Analysis, Diagnosis, Causes, Treatment, and Care of Patients with Cerebellar Ataxia - Essay Example

?Running head: CEREBELLAR ATAXIA Cerebellar Ataxia (school) Cerebellar Ataxia Introduction There are various health issues encountered by health professionals while caring for their patients. These issues require adequate care and health interventions from the health professionals. With adequate and quality health services, these patients can potentially experience improved outcomes and eventually regain normal lives. This paper shall discuss the care administered for a cerebellar ataxia patient. It shall first describe his background and establish reasons why he is chosen for this analysis. A description of his family and his cultural background shall also be presented. A brief outline of the basis of the patient’s need for health care shall also be established. This study shall also compare and contrast the two definitions of culture from the literature and establish their relevance on their health and well-being. It shall explain how information on the patient’s culture was gathered. It shall explain the evidence and research used to describe and assess the client’s cultural perspectives, as well as the needs and factors influencing their understanding of their health, illness, and treatments. The crucial cultural issues from the client’s perspective shall also be described. This paper shall also discuss how the culture of the patient may or may not match the culture of the care setting. Finally, it shall summarize the strengths and weaknesses of care provision related to culture, making suggestions for improvement. This paper is being undertaken in order to come up with a clear and culture-based understanding of the patient’s care and to secure all pertinent elements needed for his full and patient-based recovery. Discussion Description of the patient’s social/cultural background This patient who was encountered during my community placement was diagnosed with cerebellar ataxia. He is 52 years old, of the Indian race, married, and living at the first floor of his home. He is a retired salesman. He and his wife have four children, all married but living in the same family compound. He was first admitted two weeks prior to the current consultation for medical care; he was complaining of slurred and awkward speech. Diagnostic examinations revealed that he had a mild hemorrhagic stroke and was bleeding into his cerebellum. He underwent surgery to drain the bleeding. A week after the surgery, he experienced some more headaches, his speech became clumsy; he also manifested repeated and uncoordinated eye movements; and he manifested an unsteady gait. His symptoms were collectively considered as cerebellar ataxia. Another CT scan was ordered and this revealed some more bleeding in his cerebellum. This was causing the cerebellar ataxia. The patient is a migrant from India in South Asia. He migrated to the US with his family when he was 16 years old. His parents had an Indian restaurant which he helped out with until he finished high school. He attended business school for three years and dropped out after being asked by his father to take over the family restaurant. He married a fellow Indian with whom he had four children, two girls and two boys. He worked in the restaurant, managing the business for 10 years until hard times caused them to declare their business bankrupt. He then worked as a shoe salesman for 20 years until hard times with the company forced him to opt for early retirement. His family’s culture is very much entwined in the Indian culture and practices. The patient and his family belong to the Hindu faith. They are active in their faith and the beliefs set forth by that religion. The family has a strict social and family hierarchy with the older members of the family serving as primary authorities in the family and in their society in general. As the father, he is considered the head of the family and all issues are resolved by him. Even in the lives of his married children, he is still deferred to in terms of authority and decision-making. Decisions in his care are based on his opinion and on his say so; his family is not consulted at home for these decisions. In the absence of the father, the patriarchal authority is deferred to the eldest male relative (Park, et.al., 2006). This is typical of Indian families which are largely patriarchal and family-centered. Most Indian families defer to the family patriarch in their decision-making processes (Park, et.al., 2006). Most of them are also inclined to live in one household beyond the age of majority and after marriage. Hence, children and grandchildren, as well as other members of the family are normally found in one household, sharing in each other’s activities and providing emotional, as well as physical support to members who need such assistance (Harriss-White, 2001). One of the practices in India is on arranged marriages. The patient’s marriage was in fact arranged, but with his and his bride’s consent. No dowry was needed for the marriage to proceed. Drinking alcohol is not part of the Indian culture; hence, the patient has not had a history of alcohol drinking (Park, et.al., 2006). The Indian diet is rich in herbs and spices. The patient’s diet has mainly consisted of