“The Irish of America”

ID: 0232713
NUR 211 Days
April 2012

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A. SG, is a beautiful 26 year old female born to a loving family with parents whom have

been supporting her since birth. Tragically at birth, SG was deprived of oxygen during a

difficult labor in which she suffered great brain anoxia, resulting in cerebral palsy. Due to her

diagnosis, cerebral palsy has left SG with very little to hardly any muscle tone, movement and

motor skills. From newborn to 21 years of age, SG’s parents provided all services of care

through their home and acquired special schooling through their hometown. As with SG’s

heritage background, the Irish when struck with a crisis involving disability are always

compassionate. Especially, when family is involved, they are willing to care for a disabled

person at home as did SG’s parents. Lipson and Dibble states that, “The Irish also view illness

and disability as human fate which involves suffering, bearing the natural consequence of living

and of God’s will.” (p. 286) Although today many Irish view disability and illness as a result of

natural causes. As Americans, Nicole Webster (2010) expresses, “The trend is that American

society is a culture that is less than accepting of disabilities, and thus the lifestyles of those with

disabilities are less than equal compared with those without disabilities. This inequality could be

much improved with the education of “normal” people through disability studies and the practice

of empathizing. Everybody has their obstacles; some are just more visible or more challenging

than others. Americans must look deeper than that which appears on first impression to

understand that people are just people.” (p. 6)

B. Being under the care of her parents and skilled nursing services her entire life, SG hasn’t
Been able to live the dream of an American, which involves friendships, relationships, marriage,

raising a family, and excelling in a career. From 21 until now, SG has been residing in NEPC,

because her parents became stressed and couldn’t provide everything for their daughter. As a

result, long term care became the ultimate decision.

SG, the client, is Irish-American or of Irish descent. Immigration began predominately in

the 1700’s when the Scots Irish began seeking opportunities in the New World. The next group

of settlers were Catholics from Southern Ireland, who immigrated as a result of the Great

Potato Famine of the 1840’s. Overall, there continued to be a steady stream of immigrants from

1846-1985. Irish-Americans continue to populate mostly California, New York, Pennsylvania,

Florida and Illinois.

Protestant and Catholic are the two most common spiritual affiliations amongst the Irish.

Individuals attend the Protestant and Catholic churches and practice Celtic Paganism as sources

of comfort and strength. Prayer is considered a time of quiet and privacy. Catholics attend daily

masses and may wear rosary beads. Although clergy hadn’t been present, inside SG’s bureau

was a beautiful set of rosary beads. In regards to spiritual healers, they’re mostly associated

with the Catholics, where priests perform rituals with oils, prayers and blessings. Finally, the

two most important holidays related to SG’s ancestry are Christmas and Easter; the celebration

Christ.

Economically, SG is acquiring her care at New England Pediatric Center (NEPC) by the

funding of Medicare. Medicare is a federal government program that gives health coverage to

individuals 65 or older or in SG’s case, who have a disability. Medicare contains four different

parts. (A,B,C,D) SG has part A, which covers long term needs such as skilled nursing services,

physical, occupational and speech therapies, meals, medications, dietary counseling, medical Irish 2 equipment and supplies, medical social services, a room and ambulance transportation.

Socially, SG smiles when greeted by her first name. A trait commonly found in young adult

Irish-Americans; friendly and informal. The Irish tend to communicate indirectly and speak in

euphemisms and metaphors. Meaning, they tend to talk around a subject and avoid saying

anything at all. Emotions are concealed and true feelings are hard to interpret; which made

caring for SG a real challenge.

C.

Four functional health patterns which apply to SG are Health perception, Nutrition,

Elimination, and Sleep.

