Grandmother Ella’s case


GrandmotherElla’s case

Thereare many issues brought about by Ella’s scenario regarding thecontext of treatment and treatment alternatives. The kind of care shereceives can be greatly affected by decisions on whether to followconventional medicine or traditional and alternative medicalpractices and beliefs. Other factors such as traditions and culturalexpectations will also play a role when it comes to choosing the typeof care Ella gets.

Asa result of Grandmother Ella’s medical condition and prognosis,there exist other micro, mezzo and macro factors that affect hertogether with her diverse members of the family. It is important tounderstand that the decision to whether receive care at home orhospital has both advantages and disadvantages. In this case, it isbest to go for an option that has more advantages. Factors such asfamily diversity, social and psychological issues will be put intoconsideration when choosing the appropriate treatment options.Besides, if individuals fail to seek prompt help for their ownproblems, their views on lifespan development will be affected.Proper intervention strategies can be formulated by examining andunderstanding various influences clearly depicted in Ella’sscenario to help Ella and her family handle they are facingharmoniously.

Culturaland traditional issues

Thereare various cultural and traditional aspects that will affect thedecision of whether to accord Ella traditional or the morealternative and modern medical attention. It is clear that this issuepresents a huge dilemma, not only to the grandmother, but also to theentire extended family. To start with, Ella’s grandfather, who isAmerican Indian practices traditional healing and is a firm believerin traditional medical care. As a consequence, it is abundantly clearthat the grandfather will be for the idea of having Ella being caredfor at home as opposed to being taken to a hospital setting. Theextended family of Ella will play an extremely vital role in thedecision making of the form of treatment that she will receive(Beckeret al., 1998).It is abundantly clear that Ella identifies with the extended familyand therefore their input in the decision making process will bevital. Ella’s family is diverse and they present varying opinionsas to whether Ella would receive care in the hospital or at home.

Thediversity of opinions in the extended family is well manifested bythe support that Ella receives from different members of the familydepending on the choice that will be made. For instance, her husbandis in support of alternative and complimentary treatment. On thecontrary, the grandfather, who is America Indian and practicestraditional healing would not be for this option. This is a clearindication that the entire family was in dilemma of which was thebest option for Ella. It is clear that the treatment option accordedto Ella will largely depend on her diverse family’s opinions. Theextended family has varying cultural beliefs and preferences. Thiswill play out in the decision that the family will make with regardto the form of care that Ella will be accorded until her death.


Thereare other factors namely Micro, Mezzo and Macro that will influenceElla, as well as her family in the decision making process. The microfactors that will affect the decision that will be made include thechoice and the preference of Ella. It is clear from the case thatElla prefers home care where she manages her own condition. It isclear that her greatest wish is to continue with the care at home asshe awaits her death. She has been stressed out by the struggle,discord and discomfort that she has taken the extended family throughsince her hospitalization. It is will be upon the family members toheed to the wishes of Ella since the entire controversy is revolvingaround her. However, despite the fact that Ella is awaiting for herdeath, it is imperative to consider an option that will provide thebest care for her. It is clear that Ella was raised in a firm in therural area and she does not therefore trust modern forms ofmedication.

Theattitudes and the beliefs that the family members have will alsoaffect the delivery of care to the grandmother. It is abundantlyclear that the attitudes of the different family members with regardto the Ella’s care are diverse. For instance, the grandfather wouldbe supportive of traditional medicines and home care while Ella’shusband would support alternative care. Sarah is not sure of whetherto adopt the modern forms of medication or go for the traditionalforms of medication. Ella’s husband, John, uses traditional meansfor health purposes and this is a clear indication that he preferstraditional forms of medication and care. Manny Maldonado, who isSarah’s father, is a third generation Hispanic American who wouldbe in support of a hospital form of care for Ella. It is clear thatmajority of the members in the extended family are suffering fromvarious chronic diseases such as HIV, leukemia and diabetes. Thisattracts varying opinions with regard to the topic of heath in thefamily. Each and every member of the family has varying views withregard to the form of heath that is effective. These are just butsome of the micro factors that will affect the decision that will bearrived at with regard to the form of care that Ella will beaccorded. These factors create a dilemma and might even create amisunderstanding between the family members as a result their diversecultural backgrounds, beliefs and values.


Besidesthe micro factors, there are also a number of Mezzo factors that willinfluence the decision making process. It is clear that cancer ischronic illness and requires attentive care by people who are trainedand who are committed. There is the argument that there are varioussupport groups in the neighborhood, who look after people withchronic illnesses such as Ella’s cancer condition. This is anargument that will influence the decision making process. It is clearthat this is an aspect that would favor the home form of care thatElla would wish to have and that is supported by the traditionalmembers of the family such as Ella’s husband. Another mezzo factorthat must be considered in the decision making process is theavailability of tools and expert health workers in the community. Itis evident that the required tools and expert health workers areavailable in the community (Northen&amp Kurland, 2013).It is clear that the presence of such expert health workers and thenecessary tools in the community would ensure that Ella receivesprofessional home care of her cancer condition.

