anthony wallace case study 1

LIFE’S MIGRANTION JOURNEY

Case Study 1

Anthony Wallace

Liberty University

AN IMMAGRANTS WELLNESS JOURNEY 2

Background Narrative

There was a man named Ushery, who is a Russian immigrant from Istra,

Moscow and immigrated to the United States in the mid 1900s. Ushery was a

vibrant young fellow with a dream to start his own grocery business. Mr. Ushery

educated himself and was able to gain the working capital to start his small grocery

store in Bronx, NY. Mr. Ushery also has musical talents, playing the violin for the

annual town festival that celebrates past Russian immigrants migrating to the United

States.

In his early 20s, Mr. Ushery came to America with dreams of owing his own

grocery store to pass down to his family members. One day while Mr. Ushery was

cleaning his storefront, he found his soul mate, Katie. The couple married in the

spring of that year and had three beautiful children. The couple attends religious

services every Sunday at Mt. Zion Missionary COGIC. The family volunteers in the

new neighbor orientation block parties during the festival season. The family is very

well loved throughout the community.

One day while playing his violin at the festival, Mr. Ushery collapses on

stages. Mr. Ushery is unresponsive and not breathing. The family and bystanders

rush to his aid. A bystander, who happens to be a nurse, performs CPR in

desperation to save Mr. Ushery’s life. The bystander shout “stand back, give him

some air! The sirens scream in the background as the paramedics are rushing to Mr.

Ushery’s aid. The bystander is calling for Mr. Usery to come back. As people are

standing around looking at the bystander pump on Mr. Ushery’s chest and shout

one, two, three, breathe! Another bystander comes to join in the fight to save


Mr Ushery’s life. The bystander shouts again one, two, three, breath! The family

watches in horror and panic of their sick father fights for his life.

The paramedics arrive on scene to find Mr. Ushery in full arrest with no pulse

and not breathing. The bystander goes to comfort the family as the paramedics load

Mr. Ushery on the stretcher and into the ambulance, the wife is overcome with grief

and passes out on the pavement. The eldest son jumps into the ambulance and tells

the paramedic “oh God pop come back, please come back!” The ambulance races

down the freeway with sirens screaming “rarrrrrrrwwww!” the adrenaline of the

paramedic was hot. The paramedic started IVs, gave meds, and even performed

CPR.

The paramedic reaches for the paddles and shouts “stand back!” the

paramedic shocks the patient “swwwwish plop”. Mr. Ushery body flops. Again,

swwwwwish plop! The paramedic knocked on the window with urgency and shouts

"Hurry we're losing him!" The driver slams on the gas and the wheel screech, the

sirens roar, as the paramedic verge to the right and the left to get Mr. Ushery to the

hospital for advance care. The son cries aloud, stretching his hand out to his father,

and says “come back please pop come back, we need you!” the paramedic finally

gets a pulse, but its faint. The ambulance arrives at the bay. The son is running

beside the stretcher holding his father’s hand. Mr. Ushery looks at his son and says,

“I love you son, take care of the family”. The nurse stops the son at the emergency

room door and directs him to the waiting room.


Meanwhile, in the emergency room, Mr. Ushery is trying to answer as many

questions that were thrown at him all at one time. It was hard to keep up with who

was asking the questions. Mr. Ushery asked the ER nurse “where is my beautiful

Katie? I need to tell my Katie that I love her.” The ER nurse continues to perform

her care duties, but ignored his comments. Mr. Ushery’s vitals on arrival were B/P-

100/70, P-98 and weak, R-10, and T-97.6 ax. The lab results revealed an elevated

ALT and Bilirubin levels. The X-rays also revealed evidence of an enlarged heart

leading to advanced heart disease.

The doctor goes into the waiting room to discuss options in treating Mr.

Ushery advanced disease. Mr. Ushery’s family is devastated and overwhelmed with

the news that their father was dying. The doctor told the family that his prognosis is

not favorable in performing other treatments. The doctor beings to talk to the family

about other options that are available to him such as hospice care at home. The wife

shouts, “oh my God have mercy on my husband.” Mrs. Ushery falls to the floor and

cries bitterly with anguish bitter yells “why! Lord why! I am empty without him.”

The family grieves with their mother.

