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[ANSWERED] Elmer and Mary Miller, both 35 years old, live with their five children in the main house on the family farmstead in one of the largest Amish settlements in Indiana

Complete the following Case Studies:

  • Amish case study
  • Jewish Case study #1

Write a 3-4 page APA essay, using two scholarly sources in addition to the textbook.

AMISH CASE STUDY

Elmer and Mary Miller, both 35 years old, live with their five children in the main house on the family farmstead in one of the largest Amish settlements in Indiana. Aaron and Annie Schlabach, aged 68 and 70, live in the attached grandparents’ cottage. Mary is the youngest of their eight children, and when she married, she and Elmer moved into the grandparents’ cottage with the intention that Elmer would take over the farm when Aaron wanted to retire.

Eight years ago, they traded living space. Now, Aaron continues to help with the farm work, despite increasing pain in his hip, which the doctor advises should be replaced. Most of Mary’s and Elmer’s siblings live in the area, though not in the same church district or settlement. Two of Elmer’s brothers and their families recently moved to Tennessee, where farms are less expensive and where they are helping to start a new church district.

Mary and Elmer’s fifth child, Melvin, was born 6 weeks prematurely and is 1 month old. Sarah, aged 13, Martin, aged 12, and Wayne, aged 8, attend the Amish elementary school located 1 mile from their home. Lucille, aged 4, is staying with Mary’s sister and her family for a week because baby Melvin has been having respiratory problems and their physician told the family he will need to be hospitalized if he does not get better within 2 days.

At the doctor’s office, Mary suggested to one nurse, who often talks with Mary about “Amish ways,” that Menno Martin, an Amish man who “gives treatments,” may be able to help. He uses “warm hands” to treat people and is especially good with babies because he can feel what is wrong. The nurse noticed that Mary carefully placed the baby on a pillow as she prepared to leave.

Elmer and Mary do not carry any health insurance and are concerned about paying the doctor and hospital bills associated with this complicated pregnancy. In addition, they have an appointment for Wayne to be seen at Riley Children’s Hospital, 3 hours away at the University Medical Center in Indianapolis, for a recurring cyst located behind his left ear. Plans are being made for a driver to take Mary, Elmer, Wayne, Aaron, Annie, and two of Mary’s sisters to Indianapolis for the appointment. Because it is on the way, they plan to stop in Fort Wayne to see an Amish healer who gives nutritional advice and does “treatments.” Aaron, Annie, and Elmer have been there before, and the other women are considering having treatments, too. Many Amish and non-Amish go there and tell others how much better they feel after the treatments.

They know their medical expenses seem minor in comparison to the family who last week lost their barn in a fire and to the young couple whose 10-year-old child had brain surgery after a fall from the hayloft. Elmer gave money to help with the expenses of the child and will go to the barn raising to help rebuild the barn. Mary’s sisters will help to cook for the barn raising, but Mary will not help this time because of the need to care for her newborn.

The state health department is concerned about the low immunization rates in the Amish communities. One community-health nurse, who works in the area where Elmer and Mary live, has volunteered to talk with Elmer, who is on the Amish school board. The nurse wants to learn how the health department can work more closely with the Amish and also learn more about what the people know about immunizations. The county health commissioner thinks this is a waste of time and that what they need to do is let the Amish know that they are creating a health hazard by neglecting or refusing to have their children immunized.

