Ahmed and Katya recently migrated to Australia from Iran. They have 8 children, including 7 from their previous marriages, who are aged 7 months to 17years. Katya was recently diagnosed with advanced cervical cancer and has to undergo further tests in hospital, needing a three day inpatient stay. This case study will discuss the main issues faced by Katya and her family including the immediate challenges, strength and weaknesses of the family coping with their stressors, the advantages and challenges of a blended family and the areas which could impact on the families ability to access health care. A health education program will be analysed in relation to how it operates to assist people suffering grief due to cancer related illnesses. The case study will also focus on health care providers who, as part of the multidisciplinary team, could provide active support in managing the family’s stress. The professional and practical issues encountered by the nurse who is caring for Katya and her family and the psycho social, psychosexual and cognitive development of Zak, the eldest child of the family, will also be discussed. Finally, this case study will outline the information and resources available regarding choices about immunisation for Katya’s family and the strategies which can be implemented to provide awareness of immunization based education.
Katya is limited in her English skills, has studied up to 8th grade and relies on her parents for support, being the only child in the family. The fact that her parents did not migrate to Australia puts her at greater risk of failing to manage her cancer situation, especially when she is already concerned about how her situation will impact on her husband and children. According to Hobbs (2009), cervical cancer can traumatise the lives of women, create long-term problems for families such as financial issues, depression and challenge health care systems. Since Katya is illiterate and speaks little English, it is important to have the services of a translator to educate her and to explain procedures, remaining tests and treatment during her stay at the hospital (Tschurtz et. al 2011). In the interim the involvement of Katya’s parents is imperative because their presence can reduce Katya’s anxiety related to her main responsibility of taking care of her children’s needs (Your Life Choices 2012). Another immediate family challenge will be looking after 3 year old Zari who is very attached to her mother and is experiencing day time wetting and 7 month old Layla who would solely depend on her mother’s care and protection. Both these children will be affected by losing their mother’s care while Katya is undergoing tests for 3 days at the hospital. A social worker could be appointed to looking after Zari’s and Layla’s until Katya returns home (Miller 2012).
Strengths and weaknesses of the family when managing stress
There will be common signs and symptoms that may indicate the level of stress in Katya’s family. Ahmed, as the father and the bread winner of the family, will be accountable for each and every child’s wellbeing. Under this circumstance he may experience sleeping disturbances, feelings of tension, irritability and mainly the overuse of tobacco which can put toil on his deteriorating health (Carers ACT 2013). Adolescents’ like Zak and Samira are vulnerable to experience more stress when they perceive a situation as difficult or painful and they do not have the ability to cope (Australian Government Cancer Australia 2012).In this situation they could endure constant worries due to school demands, negative thoughts and feelings, family financial problems and the illness of their mother (Australian Government Cancer Australia 2012). Considering the fact that Katya’s family has no social support and the only care giver, Ahmed, is experiencing health issues such as chest pain and possible hypercholesterolemia, it will prevent these children getting the much needed support and care to overcome their stresses. One encouraging sign this family demonstrates in managing stress is by Zak (17 years old) and Samira (13 years old) relieving some responsibility from their father by taking care of their other little brothers and sisters. This will take off a lot of stress from Ahmed who will struggle immensely to negotiate the present condition otherwise.
Advantages and challenges of a blended family
According to the State Government of Victoria (2013), blended families are common in Australia. Establishing a blended family has advantages and disadvantages, depending on the people involved and generally, patience, respect, commitment and time help to overcome most problems (State Government of Victoria 2013). According to The State Government of Victoria (2013), advantages of a blended family can be described as in Katya’s family, the children can get extra care from their other parent if the parent is willing to come to Australia providing that the government do the the necessary to support them. Children also have extra brothers and sisters with whom they can face this difficult time together (State Government of Victoria 2013). One challenge this family might face in this situation is the lack of mutual bond and understanding of each other. Ahmed as the father of the family may be finding it difficult to build close bonds with his step children and therefore struggle to calm the anxiety of Katya’s 3 children (Relationships Australia 2013). Family members may have experienced emotional upheavals such as distress from the break-up of the previous marriage or relationship and thechildren may still be grieving for the family they have lost (Relationships Australia 2013 ).
