Minimum of 300 words with at least 2 peer review reference in 6th edition APA style.

 

1. Discuss the epidemiology of thalassemia and share evidence-based practice guidelines necessary for chronic management.
2. Sickle-cell anemia has treatment parameters in the chronic state and acute exacerbation. The acute phase requires aggressive hydration and pain medication. What is the physiologic pattern for this problem?

Minimum of 250 words with at least 2 peer review reference in 6th edition APA style.

 

1. Anemia of chronic disease is a common occurrence in elderly patients. What is the pathophysiological mechanism behind this disease process?
2. Virchow’s triad refers to states that can produce hypercoagulability. What are the three categories? Give an example for each and explain the pathophysiological changes seen.

Minimum of 250 words with at least 2 peer review reference in 6th edition APA style.

 Health plans participating in the Affordable Care Act must be accredited; what is the difference between the National Committee for Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC)? Why would a health plan select one over the other? 

The Future of Healthcare Informatics

Write an essay addressing each of the following points/questions. Be sure to completely answer all the questions for each number item. There should be three sections, one for each item number below, as well the introduction (heading is the title of the essay) and conclusion paragraphs. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least three (3) citations in your essay. Make sure to reference the citations using the APA writing style for the essay. The cover page and reference page do not count towards the minimum word amount. Review the rubric criteria for this assignment.

1. Identify the current role of the informatics nurse and predict the future role of the informatics nurse, based on scholarly sources.
2. Explain what is meant by connected health. Provide three examples of connected health in todays healthcare environment. Explain the benefits and drawbacks of each.
3. In what ways has informatics impacted public health please provide at least three examples.

Assignment Expectations:

Length: 500 words per essay prompt/section (1500 total for this assignment)

Structure: Include a title page and reference page in APA style. These do not count towards the minimal word amount for this assignment. All APA Papers should include an introduction and conclusion. 

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims.

Rubric: This assignment uses a rubric for scoring. Please review it as part of your assignment preparation and again prior to submission to ensure you have addressed its criteria at the highest level.

Format: Save your assignment as a Microsoft Word document (.doc or .docx) or a PDF document (.pdf)

File name: Name your saved file according to your first initial, last name, and the module number (for example, RHall Module 1.docx)

1 reply 150 words citation reference

The aim of health promotion is to improve the health of not only individuals but also populations through health education. One among other models that ensures health promotion is the Ponders health promotion model. This model was developed when Nola Pender noticed that health care professionals only paid attention to treating diseases but didnt recognize the need for promotion of healthy lifestyles. In 1982 therefore, this model came into existence to provide a framework that helps to understand health promotion behaviors by recognizing the family as the unit of assessment and intervention. Through identification of available resources and fostering resilience among individual family members this theory encouraged behavioral changes that led to promotion of health among family members. The other components of this model that influences behavioral change include; recognizing experiences and characteristics of individuals, understanding behavior-specific cognition and affect and implementing behavioral outcomes (Kwong & Kwan, 2007)

As important as health teaching seems, nurses should also be aware of other variables that are likely to affects patients ability to learn. Such variables include; race, ethnicity, disability, sex, sex orientation, environmental threats, poverty levels, access to health care and lack of education. Other factors such as cultural, socio-economic and socio-political influences affect the patients experiences while other components like stereotype, biases and other forms of discrimination can limit the healthcare providers ability to share relevant health information. Being able to self-analyze and analyze their target populations, health providers can effectively eliminate these barriers to safeguard health promotion strategies (Whitney, 2018)

Through the transtheoretical model, health providers are able to assess the patients readiness to change. The different stages involved include; precontemplation, contemplation, planning, action, maintenance and termination. As the providers work with patients through this model, they are able to note any positiveness or unwillingness depending on their participation. If patients turn out to be positive, they are more actively involved in the decision making of their specific tailored care plans and this ultimately leads to effective learning outcomes as they continue in healthy living behaviors (Whitney, 2018)

References.

Whitney, S. (2018) Health Promotion: Health & Wellness Across the Continuum. Grand Canyon University. Retrieved from 

Kwong, E. W., & Kwan, A. Y. (2007). Participation in health-promoting behavior: Influences on community-dwelling older Chinese people. Journal of Advanced Nursing, 57(5), 522-534.

