Anthony Wallace Case Study 1

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This is an old Case Study that I used in class to illustrate how our healthcare system can improve the existing services to immigrants. The story is fictional, but imagine the answer to the questions.

Published in: Health & Medicine
  • Ok, If you would read the essay, this was a fictitious story of an immigrant that came to America in hopes of find his new frontier. The story has its point of dramatics but it also illustrates his legacy before he died. I am was in EMS and this story is fiction. It is against the law to use real names and scenarios. .
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  • While an interesting review with many salient points, I have to say that the presentation of the paramedic and EMS system, as well as technical accuracy of prehospital care, leaves very much to be desired. I would think, being a 23 year veteran of EMS myself, that you got more information about EMS , what, and how Paramedics do their job from watching bad TV than any actual reference. Vry sad that you are putting forth this 1960's version of what EMS is, and does, as fact.
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Anthony Wallace Case Study 1

  1. 1. LIFE’S MIGRANTION JOURNEY Case Study 1 Anthony Wallace Liberty University
  2. 2. AN IMMAGRANTS WELLNESS JOURNEY 2 Background Narrative There was a man named Ushery, who is a Russian immigrant from Istra, Moscow and immigrated to the United States in the mid 1900s. Ushery was a vibrant young fellow with a dream to start his own grocery business. Mr. Ushery educated himself and was able to gain the working capital to start his small grocery store in Bronx, NY. Mr. Ushery also has musical talents, playing the violin for the annual town festival that celebrates past Russian immigrants migrating to the United States. In his early 20s, Mr. Ushery came to America with dreams of owing his own grocery store to pass down to his family members. One day while Mr. Ushery was cleaning his storefront, he found his soul mate, Katie. The couple married in the spring of that year and had three beautiful children. The couple attends religious services every Sunday at Mt. Zion Missionary COGIC. The family volunteers in the new neighbor orientation block parties during the festival season. The family is very well loved throughout the community. One day while playing his violin at the festival, Mr. Ushery collapses on stages. Mr. Ushery is unresponsive and not breathing. The family and bystanders rush to his aid. A bystander, who happens to be a nurse, performs CPR in desperation to save Mr. Ushery’s life. The bystander shout “stand back, give him some air! The sirens scream in the background as the paramedics are rushing to Mr. Ushery’s aid. The bystander is calling for Mr. Usery to come back. As people are
  3. 3. AN IMMAGRANTS WELLNESS JOURNEY 3 standing around looking at the bystander pump on Mr. Ushery’s chest and shout one, two, three, breathe! Another bystander comes to join in the fight to save Mr Ushery’s life. The bystander shouts again one, two, three, breath! The family watches in horror and panic of their sick father fights for his life. The paramedics arrive on scene to find Mr. Ushery in full arrest with no pulse and not breathing. The bystander goes to comfort the family as the paramedics load Mr. Ushery on the stretcher and into the ambulance, the wife is overcome with grief and passes out on the pavement. The eldest son jumps into the ambulance and tells the paramedic “oh God pop come back, please come back!” The ambulance races down the freeway with sirens screaming “rarrrrrrrwwww!” the adrenaline of the paramedic was hot. The paramedic started IVs, gave meds, and even performed CPR. The paramedic reaches for the paddles and shouts “stand back!” the paramedic shocks the patient “swwwwish plop”. Mr. Ushery body flops. Again, swwwwwish plop! The paramedic knocked on the window with urgency and shouts "Hurry we're losing him!" The driver slams on the gas and the wheel screech, the sirens roar, as the paramedic verge to the right and the left to get Mr. Ushery to the hospital for advance care. The son cries aloud, stretching his hand out to his father, and says “come back please pop come back, we need you!” the paramedic finally gets a pulse, but its faint. The ambulance arrives at the bay. The son is running beside the stretcher holding his father’s hand. Mr. Ushery looks at his son and says,
  4. 4. AN IMMAGRANTS WELLNESS JOURNEY 4 “I love you son, take care of the family”. The nurse stops the son at the emergency room door and directs him to the waiting room. Meanwhile, in the emergency room, Mr. Ushery is trying to answer as many questions that were thrown at him all at one time. It was hard to keep up with who was asking the questions. Mr. Ushery asked the ER nurse “where is my beautiful Katie? I need to tell my Katie that I love her.” The ER nurse continues to perform her care duties, but ignored his comments. Mr. Ushery’s vitals on arrival were B/P100/70, P-98 and weak, R-10, and T-97.6 ax. The lab results revealed an elevated ALT and Bilirubin levels. The X-rays also revealed evidence of an enlarged heart leading to advanced heart disease. The doctor goes into the waiting room to discuss options in treating Mr. Ushery advanced disease. Mr. Ushery’s family is devastated and overwhelmed with the news that their father was dying. The doctor told the family that his prognosis is not favorable in performing other treatments. The doctor beings to talk to the family about other options that are available to him such as hospice care at home. The wife shouts, “oh my God have mercy on my husband.” Mrs. Ushery falls to the floor and cries bitterly with anguish bitter yells “why! Lord why! I am empty without him.” The family grieves with their mother. The family goes to the back to find that Mr. Ushery has tubes running from everywhere and connected to the ventilator. The wife hold his hand as the room gets quieter and quieter as sounds of the ventilator “psssss pa!" psssss pa!” echoes in the background. Mr. Ushery is in a drug-induced coma to keep him comfortable and
