Health Case Studies
Case Study On The Experience Of Health & Illness
Introduction
I will focus on the culture, and the service user 's experience in my essay. The story will explain, and analyse the cultural meanings, in impacts, of a client ' illness, or health condition. There are so many cultures in the United Kingdom, that function differently, and effectively, within their community; People have different values, beliefs, and ideas about nursing. This essay will be drawn from the observation, and interview, which were conducted during my IPE (Inter-Professional Education) Middle Years. Through this interview, I will be explaining what is deemed as normal practice, and will give account of how patients could be affected through their experiences of health and illness.
The patient I would be talking about is 75 years old, female, and is of African descent, from Mozambique. Consent was sought, with the patient agreeing for her personal …show more content…
information to be used for this case study alone; she was assured confidentiality, in accordance with the Nursing and Midwifery (NMC) Code Of Professional Conduct (any information given in a situation where it is normal for the information to be given, that information should remain in confidence (NMC 2009). This patient would be referred to as Mrs Jebbiebbi.
Case Study
Mrs Jebbiebbi was with her daughter and family that consist of her husband (Mrs. Jebbi 's son-in-law) and four children (Mrs Jebbiebbi 's grandchildren who are between the ages of 2 and 10 years old); her daughter is a successful fashion designer, with a company that she had set up herself, and is doing well. One day, Mrs Jebbiebbi heard a scream, and on reaching the room where it was coming from, found her daughter on the floor causing her to call the ambulance; unfortunately, her daughter died before the ambulanced arrived. Mrs Jebbiebbi was left to take care of her grandchildren as her son-in-law did not accept any responsibilities, was a drunk, and was promiscuous. She was unfamiliar with her daughter 's business dealings, and had no idea as to how to move forward; the business was subsequently sold off.
Mrs Jebbi has remained heartbroken, and unable to get over her daughter 's death.
History Of Healthcare Need
Mrs Jebbi was admitted into the hospital, due to a cerebrovascular accident, a stroke, which occurs when the blood circulation to a part of the brain is cut off; the circulation is cut off, because of a dislodged blood clot, or a ruptured blood vessel, causing a rapid loss of brain function, and the brain tissues to die (Marieb 2009). The motor area of Mrs Jebbi 's right cerebral hemisphere that controls the left side of her body has been damaged by the occurrence of a stroke; she has weakness on the left side of her face and arm, has difficulties in moving her lips, causing her to now speak with slurred speech. Also, Mrs Jebbi had language barriers, and needed an interpreter to overcome this barrier. According to Cullet and Dyson (2010), “one in seven people from ethnic minorities faces language barriers in accessing public services”. Language needs should be identified as a key driver of social exclusion, and it is recognised as a major obstacle in the effective delivery of healthcare. Mrs Jebbi went from being the sole carer of her grandchildren to being the one being cared for, and depending on nurses to accomplish everyday activities like; eating, washing, and getting dressed.
"Every year an estimated 150,000 people in the UK have a stroke. That 's one person every five minutes. Most people affected are over 65, but anyone can have a stroke, including children and even babies." Http://www.stroke.org.uk/about-stroke (The Stroke Association 2009). A stroke can cause severe disabilities. Mrs Jebbi is diabetic, and being a type II diabetic, needs insulin administration ["type II diabetes occurs when the body doesn 't produce enough insulin to function properly, or the body’s cells don 't react to insulin. This is known as insulin resistance." http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Introduction.aspx]. She is putting on weight, which is not good because of her diabetes, which runs in the family. Her weight, and blood sugar, are being monitored, to avoid excessive weight gain; her foot is being accessed to ensure good mobility, and to avoid the development of ulcers; her injection skill is being monitored to ensure that she is administering the insulin correctly; and she is monitored to ensure that she is responding to treatment. The diabetic nurse in charge of Mrs Jebbi 's care was certain that she had the adequate diet to avoid the occurrence of pressure ulcers, the nurse advised her to change positions when she is in a spot for a long period of time, and too weak to get up.