2 reply 150 words citation references

Banduras self-efficacy theory of behavior change is a model developed by Albert Bandura that is used to initiate behavioral changes. Whitney (2018) states He believed that feelings of self-efficacy can lead to competency; in other words, he believed that individuals have the ability to bring about their own outcomes (Whitney, 2018, para. 30). This model emphasizes the importance of the patient feeling that he/she is capable of making changes that will lead to the desired outcomes. The patient must feel confident in their own abilities to bring about postive outcomes.

Banduras model helps in teaching behavioral changes by giving the patients the knowledge needed so that they can feel confident in themselves. Whitney (2018) states This conceptual theory explains how learning is influenced by repetition, reinforcement, and symbolic modeling.learning (Whitney, 2018, para. 30). When patients are in doubt of their own capabilities it makes it hard for them to believe that they are capable of attaining the outcome that is desired for them. However, when patients are taught through repetition and reinforcement, they gain confidence in their own abilities and that is what is needed to bring about the desired outcome.

There are many barriers that may affect a patients ability to learn. According to Whitney (2018) Patients physical condition, including limited vision and auditory function, mobility, alertness, mental capacity, or high levels of physical pain, may impede learning capability (Whitney, 2018, para. 18). All of these physical conditions can negatively affect the patients ability to learn. There are other barriers, such as language barriers, that can make it a difficult for a patient to learn, so it is imperative that there is a translator available when needed to be certain that the patient understands what is being taught. 

It is important for the nurse to assess the patient to identify their readiness to learn. If a patient is not willing and ready to learn or willing to make the needed changes then the learning outcomes will be negatively affected. The learning outcomes will be positively affected by the patient that is ready and willing to make changes. The patient must be ready to learn and change for the teaching to be successful.

Reference

Whitney, S. (2018). Grand Canyon University (Ed). Health promotion: Health & wellness across the continuum. Retrieved from

 

tart by reading and following these instructions:

1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.

2. Read the required chapter(s) of the textbook. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.

3. Consider the discussion and the any insights you gained from it.

4. Produce the Assignment submission in a single Microsoft Word or Open Office document. Be sure to cite your sources, use APA style as required, check your spelling.

Discuss mechanisms that you can implement which will reduce medical errors. Which departments will interact to ensure patient safety and how?

Assignment Description: This assignment will be at least 1500 words or more

This week you will reflect upon patient safety and satisfaction to answer the following questions:

• How can patient safety measures lead to cost savings?  
• Briefly define the Joint Commissions role in healthcare.
• Reflect on your future role in healthcare, and how you will contribute to patient safety.
• How do you see the role of the chief nursing officer regarding patient safety?

Assignment Expectations: How will students be successful?

• Length:
  • 1500-2000 words (6-8 pages); answers must thoroughly address the questions in a clear, concise manner
• Structure:
  • Include a title page and reference page in APA style
• References:
  • Two scholarly references are required; you should include the appropriate APA style in-text citations and references for all resources utilized to answer the questions
• Format:
  • Save your assignment as a Microsoft Word (.doc or .docx), Open Office (.odt) or rich text format (.rtf) file type
• File name:
  • Name your saved file according to your last name, first initial and the week (for example, jonesb.week1)
• Submission:
  • Submit your assignment to the Drop Box

For this assessment, you will implement the preliminary care coordination plan you developed in Assessment 1. Present the plan to the patient in a face-to-face clinical learning session and collaborate with the patient in evaluating session outcomes and addressing possible revisions to the plan.

NOTE: You are required to complete this assessment after Assessment 1 is successfully completed.

Care coordination is the process of providing a smooth and seamless transition of care as part of the health continuum. Nurses must be aware of community resources, ethical considerations, policy issues, cultural norms, safety, and the physiological needs of patients. Nurses play a key role in providing the necessary knowledge and communication to ensure seamless transitions of care. They draw upon evidence-based practices to promote health and disease prevention to create a safe environment conducive to improving and maintaining the health of individuals, families, or aggregates within a community. When provided with a plan and the resources to achieve and maintain optimal health, patients benefit from a safe environment conducive to healing and a better quality of life.

This assessment provides an opportunity for you to apply communication, teaching, and learning best practices to the presentation of a care coordination plan to the patient.

