Required Formal Paper: The purpose of this required assignment is to give the student the opportunity to demonstrate the required critical thinking for NUR III through analysis and problem solving skills documented in written form according to Bunker Hill Community College policies for writing. The Nursing III paper must be written in American Psychological Association (APA) style. Students needing guidance with preparation of the paper should meet with a NUR 211 faculty member. Students may submit one draft of their term paper for review by a faculty member at least 2 weeks before the paper is due. Grading Rubric: .The student will present a client situation, which the student has encountered during the clinical rotation that demonstrates a conflict with traditional “American Health Care Culture.” The paper will describe the culturally-sensitive nursing care that the student provided to a client cared for in the maternity setting for the current semester. The student will demonstrate how culturally-sensitive care is integrated into the nursing care plan needed to manage the client’s current health status. In order to complete the assignment in a satisfactory manner, the student will (using APA format 6th ed): A.Describe the client situation in which behavior(s) used to maintain and/or attain optimal health status is/are assessed to be different from the “American Health Care Culture.” 10 POINTS B.Present research describing the client’s culture or subculture. At least 4 nursing journals within the last 5 years must be included. Include pertinent information about health beliefs and health practices that is applicable to the client’s and family’s plan of care. Research can also be included in other areas of the paper (e.g, rationales for interventions or community implications). 20 POINTS C.Assessment – Choose four (4) Functional Health Patterns that relate to the client’s health status and culture. Be sure to develop each FHP fully, according to the established FHP Guidelines. Be sure to include physiologic and psychosocial assessments for your client’s/family’s priority needs. 15 POINTS D.Identify priority problems derived from two (2) of the four (4) Functional Health Patterns. Analyze these data and develop two (2) nursing diagnoses. Each nursing diagnosis must be supported by FHP data in Section 5 POINTS E.For each nursing diagnosis, establish one goal and two desired behavioral outcomes, one with a short-term time frame and one with a long-term timeframe. 10 POINTS F. Present the nursing interventions that could/should be used to assist/assure client goal/outcome attainment, including the rationales for these actions. Rationales should have citations from the literature included. Cultural considerations should be included in the development of nursing teaching and interventions. 15 POINTS G. Explain the evaluation criteria that was or could/should be used as related to the client goals and outcomes as stated. Reflection on pertinent interventions in achieving client goals may be included. 5 POINTS H. Discuss implications/implementation for adaptation of nursing care for client/family in the community after discharge 10 POINTS Focus: Here is a sample of how I need the paper to look like it. But within the Brazilian and Jehovah’s witnessess as a focus point of the paper. F.A is a 32-year-old, Caucasian woman who follows the Islamic religion and is of the Nigerian culture. She is two days’ post-partum, dressed in culturally specific clothing, and appears in no immediate distress. She stated not to be in any new acute pain and appears clean. She has complained of bloating and abdominal discomfort due to constipation. She is currently widowed, but is involved with a man who has asked for her hand in marriage. F.A states that she is undecided in the decision, claiming that she isn’t sure if she is ready to move on from the death of her recent husband, who is her newborn’s father. F.A is a G1 P1 A0 new mother welcoming her new child with the support of her family and the man who she classifies has a potential new spouse. The father of F. A’s child passed away in a car accident about 2 months prior to F. A’s pregnancy. For a large majority of her pregnancy, she has mourned the death of her husband according to the practices of her Islamic faith. In Islam, mourning the death of a loved one involves burial rituals of properly preparing a body to be buried in a selected area of land and engaging in practices that includes prayer and recitations from the Islamic holy text the Qur’an. In the case of a widowed women in accordance to Islamic practice, the woman should not engage themselves for a period of four months and 10 days before seeking a new relationship (Usama, 2012). F.A followed these rituals and practices immediately following the confirmed death of her husband. She described that her mourning extended up until about the third month of her pregnancy. F.A had plenty of support from both her own family and that of her late husband’s family both during her pregnancy and now. She described that overall, her pregnancy went well and followed all prescribed antepartum directions including dietary adjustments, danger sign monitoring, kick counts, etc. She successfully delivered vaginally a healthy full term baby boy, weighing 7 pounds 10 ounces. Following both Islamic and Nigerian cultural birthing practices, F.A requested special circumstances in relation to her labor and delivery that differed from the traditional “American Health Care Culture”. In the traditional American culture of healthcare related to the birthing process, a woman will most often have the father of the child and an array of doctors and nurses assisting in the process regardless of gender. In F. A’s case, special circumstances related to the birthing process needed to be taken including who would be requested to attend the childbirth, the gender of the health care providers, technique of delivery, and postpartum practices. Subculture B. F.A belongs to two subcultures that influence her perception and preference on health care. Firstly, she is of the Islamic religion. In relation to healthcare, the Islamic faith requires that women be cared strictly by female personnel and that no male