vegetables, nuts, lamb, fish, and other types of meat (Patel and South Asian Health Foundation, 2004). This patient was chosen because his condition has not been commonly encountered in this student’s current practice. The patient was also chosen because his ethnic and racial background is not common; it would be interesting to note how these cultural and ethnic qualities impact on his health and on his personal practices. By choosing this patient a clearer and a more unbiased understanding of the patient’s case can be established. This analysis can therefore be used as basis for other patient’s under similar circumstances. Outline of the basis of the patient’s need for health care There is a need to establish health care for the patient because his condition calls for physical support and physical therapy. Due to his cerebellar ataxia his mobility is now compromised (Shumway-Cook and Woollacott, 2011). Even with proper medical care, it would take some time before his mobility would be restored. While he is being treated for his ataxia, he must be physically assisted in his activities and he must undergo physical therapy. It is important to assist the patient during this time because he is in danger of experiencing falls and injuries due to his compromised mobility (Shumway-Cook and Woollacott, 2011). In order to prevent such falls and injuries, the patient needs to undergo physical therapy with a qualified health professional. The patient also needs to undergo occupational therapy sessions in order to teach him how to carry out his activities independently (Shumway-Cook and Woollacott, 2011). It is important for the family to also learn how to assist the patient in regaining his mobility and to eventually gain independence in his daily activities. The patient needs care because he would encounter physical as well as mental challenges in his daily activities. He would be having difficulty in moving about from one place to another, in getting up from bed, in going to the bathroom to relieve himself, in bathing himself, in eating, in dressing himself, and in carrying out his other activities of daily living. His need for care would arise from the fact that there is a need to prevent further injury from befalling him, a need to ensure that he would still get adequately nourished despite his compromised ability to feed himself, and a need to ensure that he would still be adequately groomed (Miller, 2010). On a mental level, there is a need to provide mental health to this patient because his immobility and the difficulties his condition is presenting would make him frustrated (Miller, 2010). This disease would likely emasculate him; this is not a favorable state to be in considering that he is the father and the head of a patriarchal family. Definitions of culture from the literature and relevance to health and wellbeing Geerd Hofstede defines culture as “the collective programming of the mind which distinguishes members of one human group from another…” (as cited by Bode, 2008, p. 7). In effect, this definition explains how people’s behaviors are determined or dictated by their cultures. The definition also speaks of a collective, or of a group of people acting similarly and being of one mind in their activities. The earliest definition of culture is by Sir Edward Taylor who describes it as “that complex whole which includes knowledge, belief, art, morals, law, custom and other capabilities and habits acquired by man as a member of society” (as cited by Samovar, et.al., 2008, p. 10). This definition details elements in our daily activities where culture manifests and which culture affects. Taylor specifies how matters like art, like our beliefs are placed where our culture manifests. In effect, from these activities and elements, it is capable to differentiate one culture from another. Hofstede’s definition is relevant to health and well-being in the sense the culture implies a collective programming. In this case, the behavior of people is similar to each other – they would know the same songs, they would know the same prayers, they would share beliefs about health and health habits – from brushing, grooming, eating, hygiene, etc. It would therefore be possible for one wrong behavior in terms of health habits to be shared by group of people (Samovar, et.al., 2008). If a particular cultural group believes that having immunizations would not yield solid benefits for the people then this belief shall affect the entire collective. Taylor’s definition provides a detailed manifestation of culture. In terms of health and well-being, culture impacts on belief and habits. These two definitions are both useful to the health and well-being of patients. In this particular patient, it is very much applicable because the patient’s behavior and habits are very much tied in and influenced by his culture. His activities would therefore be based on the collective’s and his cultural beliefs. Collection of Information about the patient/client's culture Information about the patient’s culture was collected primarily through an interview with the patient and his family. Such information however was not detailed enough since the family did not feel comfortable about having to explain their culture. Research for information on the Indian culture was then carried out via