You are encouraged to complete the Vila Health: Cultural Competence activity prior to completing this assessment. Completing course activities before submitting your first attempt has been shown to make the difference between basic and proficient assessment.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

• Competency 1: Adapt care based on patient-centered and person-focused factors.     
  • Design patient-centered health interventions and timelines for care delivered through direct clinical interaction that is logged in the CORE ELMS system.
• Competency 2: Collaborate with patients and family to achieve desired outcomes.     
  • Evaluate learning session outcomes and the attainment of mutually agreed-upon health goals, in collaboration with a patient.
• Competency 3: Create a satisfying patient experience.     
  • Evaluate patient satisfaction with the care coordination plan and progress made toward Healthy People 2020 goals and leading health indicators.
• Competency 4: Defend decisions based on the code of ethics for nursing.     
  • Make ethical decisions in designing patient-centered health interventions.
• Competency 5: Explain how health care policies affect patient-centered care.     
  • Identify relevant health policy implications for the coordination and continuum of care.

Preparation

In this assessment, you will implement the preliminary care coordination plan you developed in Assessment 1 and communicate the plan to the patient in a professional, culturally sensitive, and ethical manner.

To prepare for the assessment, consider the patient experience and how you will present the plan. Make sure you schedule time accordingly.

Note: Remember that you can submit all, or a portion of, your plan to for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 2448 hours for receiving feedback.

Instructions

Note: You are required to complete Assessment 1 before this assessment.

For this assessment:

• Complete the preliminary care coordination plan you developed in Assessment 1.
• Present the plan to the patient in a face-to-face clinical learning session. Communicate in a professional, culturally sensitive, and ethical manner.
• Collaborate with the patient in evaluating session outcomes and addressing possible revisions to the plan.

Reminder: The time you spend presenting your final care coordination plan must be logged in the CORE ELMS system. The total time spent in securing individual participation in this activity in Assessment 1 and presenting your plan in this assessment must be at least three hours. The CORE ELMS link is located in the courseroom navigation menu.

Please be advised that the Volunteer Experience form requires that you provide the name and contact information for at least one individual with whom you worked as part of your direct clinical activity. Your faculty may reach out to this individual to verify that you have accurately documented and completed your clinical hours.

Document Format and Length

Build on the preliminary plan document you created in Assessment 1. Your final plan should be 57 pages in length.

Supporting Evidence

Support your care coordination plan with peer-reviewed articles, course study resources, and Healthy People 2020 resources. Cite at least three credible sources.

Grading Requirements

The requirements, outlined below, correspond to the grading criteria in the Final Care Coordination Plan Scoring Guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.

• Design patient-centered health interventions and timelines for care delivered through direct clinical interaction that is logged in the CORE ELMS system.     
  • Address three patient health issues.
  • Design an intervention for each health issue.
  • Identify three community resources for each health intervention, so the patient may make an informed decision about what resources to use.
• Make ethical decisions in designing patient-centered health interventions.     
  • Consider the practical effects of specific decisions.
  • Include the ethical questions that generate uncertainty about the decisions you have made.
• Identify relevant health policy implications for the coordination and continuum of care.     
  • Cite specific health policy provisions.
• Evaluate learning session outcomes and the attainment of mutually agreed-upon health goals, in collaboration with the patient.     
  • What aspects of the session would you change?
  • How might revisions to the plan improve future outcomes?
• Evaluate patient satisfaction with the care coordination plan and progress made toward Healthy People 2020 goals and leading health indicators.     
  • What changes would you recommend to improve patient satisfaction and better align the session with Healthy People 2020 goals and leading health indicators?

Additional Requirements

Before submitting your assessment, proofread your final care coordination plan to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your plan.

You must submit your hours to the system before you can complete this assessment and course.

Portfolio Prompt: Save your presentation to your . Submissions to the ePortfolio will be part of your final Capstone course.

Apply information from the Aquifer virtual case studies to answer the following questions:

• What is the Chief complain in the case studies? What are important questions to ask the patients to formulate the history of present illness and what did the patients tell you?
• What components of the physical exams are important to review in the cases? What are pertinent positive and negative physical exam findings to help you formulate your diagnosis?
• Which differential diagnosis is to be considered with each case study? What was your final diagnosis?

Answer the same questions for case study 1 and 2

Provide references

Do 2 pages.

Select a community organization or group that you feel would be interested in learning about ethical and policy issues that affect the coordination of care. Then, develop and record a 10-12-slide, 20-minute presentation, with audio, intended for that audience. Create a detailed narrative script for your presentation, 4-5 pages in length.

