Case Scenario:

• Mang Ernest, 53-year-old man has diabetes for five years and has not followed the
prescribed treatment regimen. He has a non-healing wound on his right foot which
prompted him to go to the hospital to have it checked. His attending physician scheduled
him for a right leg below the knee amputation (cutting of a part of the body) to prevent
further complication.

• His past health history revealed that physical examination had been infrequent. He also
reported that he did not adhere to the lifestyle changes and medication regimen that was
prescribed. He smokes approximately two packs of cigarettes per day for the past 10
years. The client claims to drink alcoholic beverages occasionally.

• During history taking, the nurse found out that Mang Ernest is married living with his wife
and 3 children in a semi-concrete house in which he described as less sanitary. He is
working as a janitor in the local municipal office. His wife is unemployed and he
describes her as emotionally distant and verbally abusive at times because of financial
instability.

• He has done well after surgery though he complains of pain in the operative site with a
scale of 8 out of 10. During discharge, the nurse discusses the importance of
rehabilitation, strict drug compliance & lifestyle changes. Eventually, Mang Ernest
became agitated & said that his father & grandmother died of diabetes, why would he
adhere to the regimen if he also die the same. When the nurse explored his feelings
about what he said, Mang Ernest became extremely tearful & expressed his great
concern about him being worthless. He is worried about his future and his family. He
believes that this illness is a punishment for his past life.
 MADELEINE LEININGER

Instruction: Choose a situation in the case where we can apply the 3 culturally based nursing
actions of LEININGER and give your intervention on this:

3 Nursing Action of Situation in the Case Intervention

the Nurse

Culture Care He did not adhere to the Help Mang Ernest to use care values
Preservation / lifestyle changes and related to healthcare concerns.
Maintenance medication regimen that
was prescribed.

Culture Care The nurse discusses the Help the patient to modify personal
Accommodation/ importance of health behaviors while respecting the
Negotiation rehabilitation, strict drug patient’s cultural values. Help him cope
compliance & lifestyle up with his situation and advise him to
changes take his maintenance medicines to
prevent some possible complications.

Culture Care Mang Ernest became Help the patient to modify personal
Accommodation / agitated & said that his health behaviors while respecting the
Negotiation father & grandmother patient’s cultural values. Help him cope
died of diabetes up with his situation and advise him to
take his maintenance medicines to
prevent some possible complications.

SR. CALLISTA ROY

Instructions: Given the following situations in the case, identify which adaptive mode was
affected and give an intervention on how to help Mang Ernest solve the problem:

Situation Adaptive Mode Intervention

1. Mang Ernest is extremely tearful
and expressed his great concern
about him being worthless. He
believes that this illness is a
punishment for his past life.
Self-concept Give him enough assurance and words of
affirmation. That everything that he’s been
experiencing is not related to his past life or it is
his punishment. Narrowing your offer to help for
it gives a starting point in understanding that
person
2. Mang Ernest undergone surgery -
amputation of his right leg below the
knee and he has limitation in his
mobility.
3. Mang Ernest is married living with
his wife and 3 children. His wife is
unemployed and he describes her as
emotionally distant and verbally
abusive at times because of financial
instability. He is worried that their
relationship would get worst because
of his feeling worthless.
4. Mang Ernest is worried about his
future and his family. He is afraid that
he could no longer support and take
of his family
Physiological The focal stimulus for Mang Ernest limitation in
his mobility. For this undergone in surgery –
amputation of his right leg below the knee.
Possibly, he’s not fully well from his surgery
and needs time to recover and rest.
Interdependence In the assessment of the stimuli within the
interdependence, it reveals that Mang Ernest’s
relationship needs in his wife are not being met
and the fact that his wife is unemployed it may
be because they got married at an early age. It
would be essential to assess modes of
communication and knowledge regarding in
building their relationship.
Role-function The contextual stimulus in this role-function
adaptation mode includes the fever, illness,
weakness, fatigue, therapy, and increased
dependency to others. The effective primary
role as manifested are by less weakness, less
fatigue, willingness in allowing others to help
and desiring to resume self-care activities as
he becomes able.