Mrs. Evangelista is a 92-year-old cachectic frail-looking Filipino female who was diagnosed with dementia 7 years ago. Her oral intake has decreased over the past 6 months and she has occasional choking spells when being fed. She has lost a significant amount of weight (20 lb.) over the past year despite complete nursing care provided at home by her 2 unmarried daughters, who are now in their 60’s. She spends most of her time sitting in a chair or lying in bed, is dependent in all of her activities of daily living (ADL’s), and had falling incidents twice in the past year. She cannot carry on an intelligible conversation and can only express herself by uttering a few incomprehensible words and by using non-verbal gestures. She is incontinent with bowel and bladder function, and has developed multiple small stage 2 pressure ulcers in her buttocks.
When the health care provider made a home visit, one of the daughters expressed concern regarding her mother’s progressive weight loss due to feeding difficulties, and requested that a PEG tube be inserted. Through her knowledge of other people’s experience she believed that this intervention would improve the patient’s nutritional status. The health care provider maintained that it was not an appropriate intervention for this setting and explained the risks and benefits of the procedure to the family member. The daughter was not quite satisfied or convinced, and continued to insist on having it placed.
Discussion Topics
1. What cultural values and beliefs could explain the family member’s behavior and her concern regarding the patient’s declining condition?
2. As the healthcare provider, how can you develop the trust of the family members, and be able to formulate culturally meaningful and appropriate patient-centered goals that would be acceptable to family members as well?
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