As coordinators of care, nurses must be aware of the code of ethics for nurses and health policy issues that affect the coordination of care within the context of the community. To help patients navigate the continuum of care, nurses must be proficient at interpreting and applying the code of ethics for nurses and health policy, specifically, the Affordable Care Act (ACA). Being knowledgeable about ethical and policy issues helps ensure that care coordinators are upholding ethical standards and navigating policy issues that affect patient care.

This assessment provides an opportunity for you to develop a presentation for a local community organization of your choice, which provides an overview of ethical standards and relevant policy issues that affect the coordination of care. Completing this assessment will strengthen your understanding of ethical issues and policies related to the coordination and continuum of care, and will empower you to be a stronger advocate and nursing professional.

It would be an excellent choice to complete the Vila Health: Ethical Decision Making activity prior to developing the presentation. The activity provides a helpful update on the ethical principles that will help with success in this assessment.

Demonstration of Proficiency

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

• Competency 4: Defend decisions based on the code of ethics for nursing.     
  • Assess the impact of the code of ethics for nurses on the coordination and continuum of care.
• Competency 5: Explain how health care policies affect patient-centered care.     
  • Explain how governmental policies related to the health and/or safety of a community affect the coordination of care.
  • Identify national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination.
• Competency 6: Apply professional, scholarly communication strategies to lead patient-centered care.     
  • Communicate key ethical and policy issues in a presentation affecting the coordination and continuum of care for a selected community organization or support group. Either speaker notes or audio voice-over are included.

Preparation

Your nurse manager at the community care center is well connected and frequently speaks to a variety of community organizations and groups. She has noticed the good work you are doing in your new care coordination role and respects your speaking and presentation skills. Consequently, she thought that an opportunity to speak publicly about contemporary issues in care coordination would be beneficial for your career and has suggested reaching out to a community organization or support group to gauge their interest in hearing from you, as a care center representative, on a topic of interest to both you and your prospective audience.

You have agreed that this is a good idea and have decided to research a community organization or support group that might be interested in learning about ethical and policy issues related to the coordination of care. Your manager has suggested the following community organizations and support groups, but acknowledges that the choice is yours.

• Homeless shelters.
• Local religious groups.
• Nursing homes.
• Local community organizations (Rotary Club or Kiwanis Club).

To prepare for this assessment, you may wish to:

• Research your selected community organization or support group.
• Review the Code of Ethics for Nurses With Interpretive Statements and associated health policy issues, specifically, the ACA.
• Review the assessment instructions and scoring guide to ensure you understand the work you will be asked to complete.
• Allocate sufficient time to rehearse your presentation before recording the final version for submission.

Note: Remember that you can submit all, or a portion of, your draft presentation to for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 2448 hours for receiving feedback.

Recording Equipment Setup and Testing

Check that your audio speaker and PowerPoint software are working properly. You can record audio directly to your slides, using PowerPoint or other presentation software.

Note: Technical support about the use of PowerPoint, including voice recording and speaker notes, can be found on Campus’s page.

• If using Kaltura, refer to the tutorial for directions on recording and uploading your presentation in the courseroom.

Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact to request accommodations.

Instructions

For this assessment:

• Choose the community organization or support group that you plan to address.
• Develop and record a presentation, with typed speaker notes (the script for your voice recording) and audio voice-over recording, intended for that audience. Video is not required.

Note: PowerPoint has a feature to type the speaker notes directly into the presentation. You are encouraged to use that feature or you may choose to submit a separate document. See for technical support about the use of PowerPoint, including voice recording and speaker notes.

Note: For this assessment, develop your presentation slides and speaker notes, then record your presentation. You are not required to deliver your presentation to an actual audience but you certainly could if you chose to.

Presentation Format and Length

You may use PowerPoint (recommended) or other suitable presentation software to create your slides and add your voiceover. If you elect to use an application other than PowerPoint, check with your faculty to avoid potential file compatibility issues. You can also record your presentation using Kaltura or similar software.

Be sure that your slide deck includes the following slides:

• Title slide.     
  • Presentation title.
  • Your name.
  • Date.
  • Course number and title.
• References (at the end of your presentation).

Your slide deck should consist of 1012 slides, not including a title and references slide with typed speaker notes and audio voice over. Your presentation should not exceed 20 minutes.