Areas that may impact the family to access health care
According to The Australian Institute of Family Studies (2008), lack of English proficiency in the family can prevent them from seeking out or having the confidence to access valuable information about the services and resources available in the community which they could benefit from. Even Ahmed who used to assist Katya in communication for daily needs such as shopping could struggle with the terminology used by the service providers and health practitioners and they may misinterpret the body language of Ahmed and his family (Australian Institute of Family Studies 2008).
Australian Institute of Family Studies (2008), also points out that some collectivist cultures depend upon the family as the main source of support when confronting issues and these are not revealed to outsiders. In this situation Ahmed and his family may be reluctant to seek extra-familial support due to prohibitive sociocultural rules and this will affect Katya personally because according to her culture the woman’s role is that of a carer rather than as the one who cared for (Australian Institute of Family Studies 2008).
Lloyd, O'Brien, & Lewis 2003 (cited in Australian Institute of Family Studies 2008), describe that most family counselling services have great difficulty in engaging fathers from ethnic minority groups due to traditional gender roles. The reason in this situation is that Ahmed, as the main bread winner, has a huge responsibility to meet the financial requirements of the entire family and will be mainly focusing on the importing/exporting business simply because he cannot afford to lose time. The fact that is an Islamic culture raising children is defined as being mainly a female role, would prevent Ahmed from engaging his children in counselling (Safra Project 2011).
Professional and practical issues for the nurse working with Katya
Katya’s limitation in understanding English language is a main concern which the nurse who is looking after her should address methodically. According to Victorian branch of the Australian Association of Hospital Interpreters and Translators (2013), the nurse can use the services of hospital interpreter or a translator to understand cultural issues relevant to Katya’s treatment and to explain her medical and therapeutic treatments and advancements. Since Katya is coming from a Muslim cultural background she will be morally obligated to practice religion during her stay at the hospital as Islam places responsibility of practising religion on each individual (State of Queensland Queensland Health 2010). The nurse should be able to provide suitable accommodation to perform Katya’s prayers within the resources available to her and she also has to make sure it doesn’t intrude other patients’ privacy.
According to the State of Queensland Queensland Health (2010), fasting is an essential part of the Islamic religion and is seen as a means of purifying the body and the soul during the Ramadan season. Fasting is compulsory for Muslims except critically ill or bed ridden patients’. This could have negative effects on Katya’s treatment and procedures including tests and medication. Therefore, the nurse who is looking after her should encourage Katya to make informed decisions regarding the importance of her medical treatments (State of Queensland Queensland Health 2010).
Modesty is very significant in Islam and Muslim men and women may be diffident about having their body parts exposed to a stranger especially tothe opposite sex. The nurse, as a part of his or her professional practice, should take measures to arrange a female practitioner or a healthcare provider during the examinations (State of Queensland Queensland Health 2010).
Health Education Program
Katya’s family lives in a semi-rural community. The Multicultural Centre for women’s Health is an organisation which is committed to improving the health of immigrant andrefugee women in Australia (Multicultural Centre for women’s Health 2010). This organisation conducts health educational sessions lead by bicultural health educators in the language of the women participants and are free of cost. The sessions are supported by written resourceswhich are prepared in the language of the groupand distributed to individual women (Multicultural Centre for women’s Health 2010). Resources aredesigned to offer women extra information intheir chosen language and for future reference. These resources include women health issues such as breast examination, Hormone Replacement Therapy, mental health wellbeing and pap tests/smears (Multicultural Centre for Women’s Health 2010).
The education program conducted by the Multicultural Centre for Women’s Health only concentrates on improving the health of migrant and refugee women in Australia and therefore is not of any assistance to Ahmed or any other family members. There is no involvement of the women’s male counterparts in the program. Therefore Ahmed may not know or betold by Katya about the developments or the ongoing issues especially due to her limited understanding of the English language. Also, Ahmed himself is experiencing a deterioration of health accompanied by chest pain which is constantly worsening and his poor eating habits and smoking puts him at a greater risk of having a heart attack (World Heart Federation 2013). This health education program does not provide support to overcome Ahmed’s health issues. To be more effective and productive for Katya’s family, the health education program should be more open to male gender and the participation of Ahmed and the children, could enhance the holistic approach and cover many aspects of the health issues in Katya’s family.
