Aubreyann Veyveris Counseling Activity Session I Dietitian H- Hospital Setting Introduction My client for today is Mrs. Elia Hirmez.

She is a first generation Iranian woman who is in her third trimester of pregnancy. She is 31 years old, 54, and weighs 133 pounds. She has been admitted into the hospital to rule out premature labor, after a fall down the stairs at home. Her lab results indicate that she is slightly anemic and her low weight is a major concern, both for her and for the baby. I am going to be counseling her on how to increase her weight to a healthier number so her and her baby can be as healthy as possible. Interpersonal Communication Style Iranians have a specific way of greeting each other that means different things. When women greet each other, they usually exchange a handshake and a hug, with some exchanging kisses on the cheek. However, when initially meeting, a light handshake is most appropriate1. Men greeting women, on the other hand, depends entirely upon religious beliefs. Those who are religious do not shake hands or make eye contact at all with members of the opposite sex out in public. Too much direct eye contact can be taken the wrong way and cause a lot of trouble. It would be more common for them to look at the ground when carrying on conversations1. If they do have to greet each other a slight bow 3 ft apart is done quickly. Due to all of the different rules associated with greeting it is best to wait and see what action the person you are greeting takes. This also applies to personal space and touching. Out in public, men and women are

expected to keep a little over an arms length away from each other, when communicating, if they are not husband and wife and touching of members of the opposite sex in public is highly frowned upon. Communication style tends to be very indirect and may be confusing to those who are not familiar with Iranian customs. For example, if they are angry with you, they may not openly come out and say they are angry2. It would have to be inferred based upon reading between the lines and using effective listening techniques. Often times, many Iranians have a difficult time saying No to the requests of people they are not familiar with because they think this answer may hurt their feelings. They believe this is the polite thing to do2. For Iranians, time appears to be not much of a concern. If a family member arrives late to a dinner it is not considered rude, but almost expected. Formal meetings are taken a little more seriously but overall, Iranians are not considered very punctual people1. While it is becoming more common for Iranian women to be integrated with the men in the work place, there are still places where women are expected to do most of the domestic work and take care of the family and home. Women can work, and usually do but it all depends on the approval and opinion of the husband. Beauty is also highly valued in Iranian culture and there is a lot of pressure on Iranian girls to be beautiful. As a result, many girls and women have plastic surgery to improve their appearance and tattoo on makeup. Dressing up formally and appropriately for each occasion is regarded as a sign of respect and offense may be taken if clothing is too casual for a situation2. When it comes to hand gestures, it is rude to point at someone with your index finger and it is very common to beckon with four fingers, however, beckoning with fingers in an upward

direction is considered impolite. The thumbs up sign is also considered a rude gesture. It is considered taboo to get a divorce and talking about divorce is simply not acceptable2. Health Beliefs Iranians value cleanliness of the body as well as the soul. Many burn frankincense and incense in their homes to kill insects and bacteria and to provide a pleasant smell2. Most Iranian women prefer to work only with female health care practitioners because they do not feel comfortable opening up about their personal health issues to men. Serious health issues are discussed with all family members, and often times it is expected to tell family members rather than the patient themselves any bad news3. Health care providers should be aware of the strict customs of the Islamic religion and it is best to ask patients in advance if they practice and/or strictly follow Islamic rules. For example, it is strictly forbidden to consume alcohol and certain meats, due to religious practices2. For some Iranians, Friday is considered a public holiday, so scheduling appointments on this day should be avoided. Health care is taken very serious for most Iranians, and any diagnosis given should be careful and thoroughly explained. Treatment is usually not considered complete without taking some sort of medication; however, during certain Islamic holidays medication may only be taken at night or skipped due to fasting3. Food Preparation Techniques and Possible Food Preferences In Iranian culture, it is primarily the women who do all the preparing and cooking of meals. Women are expected to stay at home and men expect that their wives will prepare only

