Questions:
 1 |
 2 |
3 |
Mr. Ramìrez uses a wheelchair for some of his mobility. Around
the house he insists on walking and often does so by holding onto furniture
and doorways rather than using the quad cane he worked with in rehabilitation.
.....He has always been stubborn. His CVA has left him impulsive (a medical
use of the word describing a frequent condition of brain injury where
a person may be able to vocalize all the potential hazards of high risk
behavior, and then responds to such situations spontaneously without
considering the risks). He has fallen several times without injury and
therefore he considers the risk of injury low. He is definitely at risk
for more severe injury from falls, during bathroom activities (toileting
and bathing, and dressing). How will you address this issue?
......a) It is important to address the issue and confront the patient
with his high-risk behavior. Confronting him with his wife and son present
will help reinforce that he must use equipment for safety in the bathroom
and bedroom. His wife and son need the reinforcement of being present
when you confront the patient so they can be more determined in preventing
the high risk behaviors. You are aware of the cultural belief of machismo
(manliness, being a man) and believe that the open confrontation of the
patient's risk for falling will help the wife and son deal with the issue.
.....b) You will recommend referral for a home assessment and that way
the patient's home will be organized for safety and fall prevention.
.....c) Fall prevention is a significant issue and you know that cultural
awareness is necessary if you want to reduce the patient's risk for falls.
Like most Hispanic/Latin American cultures, personal privacy related
to toileting and dressing must be honored if you expect the patient to
cooperate. You will not launch into this area without preparation that
includes the opportunity for the patient to ask his wife and/or son to
leave the room. You may need to discuss the toileting and dressing problems
with the wife and son individually and not in front of the patient to
honor the need for privacy and respect beliefs about machismo.
You selected answer a) It is important to
address the issue and confront the patient with his high-risk behavior.
Confronting him with his wife and son present will help reinforce that
he must use equipment for safety in the bathroom and bedroom. His wife
and son need the reinforcement of being present during your communication
with the patient. You are aware of the machismo involved and this open
confrontation of the patient's risk for falling will help the wife and
son deal with the issue.
......Confronting the patient in front of his wife and son will only reinforce
the patient's sense of loss of control of his environment and diminished sense
of machismo. It may result in more antagonism toward you and stubbornness toward
family or caregiver interventions.......Return to Question 2 and consider another
option.
You have selected answer b) You will recommend
referral for a home assessment and that way the patient's home will be
organized for safety and fall preventions.
....While a home assessment may help with the environment, it does not
address the issues of interpersonal dynamics related to the high-risk
behavior that may lead to the patient falling. The problem is related
to Mr. Ramìrez's need to maintain his belief of machismo (manliness
or being a man) by having a sense of control of his environment, and
refusing to ask for or allowing assistance. Also, in this situation,
Mrs. Ramìrez may have limited ability, as the primary caregiver,
to suggest assistance and have it accepted by the patient.
.....Return to Question 2 and consider another option.
You selected answer c) Fall prevention is
a significant issue and you know that cultural awareness is necessary
if you want to want reduce the patient's risk for falls. Like most Hispanic/Latin
American cultures, personal privacy related to toileting and dressing
must be honored if you expect the patient to cooperate. You will not
launch into this area without preparation that includes the opportunity
for the patient to ask his wife and/or son to leave the room. You may
need to discuss the toileting and dressing problems with the wife and
son individually and not in front of the patient to honor the need for
privacy and machismo (beliefs about manliness or being a man).
.....This is correct. Because Hispanic/Latin American
cultures tend to be outgoing and gregarious, many non-Hispanic/Latin
American healthcare
providers may underestimate the important cultural considerations about
privacy issues related to personal (self care) activities such as toileting
and dressing. The subject should be introduced with sensitivity and allow
the patient to decide who he wishes to be present during the discussion.
It may be necessary to cover some of the information with the patient's
caregivers. For a male patient in particular, sensitivity and respect
for privacy and for feelings of machismo may be strong values for the
individual.
.....Machismo is the sense of manliness or being a man, and of being
in control of one's environment. Thus ways to maintain machismo while
providing assistance need to be worked out between the male patient and
female caretaker, whether the female is the wife, other family members,
or other healthcare professional.
.....Regardless of the patient's culture, disability and illness take
many choices away from the patient. Providing alternatives wherein one
choice needs to be made by the patient, rather than telling the patient
only one way to do an activity would often enable the patient to maintain
machismo. Asking the patient if he wants a family member present while
you discuss toileting and hygiene issues empowers the patient with some
choices. While machisimo relates more closely to male and female roles
of who is "in charge" of a situation, machismo also has some
similarities to 'saving face' within many Asian cultures, with each culture
having different ways in which this important cultural belief of personhood
and respect is maintained. In popular American television, the television
character Tim "The Toolman" Taylor represented similar attitudes
in his love of tools and "more power," and identified his manliness
related to tools and "more power."
.....Hint: Where assistance is needed related to toileting and personal
hygiene, consideration for modesty can be maintained through the simple
placement of a towel to cover genitals during dressing, toileting and
showering to respect the patient privacy while providing assistance.
.....Continue on to Question 3, or you may wish to look at the information
for the answers you did not select.