Health Care Providers
According to The Latrobe Regional Hospital (2008), clinical psychologists can provide adapted, well planned and comprehensive psychological assessment and interventions that aim to reduce psychological distress and to promote psychological wellbeing.
Members of Katya’s family including Ahmed, Zak and Samira could seek assistance from a psychologist to manage their fear, anxiety, stress,depression and self-esteem. The psychologist will implement different methods such as cognitive behavioural therapy, stress and anxiety management (Latrobe Regional Hospital 2008). The therapy sessions involve practising relaxation and educational therapies, in order to manage the functional necessities of everyday life and Katya’s family can be benefit from the services offer to them by the clinical psychologist (Latrobe Regional Hospital 2008).
Social workers offer distinctive skills which relate to social and cultural aspects of care for the management of cancer patients and their families. According to Latrobe Regional Hospital (2008), Social workers provide services in many ways. They can assist Katya’s family during complicated conversations due to clinical change and diagnosis of Katya’s advanced cervical cancer (Latrobe Regional Hospital 2008). Social workers also work on preparing for and involvement in family meetings, working with children and adolescents, emergency financial assistance and negotiating with private health insurance. All these services available from social workers can exert a positive impact on Ahmed and his family (Latrobe Regional Hospital 2008).
Expectations of Zak’s motor, psychosexual and cognitive development and psychosocial behaviour
Zak is 17 years, the eldest child in the familyand the only child who has an understanding about the responsibilities and expectations of his parents. According to Piaget n.d. (cited in Chiooca 2011, p. 35), adolescents like Zak are in the stage of concrete operations and can think systematically and logically. This can be one reason that he feels the weight and responsibility of the family. Piaget n.d. (cited in Wong, Hockenberry & Wilson 2011, p. 746) describes that adolescents begin to think about more far reaching problems, about their futures and the nature of the society they will enter. Zak’s interest in becoming a chef and travelling around the world clearly shows that his cognitive development levels reached up to the level of what Piaget suggests.
According to Freud n.d. (cited in Chiooca 2011, p. 22), from puberty onward the individual’s main task is to liberate himself from parents. This involves discharging his bond from the mother, finding a woman of his own and confronting opposite ideas of his father as well as free himself from his father’s dominance (Freud n.d., cited in Chiooca 2011, p. 22). All the above factors will play a key role in Zak’s psychosexual and psychosocial development as he is being expected to follow his father’s business, marry early, and produce children early (mainly boys). As Freud mentions, independence never comes easily, and there is a potential that Zak will struggle to gain his independence due to the traditional and cultural demands of the family.
According to Erickson n.d. (cited in Wong, Hockenberry & Wilson 2011, p. 748), the primary task of such as Zak, is to establish a new sense of ego identity which is a feeling for whom actually he is and who he wants to put himself in the society. He also explains that adolescents at Zak’s age are uncertain about who they are and uneasily recognised with "in groups". At the same time they can become extremely clannish, intolerant, and cruel when they are rejecting others who are different (Erickson n.d., cited in Wong Hockenberry & Wilson 2011, p. 748).
Information and resources for immunisation and the strategies to enhance the understanding of immunisation
The Department of Health Australia (2013) provides information regarding vaccination and immunisation in many foreign languages including Arabic. Their resources can be used effectively to educate Katya and her family since they are coming from an Arabic background and their understanding of English language is limited. These resources offer conclusive information regarding each and every vaccine used in immunisation and the importance of understanding childhood immunisation (The Department of Health Australia 2013). To make understand the importance of the vaccination in the Katya’s family, a translator can be used to demonstrate the procedures and benefits effectively (Australian Health Directory 2013). Appointing a religious leader in the mosque Katya’s family is visiting, is a good strategy to build trust and confidence on immunisation. Muslim people have a tendency to trust upon their religious leaders more than anyone else especially when they are in a completely different environment and a culture.Therefore seeking services of such a person is practically more successful.
In conclusion Middle East born women like Katya are less likely to be screened for cervical cancer in Australia due to language barrier and culture specific barriers.These barriers compromise cancer screening, treatment and yet leave them and their family’s in turmoil.