Health perception involves perceived health status, perceived health management and

healthcare behaviors such as health promotion, illness prevention activities, medical treatments

follow up care. SG has little to no perception of her health. She is dependent on nursing staff to

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provide all care. The Irish’s concept of health is having the ability to function independently

and with great privacy. Men are more often than women, slow to seek assistance for health

problems, but both genders will follow doctor’s recommendations. Same goes for screening,

women attend regular screening whereas men will only follow through if recommended by a

physician.

Nutrition involves daily consumption of food and fluids, favorite foods, use of dietary

supplements, skin lesions and ability to heal, condition of the integument and weight, height

and temperature. SG is G tube dependent for nutrition and hydration. Nutren 1.0 240 ml/60ml

per hour via tube. Usual meal pattern of the Irish, may be coffee or tea and oats for breakfast, a

midday meal, and an evening meal. Meals are traditionally a family occasion, foods such as

bread is served with most meals. The typical entrée consists of meat and potatoes such as a pot

pie or shepherd’s pie. Fluids vary anywhere from tea and coffee to a dark beer or whiskey.

Elimination involves patterns of bowel and urinary excretion, perceived regularity or

irregularity of elimination, use of laxatives or routines, changes in time modes and quality and

quantity of excretions. SG is incontinent of both urine and stool. She is unable to acknowledge

when she’s wet or soiled. When incontinent, urine is clear and yellow no strange odors. Stools

are usually medium to large, light brown, soft and loose. When toileting the Irish expect great

privacy. Like pain, constipation or diarrhea is usually unreported and a private matter.

Individuals may feel embarrassed about constipation or diarrhea and may explain their

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symptoms vaguely.

Sleep involves patterns of sleep, perceptions of quality and quantity of sleep and use of sleep

aides. SG sleeps through the night with continuous O2 monitoring in a dorsal recumbent

position along with numerous pillows. She wears leg braces for her bowlegged condition to

keep the extremities from producing skin to skin contact. In the morning SG is often difficult to

arouse. Independently, the Irish decide their own sleeping patterns, they often don’t ask for

aides or assistance because they don’t want to be a burden on caregivers.

D. 1. Situational low self-esteem related to loss of health status, body part, independent

functioning, and sense of control.

2. Risk for imbalanced nutrition less than body requirements related to increased metabolic

demands.

3. Risk for impaired skin integrity r/t excessive exposure to moisture, chemical irritants and

reduced blood flow to tissue resulting from prolonged pressure.

4. Risk for disturbed sleep pattern as evidenced by environmental changes, noise and facility

routines.

E. 1. Client will demonstrate an accurate and nonjudgmental account of three positive qualities

as well as identify two areas that she wishes to improve by December 31, 2012. (Long Term)

Client will identify one or two strengths by March 18, 2012 at 1400. (Short Term)

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2. Client will gain 2 pounds per week for the next 3 weeks. (Short Term)

Client will exhibit no signs or symptoms of malnutrition by time of discharge from treatment

(e.g., electrolytes and blood counts will be within normal limits; a steady weight gain will be

demonstrated; constipation will be corrected; client will exhibit increased energy in participation

in activities). (Long Term)

3. Client will maintain adequate nutritional status throughout stay at facility as evidenced by

Nutritional labs (albumin, total protein, H&H, Na, K, Ca, Mg) within normal limits, no changes

From baseline skin turgor, no weight loss on a daily basis. (Short term)

Client's skin will remain intact throughout duration of residency as evidenced by absence of

reddened/ blanched areas, no disruption of skin surface. (Long term)

4. After eight hours of nursing interventions the client will achieve optimal amount of sleep as

evidenced by rested appearance. (Short term)

Within a week’s time, the client will achieve maximum quantity of sleep as manifested by rested

appearance, articulation of feeling rested and enhancement in sleep pattern

F. 1. A. Identify basic sense of self-esteem and image client has of existential, physical,

psychological self. Identify locus of control.

R: May provide insight into whether this is a single episode or recurrent or chronic situation and

can help determine needs and treatment plan. Determining whether the individual’s locus of

control is internal or external facilitates choosing most effective interventions.

