GERMAN CASE STUDY Margaret Schmidt, a terminally ill 60-year-old American of German descent, was recently admitted to a hospice service and is receiving care at home. Diagnosed with metastatic breast cancer, Margaret’s prognosis is less than 6 months. Margaret’s cancer has metastasized to her ribs and liver and often causes intense pain. Although Margaret speaks freely of her impending death, her family has expressed their discomfort at her decision to secure hospice care. Over the last 10 years, Margaret, a nurse, has practiced homeopathy (for herself and others) and consults frequently with a medical intuitionist. She follows the medical intuitionist’s recommendations to attenuate her symptoms but avoids, when she can, the traditional cancer pain–management therapies. Medical staff and her family have entered into continuous discussions with her about her lack of acceptance of traditional medical approaches. Margaret remains unconvinced of their value within her scheme of care. Margaret maintains a strong belief in an afterlife, believing that she will be reunited with her husband. Margaret meditates daily, calling upon her spiritual guides and angels for strength and peace in the dying process. She often asks those around her to join her during this time. Study Questions 1. What experiences have you had with patients of German descent? 2. How does Margaret’s German ancestry mold her beliefs about medical treatment? 3. What Western medicine concepts complicate the staff and family’s understanding of Margaret’s self-prescribed medical regimen? 4. How do you, as a health-care professional, feel about the use of homeopathic remedies? 5. What is your view of the use of medical intuitionists and other non- Western health practices? 6. How do Margaret’s health-care choices differ or match your own? 7. How do you deal with cultural health practices unlike your own? 8. Discuss Margaret’s desire to control her life even through terminal illness. 9. Relate Margaret’s strong spiritual beliefs in an afterlife to her ability to cope with her impending death. 10. Describe a plan of care that is culturally sensitive to the patient and her family. 11. How can your knowledge of the German American culture positively influence health outcomes for Margaret? 12. Discuss the cultural filters you may use as you assist Margaret in her health-care decisions. 13. Describe the enculturation you, as a health-care professional, have experienced and how this influences your own health-care decisions. IRISH CASE STUDY The O’Rourke family lives on a small farm in Iowa and comprises David, aged 30; his wife, Mary, aged 29; and two children: Bridget, aged 7, and Michael, aged 6. Both David and Mary are second-generation Irish. Before purchasing their farm 5 years ago, David sold farm equipment in Ohio. The O’Rourkes are Catholic; Mary converted to Catholicism when they married. David, who works long hours outdoors, is concerned about profitability from his corn crop because of the unpredictable size of the harvest, and thus, his income varies depending on the weather. Mary did not work outside the home because she wanted to be with their children until they started school. However, because both children are now school age, Mary has discussed with David the possibility of working part time to supplement the family income. He would prefer that she stay at home, but Mary is anxious to return to the workforce and believes the timing is right. Both David and Mary are happy with just two children and do not desire more. They use the rhythm method for family planning. Eating a healthy breakfast is important to the O’Rourkes. Because eggs are readily available on the farm, they have fried eggs with potato bread and juice at least four times a week. Their main meal in the evening usually includes meat, potatoes, and a vegetable. David enjoys a glass of beer with dinner. David has been a little edgy lately because of his concerns about the corn crop. He admits to having some minor chest pain, which he attributes to indigestion. His last visit to a physician was before their marriage. Mary knows David is concerned about finances and believes it would help if she had a job. Bridget and Michael spend a lot of time outside playing and doing some minor chores for their parents. Both children enjoy school and are looking forward to returning in the fall. Bridget is starting to show concern over her appearance. She does not like her red hair and all the freckles on her face. Her teacher has noted that Bridget has trouble reading and may need glasses. Michael wants to be a farmer like his Dad but worries about his Dad being tired at night. The O’Rourkes have not taken a vacation since they were married. They go to the state fair in the summer, which is the extent of their trips away from home. They are active in the church and attend services every Sunday. Study Questions 1. Describe the O’Rourke family structure in terms of individual roles. 2. Identify two potential health problems related to the O’Rourke’s dietary practices. 3. Identify potential health-risk factors for the O’Rourkes as a family unit and for each family member. 4. Explain the relationship between risk factors and ethnicity specific to the O’Rourke family and their Irish heritage. 5. Describe culturally competent health-promotion strategies for the identified risk factors for the O’Rourke family. 6. Describe the O’Rourke family’s fertility practices. Are they congruent with their Irish background and religious beliefs? 7. Describe the O’Rourke family’s communication patterns. 8. What are the predominant health conditions among Irish immigrants? 9. Explain the significance of the Great Potato Famine for Irish Americans. 10. Name two genetic diseases common among Irish Americans. 11. Identify accepted fertility practices for Irish American Catholics. 12. Identify three sources of strength for the Irish American in times of illness. 13. Identify traditional home remedies commonly used by Irish Americans.