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Define commonality and what are the barriers of quality care?
- Commonality is the statistical appreciation of differences in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions.
- Barriers to quality care range from those related to geographical location to age, gender, race, ethnicity, and sexual orientation.
Ex. of health disparities of African Americans in stroke, heart disease, htn, diabetes, amputations, and ischemic attacks.
50% more likely to have stroke
50% more likely to die of stroke
20% more likely to die of heart disease
1.5 times more likely to have hypertension
2.5 times more likely to have diabetes
30% more likely to have diabetes-related amputations
Ex. of Health Disparities of Mexican Americans and Native Americans
- Mexicans get 2 times more likely to have diabetes mellitus and 36% fewer prescriptions after myocardial infarction
- Native Americans are 5.7 times more likely to have DM than whites living in Hawaii.
How do you reduce health disparities ?
- Health care providers must be culturally competent
- Culturally proficient: able to move smoothly btw the world of the nurse and the world of the patients and requires cultural awareness and sensitivity, knowledge, and skills
Culture awareness is:
- Recognizing the presences of isms
- Self reflection
What is cultural knowledge?
- What a nurse brings to caring situations as well as what a nurse learns about older adults, their families, their communities, their behaviors, and their expectations
- Essential knowledge includes elder's way of life
Working with interpreters:
- Interpretations: The process of rendering oral expressions made in one language system into another in a manner that preserves the meaning and tone of the original without adding or deleting anything.
- Respectful Communication: Addressing the person in the appropriate manner. Using body language that is acceptable in the culture.
Implications for Gerontological Nursing include:
Assessment: listening is key to assessment as nurse tries to understand situation and person, health beliefs, and cultural beliefs
Cross-Cultural Caring in the Long-term care setting
- Ensuring that resident has access to professional interpreter services if needed
- Developing programs that reflect diversity of residents and staff
- Considering monocultural facilities or units where population demographics warrant
- Employing staff who reflect diversity of residents or clients
Culture, Nursing, and Maslow's hierarchy of needs
Promoting healthy aging in care of ethnic elders frequently provides gerontological nurse with new challenges, and necessitates different conceptualization of Maslow's hierarchy
Nutrition and Aging: Adequate Nutrition (3)
- Critical to preserving the health of older people
- An integral part of health, happiness, independence, quality of life, and physical and mental functioning
- All of the essential nutrients are adequately supplied and used to maintain optimal health and well-being
Major nutrition-related concerns in older adults:
Obesity and Malnutrition
Factors affection fulfillment of nutritional needs: Age related changes (4)
- Digestive System
- Regulation of appetite
Factors affecting fulfillment of nutritional needs: Lifelong Eating Habits
Implication for Gerontological Nursing and healthy aging:
Assessment: Good oral hygiene and assessment of oral health are essentials of nursing care.
Implications for gerontological nursing and healthy aging: Interventions
Oral hygiene: When the person is unable to carry out his or her dental/oral regimen, it is the responsibility of the caregiver to provider oral care.
Implications for Geri Nursing: Hospitalization and Institutional living
- Assessment of nutritional status to identify malnutrition and the risk factors for malnutrition.
- If caloric supplements are used, they should be administered at least one hour before meals or they interfere with meal intake
- Attention to the environment in which meals are served is important.
Health conditions affecting nutrition: Chronic Diseases (9)
- Gastrointestinal Disorders
- Cardiovascular and respiratory diseases
- Affects adequate nutritional intake, and in late dementia weight loss becomes a considerable concern
- Establishing a routine so the elder does not have to remember times and places for eating
- Serve well-balanced foods and fluids that the person likes and has always eaten.
- May occur as a result of neurologic diseases such as stroke, Parkinson's disease, multiple sclerosis, and dementia
- Negative consequences including weight loss, malnutrition, dehydration, and aspiration
- Carries a sevenfold increased risk of aspiration pneumonia
- Classified as oropharyngeal or esophageal
Implications for gerontological nursing and healthy aging: Assessment
Obtain a careful history of the elders response to dysphagia and observe the person during mealtime
- Suctioning equipment should be available
- Should have supervision at mealtimes.
Feeding Tube (3)
- A common approach to problems with nutritional intake in older.
- Percutaneous endoscopic gastrostomy (PEG)
- --- Complications: aspiration pneumonia, diarrhea, metabolic problems, and cellulitis
- Nurse and dietician must work closely together to determine the appropriate formula and rate of administer
- Most common GI compliant
- Constipation is a symptom: poor habits, postponed passage of stool, chronic illnesses-- both physical and psychological, side effect of medication
- The precipitants and causes of constipation
- Clarification of what the patient means by constipation
- Bowel history: usual pattern, frequency of bowel movement, size, consistency, and any changes
- Physical examination is needed to rule out systemic causes
- Examine the medications the person is taking
- Positioning during defecation
- fecal impaction removal
Protein-Calorie Malnutrition and serious consequences
- Most common form of malnutrition in older adults
- Characterized by the presence of clinical signs and biochemical indicators indicative of insufficient intake
- Serious Consequences: Infections, pressure ulcers, anemia, htn, impaired cognition, hip fractures, and increased mortality and morbidity.
Nutritional Assessment (4)
- Physical examination
- anthropometrical measurements
- biochemical analysis
- Centered on techniques to increase food intake and enhance and manage the environment to promote increased food intake
- Pharmacological therapy
- Patient education
Application of Maslow's hierarchy
- Food is a basic human need for people of all ages
- Not only does adequate nutrition satisfy biological needs, but also the experience of eating provides opportunities for belonging.