Definition of Culture
Culture plays a role in how an individual views the occurrence of an illness, therefore it is very important to understand the different meanings of culture. Helman (2007) defines culture as an inherited lens that a person used to see and grasp the world around then; Giddens et al (2007) defined culture as the values that members of a group hold on to, for example; the language spoken, the symbols they honour, the norms they follow, the beliefs they have, and the expectations they have. Culture is a set if mechanisms for survival, but it provides us also with a definition reality, it is a cycle, into which, we are born. All the definitions stated agree on culture being a set of guidelines that individual members of the particular society inherits and pass on from generation to generation. All the writers agree that culture arises from human beings living together and that it is learned. Narayan (2003) stated that there are numerous cultural groups that believe that we have no power over health, and that it is only God, date and destiny that decides.
Findings
The factors that influence the understanding, and interpretation, of the health, illness, and treatment of Mrs Jebbi were gathered from the IPE interview with the patient, her relative, and son-in-law; information gathered from healthcare professionals (who are involved in Mrs Jebbi 's care giving, these include the doctors, nurses, occupational therapists), observation made whilst in the practice, through reading, and conducting research.
It was empirical that I took permission from the nurse in charge of the ward, and gained the patient 's consent, before embarking on the interview. The interview was conducted using open-ended questions so I could gain an insight into, and understand, her culture, in regards to her health. I made sure that all the information gathered from her were recorded, as she explained, in the IPE booklet to avoid any loss of information. I asked Mrs Jebbi, during the interview, what she thought was the cause of all that had happened to her since she 'd arrived in the U.K to which she responded. She expressed strong feelings towards a certain group of people within her family that always put her down, and told her that she would amount to nothing; she also stated that these people were shocked, and somewhat disappointed, when her, now deceased, daughter became successful, independent, and wealthy, saying "tell me why these people will not go on a witch hunt, try to scatter the good God has done, and try to cause bad luck". Mrs Jebbi was grateful to the healthcare professionals, for their empathy, and 'therapeutic ' relationship with her stating that people at home, outside the hospital, would not show her so much devotion and care, because of her disabled state.
There was a language barrier between Mrs Jebbi and I, because her speech was slurred, and it was hard for her to communicate with me effectively. On the ward, she was known to be a difficult patient, because, being much older, she looked upon the healthcare professional as 'children ', and in her culture, younger people are supposed to 'take instructions from the elderly, and not the other way round '. She preferred to eat 'tasty ' food brought from her home (food which contained a high amount of calories, fat, and salt), rather than the food served at the hospital which was ideal for her diet; it is Mrs Jebbi 's responsibility to cooperate, seek and accept medical help, in order to get well, it is still the nurses ' duties to continue to remind her that her illness is serious, and consuming a balances diet, low in calories, fat, and salt, would help to speed her recovery. Mrs Jebbi is required to cooperate with the healthcare professionals in order to recover.
Theory & Literature Comparison
Mrs Jebbi is of the notion that some people in her family are witch hunting her (as they believe in witch hunting, and forest monsters (The African guide (2011) , also ‘casting bad luck spells ' on her. It is the duty of the healthcare provider to assess the healthcare needs of a patient, and cause fulfilment, by way of acknowledging their cultural needs. According to Winkleman (2008) “culture affects behaviour that exposes us to diseases, and the reason prompting us to seek care” Mrs Jebbi needs to be well informed, and be made to understand that her illness is not due to witchcraft, or spells, this needs to be done effectively, with clear communication. In addressing Mrs Jebbi 's cultural needs, the nurse gave her a clear explanation of her illness, making her understand that witchcraft did not play a part. Mrs Jebbi is unfamiliar with medical terminologies, and this nurse took this into consideration whilst her condition, and treatments, were being explained; this is because a nurse interacts with different people of different cultures, understanding that people interpret information differently. The nurse should ensure that the patient fully understands the information that has been relayed to them by asking them to repeat what was said, in their own words, (Lancaster 1999); it is the duty of the nurse to establish the patient 's cultural understanding of their illness, values, and practices, in order to deliver care that is culturally competent (Narayan 2003).
Before the interview commenced, the patient was asked how she would like to be addressed, to which she replied "you can call me Mrs Jebbi"; her request was respected, and she was addressed as such, throughout the interview. It was explained to Mrs Jebbi that though it was her preference to eat her culturally specific meals, her diabetes did not allow for that, neither did her dysphasia (resulting from the weakening of the muscles on the left side of her mouth); the nurse recommended she ate the hospital meals which met her cultural needs, as well as health needs. It is apparent that Mrs Jebbi is not fully aware of her health needs, especially her needs as a diabetic, it is important that she, and her family, receive appropriate education on the importance of eating a carbohydrate controlled diet in order to maintain a healthy blood glucose level, and avoid the onset of hyperglycaemia (a spike in the blood glucose level).
