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Explore the Role of Culturally Competent Care in Reducing Health Disparities and Promoting Optimal Health in the Elderly. Laurie Brummett, RN & Susan Goo, RN. Nurses Improving Care for Healthsystem Elders (NICHE). Developed by the Hartford Institute for Geriatric Nursing - PowerPoint PPT Presentation
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Explore the Role of Culturally Competent Care in Reducing
Health Disparities and Promoting Optimal Health in
the Elderly
Laurie Brummett, RN
&
Susan Goo, RN
Nurses Improving Care for Healthsystem Elders (NICHE)
• Developed by the Hartford Institute for Geriatric Nursing
• More than 225 hospitals in both the U.S. and Canada are participating
• NICHE has ways to improve elderly care
(Wood, 2009)
Geriatric Institutional Assessment Profile
• Skin care• Restraint use• Incontinence• Sleep issues• Attitudes and
perceptions about caring for elderly patients
(Wood, 2009)
What the NICHE Program Entails
• Training program about sensory changes r/t advancing age
• Plans to differentiate delirium and dementia
• Programs to assess fall risks
• Programs on best practices for relating to older adults.
(Wood, 2009)
John Muir Health is Utilizing NICHE
• Coordinate with existing outpatient geriatric program
• Biannual geriatric interdisciplinary professional development
• Geriatric nurse resource program
• Specialized Med/Surg unit focused on needs of the elderly
(Wood, 2009)
Stereotype of Minorities Taking Care of Their Elders
• Commonly held belief that minority families need less assistance with elders
• Research does show– Unmarried elderly African
Americans are 2x as likely as Caucasians to live with family
– Hispanic and Asian American elders are 3x as likely
– ½ of urban Native American elders live with family
(____, 2001)
Caring for Elderly Family Members
• Research shows taking care of elder family members can be overwhelming.
• Does living with extended family mean minority elders do not need formal support services?
• (______, 2001)
Wisdom Center, in Santa Maria, CA
• Adult Day Health Care (ADHC)
• Activity program• Dietary services• Meals• Medication
management• Occupational therapy• Physical therapy
• Physician services• Psychology/Psychiatry• Skilled nursing• Social Work/Services• Speech therapy• Transportation
(Santa Barbara County, n.d)
Wisdom Center
• Adult Day Program (ADP)
• Activity program• Care and supervision• Meals• Social Services• Transportation
(Santa Barbara County, n.d)
Who does the Wisdom Center serve?
• Payments accepted– Medi-cal– Veteran’s benefits– Private insurance– Private pay
(Santa Barbara County, n.d.)
• Languages spoken– English
– Spanish
– Tagalog
Emic Perspective of the Elderly on Health
• Elderly people may have a different definition of health than the younger population
• Objectives may be related to maintaining functional status, instead of preventing or eliminating disease
(Miller & Iris, 2002)
•Being healthy has been defined by the elderly as:
–Functional independence
–Self-care management of illness
–Positive outlook
–Personal growth
–Social contribution
(Miller & Iris, 2002)
Emic Definition of Health• Being healthy = actively
pursuing a healthy lifestyle
• Strategies to stay healthy include participating in healthy activities and engagement
• Motivators include social support, challenge, past activities and getting better (Miller & Iris, 2002)
“When you get into your 80’s, little pieces of you kind of break off and fall astray…most of us have some little thing going
on.”
• There is a connection between mental attitude and physical health
(Miller & Iris, 2002, p. 255)
Strategies Older Adults Use to Promote Health
• Physical– Physical activity and
exercise– Change unhealthy eating
and alcohol habits– Participate in tx and
management of illness and disability
– Use of assistive devices to maintain mobility
• Cognitive– Learn new things– Take classes– Stay up on current
events– Participate in
activities and in the community
(Miller & Iris, 2002)
Strategies Elderly Use to Maintain Health
• Psychosocial– Positive attitude– Set priorities– Avoid dwelling on
problems– Capitalize on previous
successes– Participate in activities
based on interest, needs and limitations
– Express feelings– Have fun
• Interpersonal– Volunteer– Join activities– Share experiences– Remain connected
with family & friends– Make new friends
and acquaintances
(Miller & Iris, 2002)
Emeritus Programs
• Adult fitness• Computers• Literature by local authors• Music arts• Pastel drawing & painting• Yoga• Nutrition and health• Exploring cultural and
natural wonders• Reminiscing for frail older
adults(Cuesta College, 2009)
Crabby Old Man• What do you see nurses? . .
What do you see?What are you thinking . . . . when you're looking at me?A crabby old man, . . not very wise,Uncertain of habit . . . . . with faraway eyes?
Who dribbles his food . . . . . . and makes no replyWhen you say in a loud voice . . 'I do wish you'd try!'Who seems not to notice . . . the things that you do.And forever is losing . . . . . . . A sock or shoe?
• Who, resisting or not . . . . . . . . . lets you do as you will,With bathing and feeding . . . . . . The long day to fill?Is that what you're thinking? . . . Is that what you see?Then open your eyes, nurse . . . . you're not looking at me.
I'll tell you who I am, . . .. . .. as I sit here so still,As I do at your bidding, . . . . as I eat at your willI'm a small child of Ten . . . . with a father and mother,Brothers and sisters . . . . . . . who love one another
Crabby Old Man• A young boy of Sixteen . . with
wings on his feetDreaming that soon now . . . . a lover he'll meet.A groom soon at Twenty. . . . . .My heart gives a leap.Remembering the vows . . . . . that I promised to keep.
At Twenty-Five, now . . . . . . . I have young of my own.Who need me to guide . .. . And a secure happy home.A man of Thirty . . . . . . My young now grown fast,Bound to each other . . . . . . With ties that should last.
• At Forty, my young sons . . have grown and are gone,But my woman's beside me . . .. . . . to see I don't mourn.At Fifty, once more, . Babies play 'round my knee,Again, we know children . . . . . . My loved one and me .
Dark days are upon me . . My wife is now dead.I look at the future . . . . . . . . .. . I shudder with dread.For my young are all rearing . . . . . . young of their own.And I think of the years . . And the love that I've known.
Crabby Old Man• I'm now an old man . . . . . and
nature is cruel.Tis jest to make old age. . . . . look like a fool..The body, it crumbles . . . . . . . . . . grace and vigor depart.There is now a stone . . . . . . where I once had a heart.
But inside this old carcass . . A young guy still dwells,And now and again . . . .. . my battered heart swellsI remember the joys . . . . . . . . . . I remember the pain.And I'm loving and living . . . . . . . . . . .. life over again.
•I think of the years . all too few . . . . . gone too fast.And accept the stark fact . . . . . . . that nothing can last..So open your eyes, people . . . . . open and see..Not a crabby old man Look closer . . see . . . . ME!!
(Anonymous, n.d.)