Study Questions 

  1. Develop three open-ended questions or statements to guide you in your understanding of Mary and Elmer and what health and caring mean to them and to the Amish
  2. List four or five areas of perinatal care that you would want to discuss with
  3. Why do you think Mary placed the baby on a pillow as she was leaving the doctor’s office?
  4. If you were the nurse to whom Mrs. Miller confided her interest in taking the baby to the folk healer, what would you do to learn more about their simultaneous use of folk and professional health services?
  5. List three items to discuss with the Millers to prepare them for their consultation at the medical
  6. If you were preparing the reference for consultation, what would you mention about the Millers that would help to promote culturally congruent care at the medical center?
  7. Imagine yourself participating in a meeting with state and local health department officials and several local physicians and nurses to develop a plan to increase the immunization rates in the counties with large Amish populations. What would you suggest as ways to accomplish this goal?
  1. Discuss two reasons why many Old Order Amish choose not to carry health insurance.
  2. Name three health problems with genetic links that are prevalent in some Amish communities.
  3. How might health-care providers use the Amish values of the three-generational family and their visiting patterns in promoting health in the Amish community?
  4. List three Amish values to consider in prenatal education
  5. Develop a nutritional guide for Amish women who are interested in losing

Consider Amish values, daily lifestyle, and food production and preparation patterns.

  1. List three ways in which Amish express

JEWISH CASE STUDY #1

Selecting a “typical” Jewish client is difficult. An ultra-Orthodox Jew has a particular set of special needs. Yet, it is more common to see a Jew who is a middle-of-the-road Conservative.

Sarah is an 80-year-old woman who is a first-generation American. She was raised in a traditional Conservative home. Her husband died after 50 years of a strong marriage. She has three children. Although her home is not kosher, she practices a variation of kosher-style eating, avoiding pork and not making dishes that combine meat and milk.

Two months ago, she was diagnosed with pancreatic cancer. Surgery was attempted, but the cancer was already in an advanced stage. Chemotherapy was started, but the cancer has progressed and is not responding to the medications. She is having difficulty eating because of the pressure of the tumor on the gastrointestinal tract.

Discussions are being held to determine whether or not treatments should be stopped and whether hospice care should be initiated.

Her hospital room is always filled with visitors.

Study Questions

  1. What must you anticipate in discussing with Sarah her wishes regarding the continuation of medical care?
  2. How would you respond to her initial decision to have surgery and initiate chemotherapy?
  3. What questions do you need to ask in the initial patient interview to assess her degree of religious practice? How will you determine her spirituality needs?
  4. What is your understanding of the reason she has so many visitors in her room?
  5. Is hospice care appropriate for this patient?
  6. Sarah dies with her family at her bedside. What interventions can you take at the time of death to demonstrate religious sensitivity to the family? What questions do you need to ask the family?
  7. Describe three genetic or hereditary diseases common with Ashkenazi
  8. Describe Jewish burial rituals and grieving
  9. Discuss the laws of Kashrut in regard to food practices for observant Jewish
  10. What should the health-care provider keep in mind when entering a Jewish home to provide care?
  11. Distinguish between the terms Sephardic and Ashkenazi.
  12. How might a non-Jewish and a Jewish coworker share holidays in the workforce?
  13. What is the official language the Jewish people use for prayer?

Expert Answer and Explanation

Case study: Amish

  1. “Develop three open-ended questions or statements to guide you in your

understanding of Mary and Elmer and what health and caring mean to them and to

the Amish culture.”

  • What is your opinion on professional healthcare?
  • What do you think should be the role of a nurse in caring for a patient?
  • Do you think that people of the Amish culture are accorded best care in hospitals?
  1. “List four or five areas of perinatal care that you would want to discuss with Mary.”
  • Prenatal nutrition and lifestyle management.
  • Physical and emotional changes during the pregnancy
  • Childbirth
  • Initial screening and future medical check-ups
  1. “Why do you think Mary placed the baby on a pillow as she was leaving the doctor’s

office?”

It can be considered as an act of care shown by Mary to the baby.

  1. “If you were the nurse to whom Mrs. Miller confided her interest in taking the baby

to the folk healer, what would you do to learn more about their simultaneous use of

folk and professional health services?”

Being inquisitive, unjudgmental and showing interest would make Mrs. Miller more open to sharing more on the use of folk medicine practices. Also asking on the comparisons between the two approaches and taking note of the trends in both approaches will help in creating an in-depth understanding of both methods.

5. “List three items to discuss with the Millers to prepare them for their consultation at

the medical center.”