Mrs Jebbi was encouraged to always eat meals consisting of soft textured foods, because of her problems with swallowing. If she is adamant on eating her culturally specific meals, the, then the nurse can speak with her home caregiver (such as a relative), advising them to provide home made food low in calories, salt, and saturated fats, generally, foods that will not increase the risk of another stroke; not only do nurses need to be sensitive to patients ' preferences by respecting their desires, they also have to gain an understanding as to why patients follow certain, health promoting, practices, and do not follow, set out, treatment plans (Lancaster 1999). Mrs Jebbi requested that her pastor visit, and pray, for her whilst she was on the ward, she asked the nurse if she could undergo a religious fast whilst in the hospital, with the nurse explaining that it was difficult as she is on medication, and her insulin absorption would be affected. On hearing the nurse 's response, Mrs Jebbi retorted with "man shall not live by bread alone, Jesus fasted for 40 days and yet He lived, I can manage 1 or 2 days!"; according to Galanti (2004) religion plays a big role in the lives of many African people, and this role is exacerbated when they are ill. Because it is apparent that Mrs Jebbi has strong cultural beliefs, mainly religious, the healthcare professionals can hold a meeting, for the sole purpose of addressing these beliefs, and how to meet her needs in accordance to her beliefs. As Mrs Jebbi requested a visit from her pastor, her relatives were contacted, and asked to invite him to visit her. The pastor 's contact details were also imputed into her records so they could call him in future, if the need arose; the nurse indicated that the pastor would be asked, for the purpose of cooperation, to explain to Mrs Jebbi the need to eat, and not go on a fast, because of her health, and that he would be asked to assure her that God was using them to heal her. No matter how a nurse feels, or what they believe, their cultural norms are not to be forced on to a patient, and should, instead, adjust the care they give to meet the cultural needs of the patient (Narayan 2003); as Mrs Jebbi is very religious, she should be given the room to peacefully exert her beliefs, with understanding, as her care is priority.
Mrs Jebbi also expressed her loneliness, and made mention of the fact that she 'd been thinking of her 'dead daughter '; she also said that she missed her grandchildren, because they hardly visited, and other relatives were 'scarce ', because of work, and the travelling distance between the hospital and their home. According to Taylor (2006), patients who have survived a stroke can find it difficult to form, or maintain, social relationships, because of the potential problem of communicating effectively (caused by the weakness of the muscles on one side of the face, causing a disfigured appearance); this disfigured appearance can cause a social stigma where the patient is rejected, or avoided. Mrs Jebbi could be feeling lonely, because she is somewhat ashamed of her appearance, and discourages visits from family and friends, so as not to be rejected, or avoided. The cultural needs of Mrs Jebbi are apparent, as she is used to being in a socially lovely environment, surrounded by her extended family, she needs to interact with more people socially. This is however a problem, because she is avoiding social situations, for fear of being stigmatised. Mrs Jebbi made it clear that she was happy to be 'holed up ' in the hospital, because 'no one gets to see ' her 'in that 'hideous ' condition, indicating that she was avoiding any possibilities of being socially rejected; Giddens et al (2007) seem to corroborate her feelings by stating that when an illness is deemed as an embarrassment, the patient would be excluded from the rest of the population, because stigmas are based, not on correct perceptions, but from incorrect assumptions, by people. Mrs Jebbi can be encouraged to socialise with other patients in the communal area (day room), so she doesn 't feel lonely; a visit from her friends, and acquaintances from church could also be arranged so as to give her some, much needed, emotional support. The recovery process could be sped up when a patient socialises, because socialising alleviates psychological distress (for example, depression) Taylor (2006).