The family goes to the back to find that Mr. Ushery has tubes running from

everywhere and connected to the ventilator. The wife hold his hand as the room gets

quieter and quieter as sounds of the ventilator “psssss pa!" psssss pa!” echoes in the

background. Mr. Ushery is in a drug-induced coma to keep him comfortable and

free of pain. Mr. Ushery is alert to sounds, but unaware of who is in the room with

him. The family is confused and do not understand Mr. Ushery’s prognosis.


Discussion Questions

1. Discuss the reasons that the advanced practitioner must consider the family

when assisting the dying patient to planned care?

I believe that the practitioner must look at the patient and the family as a

whole unit. It is sad to see any one pass away, but we can become a comfort to

the patient by encouraging them to explore their emotions. We can also use the

term SWOT in making a care plan for the family.

The SWOT acronym represents the family unit impacted by the feelings of

death. The strengths, weakness, opportunities, and threats make a great impact

on the emotions while the patient is dying and after (Matzo et.al, 2010). The

practitioner must have open eyes to see the inner dynamics of the family. The

family may appear stable, but after the patient has died, the family unit maybe

broken.

The practitioner can help the patient physically, but a lot of the time the

patient and the family needs a listening ear. A healing heart never heals

instantly, but heals over time and with patience.

2. Identify possible barriers in the effectively planning family-oriented care.

In this case scenario, the language or cultural influences may play a

sufficient role in decision making. The status quo and the family position may

have an impact of who makes the decision and what happens. The husband in

this case is the breadwinner and had the authority in the home. In most


cultures, the eldest is in charge of all responsibilities in the event the parents

are not there to resume that duty.

The environment can hinder care services to the patient (i.e. small

bedrooms, crime in the neighborhood, family dynamics, etc). Religion may

hinder the patient care due to their belief system (i.e. an atheist nurse caring

for a Christian patient). Most family members prefer same religion caregivers.

3. Perform a SWOT analysis on the family unit

S- Strengths – The unit banded together to help their mother in her time of need.

The children were willing to help their father as a support for him while he was

being worked on in the ambulance.

W – Weakness – The family is devastated and need much support from social

work in connecting them with a local support groups. The dad was the rock of

the family and now the children will have to take his place. This can become a

heavy burden for the eldest son.

O – Opportunities – This may give the oldest son the opportunity to lead and

prove himself to his immediate family. It will give him a chance to be a man and

help his fellow family members recover. The death of the father may appear to

be the death of a memory, but it is a start of a new beginning within the next

generation

T – Threats – This is a prediction clause after the family member has passed.

The only stumbling block that could occur is the hindrance in the grieving


process. The family members may grieve themselves to death. The family may

not want to continue with running the store. This can kill their fathers dreams

and cause stress upon their mother. The family could have a lack of healthcare

coverage that can cause large hospital bills after death. If there is healthcare

coverage, it may not cover home healthcare or hospice care.

There is a peer article written in 2009, Massachusetts Cuts back Immigrants’

Health Care. This article explains the government’s intention in relieving

31,000 legal immigrants’ of hospice benefits due to state budget cuts. The

governor proposes new guidelines for the immigrant population that has an

active green card for a minimum of 5 years. The governor says that after

December 1, 2009, the immigrant population affected will have to rely on

hospitals that provide free care (Goodnough, 2009).

4. Analyze the outcomes of the case and determine if there was room for

improvement in the planning and delivery of care?

In this case, the nurses could have been more understanding to the Mr.

Ushery’s needs. I believe that if the physician knew of other therapies, maybe

the prognosis would not have been death right away. According to the text, a

recent study conducted in 2010, recognized by the acronym SUPPORT, states

that sever pain was the most common repeated sign. The text suggests that the

pain is due to the engorgement in the liver because of heart failure (Matzo,

2010). This could be why the patient had an acute episode at the festival.


The acronym SUPPORT represents the study to understand prognosis and

preferences for outcomes and risk treatments.

I believe that it will take time for this family to heal due to the impact

that the dad had on his family. If I were the practitioner, I would have social

work to visit the patient including the chaplain. The family can rebuild their

lives as time heals all wounds.


References

Goodnough, A. (2009). Massachusetts Cutback Immigrants' Healthcare . The New York Times .

Matzo, M. S. (2010). Palliative Care Nursing: Quality Care to the End of Life 3rd Edition . New York, New York : Springer Publishing Company.

anthony wallace case study 1

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