Recent Migrants From Iran

Published Date: 02 Nov 2017

Holmesglen

Assessment 1: case study- written assignment

Nursing 4- Family Centred Care

Nicole Jansz- JAN12372448

JAN12372448

Word Count: 2,189

This case study reflects on a family of recent migrants from Iran, Ahmed and Katya. This essay will explore the immediate challenges as well as the strengths and which may enable or prohibit them from managing their stressors. Several advantages and challenges of a blended family will be critically analysed identifying areas that may impact on their ability to access health care. A health education program will be identified. Moreover there will be a discussion of a multidisciplinary health care team who would be helpful for caring for the family. This essay will also critically analyse the professional and practical issues for the nurse working with the family. Development milestones of Zari, the daughter of Ahmed and Katya will be discussed. Lastly, this essay will provide information, resources and strategies on immunisation program available in Australia.

Ahmed, Katya and their children have been faced with immediate challenges since moving from Iran to Australia including the major issue of communication due to the language barrier. Katya speaks limited English, which may pose difficulties to interact with the community. They have limited financial resources; therefore may be hard to access health care providers or facilities. Another challenge is how they will cope while Katya is hospitalised as she has been diagnosed with cervical cancer. There is a lot of pressure on Ahmed as Katya relies on him for daily needs such as shopping.Lastly, they have no social support in Australia, unable to have connections with others and the ability to access help when needed.

This family is under a lot ofstress; however there are some strengths as well as weaknesses that will enable them to manage their stressors. Having a large family can be a positive as there are more children to play with as well as share new experiences and build mutual support. Another positive could be Ahmed’s business, which will help him gain employment in Australia as well as support his family.

Some weaknesses that may prohibit them from managing their stressors could be that the children have never been immunised and are at risk of infection and serious illness and Katya having a language barrier due to speaking limited English and relying on her husband for the daily needs. Furthermore there are questionable issues with Ahmed’s lifestyle as he is a heavy smoker with a poor diet.

Blended families are referred to as stepfamilies and occur when one or both of the parents remarry(Dupuis 2010). Positive role models are important in a child's life, and blended marriages provide greater access to people who fulfil this role(Dupuis 2010).Supportive parenting relationships can allow more time for each set of parent to be alone to establish their own relationship with their children(Hockenberry & Wilson 2011). Flexibility, mutual support, and open communication are critical in successful relationships in stepfamilies situations (Hockenberry & Wilson 2011).

Disadvantages of a blended family may be disagreements among the children not be getting along with each other, therefore causing conflicts and possible fighting. Due to Ahmed and Katya having eight children, it may lead to large costs such as providing food and clothes to the children which may produce stress for both parents.

There are potential barriers that may impact on Ahmed, Katya and their children to access health care. Language is one of the strongest barriers to accessing health services (Perrigue 2013). It can jeopardize effective communication between ethnic minority patients and health care personnel(Scheppersa 2008). People and their doctors may not speak a common language fluently therefore if Katya was to go to her doctor, itmay result in misunderstandings by both the doctor and herself.

Having financial barriers can prevent low income people from receiving timely medical care because they do not see their doctor as regularly as they should. This may impact on Ahmed, Katya and their childrendue to having limited financial resources to regularly visit a doctor for both health and immunising the children.

Having no social support would impact the ability of accessing a health care.Having family and friend support is an advantage in providing emotional support(Bremner 2009). Relationships can furnish assistance, companionship and of course stability. Katya relied on her parents for support but now since moving to Australia they have no social support. If they had access to the mosque, they could re-establish a social network.

Geographic isolation can create access barriers for people who live in rural areas, therefore not having immediate access to emergency services (Perrigue 2013).Ahmed chose a semi-rural community as the home base for his family. Therefore they may have to travel long distances for basic medical care, and even further if they need to visit a specialist. Living in a rural area may have a large impact on the family as Katya does not drive and can no longer attend the mosque daily.

Katya and Ahmed’s culture and religion could impact on them accessing health care due them maybe having cultural beliefs. It is important to remember that some cultures only allow the same gender health professional to provide them care.

A health program that is utilised in the community is The National Cervical Screening Program which aims to reduce deaths from cervical cancer(Ageing 2009). The program is aimed at only women and promotes routine screening with Pap smears every two years for women between the ages of 18 and 69 years (Ageing 2009).

The National Cervical Screening Program is targeted to only women but it does havesignificance on men as well. Human Papillomavirus is a virus that causes abnormal tissue growth or warts and is often associated with some types of cancer(Victoria 2012). Men can be carriers of cervical cancer through the Human papillomavirusandcan increase a woman’s risk of cervical cancer (Ageing 2009). HPV is passed on through genital contact, most often during vaginal and anal sex. Even though men cannot get cervical cancer, they can pass on the virus to women and they may develop cervical cancer (Murphy & Mark 2012).

There may be several ways to alter the program to ensure it targets both gender. Australian teenage boys are able to receive the cervical cancer vaccine from today even though it’s a cancer they will not ever develop. The vaccine fights off 70 per cent of cervical cancers caused by the human papilloma virus and although boys cannot develop the cancer they still carry the virus and can infect female sexual partners (Dunlevy 2013).Other ways to get the message across about cervical cancer to both genders may be getting someone to talk to all schools about the cervical cancer vaccine and how it can benefit both women and men. It should be widely spoken about as part of the health education in schools and also encouraging students to practice safe sex.Furthermore flyers or brochures can be sent in the mail to all residents as well as supplying large posters around schools displaying information about the human papillomavirus and cervical cancer vaccine.