Conclusion
The process of caring for a patient should not be taken lightly, as learned from my interview and observation. Nurses need to have satisfactory knowledge of every individual from different backgrounds, with different views, and cultures, to give care that is culturally acceptable; without this knowledge a nurse will exert her own beliefs on patients, which is a practice that is unacceptable. A nurse is obligated to respect, and not judge, the religious beliefs of a patient, no matter how unusual it may seem, otherwise conflicts and confrontation would arise Jones (2007). When a nurse is aware of a patient 's cultural needs, and expectations, an excellent level of care will be given to that patient; understanding a patient 's cultural need is understanding that every individual is different, so are their needs, therefore providing 'tailor made ' care will enhance each patient 's experience. Mrs Jebbi 's norms, cultural beliefs, and values have caused me to be more aware of how I perceive situations, my own beliefs, and how to work with other individuals, understanding their beliefs, not imposing mine. In order to provide the best care, it is important that I am more sensitive to how big a role culture, beliefs, and values, play in the healthcare experience of a patient.
Interview With Mrs Jebbi
Student - Good morning *I mentioned my name, and introduced myself*
Mrs J - *in response to my greeting, introduced herself as well*
Student - I asked for consent to interview you this morning
Mrs J - I accept, and give you permission
Student - why are you within this healthcare setting?
Mrs J - after the death of my daughter, I was never the same. I then had a stroke, which resulted in so many complications, I couldn 't move my lips and my speech was slurred. I also don 't have any close relatives who can take care of me if I do get discharged.
Student - how old are you, please?
Mrs J - I am 75 years old
Student - where were you born?
Mrs J - I was born in Chinde, Mozambique
Student - what is your ethnicity?
Mrs J - I am African, from Mozambique
Student - please tell me about our educational background
Mrs J - I went to primary school in my country
Student - where did you live before coming into this facility?
Mrs J - I lived in Tower
Hamlets
Student - did you work at any place?
Mrs J - when I was back home, I has a farmland, where I worked really hard, I was good at farming. Then I came here, and all the work I did was in the house, with the children.
Student - what is your marital status?
Mrs J - I am a widow, my husband passed from diabetes.
Student - I know you, previously, mentioned the passing of your daughter, do you have any other children?
Mrs J - yes I do. I have three sons, and two daughters who are alive, and are back home.
Student - I would like to know about your family background
Mrs J - my parents were farmers, God rest their souls. My parents had eight children, I have four sisters, and three brothers. We all grew up in Mozambique, and are all successful farmers, taking over from our parents.
Student - what two examples of cultural issues do you have?
Mrs J - my nutrition does not correspond with this healthcare setting. I am no longer allowed to eat he foods I want, which is my tasty native food. My health seems to be deteriorating as well.
Student - what are your experiences with health and illness?
Mrs J - I was very healthy before I came to this country, but now, my health is really failing me, and I am not happy about that
Student - what impact has this experience placed on your life?
Mrs J - I now realise that our lives are in God 's hands, and I thank the NHS staff for all their support and care
Student - what has been the impact of all these experiences on your family?
Mrs J - my children are not happy to hear what is going on with me here, since they know me to be a strong woman
Student - what type of diseases do you think you have?
Mrs J - I had a stroke
Student - how has this affected your body image?
Mrs J - I feel ashamed to be amongst the people that knew me before
Student - the interview is over now, thank you for your patience
Mrs J - thanks for choosing me
References
Browne, K. (2011) Introduction to sociology. 4th edition. Polity press
Culley, L., and Dyson, S., (2010) Ethnicity and healthcare practice. CLE, Huntingdon, Cambridge
Galanti G. (2004) Caring for patients from different culture. 3rd edition. USA: Pennsylvania press
Giddens, E., Duneier, M. and Appelbaum, R. (2007) Introduction to Sociology. 6th Edition. USA: Norton
Helman, C. (2007) Culture, health and illness. 5th Edition. London: Hodder Arnold
Jones, R. (2007) Nursing leadership, and management: Theories, process and practice. USA: F.A Davis
Lancaster, J,. (1999) Nursing issues in leading and managing change. USA: Mosby
Marieb, E. (2009) Essentials of human anatomy and physiology. 9th edition. USA: Pearson Benjamin Cumming.
