Caring for Cuban, Amish, & Irish Populations

Full Answer Section

• • healthcare system and their reasons for leaving can shape their trust and expectations of the U.S. system.
  • Mariel Boatlift (1980): This wave included a more diverse group, including individuals with lower socioeconomic status and some with criminal backgrounds, which may have led to different levels of acculturation and experiences with social services.  
  • Post-Soviet Era (1990s onwards): Economic hardship in Cuba after the collapse of the Soviet Union led to further immigration, often with different economic and social challenges upon arrival.  

• Level of Acculturation: The longer an individual has lived in the U.S., the more likely they are to have adopted American cultural norms, including healthcare practices and communication styles. Newer immigrants may still strongly adhere to Cuban cultural beliefs and practices regarding health, illness, and family involvement in care.

• Language Proficiency: Those who immigrated earlier may have had more time to learn English proficiency, while more recent immigrants may face language barriers that significantly impact their ability to understand medical information and communicate their needs.

• Socioeconomic Status in the U.S.: The time of immigration can correlate with current socioeconomic status in the U.S. Earlier, more affluent immigrants may have better access to comprehensive healthcare compared to more recent immigrants who may face financial constraints or lack of insurance.

• Experiences with the Cuban Healthcare System: Individuals who experienced the Cuban healthcare system, regardless of their departure time, will have different expectations regarding access, the role of the physician, and the types of treatments available. This can influence their perception of the U.S. system.

• Political Views and Trust: Their experiences with the political climate in Cuba at the time of their departure and their subsequent experiences in the U.S. can influence their level of trust in institutions, including the healthcare system.

B. What can a nurse do to make life in the hospital more culture-specific for an Amish client?

Nurses can take several steps to provide culturally sensitive care that respects the Amish client's values and practices while they are in the hospital:

• Respect for Modesty: Provide gowns and coverings that offer maximum privacy. Be mindful of exposure during examinations and procedures, explaining the necessity beforehand. Allow family members (often of the same gender) to assist with care if the client is comfortable.
• Family Involvement: Recognize the importance of family in decision-making and support. Allow family members to stay with the client as much as possible, respecting their roles in providing comfort and care. Clarify who the primary decision-maker is within the family.
• Communication: Speak clearly and respectfully. Be aware that some Amish individuals may have limited experience with modern technology and medical terminology. Use simple language and allow ample time for questions. Be patient and understanding if their English is not their first language (Pennsylvania Dutch is often spoken).
• Technology Considerations: Understand that many Amish do not use modern technology like televisions, radios, or computers in their daily lives. Refrain from automatically turning these on in the room unless specifically requested. Be discreet about using personal electronic devices in their presence.
• Dietary Needs: Inquire about specific dietary practices. While there isn't a strict "Amish diet," many prefer simple, home-cooked foods and may have preferences regarding processed foods. Be prepared to accommodate these preferences as much as the hospital allows.
• Dress and Appearance: Understand that their clothing is plain and modest. If personal clothing needs to be stored, handle it with respect. If the hospital provides clothing, ensure it aligns as closely as possible with their standards of modesty.
• Social Interaction: Be mindful that their social interactions are often within their close-knit community. Facilitate visits from family and community members as appropriate within hospital guidelines.
• Spiritual Needs: Respect their religious beliefs and practices. Inquire if they have a spiritual leader or deacon they would like to contact. Provide privacy for prayer or reading religious materials.
• Limited Information Seeking Online: Understand they are unlikely to seek health information online. Provide clear, written instructions and explanations.
• Acceptance and Non-Judgment: Approach the client with an open and accepting attitude, respecting their cultural choices without judgment.

C. List at least two etiological reasons for the development of alcoholism within an Irish-American family.

The development of alcoholism is a complex issue with multiple contributing factors, including genetic, psychological, social, and cultural influences. Within Irish-American families, several etiological reasons might contribute to a higher prevalence or acceptance of alcohol use and potentially alcoholism:  

1. Cultural Norms and Historical Context: Historically, alcohol consumption has been deeply ingrained in Irish culture, often associated with social gatherings, celebrations, and even coping mechanisms for hardship. Irish immigrants brought these cultural norms to America, and for some families, heavy drinking patterns may have been passed down through generations as a socially acceptable or even expected behavior. This cultural acceptance can normalize high alcohol consumption and make it more difficult to recognize or address problematic drinking within the family.  

2. Stress and Trauma Associated with Immigration and Acculturation: The experience of immigration itself can be stressful, involving adapting to a new culture, language, and social environment. For Irish immigrants and their descendants, historical periods of economic hardship, famine, and discrimination in America may have contributed to increased alcohol use as a coping mechanism for stress, anxiety, or feelings of displacement. This can create a family history where alcohol becomes a maladaptive way to deal with emotional distress, increasing the risk of developing alcoholism.  

It's crucial to remember that alcoholism is a multifaceted disease, and these are just two potential etiological factors within the specific context of Irish-American families. Individual experiences, genetics, and other social and psychological factors also play significant roles.

Sample Answer

Here are the answers to your questions, keeping in mind the current time and location (though these factors don't directly influence the cultural considerations):

A. What are the differences that may affect Cuban-American patients who immigrated at different times?

Cuban-Americans who immigrated at different times may have varying experiences and perspectives that can significantly affect their healthcare interactions and needs. These differences can stem from:  

• Reasons for Immigration:

  • Pre-1959: Many early immigrants were often from wealthier backgrounds and had different political and economic motivations for leaving Cuba before the revolution. They may have a different worldview and expectations of healthcare systems.
  • Post-1959 (waves throughout the decades): Subsequent waves of immigrants often had different socioeconomic backgrounds and motivations, including political persecution, economic hardship, and family reunification. Their experiences with the Cuban