healthcare figures be present care. This includes antepartum, intrapartum, and postpartum care. Furthermore, female friends and family members are preferred to be in attendance during delivery of the child, but the father is often required to wait in an environment outside the delivery room until the process is complete (Mujallad, 2016). Second, F.A also follows the Nigerian culture. Many of the customs associated with the Nigerian culture also tie in with that of the Islamic religion. For example, pregnancy is deemed as a “woman’s domain”. Therefore, the husband or partner will not accompany her to prenatal visits or screenings. Furthermore, a woman will generally continue her daily activities which include sexual activities (Dike, 2013). Despite her husband not being involved due to him being deceased, F.A continued all of her daily living activities such as exercise when appropriate and her occupation as a teacher. During labor practices, drugs or medications to assist with the delivery are not given unless medically indicated for complications since they are believed to be harmful to the baby. Like Islamic practice, only female family and friends are allowed to attend the birthing of the newborn. A vaginal delivery is preferred as a C-section is deemed an abomination towards the natural holy aspect of child bearing (Dike, 2013). Women are encouraged to breastfeed, but a growing number of immigrants in the U.S have preferred bottle-feeding due to its association with high status. C, D, E, F, G Activity/Exercise: Prior to her pregnancy, F.A was a very active individual. She performed frequent cardiovascular exercise such as jogging and running both outdoors and at her local fitness facility. She also performs moderate weight bearing training under the supervision of a licensed personal trainer. She also continued her activity throughout her pregnancy provided it was at a modest level and not contraindicated as confirmed by her physician. Postpartum, she has been able to ambulate more frequently without any critical pain or discomfort despite feeling slightly lethargic at times. She claims she still has some occasional exhaustion from the delivery process. Overall though, she appears to have no significant limitations in her activity abilities and states that she is eager to continue her original exercise routine as soon as possible. Coping/Stress Tolerance Pattern: F.A describes that while she was initially able to set aside her depression for the loss of her husband for the sake of caring for her developing child during her pregnancy, she states that she still mourns his death and has doubts about how she can truly raise her child on her own. Furthermore, the man who has asked for her hand in marriage as a means to help her move on, may seem like an incentive to aid in raising her child, but she does not feel like she is ready to move on so quickly. Still, she has not denied the man’s request since he is another man she knew in the past through professional relationship. Furthermore, she believes that he can potentially be a suitable father figure for her child. Nonetheless, moving on so quickly from the death of her husband and baby’s father is, as she describes, “is no easy task”. Her primary concern is whether she possesses the mental and physical capacity to be the mother that she can be in order to raise her child even with familial support. Bowel Elimination Pattern: F.A has reported no difficulties in urinating since giving birth to her child. Her urine output has averaged around 1300-1400ml a day. Her urine is normal in appearance with no evident signs of infection or hemorrhage such as cloudiness, foul order, or dark color. However, she has not been able to have a bowel movement within 48 hours after giving birth. She has increased her fluid and fiber intake and has recently been given a prescription for 300mg of Colace. She has also implemented cultural remedy herbals such as bitter lead water to aid in her constipation. Role/Relationship Pattern: F.A has a wide system of familial and friend support. She has family who live in close proximity of her comprising of both her parents and a younger adult sibling. Furthermore, the support of her late husband’s family are also not very far from her and have continued offering her support for both her and her child. Friends consisting mostly of co-workers and past acquaintances have offered additional help in the form of possible babysitting and guidance to support services if needed. Lastly, she claims to be in no financial distress as her job, family, and friends have all provided adequate sources of supplementary income and aid. H. Upon discharge back into her community, F.A will need continuous support to care for her newborn child and to ensure she continues to cope effectively. Her family as well as her husband’s family have ensured to provide substantial support both financially and with newborn care. Her local fitness facility consists of specialized programs designed to help implement stress relieving technique such as yoga and meditation as well as offer free child care orientation seminars to help struggling single mothers. F.A high school to where she teaches, has a club specifically for individuals of Nigerian culture as well as clubs for Islamic customs. Discussions of cultural practices to those who may be experiencing crisis are frequent in these clubs’ activities. For example, when depression as a result of grief from the death of a loved one is present, Nigerians will often convey mutual respect towards those who are depressed by being supportive of their emotional openness and encouraging the expression of sorrow. Follow up home visits from visiting nurses will be implemented in order to assess the health and well-being of both F.A and her newborn. Should there be any discrepancies such as a danger to neglect of care, relapse of pathogenic grief, or signs and symptoms of postpartum depression, immediate interventions will be implemented to ensure safety and health of both F.A and her child. Nurses will also provide education on breastfeeding and include resources of online connections detailing special facts and customs regarding the benefits and alternatives to breastfeeding.