What are your thoughts on the nurse’s reaction about Ana that “she doesn’t seem to really care about her baby”?

As healthcare practitioners, you will be seeing patients from
diverse backgrounds and you need to demonstrate respect for a patient’s
diversity keeping in mind your own biases about race, gender, religion, and
economic status. This is called culturally competent care. This has
become even more critical in the sensitive
world in which we are currently living!
This
assignment is an affective (behavior) competency you need to pass as mentioned
in the student learning objectives on syllabus. It is a fictional case study
with some controversial issues that you will run into in your daily lives as a
healthcare professional. Be assured your responses will be kept confidential,
read and graded only by me and Sue. The learning outcome of this assignment is
to help you understand your own biases and also to develop an open-minded
attitude while interacting or treating your patients. This skill comes
eventually and also with years of experience. This assignment and many more in
the MA program are the starting point to develop this skill.
PS: The case study has been adopted from Markkula Center of
Applied Ethics at Santa Clara University. Following
the case study, there are perspectives and reflections provided. We want to
know what you think, not someone else, so please do not read these
perspectives/reflections and then copy/paste or paraphrase and use them in your
responses. If that happens, you will be given a failing grade for this
assignment.
Hence, read the case study and the associated questions
thoroughly and answer them to the best of your knowledge and abilities. If you use any other source(s), you are required
to cite the source(s) at the end of your paper on a separate page with
“Works Cited” written at the top – 25 points total
There
are five questions on the case study. Each question is worth 3 points. The
responses should be thorough, answer all parts of each question, and be no less
than 1-2 paragraphs (5-7 lines for each paragraph) to earn full credit. – 15 points
Sue
will grade for grammar, vocabulary, spelling, mechanics, citations- 10 points.

Difficult
Birth: Navigating Language and Cultural differences

(Case Study Resource:
Markkula Center for Applied Ethics at Santa Clara University)
Following the case study on the website, there
are perspectives and reflections provided. We want to know what you think, not
someone else, so please do not read these perspectives/reflections and then
copy/paste or paraphrase and use them in your responses. If that happens,
you will be given a failing grade for this assignment.

