Module 3: People of African–American, European American, and Appalachian Heritage
Complete the following Case Studies:
- African–American case study #2
- Appalachian case study #1
Write a 3-4 page APA essay, using two scholarly sources in addition to the textbook.
AFRICAN AMERICAN CASE STUDY #2
Mr. and Mrs. Evans are an African American couple who retired from the school system last year. Both are 65 years of age and reside on 20 acres of land in a large rural community approximately 5 miles from a Superfund site and 20 miles from two chemical plants. Their household consists of their two daughters, Anna, aged 40 years, and Dorothy, aged 42 years; their grandchildren, aged 25, 20, 19, and 18; and their 2- year-old great-grandson. Anna and Dorothy and their children all attended the university.
Mr. Evans’s mother and three of his nieces and nephews live next door. Mr. Evans’s mother has brothers, sisters, other sons and daughters, grandchildren, and great-grandchildren who live across the road on 10 acres of land. Other immediate and extended family live on the 80 acres adjacent to Mr. Evans’s mother. All members of the Evans family own the land on which they live.
Mrs. Evans has siblings and extended family living on 70 acres of land adjacent to Mr. Evans’s family, who live across the road. Mr. and Mrs. Evans also have family living in Chicago, Detroit, New York, San Francisco, and Houston. Once a year, the families come together for a reunion. Every other month, local family members come together for a social hour. The family believes in strict discipline with lots of love. It is common to see adult members of the family discipline the younger children, regardless of who the parents are.
Mr. Evans has hypertension and diabetes. Mrs. Evans has hypertension. Both are on medication. Their daughter Dorothy is bipolar and is on medication. Within the last 5 years, Mr. Evans has had several relatives diagnosed with lung cancer and colon cancer. One of his maternal uncles died last year from lung cancer. Mrs. Evans has indicated on her driver’s license that she is an organ donor.
Sources of income for Mr. and Mrs. Evans are their pensions from the school system and Social Security. Dorothy receives SSI because she is unable to work any longer. Mr. Evans and his brothers must assume responsibility for their mother’s medical bills and medication. Although she has Medicare parts A and B, many of her expenses are not covered.
Mr. and Mrs. Evans, all members of their household, and all other extended family in the community attend a large Baptist church in the city. Several family members, including Mr. and Mrs. Evans, sing in the choir, are members of the usher board, teach Bible classes, and do community ministry.
- Describe the organizational structure of this family and identify strengths and limitations of this family structure.
- Describe and give examples of what you believe to be the family’s values about
- Discuss this family’s views about child
- Discuss the role that spirituality plays in this
- Identify two religious or spiritual practices in which members of the Evans family may engage for treating hypertension, diabetes, and mental
- Identify and discuss cultural views that Dorothy and her parents may have about mental illness and
- To what extent are members of the Evans family at risk for illnesses associated with environmental hazards?
- Susan has decided to become an organ donor. Describe how you think the Evans family will respond to her
- Discuss views that African Americans have about advanced
- Name two dietary health risks for African
- Identify five characteristics to consider when assessing the skin of African Americans.
- Describe two taboo views that African Americans may have about
APPALACHIAN CASE STUDY #1
William Kapp, aged 55 years, and his wife, Gloria, aged 37, have recently moved from an isolated rural area of northern Appalachia to Denver, Colorado, because of Gloria’s failing health. Mrs. Kapp has had pulmonary tuberculosis for several years. They decided to move to New Mexico because they heard that the climate was better for Mrs. Kapp’s pulmonary condition. For an unknown reason, they stayed in Denver, where William obtained employment making machine parts.
The Kapp’s oldest daughter, Ruth, aged 20, Ruth’s husband, Roy, aged 24, and their daughter, Rebecca, aged 17 months, moved with them so Ruth could help care for her ailing mother. After 2 months, Roy returned to northern Appalachia because he was unable to find work in Denver. Ruth is 3 months’ pregnant.