Due to the family being under a lot of stress, a number of health care professional can assist in caring for them. A social worker would be a good person to have in the team to care for them. This is because they will be able to provide counselling and support through their stressful times, provide them with information about services and provide letters of referral that will help them to obtain other services such social security benefits(Melke 2013).

A language interpreter needs to be in the team caring for the family as Katya has very limited English. When Katya goes to the doctors or hospital, there needs to be someone who can help translate so Katya has an understanding about what is being said. A language interpreter will be able to help the family by interpreting verbal communications as well as orally translates written texts(Edwards 2012).

A psychologist would help this family out, especially because Ahmed and Katya are under stress. They will be able to talk to the psychologist about what is going on in their lives and how they can overcome their challenges. Lastly, having council help where someone can assist with cooking and cleaning as well as babysitting the children while Katya is in hospital.

When caring for Katya in hospital, the nurses need to be aware of professional and practical issues.To understand and deal effectively with families in a multicultural community, nurses must be aware of their own attitudes and values. Nurses should function within the framework of a professional culture with its own values and traditions(Hockenberry & Wilson 2011). A challenge for the nurses is to address the separation with families and to develop mutually agreed goals. When the nurse is able to respect the cultural differences of a family then they are better able to determine whether the behaviour is distinctive to the individual or a characteristic of the culture(Hockenberry & Wilson 2011). Nurses should plan and implement care specific to an individual’s situation including cultural, emotional, physical, religious and social(Hockenberry & Wilson 2011). They need to build on the strengths of families and enable them to identify and mobilise their coping resources as well as working in partnership with families sharing the decision making (Hockenberry & Wilson 2011). Another issue is for the nurses to respect the families’ culture decisions, because Katya may only want to be looked after by a female nurse.

All three year old children are different and they may develop at different rates(Croze 2011). Zari is three and was meeting her developmental milestones back in Iran but since moving to Australia, she has regressed.Motor development refers to the development of a child’s bones, muscles and ability to move around and manipulate his or her environment(Polan & Taylor 2007).For gross motor skills, Zari should be able to balance on one foot, jump on both feet, walk up steps using both feet, run, hop and walk a few steps on tiptoe(Polan & Taylor 2007). Fine motor skills that a three year old should be able to do are ride a bike, put simple puzzles together, build a tower of blocks and turn knobs and opens lids.

Psychosocial development considers the impact of external factors, parents and society on personality development childhood to adulthood(McLeod 2008a). According to Erikson, autonomy is a major psychosocial task for a three year old child. A three year old should be able to tolerate short separations from mother, dress and undress self and nearly fully toilet trained(McLeod 2008a). For Zari, she should be meeting her developmental milestones of being toilet trained but since moving to Australia, she has regressed and now experiences day time wetting.

Freud proposed that psychosexual development in childhood takes place in a series of fixed stages.  Anal and phallic stage is the most relevant to a three year old. The three year old becomes focused on the anus and grows great pleasure from defecating(McLeod 2008b). Early potty training can lead to the child becoming an anal-retentive personality who hates mess, is obsessively tidy and punctual (McLeod 2008b). In the phallic stage, a three year old becomes interested in genitals and is aware of anatomical sex differences(McLeod 2008b).

Cognitive development continues to develop by trial and error. Piaget's theory suggests that cognitive development occursin a series of four distinct(Polan & Taylor 2007). Stage two, the preoperational stage relates to what three year olds milestones should be. A three year old child should be able to search and find toys, locate body parts, knows relationships between things and person and gives full name(Polan & Taylor 2007). It is evident that Zari may not be reaching her cognitive milestones as she has regressed in her vocabulary since moving to Australia.

Several information and resources needs to be provided to Katya and the family about immunizing the children to ensure they are enabled to make informed choices about immunization.Firstly, thepaediatrician should listen carefully and respectfully to the parent's concerns (Douglas & Diekema 2008).The paediatrician should share honestly what is and is not known about the risks and benefits of the vaccine, understand the parent's concerns about immunization, and attempt to correct any misperceptions and misinformation(Douglas & Diekema 2008). Paediatricians should also assist parents in understanding that the risks of any vaccine should not be considered in isolation but in comparison to the risks of remaining unimmunized(Douglas & Diekema 2008).

Several information and resources should be provided to the family so they can make an informed choice about immunization. Resources may include brochures and posters written in their language. Since Katya is a woman with eight small children, who has cervical cancer, she may not have the time or the energy to try and decipher brochures and poster, therefore someone in the multidisciplinary health team such as social worker could come out and talk to Katya about immunisations and discuss the importance of getting her children immunised.

In conclusion, Ahmed, Katya and their children face several challenges but overcoming the negatives and improving access for them requires sustained attention by several health care providers. With the help of health care providers, they will be able to access health care facilities. The National Cervical Screening Program may help the family understand cervical cancer better. Providing resources and information to the family is needed to help them understand the benefits of immunizations. The family choosing to migrant to Australia from Iran is a good opportunity for the children to have better education and for Ahmed to utilise his management skills in a business. Lastly, it is important for all health care providers and nurses to mutual trust and respect when working with the family.