Introductory Paragraph and Outline

IntroductoryParagraph and Outline

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.



A.Background Information

1.The condition of Grandmother Ella not only significantly affects herlife but the lives of other members of family as well.

2. The decisions on how care is dispensed are affected by variousissues which include context of health care settings, social,psychological, cultural and traditional issues.

3.The type of care and family members’ reaction will also beinfluenced by other Micro, mezzo and macro issues.

B.Thesis Statement

Properintervention strategies can be formulated by examining andunderstanding various influences clearly depicted in Ella’sscenario to help Ella and her family handle the situation they arefacing harmoniously.


  1. Examples of possible cultural or traditional issues

  1. Ella’s American Indian Grandfather practices traditional healing insistently.

  2. The critical role played by the extended family in decision-making (Becker et al., 1998). Identifying with the extended family will be strongly emphasized.

  3. Ella will receive support from the family particularly her husband if she opts for alternative and complimentary treatment.

  1. Micro, Mezzo, and Macro Factors Impacting Ella and her Family

  1. Micro factors

  1. Ella prefers to take up the role of managing her condition, since her wish is to continue her care at home.

  2. The decisions to deliver healthcare will be affected by attitudes and beliefs that the family members have.

  1. Mezzo factors

  1. There are support groups available in the neighborhood for people with chronic conditions.

  2. There are appropriate tools and expert health workers in the community (Northen &amp Kurland, 2013)

  3. There is a coordinated, integrated and evidence-based care due to availability of vibrant information systems.

  4. The community has available resources such as consumer groups, and patient advocates non-governmental agencies (Northen &amp Kurland, 2013)

  1. Macro factors

  1. There exists a stringent legislative framework to enhance quality of health care services (Parekh et al., 2011)

  2. The government has prioritized and allocated resources to facilitate management of chronic conditions (Northen &amp Kurland, 2013)

  3. Continued education for health care providers has been emphasized across the nation

  1. Delimitations and Limitations of Hospital versus Home Care

  1. Delimitations of hospital care

  1. Availability of immediate and specialized medical care and medical care for cancer treatment (Melnyk et al., 2011)

  2. There is medical staff to constantly monitor the patient all the time.

  1. Limitations

  1. A patient may have limited privacy.

  2. There is no active participation of family members in care giving care at the hospital setting (Edelman et al. 2013)

  1. Delimitations of home care

  1. Home setting might be Ella’s source of security, comfort, relaxation and love.

  2. At home, the patient and family members are able to carry out their daily routines at their own time (Holosko &amp Dulmus, 2013)

  1. Limitations

  1. Emergencies may not be handled promptly at home.

  2. There may be no adequate facilities in home setting to deliver effective health care.

  1. Psychological and social factors present in the scenario

  1. The family members are emotionally burdened by prospects of Ella’s death.

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

  3. The family’s access to quality health care might be affected by the socioeconomic status (Becker et al., 1998)

  4. There is fear and hopelessness among all family members as a result of Ella’s ongoing illness.

  1. Existing circumstances as Regarding to Diversity and cultural, psychological and social aspects

  1. There is pressure to maintain cultural practices because the family is American Indian (Edelman et al. 2013)

  2. Individual needs are viewed as less important than community or family needs.

  3. American Indians regard emotional and physical health as more important than psychological health. (Becker, et al. 1998)

Thelifespan development of all the members of the family will beaffected by the situation Ella is in. If the grandfather, Lucy, Lila,Josh, Sam and Sarah do not get proper help to cope with theirconditions, they will continue having pessimistic views.Consequently, this will result into lessened judgmental, intellectualand cognitive capabilities.


  1. Grandmother Ella’s condition has affected the diverse family and has also presented various dilemmas.

  2. The decision as to whether provide care in home or hospital environment has been significantly affected by cultural and traditional influences.

  3. The dispensation of care to chronically ill patients might also be affected by other micro, mezzo and macro influences and perceptions of family members.

  4. The interest of patient and that of the family members should be considered when providing care.


Becker,G., Beyene, Y., Newsom, E. M., &amp Rodgers, D. V. (1998). Knowledgeand care of chronic illness in three ethnic minority groups. FAMILYMEDICINE-KANSAS CITY-,30,173-178.

Edelman,C. L., Mandle, C. L., &amp Kudzma, E. C. (Eds.). (2013). Healthpromotion throughout the life span.Elsevier Health Sciences.

Melnyk,B. M., &amp Fineout-Overholt, E. (Eds.). (2011). Evidence-basedpractice in nursing &amp healthcare: A guide to best practice.Lippincott Williams &amp Wilkins.

Northen,H., &amp Kurland, R. (2013). Socialwork with groups.Columbia University Press.

Parekh,A. K., Goodman, R. A., Gordon, C., Koh, H. K., &amp HHS InteragencyWorkgroup on Multiple Chronic Conditions. (2011). Managing multiplechronic conditions: a strategic framework for improving healthoutcomes and quality of life. Publichealth reports,126(4),460.