Introductory Paragraph

Ella's scenario raises various issues with regard to treatment alternatives and treatment context. Decisions on whether to pursue alternative and complementary medicine and beliefs or mainstream medical practices can significantly influence the care she receives. Cultural and traditional expectations will also influence the decisions on the type of care she receives. In addition, there are other micro, mezzo, and macro influences affecting Grandmother Ella and her diverse family members due to her medical condition and prognosis. It is worth noting that receiving care at a hospital or at home comes with advantages and disadvantages, and the best option would be the one whose benefits far outweigh the drawbacks. Issues related to the diversity of the family as well as other psychological and social factors will guide their decisions on the best treatment alternatives. Furthermore, each individual's perspective on lifespan development will be affected if they do not seek timely help for their own problems. Examining and understanding the various influences evident in Ella's scenario will help in formulating better intervention strategies that can help the patient and her diverse family members to deal with the situation amicably.

Outline

I. Introduction

A. Background Information

1. Grandmother Ella's condition has significant implications on her life and the lives of other family members

2. Cultural and traditional issues, context of health care setting as well as psychological and social issues affect decisions on dispensation of care

3. Micro, mezzo and macro issues will also influence care and reaction of family members

B. Thesis Statement

Examining and understanding the various influences evident in Ella's scenario will help in formulating better intervention strategies that can help the patient and her diverse family members to deal with the situation amicably

II. Body

A. Cultural or traditional issues that might arise

1. Insistence of traditional healing practices by the American Indian grandfather

2. Extended family plays a critical role in decision-making (Gallant, Spitze, & Grove, 2010). There will be strong emphasis on identifying with the extended family

3. If Ella wants to stick with alternative and complimentary treatment, the family especially her husband will be supportive

B. Micro, Mezzo, and Macro Influences Affecting Ella and the Family

1. Micro influences

a. The preferences (values) of Ella about her role in managing the condition, as she wishes to continue with her care at home

b. The attitudes and beliefs of the family members will affect the decisions for healthcare delivery

2. Mezzo Influences

a. Availability of support groups for people with chronic conditions in the neighborhood

b. The existence of expertise and appropriate tools among health care workers in the community (Holosko & Dulmus, 2013)

c. Availability of a vibrant information systems for a coordinated, evidence-based and integrated care

d. Availability of community resources such as consumer groups, non-governmental agencies and patient advocates (Davidson, 2014)

3. Macro Influences

a. The existence of a stringent legislative framework for enhancing quality of health care services (WHO, 2002)

b. Government prioritization and allocation of resources for management of chronic conditions (Holosko & Dulmus, 2013)

c. Emphasis on continued education for health care providers across the nation

C. Advantages and Disadvantages of Hospital versus Home Care

1. Advantages of hospital care

a. Specialized equipment and medical care for cancer treatment are available immediately (Davidson, 2014)

b. Constant monitoring by medical staff round the clock

2. Disadvantages

a. There may be little patient privacy
b. Family members may not be able to participate actively in care giving at the hospital setting (Smyer & Stenvig, 2007)

3. Advantages of home care

a. Ella might feel most secure, comfortable, relaxed and loved at home

b. The home environment offers flexibility for the patient and the family in their daily routines (Holosko & Dulmus, 2013)

4. Disadvantages

a. It may be problematic to handle emergencies at home

b. Many home environments do not have adequate facilities required for effective health care delivery

D. Psychological and social issues evident in the scenario

1. The prospects of Ella's death is emotionally burdening to the family members

2. Drug problems by Sam, Lucy and Josh might be interfering with their mental and psychological health

3. The socioeconomic status of the family might be affecting the family member's access to quality care (Gallant et al., 2010)

4. The ongoing illness of Ella has rendered the family members hopeless and contributed to increased fears among all members

E. Current situation as Pertains to Diversity as well as to cultural, psychological and social perspectives

1. As American Indian family, there is more strain to maintain cultural practices (Smyer & Stenvig, 2007)

2. People view community or family needs as more important than individual needs

3. Emotional and physical health also has more priority than physical health among American Indians (Gallant et al., 2010)

Ella's situation will significantly affect the lifespan development of all the family members. The grandfather, Sam, Lila, Josh, Lucy and

Sarah will all continue to have pessimistic views if they do not find appropriate help for coping with their conditions. This will lead to

reduced judgmental, cognitive and intellectual capabilities.

III. Conclusion

1. Grandmother Ella's condition presenting various dilemmas and affecting the diverse family

2. Cultural and traditional influences significantly affect the decisions of where to provide care, in the hospital setting or in the home

environment

3. Other micro, mezzo and macro influences as well as perceptions of family members might influence the dispensation of care to the

patient with chronic illness

4. Care should be provided where it is in the best interest for the patient and the family members