Because Mrs. Kapp has been feeling “more poorly” in the last few days, she has come to the clinic and is accompanied by her husband, William, her daughter Ruth, and her granddaughter, Rebecca. On admission, Gloria is expectorating greenish sputum, which her husband estimates to be about a teacupful each day. Gloria is 5 ft 5 in. tall and weighs 92 pounds. Her temperature is 101.4°F, her pulse is regular at 96 beats per minute, and her respirations are 30 per minute and labored. Her skin is dry and scaly with poor turgor.
While the physician is examining Mrs. Kapp, the nurse is taking additional historical and demographic data from Mr. Kapp and Ruth. The nurse finds that Ruth has had no prenatal care and that her first child, Rebecca, was delivered at home with the assistance of a neighbor. Rebecca is pale and suffers from frequent bouts of diarrhea and colicky symptoms. Mr. Kapp declines to offer information regarding his health status and states that he takes care of himself.
This is the first time Mrs. Kapp has seen a health-care provider since their relocation. Mr. Kapp has been treating his wife with a blood tonic he makes from soaking nails in water; a poultice he makes from turpentine and lard, which he applies to her chest each morning; and a cough medicine he makes from rock candy, whiskey, and honey, which he has her take a tablespoon of four times a day. He feels this has been more beneficial than the prescription medication given to them before they relocated.
The child, Rebecca, has been taking a cup of ginseng tea for her colicky symptoms each night and a cup of red bark tea each morning for her diarrhea.
Ruth’s only complaint is the “sick headache” she gets three to four times a week.
She takes ginseng tea and Epsom salts for the headache.
Mrs. Kapp is discharged with prescriptions for isoniazid, rifampin, and an antibiotic and with instructions to return in 1 week for follow-up based on the results of blood tests, chest radiograph, and sputum cultures. She is also told to return to the clinic or emergency department if her symptoms worsen before then. The nurse gives Ruth directions for making appointments with the prenatal clinic for herself and the pediatric well-child clinic for Rebecca.
- Describe the migration patterns of Appalachians over the last 50
- Discuss issues related to autonomy in the workforce for
- Identify high-risk behaviors common in the Appalachian
- Describe barriers to health care for people living in Appalachia.
- What might the nurse or physician do to encourage Mrs. Kapp to comply with her prescription regimen?
- What would your advice be regarding each of the home remedies that Kapp is taking? Would you encourage or discourage her from continuing them?
- What might the nurse have done to help ensure that Ruth would make the appointments for herself and her daughter?
- What advice would you give Ruth regarding the home remedies that she and her daughter are currently taking? Would you encourage or discourage their use?
- Do you think Mrs. Kapp will return for her appointment next week? Why? What would you do if she did not return for her appointment?
- Do you think that Ruth will make and keep appointments for herself and her daughter?
- What would you do to encourage Mr. Kapp to consent to a health assessment?
- What additional services could you suggest to assist the Kapp family at this time?
- What additional follow-up do you consider essential for the Kapp family?
- What advice would you give Ruth regarding her daughter’s frequent bouts of diarrhea?
Expert Answer and Explanation
African-American case study #2 Questions
- “Describe the organizational structure of this family and identify strengths and limitations of this family structure”.
Mr. Evans Mother is the eldest family member together with her brothers and sisters. She is followed by Mr. and Mrs. Evans together with Mr. Evans’s siblings, some who live in Chicago, while others live in the neighboring farm. Mr. and Mrs. Evans also have two daughters with several nieces and nephews. The next in line is Mr. Evans’s grandchildren and lastly great-grandchildren.
For such kind of family structure, its strength is that it becomes easy for family members to cooperate and form strong family bonds. Its limitation however is that the expenses of the family can be placed on one family which can become a burden (Fletcher, 2020).
- “Describe and give examples of what you believe to be the family’s values about education.”
The family has a high opinion of obtaining formal education. This is a tradition obtained from Mr. and Mrs. Evans who were working in the education sector. Their two children and grandchildren have all been to the university which highlights that the family considers education to be of great importance.
- “Discuss this family’s views about child-rearing.”