the best meals for when they return from work. Homemade food is considered more precious and appreciated and is preferred over dining out at restaurants4. Consideration of others and good manners are taken very seriously in the Iranian culture and are strictly enforced and practiced during meals and ceremonies3. Iranians believe in the idea of hot and cold food and that it is very important to accurately mix these types of foods in order to create a balanced meal4. Iranian staples include lamb, wheat bread, eggplant, yogurt, and most importantly, rice which they consume at almost every meal. Seasonal fruits and vegetables and many herbs and spices are also consumed regularly. Very little seafood is eaten and pork is strictly forbidden in Islamic rule3. Meat is eaten, however it must be Halal, meaning permitted, and so there are only certain shops that sell this meat. The main beverage consumed is sweet clear tea, which is taken at most meals and for a sweet snack throughout the day4. Large quantities of carbonated beverages and soft drinks are also consumed.

References 1. Culture Crossing: Iran. http://www.culturecrossing.net/basics_business_student_details .php?Id=15&CID=98. Accessed on September 29, 2013. 2. Shadpour, K. Primary health care networks in the islamic republic of iran. Eastern Mediterranean Health Journal. 2000;(4)6: 822-825. http://www.emro.who.int/Publ ications/EMHJ/0604/25.htm. Accessed on September 29, 2013. 3. Iranian Food Culture. http://www.farhangsara.com/iranian_food_culture.htm. Accessed on September 29, 2013. 4. Culture of Iran: Persian Cuisine, a Brief History. http://www.cultureofiran.com/p ersian_cuisine.html. Accessed on September 29, 2013.

Questions to ask Mrs. Hirmez Introduction 1. How are you doing today?

2. Have you ever seen a Dietitian before?

3. Walk me through your typical day. When and what do you usually eat and at what time?

4. Who normally prepares the meals at home? How many people are eating?

5. Who normally does the grocery shopping and choosing of what to purchase?

6. What grocery stores/shops are usually shopped at?

7. What kinds of foods do you prefer to eat?

8. What types of foods do you usually avoid?

9. Do you have any religious food restrictions?

10. How many times a week do you eat out at restaurants or fast food establishments? What do you usually order?

11. What type of beverages do you consume regularly?

12. Do you feel full after meals?

13. What is your usual body weight?

14. How much weight have you gained since becoming pregnant?

15. Do you do any physical activities? Before pregnancy? After pregnancy?

16. Is this your first pregnancy?

17. Did your doctor give you any lab results?

18. Whom do you live with? Are you married? What does your husband do? Is he normally home during the day or night?

19. Do you take any vitamins or supplements? If so, what kinds?

20. Are you currently on any medications?

21. How many hours of sleep do you get each night?

Aubreyann Veyveris Client B- Mrs. Jeanette Hamilton Mrs. Hamilton is 55 years old, 58 and weighs 180 pounds. She is a wealthy African American woman who is married and has two kids, ages 18 and 21, who are away at college. She was born in a small town about an hour outside of Atlanta and attended the University of Georgia. After college, she moved to Atlanta and lived there until two years ago when she moved to San Diego for her job as an executive for an up and coming dot com company. She has been diagnosed with angina and complains of chest pains. Her father was an uncontrolled hypertensive and had a heart attack at age 51. Her total cholesterol is 285 and her triglycerides are 300. She has a lot of stress at work, works long hours, never exercises, and has a few drinks after work every night to relax. She also enjoys watching sports on TV. Her cardiologist is keeping her in the hospital to run a few more tests. Interpersonal Communication Style African Americans conversational style is very expressive and engaging. They speak and respond very quickly and words are often spoken passionately and rhythmically. They frequently use interjections of agreement of disagreement when communicating with others1. Eye contact is made when speaking but prolonged eye contact is considered impolite. It is best when counseling to be very respectful, yet direct1. It may be common for African Americans to avert their eyes while listening; however, rapid eye aversion could be taken as an insult to some. Attentative listening may be more important than direct eye contact.