history books on India South Asian culture. Research on religion, culture, language, and beliefs were carried out through these history books. Renowned Indian authors and sociologists were also reviewed for their explanations on Indian culture. Much care was made to ensure that the data being gained about the Indian culture comes from an Indian perspective, not from a Western or any other perspective. Information was also gained from journals, magazines, and newspaper articles published in India or discussing Indian culture. Most information gained from these articles are able to provide more casual information about the Indian culture. The information gained from the Indian authors on Indian culture and history was used to understand the patient’s culture – to understand why they acted the way they did and why they believed the things they believed in. Information gained from the patient’s family also helped health practitioners in understanding why all decisions in the patient’s care needed to be consulted with the patient, despite the patient’s compromised health status (Sonuga-Bark, 2000). The research also gained from some Indian cultural magazines painted a picture of the patriarchal nature of Indian society, the importance of obedience and honor afforded to the patriarch and the importance of family members being supportive of each other (Sonuga-Bark, 2000). The history and cultural books written on the patient’s culture also highlighted the importance of family to the Indians. These books highlighted how important family connection is for the family members; such connection is likely to determine the patient’s care, as well as the planning and the implementation of such care. Furthermore, such connection would likely impact on the positive or negative outcome of the patient’s care. Important cultural issues from the patient/client perspective The patient believes that his illness is due to some form of kharma. Kharma is part of the Hindu faith. Although the pathophysiology and the causes of his illness were explained to him, he was not fully convinced that his illness was wholly attributed to some physiological issues. He believes that his illness, to some extent is caused by a bad deed he may have unwittingly carried out against another person. Since he does not believe that the cause of his illness is physiological, he does not have as much faith in his medical treatment. He expressed at one point that he deserves the pain and suffering because he caused other people pain and suffering. Another issue encountered in the patient’s care is the fact that he was not comfortable with the female nurses and medical staff. He was not comfortable being touched by them and being seen by them in his hospital gown. In fact, he also did not like the fact that he had to wear a hospital gown. He also did not like that the physiotherapist assigned to him was female and he was requesting that a male physiotherapist be assigned to him. He refused to cooperate with the female staff and he sometimes did not like speaking to them. He also did not express pain, even when asked if he was experiencing any pain. He preferred to bear the pain, no matter how mild or severe it was. This prompted the staff to observe for non-verbal cues like pain guarding and facial expressions to detect feelings of pain. The patient also took issue with the members of his family being consulted about his health care. At one point, while the patient was asleep, his wife was asked permission for a medical intervention. The wife had to wake the patient to consult about the decision. The patient got angry because he believed that his wife should not have been consulted about his care. He emphasized that he should always be consulted and his wife not consulted at all for his care. If he is asleep, he should be woken up, he says. In effect, the patient took issue with the fact that he was being treated like an incompetent person and being ignored as the head of the family. The prescribed hospital diet for the patient which was rich in fiber and protein was not to the patient’s liking. He found it too bland. He also had to check if there was beef in his food because he loudly explained that he did not eat beef. He wanted to eat his spicy wife’s cooking, and he clearly did not believe the benefits of the hospital-prescribed food. On his second day in the hospital when he was to be catheterized, he protested to the female nurse about to carry out the procedure. A male nurse had to be assigned to carry out the task. The patient also had many visitors in his hospital room, including his immediate family and extended family members as well as friends. Even when the hospital staff reminded the family members not to tire the patient with too many visitors, the patient himself protested to this reminder. He was firm in expressing that he preferred his family being there with him. The family’s presence at most times made the nurse and medical care awkward and difficult because the family members were often crowding the room or had to observe every procedure being carried out on the patient. Sometimes, they also had to question all the medical interventions being carried out by the hospital staff. Culture of the patient and culture of the care setting The culture of the patient at times does not