  • Their previous health history
  • The type of medical tests they may be required to undertake
  • The importance of having the consultation
  1. “If you were preparing the reference for consultation, what would you mention about the Millers that would help to promote culturally congruent care at the medical center?”

I would mention that the Millers are a culturally rich family with strong family ties.

  1. “Imagine yourself participating in a meeting with state and local health department officials and several local physicians and nurses to develop a plan to increase the immunization rates in the counties with large Amish populations. What would you suggest as ways to accomplish this goal?”

I would first suggest that the officials carry out community sensitization initiatives on the importance of the immunization drive. As part of the sensitization, it is also important to capture the cultural implications of the immunization drive. Sensitization on any health drive is known to reduce resistance from the target population.  It is also important to not impose the immunization drive on the community rather, involve them throughout to encourage more participation and uptake of the drive.

8.” Discuss two reasons why many Old Order Amish choose not to carry health insurance.”

One of the reasons may be that a good number of the Amish come from low-income households making it difficult for them to afford a good healthcare cover. Another reason might be because of the community’s strong support for one another using means such as fundraising drives. This is considered as being a less costly and quick solution to raising hospital funds in case of large medical bills, as can be seen when the Millner’s offer to give their support to a family whose son had brain surgery.

  1. “Name three health problems with genetic links that are prevalent in some Amish

communities.”

  • Dwarfism
  • Angelman syndrome
  • Tay-Sachs disease
  1. “How might health-care providers use the Amish values of the three-generational family and their visiting patterns in promoting health in the Amish community?”

The Amish family values and their visiting patterns can be used to deliver health promotional messages by strategically timing when the family members have congregated in one place. By sharing health promotion messages with as many family members as possible, a bigger change in health behavior is usually observed which trickles down to have an impact on the larger community.

  1. “List three Amish values to consider in prenatal education classes.”

According to Purnell and Fenkl, (2019) the following are some of the considerations to be taken during prenatal education classes for the Amish community

  • The Amish community give strong emphasis on natural birth
  • The Amish take the matter of secrecy and privacy in the whole aspect of pregnancy in high regard
  • Modesty during the prenatal check-ups is also a major consideration
  1. “Develop a nutritional guide for Amish women who are interested in losing weight.

Consider Amish values, daily lifestyle, and food production and preparation patterns.”

For Amish women, given that they are mostly a farming community, it is good to have a balanced breakfast rich in carbohydrates and vitamins to sustain their activities throughout the day. Lunch should consist of a smaller portion, balanced, preferably with large portions of vitamins as compared with other food groups. The dinner should be in low portions given the level of activity being low as compared to during the daytime. Avoiding fatty meals will also be of great help.

  1. “List three ways in which Amish express caring.”
  • Through collective community support
  • By family support especially after instances of childbirth where the extended family comes together to support their family member.
  • By always prioritizing help to those whose problems are graver.

 

Jewish Case study #1

  1. “What must you anticipate in discussing with Sarah her wishes regarding the continuation of medical care?”

I should anticipate the possibility that Sarah may be considering to stop her medications all together with the hope of having a peaceful death. Another possibility is the option for spiritual intervention at the expense of medical care

  1. “How would you respond to her initial decision to have surgery and initiate chemotherapy?”

I would consider running her through the implications of having surgery and the potential repercussions of undergoing the surgery and chemotherapy, especially at her age. Ultimately, I would have to respect her decision nonetheless.

  1. “What questions do you need to ask in the initial patient interview to assess her degree of religious practice? How will you determine her spirituality needs?”

I would ask the patient if she can or has considered spiritual interventions for her health issues. To determine the spiritual needs of the patient it is important to take note of her attitude and conformance towards spiritual practices.

  1. “What is your understanding of the reason she has so many visitors in her room?”

The visitors might believe that Sarah is about to die hence the need to spend the last of her days with her.

  1. “Is hospice care appropriate for this patient?”