  5. 5. AN IMMAGRANTS WELLNESS JOURNEY 5 free of pain. Mr. Ushery is alert to sounds, but unaware of who is in the room with him. The family is confused and do not understand Mr. Ushery’s prognosis. Discussion Questions 1. Discuss the reasons that the advanced practitioner must consider the family when assisting the dying patient to planned care? I believe that the practitioner must look at the patient and the family as a whole unit. It is sad to see any one pass away, but we can become a comfort to the patient by encouraging them to explore their emotions. We can also use the term SWOT in making a care plan for the family. The SWOT acronym represents the family unit impacted by the feelings of death. The strengths, weakness, opportunities, and threats make a great impact on the emotions while the patient is dying and after (Matzo et.al, 2010). The practitioner must have open eyes to see the inner dynamics of the family. The family may appear stable, but after the patient has died, the family unit maybe broken. The practitioner can help the patient physically, but a lot of the time the patient and the family needs a listening ear. A healing heart never heals instantly, but heals over time and with patience. 2. Identify possible barriers in the effectively planning family-oriented care. In this case scenario, the language or cultural influences may play a sufficient role in decision making. The status quo and the family position may
  6. 6. AN IMMAGRANTS WELLNESS JOURNEY 6 have an impact of who makes the decision and what happens. The husband in this case is the breadwinner and had the authority in the home. In most cultures, the eldest is in charge of all responsibilities in the event the parents are not there to resume that duty. The environment can hinder care services to the patient (i.e. small bedrooms, crime in the neighborhood, family dynamics, etc). Religion may hinder the patient care due to their belief system (i.e. an atheist nurse caring for a Christian patient). Most family members prefer same religion caregivers. 3. Perform a SWOT analysis on the family unit S- Strengths – The unit banded together to help their mother in her time of need. The children were willing to help their father as a support for him while he was being worked on in the ambulance. W – Weakness – The family is devastated and need much support from social work in connecting them with a local support groups. The dad was the rock of the family and now the children will have to take his place. This can become a heavy burden for the eldest son. O – Opportunities – This may give the oldest son the opportunity to lead and prove himself to his immediate family. It will give him a chance to be a man and help his fellow family members recover. The death of the father may appear to be the death of a memory, but it is a start of a new beginning within the next generation
  7. 7. AN IMMAGRANTS WELLNESS JOURNEY 7 T – Threats – This is a prediction clause after the family member has passed. The only stumbling block that could occur is the hindrance in the grieving process. The family members may grieve themselves to death. The family may not want to continue with running the store. This can kill their fathers dreams and cause stress upon their mother. The family could have a lack of healthcare coverage that can cause large hospital bills after death. If there is healthcare coverage, it may not cover home healthcare or hospice care. There is a peer article written in 2009, Massachusetts Cuts back Immigrants’ Health Care. This article explains the government’s intention in relieving 31,000 legal immigrants’ of hospice benefits due to state budget cuts. The governor proposes new guidelines for the immigrant population that has an active green card for a minimum of 5 years. The governor says that after December 1, 2009, the immigrant population affected will have to rely on hospitals that provide free care (Goodnough, 2009). 4. Analyze the outcomes of the case and determine if there was room for improvement in the planning and delivery of care? In this case, the nurses could have been more understanding to the Mr. Ushery’s needs. I believe that if the physician knew of other therapies, maybe the prognosis would not have been death right away. According to the text, a recent study conducted in 2010, recognized by the acronym SUPPORT, states that sever pain was the most common repeated sign. The text suggests that the
  8. 8. AN IMMAGRANTS WELLNESS JOURNEY pain is due to the engorgement in the liver because of heart failure (Matzo, 2010). This could be why the patient had an acute episode at the festival. The acronym SUPPORT represents the study to understand prognosis and preferences for outcomes and risk treatments. I believe that it will take time for this family to heal due to the impact that the dad had on his family. If I were the practitioner, I would have social work to visit the patient including the chaplain. The family can rebuild their lives as time heals all wounds. 8
  9. 9. AN IMMAGRANTS WELLNESS JOURNEY 9 References Goodnough, A. (2009). Massachusetts Cutback Immigrants' Healthcare . The New York Times . Matzo, M. S. (2010). Palliative Care Nursing: Quality Care to the End of Life 3rd Edition . New York, New York : Springer Publishing Company.
  10. 10. AN IMMAGRANTS WELLNESS JOURNEY 9 References Goodnough, A. (2009). Massachusetts Cutback Immigrants' Healthcare . The New York Times . Matzo, M. S. (2010). Palliative Care Nursing: Quality Care to the End of Life 3rd Edition . New York, New York : Springer Publishing Company.

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