Narayan, M. (2003) Cultural assessment and care planning. Home healthcare nurse. 21 (9) September: 611-619
Taylor, S. (2006) Health Psychology. 6th Edition. Singapore: McGrew-Hill
Winkleman, M., (2008) Culture and Health, 1st Edition. USA: Jossy Bass Ltd
Internet Resources
http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Introduction.aspx
http://www.stroke.org.uk/about-stroke)
Introduction
I will focus on the culture, and the service user 's experience in my essay. The story will explain, and analyse the cultural meanings, in impacts, of a client ' illness, or health condition. There are so many cultures in the United Kingdom, that function differently, and effectively, within their community; People have different values, beliefs, and ideas about nursing. This essay will be drawn from the observation, and interview, which were conducted during my IPE (Inter-Professional Education) Middle Years. Through this interview, I will be explaining what is deemed as normal practice, and will give account of how patients could be affected through their experiences of health and illness.
The patient I would be talking about is 75 years old, female, and is of African descent, from Mozambique. Consent was sought, with the patient agreeing for her personal …show more content…
information to be used for this case study alone; she was assured confidentiality, in accordance with the Nursing and Midwifery (NMC) Code Of Professional Conduct (any information given in a situation where it is normal for the information to be given, that information should remain in confidence (NMC 2009). This patient would be referred to as Mrs Jebbiebbi.
Case Study
Mrs Jebbiebbi was with her daughter and family that consist of her husband (Mrs. Jebbi 's son-in-law) and four children (Mrs Jebbiebbi 's grandchildren who are between the ages of 2 and 10 years old); her daughter is a successful fashion designer, with a company that she had set up herself, and is doing well. One day, Mrs Jebbiebbi heard a scream, and on reaching the room where it was coming from, found her daughter on the floor causing her to call the ambulance; unfortunately, her daughter died before the ambulanced arrived. Mrs Jebbiebbi was left to take care of her grandchildren as her son-in-law did not accept any responsibilities, was a drunk, and was promiscuous. She was unfamiliar with her daughter 's business dealings, and had no idea as to how to move forward; the business was subsequently sold off.
Mrs Jebbi has remained heartbroken, and unable to get over her daughter 's death.
History Of Healthcare Need
Mrs Jebbi was admitted into the hospital, due to a cerebrovascular accident, a stroke, which occurs when the blood circulation to a part of the brain is cut off; the circulation is cut off, because of a dislodged blood clot, or a ruptured blood vessel, causing a rapid loss of brain function, and the brain tissues to die (Marieb 2009). The motor area of Mrs Jebbi 's right cerebral hemisphere that controls the left side of her body has been damaged by the occurrence of a stroke; she has weakness on the left side of her face and arm, has difficulties in moving her lips, causing her to now speak with slurred speech. Also, Mrs Jebbi had language barriers, and needed an interpreter to overcome this barrier. According to Cullet and Dyson (2010), “one in seven people from ethnic minorities faces language barriers in accessing public services”. Language needs should be identified as a key driver of social exclusion, and it is recognised as a major obstacle in the effective delivery of healthcare. Mrs Jebbi went from being the sole carer of her grandchildren to being the one being cared for, and depending on nurses to accomplish everyday activities like; eating, washing, and getting dressed.
"Every year an estimated 150,000 people in the UK have a stroke. That 's one person every five minutes. Most people affected are over 65, but anyone can have a stroke, including children and even babies." Http://www.stroke.org.uk/about-stroke (The Stroke Association 2009). A stroke can cause severe disabilities. Mrs Jebbi is diabetic, and being a type II diabetic, needs insulin administration ["type II diabetes occurs when the body doesn 't produce enough insulin to function properly, or the body’s cells don 't react to insulin. This is known as insulin resistance." http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Introduction.aspx]. She is putting on weight, which is not good because of her diabetes, which runs in the family. Her weight, and blood sugar, are being monitored, to avoid excessive weight gain; her foot is being accessed to ensure good mobility, and to avoid the development of ulcers; her injection skill is being monitored to ensure that she is administering the insulin correctly; and she is monitored to ensure that she is responding to treatment. The diabetic nurse in charge of Mrs Jebbi 's care was certain that she had the adequate diet to avoid the occurrence of pressure ulcers, the nurse advised her to change positions when she is in a spot for a long period of time, and too weak to get up.