The expected greeting would be a firm handshake and a smile. Hugging and kissing may also be included in greeting those who are familiar. Touching is very common, and reluctance to touch may be perceived as personal rejection1. Some African Americans feel patronized by non-black health care providers and may choose to ignore their health issue rather than be humiliated. Others may be hostile or suspicious when working with non-black health care professionals. Interaction with providers may be limited due to the feelings of inferiority with health care providers and for this reason, important needs or questions may not be addressed. Often times African Americans feel their health care is out of their control, and simply up to luck or destiny1. It has been found to be more effective for African Americans to participate in family oriented programs and/or group classes, rather than individually because family and community are such a vital part of their culture1. Health Beliefs African Americans rely a lot on the advice from those close to them, such as family, friends, or even their minister, as to how to deal with health issues they are having. They also believe that health is maintained through harmony and that life is viewed as energy rather than matter. Life events are believed to be influenced by certain forces and a person can, in turn, influence those forces toward good or evil1. Some African Americans define health as more than simply just a lack of illness. They view health as the ability to support their family, maintain spiritual and emotional well-being, as well as fulfill social obligations. For those that are religious, prayer for health is common, and

some believe that illness is a punishment from God and God acts through physicians to heal patients1. Stress has been cited as one of the main reasons for poor health, believing to cause hypertension and diabetes by many African Americans1. Few today believe in African witchcraft or employ root doctors, like their ancestors, however, the influence of traditional healing practices is still found in the ideas and beliefs that poor health is a result of bad luck or fate. As a result, often times home remedies or natural therapies are sought after before seeking medical attention from professional health care providers1. Food Preparation Techniques and Possible Food Preferences Food preferences and techniques of African Americans today have been influenced by many cultural events. The traditional Southern African American cuisine now a day has evolved from West African, slave, and post abolition times. The emphasis is on texture, rather than flavor and pork, pork products, corn, and greens form the foundation of the diet1. All variety of pork products are consumed with various cooking methods. Intake of fresh fruits and vegetables is low and vegetables that are consumed are most popularly cooked with ham, bacon, and hot sauce. Dishes are frequently seasoned with hot pepper sauces and spices and onion and green pepper are common flavoring ingredients. Corn is the primary grain product consumed, making up popular dishes such as corn breads, hominy, and grits. As for beverages, popular choices include fruit juices, coffee, soft drinks, and tea. Many African Americans prefer cookies and candy as a snack1. Most researchers have found that the food habits of African Americans today usually reflect work schedule, geographic location, and socio-economic status rather than their African

or Southern heritage. The typical Southern style breakfast of boiled grits, homemade biscuits, eggs, ham, and bacon that was once common in African American culture might now be served only on weekends and holidays with coffee and tea being the staple beverages rather than juice and milk1. Typically, African Americans throughout the country now eat a lighter breakfast, lighter lunch and dinner is the larger main meal. Snacking throughout the day is very common as well. Meal schedules are often irregular and it is often more convenient for family members to eat snacks to replace their meals, simply because it is fast and easy. Frying is still one of the most popular methods of preparing food, along with boiling and baking right behind1. Client Actions As my role as Jeanette Hamilton, I intend to act very nonchalant about my stay in the hospital and being diagnosed with angina. I am so very busy and stressed out about work I will act as if my stay in the hospital is a hindrance to my productivity and my job as an executive. I plan to be short with my Dietitian and will not openly give a lot of information when she asks me questions. I will make it apparent that my health is not my number one priority in my life right now.

References 1. Kittler and Sucher. Food and Culture. 6th ed. Belmont, CA: Thomson Wadsworth; 2012:198-214.