Create a detailed narrative script for your presentation, approximately 45 pages in length.

Supporting Evidence

Cite 35 credible sources from peer-reviewed journals or professional industry publications to support your presentation. Include your source citations on a references page appended to your narrative script.

Grading Requirements

The requirements outlined below correspond to the grading criteria in the Ethical and Policy Factors in Care Coordination Scoring Guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.

• Explain how governmental policies related to the health and/or safety of the community affect the coordination of care.     
  • Provide examples of a specific policy affecting the organization or group.
  • Refer to the assessment resources for help in locating relevant policies.
  • Be sure influential policies include the Health Insurance Portability and Accountability Act (HIPPA).
• Identify national, state, and local policy provisions that raise ethical questions or dilemmas for care coordination.     
  • What are the implications and consequences of specific policy provisions?
  • What evidence do you have to support your conclusions?
• Assess the impact of the code of ethics for nurses on the coordination and continuum of care.     
  • Consider the factors that contribute to health, health disparities, and access to services.
  • Consider the social determinants of health identified in Healthy People 2020 as a framework for your assessment.
  • Provide evidence to support your conclusions.
• Communicate key ethical and policy issues in a presentation affecting the coordination and continuum of care for a selected community organization or support group. Either speaker notes or audio voice-over are included.     
  • Present a concise overview.
  • Support your main points and conclusions with relevant and credible evidence.

Additional Requirements

Before submitting your assessment, proofread your presentation slides and speaker notes to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your presentation.

Portfolio Prompt: Save your presentation to your . Submissions to the ePortfolio will be part of your final Capstone course.

MEXICAN CASE STUDY #2 

Pablo Gaborra, aged 32, and his wife, Olga, aged 24, live in a migrant-worker camp on the eastern shore of Maryland. They have two children: Roberto, aged 7, and Linda, aged 18 months. Olgas two younger sisters, Florencia, aged 16, and Rosa, aged 12, live with them. Another distant relative, Rodolpho, aged 28, comes and goes several times each year and seems to have no fixed address. Pablo and Olga, born in Mexico, have lived in the United States for 13 years, first in Texas for 6 years and then in Delaware for 1 year, before moving to the eastern shore of Maryland 5 years ago. Neither of them have U.S. citizenship, but both children were born in the United States. Pablo completed the sixth grade and Olga the third grade in Mexico. Pablo can read and write enough English to function at a satisfactory level. Olga knows a few English words but sees no reason for learning English, even though free classes are available in the community. Olgas sisters have attended school in the United States and can speak English with varying degrees of fluency. Roberto attends school in the local community but is having great difficulty with his educational endeavors. The family speaks only Spanish at home. Not much is known about the distant relative, Rodolpho, except that he is from Mexico, speaks minimal English, drinks beer heavily, and occasionally works picking vegetables. The Gaborra family lives in a trailer on a large vegetable farm. The house has cold running water but no hot water, has an indoor bathroom without a shower or bathtub, and is heated with a wood-burning stove. The trailer park has an outside shower, which the family uses in the summer. The entire family picks asparagus, squash, peppers, cabbage, and spinach at various times during the year. Olga takes the infant, Linda, with her to the field, where her sisters take turns watching the baby and picking vegetables. When the vegetable picking season is over, Pablo helps the farmer to maintain machinery and make repairs on the property. Their income last year was $30,000. From the middle of April until the end of May, the children attend school sporadically because they are needed to help pick vegetables. During December and January, the entire Gaborra family travels to Texas to visit relatives and friends, taking them many presents. They return home in early February with numerous pills and herbal medicines. Olga was diagnosed with anemia when she had an obscure health problem with her last pregnancy. Because she frequently complains of feeling tired and weak, the farmer gave her the job of handing out chits to the vegetable pickers so that she did not have to do the more-strenuous work of picking vegetables. Pablo has had tuberculosis for years and sporadically takes medication from a local clinic. When he is not traveling or is too busy picking vegetables to make the trip to the clinic for refills, he generally takes his medicine. Twice last year, the family had to take Linda to the local emergency room because she had diarrhea and was listless and unable to take liquids. The Gaborra family subscribes to the hot and cold theory of disease and health-prevention maintenance. 

Study Questions 1. Identify three socioeconomic factors that influence the health of the Gaborra family. 