Definition of Culture
Culture plays a role in how an individual views the occurrence of an illness, therefore it is very important to understand the different meanings of culture. Helman (2007) defines culture as an inherited lens that a person used to see and grasp the world around then; Giddens et al (2007) defined culture as the values that members of a group hold on to, for example; the language spoken, the symbols they honour, the norms they follow, the beliefs they have, and the expectations they have. Culture is a set if mechanisms for survival, but it provides us also with a definition reality, it is a cycle, into which, we are born. All the definitions stated agree on culture being a set of guidelines that individual members of the particular society inherits and pass on from generation to generation. All the writers agree that culture arises from human beings living together and that it is learned. Narayan (2003) stated that there are numerous cultural groups that believe that we have no power over health, and that it is only God, date and destiny that decides.
Findings
The factors that influence the understanding, and interpretation, of the health, illness, and treatment of Mrs Jebbi were gathered from the IPE interview with the patient, her relative, and son-in-law; information gathered from healthcare professionals (who are involved in Mrs Jebbi 's care giving, these include the doctors, nurses, occupational therapists), observation made whilst in the practice, through reading, and conducting research.
It was empirical that I took permission from the nurse in charge of the ward, and gained the patient 's consent, before embarking on the interview. The interview was conducted using open-ended questions so I could gain an insight into, and understand, her culture, in regards to her health. I made sure that all the information gathered from her were recorded, as she explained, in the IPE booklet to avoid any loss of information. I asked Mrs Jebbi, during the interview, what she thought was the cause of all that had happened to her since she 'd arrived in the U.K to which she responded. She expressed strong feelings towards a certain group of people within her family that always put her down, and told her that she would amount to nothing; she also stated that these people were shocked, and somewhat disappointed, when her, now deceased, daughter became successful, independent, and wealthy, saying "tell me why these people will not go on a witch hunt, try to scatter the good God has done, and try to cause bad luck". Mrs Jebbi was grateful to the healthcare professionals, for their empathy, and 'therapeutic ' relationship with her stating that people at home, outside the hospital, would not show her so much devotion and care, because of her disabled state.
There was a language barrier between Mrs Jebbi and I, because her speech was slurred, and it was hard for her to communicate with me effectively. On the ward, she was known to be a difficult patient, because, being much older, she looked upon the healthcare professional as 'children ', and in her culture, younger people are supposed to 'take instructions from the elderly, and not the other way round '. She preferred to eat 'tasty ' food brought from her home (food which contained a high amount of calories, fat, and salt), rather than the food served at the hospital which was ideal for her diet; it is Mrs Jebbi 's responsibility to cooperate, seek and accept medical help, in order to get well, it is still the nurses ' duties to continue to remind her that her illness is serious, and consuming a balances diet, low in calories, fat, and salt, would help to speed her recovery. Mrs Jebbi is required to cooperate with the healthcare professionals in order to recover.
Theory & Literature Comparison
Mrs Jebbi is of the notion that some people in her family are witch hunting her (as they believe in witch hunting, and forest monsters (The African guide (2011) , also ‘casting bad luck spells ' on her. It is the duty of the healthcare provider to assess the healthcare needs of a patient, and cause fulfilment, by way of acknowledging their cultural needs. According to Winkleman (2008) “culture affects behaviour that exposes us to diseases, and the reason prompting us to seek care” Mrs Jebbi needs to be well informed, and be made to understand that her illness is not due to witchcraft, or spells, this needs to be done effectively, with clear communication. In addressing Mrs Jebbi 's cultural needs, the nurse gave her a clear explanation of her illness, making her understand that witchcraft did not play a part. Mrs Jebbi is unfamiliar with medical terminologies, and this nurse took this into consideration whilst her condition, and treatments, were being explained; this is because a nurse interacts with different people of different cultures, understanding that people interpret information differently. The nurse should ensure that the patient fully understands the information that has been relayed to them by asking them to repeat what was said, in their own words, (Lancaster 1999); it is the duty of the nurse to establish the patient 's cultural understanding of their illness, values, and practices, in order to deliver care that is culturally competent (Narayan 2003).
Before the interview commenced, the patient was asked how she would like to be addressed, to which she replied "you can call me Mrs Jebbi"; her request was respected, and she was addressed as such, throughout the interview. It was explained to Mrs Jebbi that though it was her preference to eat her culturally specific meals, her diabetes did not allow for that, neither did her dysphasia (resulting from the weakening of the muscles on the left side of her mouth); the nurse recommended she ate the hospital meals which met her cultural needs, as well as health needs. It is apparent that Mrs Jebbi is not fully aware of her health needs, especially her needs as a diabetic, it is important that she, and her family, receive appropriate education on the importance of eating a carbohydrate controlled diet in order to maintain a healthy blood glucose level, and avoid the onset of hyperglycaemia (a spike in the blood glucose level).