Three-Day Food Record for: Jeanette Hamilton

Day 1 of 3 Day of the week: Monday
Date: 9/23/13

Time 7 am
9 am 12pm

Food Item Caramel Frappachino Krispy Kreme glazed donuts Double glazed baby back ribs with a side of fries and cole slaw Coke Triple Chocolate Meltdown dessert

Description & Preparation Drops by Starbucks on the way to work Have my assistant run and pick me up some donuts from the shop right next door Business lunch at Applebees

Quantity 1 venti size- 24 oz 4 regular glazed donuts 1 meal from Applebees 2 24 oz glasses 1 order of the triple chocolate meltdown from Applebees 1 venti size-24 oz 2 regular size bars 1 sandwich 1 large- 30 oz 1 large order from McDonalds 3 8 oz glasses 2 cups

12pm 1230 pm

Glasses of Coke with lunch After meal, order dessert from Applebees

3pm 4pm 8pm 8pm 8pm 9pm 930pm

Caramel Frappachino Snickers bars Premium Crispy Chicken Ranch BLT Sandwich Coke French Fries Red Wine Chocolate Ice cream

Have my assistant run and get me my mid day pick me up from Starbucks From the vending machine Stop by McDonalds on the way home from work for me and my husband To drink with meal Stop by McDonalds on the way home from work for me and my husband To relax after work Dryers Chocolate Ice cream

Did you take any supplements? NO. If yes, please specify: ____________________________

Day 2 of 3 Day of the week: Wednesday

Date: 9/25/13

Time 7am
8am

Food Item Carmel Frappachino Blueberry Muffin

Description & Preparation From Starbucks On Wednesdays my coworker always brings in muffins from Costco and fresh fruit for everyone in the office From Costco

Quantity 1 venti- 24 oz 1

8am 8am 1230pm 1230 pm 2pm 2pm 2pm 7pm 7pm 7pm 7pm 7pm 9pm

Apple Crumb Muffin Banana Jack Daniels Burger Chocolate Peanut Butter Pie Doritos Reeses candy bar Coke Fried Chicken Mashed Potatoes Corn Bread Potato Salad Red wine Brownies

1 1 medium sized banana

The office goes out to lunch together at TGI Fridays on Wednesdays I always order my favorite dessert after lunch From the vending machine From the vending machine From the vending machine My husband gets off work early on Wednesdays and prepares dinner

1 order 1 order 1 individual bag 1 regular sized package 1 bottle- 24 oz 2 legs, 2 breasts 2 cups 4 oz 5 oz 2- 8 oz glasses

My neighbor likes to bake and is constantly giving us treats and desserts

6 oz

Did you take any supplements? NO. If yes, please specify: ____________________________

Day 3 of 3 Day of the week: Saturday

Date: 9/28/13

Time 9am

Food Item Coffee with sugar and creamer

Description & Preparation My husband wakes up before me and brews a pot of coffee for us

Quantity 2 cups- 16 oz, 2 tbp sugar per cup, 2 oz creamer per cup 2 4 strips 1 cups 1 cup

930 am

Fried eggs Bacon Hash browns Grits

My husband also cooks us breakfast

12pm 12 pm 3pm 3pm 3pm 7pm

Meatball Marinara Sub Coke Potato chips Oreo Cookies- double stuff Beer- Corona Bloomin onion appetizer Wood-fire Grilled Pork Chop Coke Chocolate thunder from down under Red wine

Sometimes I have to run by the office and on the way Ill stop at subway and pick up a sandwich

1- 12 in sub 1 large- 24 oz

I enjoying watch sports on TV and like to snack

10 oz 6 cookies 2 bottles- 12 oz each

Sometimes my kids come home for the weekend from college and we go out to dinner as a family at Outback Steakhouse. We share this as a family. From Outback Steakhouse From Outback Steakhouse From Outback Steakhouse

of the platter

7pm 7pm 7pm 9pm

1 order 1 24 oz glass 1 order 3- 8 oz glasses

Did you take any supplements? NO. If yes, please specify: ____________________________