From the given case, it is seen that the family considers rearing of children as a collective responsibility to be shared by everyone in society. This can be seen where the elderly can punish any child after making a mistake regardless of whose child it is.
- “Discuss the role that spirituality plays in this family.”
Spirituality in Mr. and Mrs. Evans’s family can be said to be a major determinant in dictating their lifestyle, specifically the social interaction of the family members. This can be seen from the participation of Mr. and Mrs. Evans in church activities.
- “Identify two religious or spiritual practices in which members of the Evans family may engage in treating hypertension, diabetes, and mental illness.”
The Evans family being Christians may pray and read the scripture as a way of giving them the strength to deal with the various ailments they are facing (Timmins & Caldeira, 2017).
- “Identify and discuss cultural views that Dorothy and her parents may have about mental illness and medication.”
Dorothy and her parents are open about the mental disorder which Dorothy has. This is seen through the initiative taken to put Dorothy on treatment for a disease she has been dealing with for the past five years. It was until recently that Dorothy has been under employment. However, for most African Americans, mental illness is viewed as a taboo with mentally ill persons at times being hidden from the public (DeMars & Wright, 2018).
- “To what extent are members of the Evans family at risk for illnesses associated with environmental hazards?”
Given that the Evans family live not far from a chemical plant, they are highly exposed to being affected by toxic wastes from the plant including airborne toxins, waterborne and soil-borne toxins given that they are also farmers. The toxic wastes can be absorbed by their crops which becomes a serious health risk for the family. The number of deaths in the family caused by cancer can be an indicator of their exposure to environmental hazards.
- “Susan has decided to become an organ donor. Describe how you think the Evans family will respond to her decision.”
Given that Mrs. Evans is already a beneficiary of organ transplant, then I am of the opinion that the family will be open to the idea of Susan being an organ donor, so long as it does not pose a serious health risk to her.
- “Discuss views that African Americans have about advanced directives.”
African Americans have different perceptions of advanced directives depending on one’s cultural beliefs. For those practicing traditional cultures, then they may view advanced directives as a taboo given that they may be viewed as anticipating their death in case of wills. For more learned or Christian African Americans, they may be less reserved on this issue.
- “Name two dietary health risks for African Americans.”
- Type 2 diabetes
- “Identify five characteristics to consider when assessing the skin of African Americans.”
- Skin tone
- Signs of ulcerations on the skin
- Skin texture (especially induration)
- Signs of pressure damage
- Skin color after application of pressure (usually purplish instead of red for light-skinned people)
- “Describe two taboo views that African Americans may have about pregnancy.”
According to Galanti (2014), one of the African taboos is reaching out to the head as it is deemed that the umbilical cord may strangle the unborn baby.
Another taboo involves infertility, where some African Americans believe that being infertile is a taboo.
Appalachian case study #1
- “Describe the migration patterns of Appalachians over the last 50 years.”
The people with Appalachians heritage were a migratory group. However, in the last 50 years, their migratory patterns have been short-range with movements being towards metropolitan areas mostly due to employment opportunities.
- “Discuss issues related to autonomy in the workforce for the Appalachians.”
Most Appalachians live in rural areas and have for a long time been associated with living in impoverished states. However, according to the Appalachian Region Commission (2020), this trend has recently changed with more residents of the Appalachia region diversifying their economic activities delving into manufacturing, service provision among others.
- “Identify high-risk behaviors common in the Appalachian region.”
The three behaviors that poses a high-risk for residents living in the Appalachian region include tobacco use and, poor dietary habits and low engagement in physical activities, and lastly risky sexual habits.
- “Describe barriers to health care for people living in Appalachia.”
The barriers associated with residents living in the Appalachia region include lack of access to proper healthcare where a report by David and Cole (2017) indicates that despite the residents having insurance covers they still have challenges in accessing healthcare.
Another barrier is inadequate information on healthcare provided for residents living in Appalachia. Information is known to have an impact on how people perceive healthcare issues (Adler, Glymour & Fielding, 2016),
- “What might the nurse or physician do to encourage Mrs. Kapp to comply with her prescription regimen?”