Theother mezzo factor that needs to be considered in determining whetherto Ella remain in hospital or have home care is the form ofinformation system that is available and that would facilitate acoordinated, integrated and evidence based care. It is evident thatvibrant information system will be extremely efficient in home caresituation since the caregivers can quickly consult the nurses at thehospital when an emergency situation is noted. However, lack of avibrant information system in the neighborhood can hamper a homebased form of care for Ella. Lastly, the presence of resources suchas consumer groups and patient advocates non-governmental agencieswill affect the decision made (Northen&amp Kurland, 2013).The presence of these resources in the community would ensure thathome care situation is successful and provides the required care. Thegroups can also discourage the aspect of home care while consideringthe needs of the patient and the capacity of the home cares toprovide or meet such needs (Northen&amp Kurland, 2013).


Themacro factors that will play out in this scenario include thestringent legislative framework that will enhance health careservices (Parekhet al., 2011).It is clear that there are stringent legislative frameworks that seekto ensure that people receive efficient and quality healthcareservices. It is also clear that the government has increased theallocation of resources to facilitate the management of chronicdiseases. This will also affect the decision that the family and themedical practitioners at the hospital will arrive at. Additionally,the continued education to the health providers with regard to thecare and management of chronic diseases will also affect the decisionof whether to have Ella under hospital care or under home care.

Delimitationsand Limitations of Hospital versus Home Care

Delimitationsof hospital care

Thereare various advantages associated with hospital care for Ella. Tostart with, Ella can receive specialized medical care for cancer atthe hospital as opposed to the care she would receive at home (Melnyket al., 2011).It is also evident that there will be availability of immediatemedical care in case of emergency. Lastly, hospital care will ensurethat there are medical practitioners who are constantly monitoringElla while in the hospital. These medical staff will be able tonotice any medical condition and offer professional care immediately.

Limitationsof hospital care

Atthe hospital, it is abundantly clear that the patient has no privacyas compared to home based care. There are other patients at thehospital and therefore the condition of Ella at the hospital may nolonger be a private affair. Additionally, the hospital based carewill deny the family members an active role in taking care of thepatient (Edelmanet al. 2013).

Delimitationsof home care

Whileat the home, Ella will receive comfort, love and security from thefamily members. Research has shown that home based care offers a formof relaxation to the patient (Holosko&amp Dulmus, 2013).This is an extremely important element in the health of the patientand her well-being. It is also argued that at home the patient andthe family members are able to engage in other daily activitieswithout any interruptions and follow their routines.


Ahome based form of care has a number of limitations which thecaregivers and the patient may face. For instance, it would beextremely difficult to handle any emergency experienced at home.Secondly, it is evident that there might not be sufficient facilitiesand tools at home to offer efficient health care services to thepatient. This may hinder the quality of care that the patientreceives.

Psychologicaland social factors present in the scenario

Thereare a number of psychological and social factors that are eminent inthe case of Ella. It is clear that the prospect of Ella’s death hasemotional disturbances to the members of the family. It is also clearthat the children to Sarah and Joe are addictive to drugs and thesemight be having an effect on the health of the children. It is alsoclear that Joe’s brother Sam is an alcoholic and this might also beaffecting his psychological and physical health. The socio-economicstatus of the family can also affect the access to quality healthcare (Beckeret al., 1998).It is clear from the case that the family members are fearful,distressed and hopeless due to the ongoing illness of Ella and theprospect of her death.

Existingcircumstances as regarding to Diversity and cultural, psychologicaland social aspects

Thedilemma that exists in this scenario is largely due to the culturalpractices that the family seeks to maintain. It is evident thatMiller’s family is American Indian and the family would love tomaintain their cultural practice and values (Edelmanet al. 2013).It is also clear from the scenario that the family puts community andfamily needs ahead of personal needs. According to Becker, et al.1998, American Indians have been viewed as people who regardemotional and physical health as more relevant than psychologicalhealth. The lifespan development of all the members of the familywill be affected by the situation Ella is in. If the grandfather,Lucy, Lila, Josh, Sam and Sarah do not get proper help to cope withtheir conditions, they will continue having pessimistic views.Consequently, this will result into lessened judgmental, intellectualand cognitive capabilities.


Itis clear that the condition of Grandmother Ella has had a tremendouseffect on all the family members. Her condition of has presented adilemma to the family of whether to provide her with home care or lether remain in the hospital and be cared for by the medicalpractitioners. The process of deciding whether to have her remain inthe hospital environment or take her home has been affected by thevarious cultural and traditional influences. It is clear from thediscussion above that the care provided to chronically ill patientscan also be affected by micro, mezzo and macro factors. Theperceptions and the beliefs of the family members also playsignificant roles in provision of care to chronically ill patients.It is worth noting that the interests of the members of the family,as well as that of the patient must be put into consideration whenproviding care to chronically ill patients such as Ella.


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