Trans-cultural Perspectives in the Care of Older Adults

Review the attached PowerPoint presentation.  Once done, read the following clinical case below and answer the questions;

Diabetes has been emerging as a major public health concern among Native American communities in the United States for the past 40 years. The Pima Indians in Arizona currently have the highest recorded prevalence of diabetes in the world.

On average, American Indian and Alaska Native adults are 2.6 times more likely to have diabetes than non-Hispanic Whites of similar age. Diet is a key factor in controlling blood glucose levels and preventing serious cardiac, renal, peripheral vascular, and retinal complications such as heart attacks, renal failure, limb amputations, and blindness.

An Indian Health Service (IHS) nurse visits a patient in her mobile home, located on an Arizona Indian reservation. The patient is a 72-year-old, obese, female Pima Indian with a blood glucose level of 280. She is at risk for serious complications of type 2, or non–insulin-dependent, diabetes mellitus. With type 2 diabetes, the body either resists the effects of insulin or doesn’t produce enough insulin to maintain a normal blood glucose level.

The patient lives with her adult daughter, two grandchildren, and five great-grandchildren. The nurse’s goals are to use culturally appropriate diet education to repattern the patient’s eating habits for the purpose of reducing the blood glucose level to normal (between 70 and 110 mg/dL); promoting steady sustained weight loss (5 pounds per week); encouraging increased exercise and activity.

The nurse also asks the patient to participate in group sessions at the Pima Community Center focused on healthy food preparation and eating a balanced meal.

If you were a nurse who just began doing home health care on the Pima Reservation, how would you learn about the specific cultural beliefs and practices related to nutrition and diet for this patient as a member of the Pima Indian Nation, versus stereotypes about the diet of Native Americans in general?

Given that the patient’s family doesn’t own a vehicle, how will you encourage her to shop for healthy foods, prepare them, and actively participate in weight loss and exercise programs held free of charge at the Pima Community Center?

How would you assess the patient’s eating habits, for example, type of food, method of preparation, amount eaten, etc.?

Each of the patient’s children, grandchildren, and great-grandchildren is obese. How would you involve the patient’s family in the plan of care and motive them to lose weight as well?

800 Word Count

Trans-cultural Perspectives in the Nursing Care of Older Adults #1

Longer life spans and the ageing Baby Boomer generation will lead to a large population of older adults aged 65 years old and older who will seek health services.

Delivering culturally appropriate care to clients is set by how available and affordable national, state, and local health care resources are for older adults.

There are three areas of influences for older adults that guide their help-seeking behaviours: Societal and economic factors; affordability and accessibility. Cultural values, practices, patterns of care giving, and available community resources. Family, individual lifestyles, health, and coping behaviours

The Older Adult in Contemporary Society: Factors Affecting Health Care

Societal level

Demographics: ethnicity and income level, low literacy. Socioeconomic status: fixed income, increased health-related expenses, delayed retirement Theories of Ageing: explain patterns of behaviour

Is the following statement true or false?

The health status of non-Hispanic Whites is typically better than other minority ethnicity.

True

Rationale: At all ages, the health status of Hispanics, Asian Americans, African Americans, Native Americans/Alaska Natives, and Native Hawaiians/Other Pacific Islanders has long lagged behind that of non-Hispanic Whites.

Also, approximately 40% of Hispanics and African Americans have no private savings for their retirement and will look to government-funded assistance.

The Older Adult in the Community: Cultural Influences #1

Cultural level

Differences in culture and ethnicity shape health and illness behaviours and actions.

Specifically:

Physical functioning: Mobility/exercise. Social and emotional well-being: Acculturation, family/peer support

Quality of life: Satisfaction and happiness

Beliefs and practices: Remedies, traditional healers, self-care. The Older Adult in the Community: Cultural Influences #2

Cultural level (cont.)

Culture change: relocating, migrating

Care-giving: willingness of family to offer support, responsibility to care for elders

Rationale: Older adults who use self-help strategies to maintain their health generally report better psychological well-being and physical functioning than older adults who do not use these approaches.

Nurses who are aware of cultural variations can appreciate that older individuals will have different value orientations underlying their decisions to adopt health behaviours.

The Older Adult in the Community: Cultural Influences

Dimensions of Social Support:

Affective support: respect/love

Affirmational support: endorsement for one’s behaviour/perceptions

Tangible support: aid or physical assistance

Complicated by separation from family members, loss of spouse/partner, declining physical abilities

The Older Adult: Caring for Individual Clients #1

Older adults continue to meet developmental tasks:

Satisfaction of basic needs, such as safety, security, and dignity

Fulfilment of integrity and self-actualisation

Maintaining self-esteem and choices about where he/she will live

Engaging in meaningful activity

May embrace increased religion/spirituality

The Older Adult: Caring for Individual Clients #2

Continuum of care

Older adults generally require three types of care:

Intensive personal health services

Health maintenance and restorative care

Coordinated services

Nurses assess those values of independence and self-reliance may be very strong for some older clients; they may refuse any assistance; the nurse should evaluate clients’ behaviours relative to underlying values.

The Older Adult: Caring for Individual Clients #3

Community-based services for older adults

In home care

Skilled nursing facility, assisted living

Community resources: home-delivered meals

Local or church-affiliated volunteer visitors

Day programs in communities and adult day care

Which criterion is among those used to determine the appropriate level of residential placement for an older adult who is reluctant to live alone?

Age

Gender

Financial resources

Risk for injury

Answer to Question #3

1. Risk for injury

Rationale: Criteria that the nurse often considers to recommend the level of care or residential placement that would be most appropriate for an older client include mental orientation, physical mobility restrictions, degree of assistance needed to complete activities of daily living, frequency of incontinence, and level of risk for accident or injury if living independently.

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