Mrs Jebbi was encouraged to always eat meals consisting of soft textured foods, because of her problems with swallowing. If she is adamant on eating her culturally specific meals, the, then the nurse can speak with her home caregiver (such as a relative), advising them to provide home made food low in calories, salt, and saturated fats, generally, foods that will not increase the risk of another stroke; not only do nurses need to be sensitive to patients ' preferences by respecting their desires, they also have to gain an understanding as to why patients follow certain, health promoting, practices, and do not follow, set out, treatment plans (Lancaster 1999). Mrs Jebbi requested that her pastor visit, and pray, for her whilst she was on the ward, she asked the nurse if she could undergo a religious fast whilst in the hospital, with the nurse explaining that it was difficult as she is on medication, and her insulin absorption would be affected. On hearing the nurse 's response, Mrs Jebbi retorted with "man shall not live by bread alone, Jesus fasted for 40 days and yet He lived, I can manage 1 or 2 days!"; according to Galanti (2004) religion plays a big role in the lives of many African people, and this role is exacerbated when they are ill. Because it is apparent that Mrs Jebbi has strong cultural beliefs, mainly religious, the healthcare professionals can hold a meeting, for the sole purpose of addressing these beliefs, and how to meet her needs in accordance to her beliefs. As Mrs Jebbi requested a visit from her pastor, her relatives were contacted, and asked to invite him to visit her. The pastor 's contact details were also imputed into her records so they could call him in future, if the need arose; the nurse indicated that the pastor would be asked, for the purpose of cooperation, to explain to Mrs Jebbi the need to eat, and not go on a fast, because of her health, and that he would be asked to assure her that God was using them to heal her. No matter how a nurse feels, or what they believe, their cultural norms are not to be forced on to a patient, and should, instead, adjust the care they give to meet the cultural needs of the patient (Narayan 2003); as Mrs Jebbi is very religious, she should be given the room to peacefully exert her beliefs, with understanding, as her care is priority.
Mrs Jebbi also expressed her loneliness, and made mention of the fact that she 'd been thinking of her 'dead daughter '; she also said that she missed her grandchildren, because they hardly visited, and other relatives were 'scarce ', because of work, and the travelling distance between the hospital and their home. According to Taylor (2006), patients who have survived a stroke can find it difficult to form, or maintain, social relationships, because of the potential problem of communicating effectively (caused by the weakness of the muscles on one side of the face, causing a disfigured appearance); this disfigured appearance can cause a social stigma where the patient is rejected, or avoided. Mrs Jebbi could be feeling lonely, because she is somewhat ashamed of her appearance, and discourages visits from family and friends, so as not to be rejected, or avoided. The cultural needs of Mrs Jebbi are apparent, as she is used to being in a socially lovely environment, surrounded by her extended family, she needs to interact with more people socially. This is however a problem, because she is avoiding social situations, for fear of being stigmatised. Mrs Jebbi made it clear that she was happy to be 'holed up ' in the hospital, because 'no one gets to see ' her 'in that 'hideous ' condition, indicating that she was avoiding any possibilities of being socially rejected; Giddens et al (2007) seem to corroborate her feelings by stating that when an illness is deemed as an embarrassment, the patient would be excluded from the rest of the population, because stigmas are based, not on correct perceptions, but from incorrect assumptions, by people. Mrs Jebbi can be encouraged to socialise with other patients in the communal area (day room), so she doesn 't feel lonely; a visit from her friends, and acquaintances from church could also be arranged so as to give her some, much needed, emotional support. The recovery process could be sped up when a patient socialises, because socialising alleviates psychological distress (for example, depression) Taylor (2006).