B. Provide nonthreatening environment; listen and accept client as presented.

R: Promotes feelings of safety, encouraging communication.

C. Observe nonverbal communication including body posture and movements, eye contact, Irish 8

gestures, and use of touch.

R: Nonverbal language is a large portion of communication and therefore is extremely important.

how the person uses touch provides information about how it is accepted and how comfortable

the individual is with being touched.

D. Observe and describe behavior in objective terms.

R: All behavior has meaning, some of which is obvious and some of which needs to be

identified. This is a process of educated guesswork and requires validation by the client.

2. A. Determine child’s current nutritional status using age-appropriate measurements, including

weight and body build, strength, activity level, and sleep and rest cycles.

R: Identifies individual nutritional needs and provides comparative baseline.

B. Auscultate bowel sounds. Note characteristics of stool, including color, amount and frequency

of bowel movements.

R: Provides information about digestion and bowel function and may affect choice and timing of

feeding.

C. Determine psychological factors and cultural or religious desires or influences on dietary

choices.

R: Dietary beliefs, such as vegetarianism, can affect nutritional intake. Usual ethnic food choices

Can improve a child’s intake when appetite is poor.

D. Establish a nutritional plan that meets individual needs incorporating specific food restrictions

and special dietary needs.

R: Corrects or controls underlying causative factors, such as with GERD and malabsorption

disorders.

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3. A. Inspect skin for changes in color, turgor, and vascularity. Note redness and excoriation.

Observe for ecchymosis and purpura.

R: Indicates areas of poor circulation and early breakdown that may lead to decubitus formation

and infection.

B. Monitor fluid intake and hydration of skin and mucous membranes.

R: Detects presence of dehydration or overhydration that affects circulation and tissue integrity

at the cellular level.

C. Provide soothing skin care, restrict use of soaps, and apply ointments or creams such as

lanolin or Aquaphor.

R: Baking soda and cornstarch baths decrease itching and are less drying than soaps. Lotions and

ointments may be desired to relieve dry, cracked skin.

D. Change position frequently, move client carefully, pad bony prominences with sheepskin, and

use elbow and heel protectors.

R: Decreases pressure on edematous, poorly perfused tissues to reduce ischemia.

4. A. Ascertain usual sleep habits and changes that are occurring.

R: Determines need for action and helps identify appropriate interventions.

B. Provide comfortable bedding and some of own possessions, such as a pillow or an afghan.

R: Increases comfort for sleep; provides physiological and psychological support.

C. Promote bedtime comfort regimens such as a warm bath, massage, a glass of warm milk at

bedtime.

R: Promotes a relaxing, soothing effect. Helps induce sleep.

D. Avoid or limit interventions such as awakening for medications or therapies.

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R: Uninterrupted sleep is more restful, and client may be unable to return to sleep when

weakened.

G. 1. Evaluation set for December 31, 2012 at 1400. Client has made some progress toward goal; on March 18, 2012 she was able to identify two strengths and did not reject positive self feedback. Goal met. As of March 18, 2012 at 1400 client was able to identify two strengths: being a good listener and having good communication skills, through nonverbal communication.

2. Goal met, client’s weight increased or stabilized within the 3 week timeframe.

Goal not met. Client still involved in long term care. Nurse will continue to teach parents

nutritional principles, requirements, feeding techniques and special needs.

3. Goal met. Client’s skin has no signs of worsening or advanced impairment. Client’s skin

integrity has not been further compromised. Daily labs WNL.

Goal not met. Continue interventions as listed. Reposition the client at least once every

two hours. Continue to keep the client’s skin clean and dry. Continue to monitor the skin for any

signs of change or breakdown.

4. Goal met. After eight hours of nursing interventions, the client was able to sleep without being

easily awakened and participated more in daily activities due to being well rested.

Goal not met. Continue with comfort interventions, if not working contact physician for sleep

aides.