Given the age and the nature of the patient’s condition, hospice care may be appropriate for the patient.

  1. “Sarah dies with her family at her bedside. What interventions can you take at the time of death to demonstrate religious sensitivity to the family? What questions do you need to ask the family?”

The best intervention is to console the family and give them ample time in preparation of the burial rituals. I would be wise to ask the family whether they would need a Rabbi to be called or whether they have any other requests that may be contrary to the traditional Jewish cultural practices.

  1. “Describe three genetic or hereditary diseases common with Ashkenazi Jews.”
  • Gaucher disease is a hereditary disease prevalent in Ashkenazi Jews which is associated with the build-up of fatty substances in certain body tissues and organs like spleen and liver
  • Tay-Sachs disease is a hereditary disorder associated with the breakdown of the nerve cells located in the bran and spinal cord. The disease usually manifests when an infant reaches six months of age.
  • Canavan disease is also another common hereditary disease that affects Ashkenazi Jews, especially infants. It is associated with the progressive damage of the brain cells (Pleasure et al., 2018).
  1. “Describe Jewish burial rituals and the grieving process.”

Jews bury their dead within 24 hours after death. They believe in the natural process of decomposition hence the do not cremate their dead neither do they embalm. After the burial, the mourners are allowed to mourn for seven days during which the community supports them physically, emotionally, spiritually and also provides meals for the grieving family. Thirty days after the burial, the mourners can integrate into the society and within the thirty days, they do not participate in any celebration, ceremonies or public events. After thirty days, the mourners are supposed to recite the mourner’s Kaddish daily for eleven months. A monument can be erected in honor of the dead (Ochs, 2017).

  1. “Discuss the laws of Kashrut in regard to food practices for observant Jewish clients.”

The laws of Kashrut mainly describe the dietary practices observed by the Jewish people. The law stipulates various traditional rites how animals are supposed to be slaughtered including completely draining them of blood. The practice also does not allow milk and meat to be mixed in the same meal. Pork, rabbits, and shellfish are some of the foodstuffs which are not eaten as prescribed by that law. Most of the forbidden foods as per the Kosher are described in the Bible, in the book of Deuteronomy.

  1. “What should the health-care provider keep in mind when entering a Jewish home to provide care?”

A health provider should note that most Jewish families are very religious and take with great seriousness their religious practices including respecting the various material artifacts that may be displayed within the homes. Jews also have their calendar that is different and is an important point to note when taking data that requires recoding of time and date. The Jews are also observant of their dietary laws, the Kosher which may be different from those practiced by the healthcare provider.

  1. “Distinguish between the terms Sephardic and Ashkenazi.”

Sephardic Jews are those Jews who originated from areas around the Mediterranean Sea including northern parts of Africa, the Middle East, Spain, and Portugal. Ashkenazi Jews, on the other hand, are Jews who mainly settled in eastern Europe, primarily in Germany (Das, 2017).

  1. “How might a non-Jewish and a Jewish coworker share holidays in the workforce?”

The most important aspect in such a situation is for both workers, from the Jewish and non-Jewish cultures, to have respect for each other’s traditions with regard to how they conduct their specific holidays.

  1. “What is the official language the Jewish people use for prayer?”

The Hebrew language

References

Das, R., Wexler, P., Pirooznia, M., & Elhaik, E. (2017). The Origins of Ashkenaz, Ashkenazic Jews, and Yiddish. Frontiers in genetics8, 87.

Ochs, V. L. (2017). Jewish funeral and mourning practices. In The Routledge Companion to Death and Dying (pp. 55-65). Routledge.

Pleasure, D., Guo, F., Chechneva, O., Bannerman, P., McDonough, J., Burns, T., … & Hull, V. (2018). Pathophysiology and Treatment of Canavan Disease. Neurochemical research, 1-5.

Purnell, L. D., & Fenkl, E. A. (2019). The Amish. In Handbook for Culturally Competent Care (pp. 63-71). Springer, Cham.

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