Transcultural Perspectives in the care of Older Adults.

Read chapter 7 of the class textbook and 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.

1. 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?
2. 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?
3. How would you assess the patient’s eating habits, for example, type of food, method of preparation, amount eaten, etc.?
4. 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?

APA format word document, Arial 12 font, A minimum of 700 words is required(excluding the first and reference page).

 

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Hello Lauren & Class,Thank you for sharing. What techniques would you employ to cater to the various learning styles of your audience when presenting information?Thanks,

 

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Anne Kolsky    3 posts   Re: Topic 9 DQ 1  Professional Presentations  Strength: I may not be the most detail-oriented writer or person in general, my writing strengths appeal more to the lay person than the technical side. I can convey messages well to those who do not understand the “nursing side” of nursing. In other words, if I were to be on a team of professionals seeking to make changes together, I would be put on the committee that sends out the messages to the community. Although I can convey my messages in print well, I struggle with speaking coherently. Joining toastmasters or taking classes that can improve my communication to all audiences would be beneficial.  Weakness: Conversely, my attention to details are not my strength, as evidenced by the inability to pick up mistakes in citations, etc. I could be employed to find the research, but probably not chosen to be the editor. Taking classes, attending journal clubs, and other similar activities could help me improve on the technical side.  Evidence-based practice for strong leadership includes role modeling and demonstrating strong commitment to research, developing skills through staff opportunities, meeting performance appraisal expectations, policy making based on solid research, encouraging others to do their best for the patients and each other, willingness to change policies and practices based on solid evidence, demonstrate transformational leadership based on openness to listen and implement based on true needs and evidence, and encourage the entire community to research and inquire how to do things better which is no easy task as it is often perceived as “more work piled on” for those who are already maxed out. Leaders will work with administration to figure out a way to encourage this without making it a burden (Halm, 2010).  Halm MA. (2010). “Inside looking in” or “inside looking out”? How leaders shape cultures equipped for evidence-based practice. American Journal of   Critical Care, 19(4), 375–378. https://doi-org.lopes.idm.oclc.org/10.4037/ajcc2010627

 

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Carrie Smithson    1 posts   Re: Topic 9 DQ 2         Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of Evidence Based Practice is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time. There are barriers that may prevent my Evidence Based Practice change proposal from continuing to obtain the same desired results six months to a year from now. My PICOT statement is, In adults with tobacco dependency (P), would providing teaching/research about tobacco cessation (I) compared to medications to assist in tobacco cessation (C) lead to a decrease in tobacco dependency and better health outcomes (O), after four weeks of intervention/quit date (T)? One barrier is new staff coming on board and not knowing the proper way to educate patients on tobacco cessation. The current staff will receive proper education on how to educate tobacco dependent patients. To assist new staff with the process change, we can create required computer based learning assignments (CBL’s) that have to be completed before coming out of orientation. This will allow all new nurses to be up-to-date on the education process. Another barrier is language. Not only is language a barrier in education, but other forms of communication as well. Upon communicating with a patient who does not speak English, the health care team must first decide what language the patient understands best, and in what way the patient learns best. Once the assessment is completed, the nurse can obtain an interpreter. At our facility, there are interpreters on wheels; this is an IPad that we bring to the patient and an interpreter comes on live to speak to the patient in their specific language. Not only can we use the interpreter, but provide written education in different languages as well. Throughout the education process, it is important to remember communication techniques. A few communication techniques are listening, asking open ended questions, and having an open posture (Elsheikh, 2018). Change initially can be a good thing and take off quickly. It is important to sustain new change through methods like I mentioned above.  Reference  Elsheikh, K. (2018, March 21). 7 Effective Communication Techniques That Will   Make YouExcellent. Retrieved from https://medium.com/better-humans/7-  effective-communication-techniques-  that-will-make-you-excellent-89eb17e60b36

 

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The largest barrier to change in an ambulatory surgery setting would be resistance to change, as people often create habits or specific ways of performing different tasks, asking a group to change the way they think and perform these tasks, is often a difficult undertaking (Strategies for Nurse Managers, 2002). In the ambulatory surgical setting, time and operating room schedules are very important, at times even dominating the day and taking precedence.Overcoming this barrier effectively would require a variety of different strategies to gain compliance and understanding, however, maintain these standards could prove to be tricky. It is expected that five of the major surgeons who share ownership of the center. They will assist in creating the changes to practice, and how they wish the patients receive this information, as well as providing input into changes to their prescribing habits. Through the months after implementation, stakeholder satisfaction with protocol changes and implementation will be assessed through clinical staff meetings. Another way to overcome these barriers is by gaining support from the administration staff (Ginex, 2018) such as our Director of Nursing. The administration will be able to provide important information through surveys that will provide valuable feedback that nurses are continuing to follow protocol through the post-operative patient surveys. Furthermore, the administration can assist with the coordination of education and informational meetings to follow up on the new changes in practice, and reviews of the evidence that supports these changes, and the reason for implementing these new protocols (Strategies for Nurse Managers, 2002). Nurses will also be consulted in follow up meetings as to their satisfaction with the new protocols taking place, and their opinions, as well as any suggestions they may have to further increase satisfaction to the patients and staff. ReferencesGinex, P. K. (2018). Overcome barriers to applying an evidence-based process for practice change. Retrieved from https://voice.ons.org/news-and-views/overcome-barriers-to-applying-an-evidence-based-process-for-practice-changeStrategies for Nurse Managers. (2002). Breaking down resistance. Retrieved from http://www.strategiesfornursemanagers.com/content/31710.pdf

 

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