This assessment describes one household, not a community. The Tesfaye family, whose names and some details have been changed, lives in a two-bedroom apartment in Minneapolis. Ato Bekele, 72, the grandfather, came to the United States eleven years ago; he speaks Amharic and a little English. He has type 2 diabetes treated with insulin glargine at bedtime and glipizide in the morning. His son Dawit, 44, is a hospital parking supervisor; Dawit's wife, Selam, 40, is a home health aide; their daughters are 14 and 9. Everyone except Ato Bekele is fluent in English.

The assessment was carried out over two home visits, in English with Dawit and Selam, and in Amharic with Ato Bekele through a professional telephone interpreter. In the model set out by Campinha-Bacote (2002), competence is something a nurse keeps developing, and one of its parts is the cultural encounter: direct contact with people of a background different from one's own. That encounter is the part this assessment relies on most: what this family told me, rather than what I had read about Ethiopian families before I arrived.

What Is Actually Done

I asked small, answerable questions and wrote down the answers.

Fasting. The family belongs to the Ethiopian Orthodox Tewahedo Church and, as Dawit explained, fasts on Wednesdays and Fridays for most of the year and for a longer period before Easter. On fast days, they eat no meat, dairy or eggs, and Ato Bekele does not eat or drink anything until about 1500. The children eat breakfast on fast days; the adults do not.

Colds and minor illness. Selam makes a tea with ginger, garlic and honey for coughs and colds, and uses it alongside anything the pharmacist recommends.

Holy water. Ato Bekele visits the church for holy water when he feels unwell and drinks it at home; he said it does not replace his medicines.

Decisions. For any serious health decision, Ato Bekele consults Dawit, and Dawit said he would also call his older sister in Seattle. Ato Bekele said the decision is his own but he wants his son to hear the doctor's words.

Language. Serious conversations with Ato Bekele must be in Amharic. His granddaughter sometimes interprets at appointments, which he said he does not like for private matters.

Modesty. Ato Bekele prefers a male clinician for physical examinations and would accept a female one with his son present.

Beliefs, Attributed

Each belief here belongs to the person who said it. Ato Bekele said that fasting is an obligation he will not give up and that God gives strength to those who fast. He also said, "The doctor told me not to fast, but he doesn't understand." Dawit said he worries about his father on fast days but respects his choice. Selam, who works in home health, said she has seen other older adults become confused on fast days and has told her father-in-law to test his sugar at noon, which he sometimes does.

I record these as the family's beliefs and practices. Other Orthodox families, and other members of this one, may fast differently; the assessment does not generalize from them.

How Care Has Gone Before

The family's past experience shapes what they will accept. Ato Bekele said his first doctor in the United States told him to stop fasting and did not ask why he fasted. He stopped telling doctors about it. Dawit said that twice in the past year his father has felt "shaky and sweaty" in the early afternoon on a fast day, and once was found sitting on the floor of the kitchen, confused, by his granddaughter. He recovered after drinking juice. His doctor was not told.

What I Brought With Me

Before the first visit, I had read a short summary of Ethiopian health beliefs and had expected the family to prefer traditional remedies over medicines, to defer entirely to the eldest male, and to be reluctant to discuss illness. Each of those expectations turned out to be partly wrong for this family. Selam uses her ginger tea alongside pharmacy medicines, not instead of them. Ato Bekele said the decisions are his and that he wants his son present, which is different from deferring to him. And the family talked openly about the afternoon episodes once someone asked about them in a way that did not start with telling him to stop fasting.

I record this because it is the most useful thing the assessment taught me about my own practice. A summary of a group's beliefs gave me questions worth asking, but it would have been a poor substitute for the answers. If I had written this assessment from the summary, I would have recommended that the family be counseled against traditional remedies and that decisions go through Dawit, neither of which matches what they told me.

Findings Turned Into Constraints

The findings do not become recommendations that ignore them; they become constraints that any plan must fit.

Fasting will continue. A plan that tells Ato Bekele to stop fasting has already failed with him once. The constraint is to make fasting safer, not to end it. Because he takes glipizide in the morning and does not eat until 1500 on fast days, his risk of low blood sugar is highest in the late morning and early afternoon, which matches the two episodes Dawit described. The recommendation is for his primary care provider, with an Amharic interpreter present, to review his diabetes medicines specifically for fast days, since the choice of medicine and dose on those days is a prescribing decision. Until then, the family agreed that he will test his glucose at 1100 and 1300 on fast days and that Selam will teach him and both granddaughters the signs of low blood sugar and the 15-gram juice treatment, which Ato Bekele said his priest has told him is allowed when a person is ill.

Language and privacy. Future appointments will use a professional Amharic interpreter, not his granddaughter, and Dawit will attend.

Examinations. The clinic will be asked to schedule a male clinician where possible.

The unreported episodes. With Ato Bekele's permission, Dawit will tell the doctor about the two afternoon episodes at the next visit, which the family now understands are the reason for the review.

References

Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13(3), 181-184. https://doi.org/10.1177/10459602013003003