Conclusion
The process of caring for a patient should not be taken lightly, as learned from my interview and observation. Nurses need to have satisfactory knowledge of every individual from different backgrounds, with different views, and cultures, to give care that is culturally acceptable; without this knowledge a nurse will exert her own beliefs on patients, which is a practice that is unacceptable. A nurse is obligated to respect, and not judge, the religious beliefs of a patient, no matter how unusual it may seem, otherwise conflicts and confrontation would arise Jones (2007). When a nurse is aware of a patient 's cultural needs, and expectations, an excellent level of care will be given to that patient; understanding a patient 's cultural need is understanding that every individual is different, so are their needs, therefore providing 'tailor made ' care will enhance each patient 's experience. Mrs Jebbi 's norms, cultural beliefs, and values have caused me to be more aware of how I perceive situations, my own beliefs, and how to work with other individuals, understanding their beliefs, not imposing mine. In order to provide the best care, it is important that I am more sensitive to how big a role culture, beliefs, and values, play in the healthcare experience of a patient.
Interview With Mrs Jebbi
Student - Good morning *I mentioned my name, and introduced myself*
Mrs J - *in response to my greeting, introduced herself as well*
Student - I asked for consent to interview you this morning
Mrs J - I accept, and give you permission
Student - why are you within this healthcare setting?
Mrs J - after the death of my daughter, I was never the same. I then had a stroke, which resulted in so many complications, I couldn 't move my lips and my speech was slurred. I also don 't have any close relatives who can take care of me if I do get discharged.
Student - how old are you, please?
Mrs J - I am 75 years old
Student - where were you born?
Mrs J - I was born in Chinde, Mozambique
Student - what is your ethnicity?
Mrs J - I am African, from Mozambique
Student - please tell me about our educational background
Mrs J - I went to primary school in my country
Student - where did you live before coming into this facility?
Mrs J - I lived in Tower
Hamlets
Student - did you work at any place?
Mrs J - when I was back home, I has a farmland, where I worked really hard, I was good at farming. Then I came here, and all the work I did was in the house, with the children.
Student - what is your marital status?
Mrs J - I am a widow, my husband passed from diabetes.
Student - I know you, previously, mentioned the passing of your daughter, do you have any other children?
Mrs J - yes I do. I have three sons, and two daughters who are alive, and are back home.
Student - I would like to know about your family background
Mrs J - my parents were farmers, God rest their souls. My parents had eight children, I have four sisters, and three brothers. We all grew up in Mozambique, and are all successful farmers, taking over from our parents.
Student - what two examples of cultural issues do you have?
Mrs J - my nutrition does not correspond with this healthcare setting. I am no longer allowed to eat he foods I want, which is my tasty native food. My health seems to be deteriorating as well.
Student - what are your experiences with health and illness?
Mrs J - I was very healthy before I came to this country, but now, my health is really failing me, and I am not happy about that
Student - what impact has this experience placed on your life?
Mrs J - I now realise that our lives are in God 's hands, and I thank the NHS staff for all their support and care
Student - what has been the impact of all these experiences on your family?
Mrs J - my children are not happy to hear what is going on with me here, since they know me to be a strong woman
Student - what type of diseases do you think you have?
Mrs J - I had a stroke
Student - how has this affected your body image?
Mrs J - I feel ashamed to be amongst the people that knew me before
Student - the interview is over now, thank you for your patience
Mrs J - thanks for choosing me
References
Browne, K. (2011) Introduction to sociology. 4th edition. Polity press
Culley, L., and Dyson, S., (2010) Ethnicity and healthcare practice. CLE, Huntingdon, Cambridge
Galanti G. (2004) Caring for patients from different culture. 3rd edition. USA: Pennsylvania press
Giddens, E., Duneier, M. and Appelbaum, R. (2007) Introduction to Sociology. 6th Edition. USA: Norton
Helman, C. (2007) Culture, health and illness. 5th Edition. London: Hodder Arnold
Jones, R. (2007) Nursing leadership, and management: Theories, process and practice. USA: F.A Davis
Lancaster, J,. (1999) Nursing issues in leading and managing change. USA: Mosby
Marieb, E. (2009) Essentials of human anatomy and physiology. 9th edition. USA: Pearson Benjamin Cumming.
Narayan, M. (2003) Cultural assessment and care planning. Home healthcare nurse. 21 (9) September: 611-619
Taylor, S. (2006) Health Psychology. 6th Edition. Singapore: McGrew-Hill
Winkleman, M., (2008) Culture and Health, 1st Edition. USA: Jossy Bass Ltd
Internet Resources
http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Introduction.aspx
http://www.stroke.org.uk/about-stroke)