match the culture of the care setting. In the care setting, treatment and medicine, as well as personal beliefs and traditions often do not blend well with each other. Medical treatments are based on science; on the other hand, culture and religion are based on intangible beliefs which are not scientifically proven. The Indian culture incorporates both the scientific and the non-scientific. Western medicine is only a part of Indian medicine. Indian medicine includes Muslim practices, homeopathic systems, and Ayurveda. Ayurveda refers to a complicated medical system which highlights the physical, mental, and spiritual health of a person (Patwardhani, et.al., 2005). It includes treatments like yoga, massage, as well as dietary and herbal advice. Ayurveda also sets forth that illness is caused by an imbalance in the body’s three humors or “doshas.” In effect, the interaction of these three humors “determine the qualities and conditions of the individual. A harmonious state of the three doshas creates balance and health; and imbalance which might be an excess (vriddhi) or deficiency (kshaya), manifests as a sign of symptom of disease” (Patwardhani, et.al., 2005, p. 467). All in all, the emphasis of Ayurveda is on holistic treatment, with a focus on prevention. Many Indians also opt for herbal treatments for their treatment, as well as massage, diet, rest, and the application of oil in main areas of the body (Khalsa and Tierra, 2009). The culture of the patient is very much within the teachings of Hinduism and Ayurveda. To a certain extent, these are not included in traditional medicine, however, they are considered as possible options or alternative choices in the treatment of patients. They are not however carried out in the hospital setting, but only under the supervision of experts in the preferred forms of treatment. Strengths and weaknesses of care provision (related to culture) Strengths seen in the provision of care, in relation to culture are related mostly to the mental assurance given to the patient. Integrating the patient’s culture in the provision of patient care provides mental and emotional reassurance to the patient (Walter and Fridman, 2004). It would assure him that he is very much in close touch with his culture and his heritage. It would link and associate him with what is familiar to him. In the end, a calm and mentally assured patient would be more cooperative during the treatment process (Walter and Fridman, 2004). His treatment process would also be empowered by his mental thoughts and strength of will. All in all, a patient’s culture made part of the provision of health provides a more psychological basis for treatment, ensuring holistic patient care which all forms of medicine and treatment eventually aim for. Weaknesses however in the provision of care tied in with culture are the fact that the patient may rely on his cultural beliefs for his treatment, and ignore or refuse the traditional forms of treatment. He may prefer to have his treatment purely based on his beliefs and on his religion. This may delay treatment and place his life and well-being at further risk. Some aspects of a patient’s culture may also interfere with the scientifically-tested treatments, further exposing the patient to medical issues and adverse reactions to treatment. In order to improve the treatment process for the patient, it is important to gain his cooperation with the prescribed treatment and hospital processes. There are aspects of his culture which can be integrated into his treatment process, however, these processes must not interfere with his clinical interventions (Falvo, 2010). Cultural practices can be incorporated into the treatment process for as long as they serve therapeutic purposes. For example, allowing family members to visit the patient can help the patient be more relaxed and comfortable. Ayurvedic forms of treatment may be allowed for as long as they are carried out by qualified experts in the field. These forms of treatment are not mutually exclusive from each other. It is possible to gain positive outcomes for the patients for as long as the appropriate remedies are monitored by the practitioners. Works Cited Bode, S. (2008). The Importance of Culture. Germany: GRIN Verlag. Falvo, D. (2010). Effective Patient Education: A Guide to Increased Adherence. London: Jones & Bartlett Learning. Harriss-White, B. (2001). Development and Productive Deprivation: Male Patriarchal Relations in Business Families and their Implications for Women in S. India. Queen Elizabeth House. Retrieved 18 July 2011 from http://www3.qeh.ox.ac.uk/pdf/qehwp/qehwps65.pdf Khalsa, K. & Tierra, M. (2009). The Way of Ayurvedic Herbs: The Most Complete Guide to Natural Healing and Health with Traditional Ayurvedic Herbalism. Poole; Dorset: Lotus Press. Miller, C. (2008). Nursing for wellness in older adults. London: Lippincott Williams & Wilkins. Park, C., Endo, R., & Goodwin, L. (2006). Asian and Pacific American education: learning, socialization, and identity. London: Cambridge University Press Patel, K. and South Asian Health Foundation (2004). The epidemic of coronary heart disease in South Asian populations: causes and consequences. Birmingham: SAHF. Patwardhani, B., Warude, D., Bhatt, N. (2005). 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