To motivate Mrs. Kapp to stick to her prescription regiment, carrying out patient education on her health issue and the importance of her in taking the prescribed medicines may be of great help.
- “What would your advice be regarding each of the home remedies that Mrs. Kapp is taking? Would you encourage or discourage her from continuing them?”
I would recommend Mrs. Kapp to reconsider some of the home remedies she is currently using. Some of the substances used in her home remedies may carry with them some health risks, for example, the inclusion of whiskey in her concoction is not advisable. There are some, like honey, which are known to have positive health benefits and may not bring any harm to her. I would therefore discourage not use some of the home remedies being used by her.
- “What might the nurse have done to help ensure that Ruth would make the
appointments for herself and her daughter? “
The nurse might have informed Ruth about the dangers and risks associated with foregoing medical check-ups, and why Ruth and her daughter should consider taking one amidst her parents’ medical history.
- “What advice would you give Ruth regarding the home remedies that she and her daughter are currently taking? Would you encourage or discourage their use?”
With regard to the home therapies, my recommendation would be that in as much as they are engaging in home remedies, it is recommended for them to take more effective pharmacotherapeutic regimens prescribed by professional health providers. I wouldn’t discourage their use since they pose no harm, however, usage in moderation will be advised.
- “Do you think Mrs. Kapp will return for her appointment next week? Why? What would you do if she did not return for her appointment?”
Mrs. Kapp returning will depend on the impact of the prescription given by the physician. This is one of the reasons why they opted for home remedies in the first place. The previous medication regimen failed to work reducing their trust levels on proper medication. In case she may not return, a follow-up check-up through a phone call will be the right step to confirm her health progress (Martich, 2016).
- “Do you think that Ruth will make and keep appointments for herself and her daughter?”
Given that Ruth is currently informed on the importance of proper medical check-ups both prenatal and pediatric, she is more likely to come to further improve the health status of her daughter and herself.
- “What would you do to encourage Mr. Kapp to consent to a health assessment?”
For Mr. Kapp, more engagement will be proper, but he needs to be given time to restore his trust levels with the proper healthcare procedures. Seeing positive health results from his family members, especially his wife will help encourage him to agree to a health assessment.
- “What additional services could you suggest to assist the Kapp family at this time?”
Additional health promotional activities such as patient education and engagement need to be conducted to improve the information held by the Kapp family on health issues.
- “What additional follow-up do you consider essential for the Kapp family?”
Other than following up on proper medication use, it would be proper to also check on whether they are still engaging in home remedies. It would also be good to follow up on their dietary habits and their level of physical activity.
- “What advice would you give Ruth regarding her daughter’s frequent bouts of diarrhea?”
It would be best for Ruth to switch the foods her daughter is currently taking to more starchy foods like rice until diarrhea stops. Increase the water intake will also be advised.
Appalachian Region Commission (2020). The Appalachian Region, Retrieved from: https://www.arc.gov/appalachian_region/TheAppalachianRegion.asp
Adler, N. E., Glymour, M. M., & Fielding, J. (2016). Addressing social determinants of health and health inequalities. Jama, 316(16), 1641-1642.
David, R. R., & Cole, S. (2017). Healthcare in Appalachia and the Role of the Federal Government. W. Va. L. Rev., 120, 1001.
DeMars, A., & Wright, M. (2018). Mental Illness Stigmas. Mental Illness.
Fletcher, T. (2020). The Extended Extended Family, Sport, and Familial Relationships. In Negotiating Fatherhood (pp. 159-178). Palgrave Macmillan, Cham.
Galanti, G. A. (2014). Caring for patients from different cultures. University of Pennsylvania Press.
Martich, D. (2016). Telehealth Nursing: Tools and Strategies for Optimal Patient Care. Springer Publishing Company.
Timmins, F., & Caldeira, S. (2017). Understanding spirituality and spiritual care in nursing. Nursing Standard, 31(22).
Write a fully developed and detailed APA essay addressing each of the following points/questions. There is no required word count; be sure to completely answer all the questions for each question in detail.