Read the case study below and answer the five questions that follow
it.
Ana
Lopez is 17 years old and works in the U.S. as a farm laborer. Ana speaks no
English and very little Spanish; she is an immigrant from Oaxaca, Mexico, and
her primary language is Mixteco. She is illiterate. Roughly estimated to be 36
weeks pregnant, she is admitted through the emergency room to East Valley
Hospital with cramping and vaginal bleeding. Upon examination, placental
abruption is diagnosed, and the medical team recommends a Cesarean section. Ana
is also discovered to be severely anemic. Toward the start of these exams, a
nurse offers Ana ice chips (a normal procedure for laboring women), which Ana
quietly refuses. Although the medical team considers Ana’s C-section to be an
emergency measure (thus not requiring explicit consent), the hospital staff
nevertheless do attempt to obtain Ana’s consent before the surgery; she replies
“yes” to all questions and appears to acquiesce ( to everything the
medical team suggests. However, since no one on staff speaks Mixteco, they cannot
be sure that Ana fully understands her (or her child’s) situation. After the
C-section, the baby boy’s APGAR scores, which measure the vital signs of a
newborn, are quite low. He is immediately transferred to the neonatal intensive
care unit (NICU) with diagnoses of neonatal encephalopathy, a disease of the
brain, and being small for gestational age (SGA).
Ana
had arrived at the hospital early in the morning with her mother and sister,
neither of whom speaks English or Spanish. She does have a husband, Hugo, but
he was not present at the admission or the time of the birth since he feared
losing his job if he missed work for the day. Hugo eventually arrives at the
hospital later in the afternoon. He speaks no English but is haltingly
conversant in Spanish.
A
social worker, fluent in Spanish but not Mixteco, meets with Ana and Hugo and
discovers (to the best of her abilities) that Ana has no health insurance and
had not been able to obtain any regular prenatal care (which would explain why
her anemia had gone undiagnosed). She had no money even for vitamins, which
(the social worker surmised) Ana may nevertheless have taken intermittently,
when she could obtain them from a mobile health clinic. The social worker
guesses that Ana had worked in the fields right up until the previous day. She
wonders privately about Ana’s exposure to harmful pesticides during her
pregnancy. She is fairly certain that Ana has no legal immigration papers.
Once
Ana is stabilized after the birth she is allowed to go to the NICU to see her
baby. Her husband Hugo remains with her in the NICU, along with a
Spanish-language translator called for by the social worker. Through this
translator, Hugo is able to communicate imperfectly on and off with the medical
team.
Throughout
this process, Ana shows very little emotion, at least publicly, and the nurses
present are bothered by her flat, unemotional affect. The nurse manager of the
NICU in particular wonders (aloud, to her co-workers) why Ana “doesn’t
seem really to care about” her sick baby. Ana’s mother and sister,
meanwhile, speak quietly but urgently with Hugo whenever they get the chance.
Late
that evening, Hugo tentatively interrupts a nurse and asks her (via the
translator) whether the baby might be visited by a “curandero,” a
traditional healer from their community. He suggests (apparently at the
insistence of his mother-in-law) that the baby should be “cleaned with an
egg.” The nurse in charge is clearly uncomfortable with his request (and a
treatment unfamiliar to her) and responds that the baby may be too unstable to
be subjected to any “alternative” treatments. She reminds Hugo,
somewhat sharply, that his baby is very sick but under the care of the best
medical experts. When Ana’s relatives appear chagrinned and distressed by this
response, the nurse’s demeanor softens, and she gently asks them if they have
had anything to eat recently and suggests that they pay a visit to the hospital
cafeteria. Hugo looks at the ground and utters a polite refusal. He does not
repeat the request.
After
three days, Ana herself is discharged from the hospital, though the baby
remains in the NICU. Over the course of the next few weeks, the baby
stabilizes. The extent of brain impairment is unclear and, according to the
medical team, will only make itself known over time. During these few weeks,
Hugo is unable to be present at the hospital much during the day, but Ana is
regularly accompanied by her mother and other family members, who bring food
and sit with her as much as possible. The social worker pays special attention
to Ana and Hugo’s situation, particularly making an effort to get them signed
up with a Medicaid-sponsored program. While ultimately successful, this move
proves challenging, since they initially fear discovery of their undocumented
status. Ana and Hugo eventually are able to take their baby boy home, unsure of
what long-term complications he may encounter.

Answer the following questions:
IMPORTANT: Refer to Case Study
instructions before you start answering. – 25
points total
1) How does
Ana’s socioeconomic status play a role in the health crisis she and her baby
are in? What are the various factors that have landed her in this situation?
What are your thoughts on the interpreter referring Ana to a Medicaid-sponsored
program?- 3
points
2)
Should Ana’s acquiescence (accept something reluctantly without protest) to the
healthcare team’s suggestion of an emergency C-section be considered as her
consent to surgery? Why or why not? How does her cultural background, fear and
socioeconomic status contribute to her acquiescence?- 3 points
3)
Since no one on the healthcare team knew Mixteco, the language that Ana and her
husband spoke, what approach should the healthcare team have taken to make the
family more involved in the treatment plan for Ana and her baby?- 3 points
4)
What are your thoughts on the nurse’s reaction about Ana that
“she doesn’t seem to really care about her baby”? What factors
in Ana’s situation could be responsible for Ana’s stoic behavior? – 3 points
5)
What are your thoughts on how the staff at East Valley Hospital behaved when
Hugo, Ana’s husband, requested to bring a traditional healer to heal their
baby? How would you have tackled this request in a culturally competent
manner?- 3
points
Sue
will grade for grammar, mechanics, spelling, citations, etc. – 10 points

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