2. Name three health-teaching interventions the health-care provider might use to encourage Olga to seek treatment for her anemia. 

3. Identify strategies to help improve communications in English for the Gaborra family. 

4. Identify three health-teaching goals for the Gaborra family. 

5. Name three interventions Olga must learn regarding fluid balance for the infant, Linda.

6. Discuss three preventive maintenanceteaching activities that respect the Gaborra familys belief in the hot and cold theory of disease management. 

7. Identify strategies for obtaining health data for the Gaborra family.

8. Identify four major health problems of Mexican Americans that affect the Gaborra family.

9. If Olga were to see a folk practitioner, which one(s) would she seek? 

10. Explain the concept of familism as exhibited in this family. 

11. Distinguish between the two culture-bound syndromes el ataque and susto. 

12. Discuss culturally conscious health-care advice consistent with the healthbelief practices of the pregnant Mexican American woman. 

13. Discuss two interventions to encourage Mexican American clients with tuberculosis to keep clinic appointments and to comply with the prescribed medication regimen. 

14. Identify where the majority of Mexican Americans have settled in the United States. 

PUERTO RICAN CASE STUDY #2 

Carmen Medina, aged 39, lives with her husband, Ral, aged 43, who works as a mechanic in a small auto shop. Mr. Medina has worked in the same place since he and his wife came to the United States from Puerto Rico 15 years ago. The Medinas have a 4- year-old son, Jos; a 16-year-old daughter, Rosa; and an 18-year-old son, Miguel. The Medinas both attended vocational school after completing high school. Mrs. Medina is employed 4 hours a day at a garden shop. She stopped working her full-time job to care for her ill mother and aged father, who do not speak English and depend on government assistance. The family income last year was $28,500. The family has health insurance through Mr. Medinas job. They live in a threebedroom apartment in a low-income Illinois community. Miguel works in a fast-food store a few hours a week. Because Rosa has responsibilities at home, the Medinas do not allow her to work outside the home. She is very close to her grandmother but avoids talking with her parents. Both Rosa and Miguel are having difficulties in school. Rosa is pregnant and the family does not know. She is planning to drop out of school, get a job in a beauty shop, and leave home without telling the family. Miguel frequently comes home late and, on occasion, sleeps out of the home. He is beginning college next semester and has plans to move out of the house during the summer. The family is having difficulty dealing with Rosas and Miguels developmental and behavioral challenges. Although Mrs. Medina is outspoken about these concerns, Mr. Medina is quiet and not actively involved in the discussion. He is more preoccupied with the familys financial situation. Mrs. Medinas parents are encouraging them to return to Puerto Rico. Mr. Medina was diagnosed with hypertension 2 months ago, when he went to the emergency room for a respiratory infection. He smokes cigarettes and drinks two to three beers every evening after work. He has not followed up on his blood pressure treatment. Miguel is beginning to smoke, but not at home. Jos has had frequent colds and sinus allergies. He has been to the emergency room three times during the past year for respiratory infections. Mrs. Medinas last physical examination was after she had Jos. She is experiencing insomnia, tiredness, headaches, and gastrointestinal problems. She is very concerned about Rosa and Miguel, her parents, and the familys finances. Mrs. Medina is Catholic and recently has been visiting her church more often. Study Questions 

1. Explain Mrs. Medinas attitude in her relationship with her adolescent daughter. 

2. Identify strategies to ensure that Rosa seeks prenatal care. 

3. Identify barriers to accessing health care for the Medina family. 

4. What are the high-risk behaviors exhibited by this family? 

5. What communication barriers exist in this family that affect care delivery? 

6. Discuss gender and family roles in the context of traditional Puerto Rican culture. 

7. Identify sociodemographic factors affecting the physical- and mentalhealth well-being for this family.

8. Identify Puerto Rican folk practices appropriate for this family.

9. If the Medina family chose to visit a folk healer, which one(s) do you think they might visit? Why? 

10. If Mrs. Medinas parents visit a health-care provider, what might they expect? 

11. Identify culturally congruent interventions to ensure compliance with Western health prescriptions for Mr. Medina.

12. Discuss the importance of respeto and familism in the Medina family. 

13. Identify culturally congruent interventions for Rosas pregnancy. 

14. Identify health-promotion and disease-prevention interventions needed for Jos.