Monday, September 26, 2016

Race and Class Biases Among Nurses and Doctors (Research, Video 2:34)

Have you ever become so accustomed to an odor, even a bad one, that you stopped noticing it at all? Sometimes race and class biases are like that. Unfortunately, men, women, and children can be harmed, even killed, as a result. Many people don’t realize how embedded racism and classism are in our society, particularly when they are not victimized regularly themselves. Overt acts are intended, meant to be hurtful. Covert acts are implied, often done unconsciously, but still do damage because the recipients of these actions are mistreated. The healthcare industry, like many others, consists of workers who make decisions about people’s lives on a daily basis. Consistently high numbers of disparities related specifically to race and class have existed over many years. Still, most healthcare workers continue to say they treat all patients equally.

This post is based on race and class bias research in which implied preferences for a specific social group are shown that can have adverse consequences for patient care of other groups.  Clinical stories were used and analyzed to determine whether implicit race or class biases among registered nurses influenced their decisions in managing patients. Performed at the Johns Hopkins Hospital, the study involved nurses who were given 8 multi-stage clinical stories to read in which patients' race or social class were randomly altered. In addition, nurses were given implicit association tests about race and social class.

Results of this study involving 245 mostly white and female registered nurses were the following:
1)   Most nurses stated that they had no explicit race or class preferences.

2)   Only 36 nurses demonstrated no implicit race preference as measured by implicit association tests for race and social class.

3)   Only 16 nurses displayed no implicit class preference on the implicit association tests for social class and race.

This research, along with many other examples, concluded that the majority of registered nurses displayed implicit (unconscious) preferences toward white race and upper social class patients. However, unlike published data on physicians, implicit biases among registered nurses did not correlate with clinical decision-making.

In this video, Michelle van Ryn, Ph.D., a researcher at the Mayo Clinic, describes implicit bias in health care and future research underway to understand and further address this critical issue. Keep in mind that this is not only a healthcare issue, but also a moral one.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Implicit and Overt Racism, Overt and Implicit Classism, Nurses and Doctors Racism-Classism, Dr. Michelle van Ryn, Bias in Healthcare Research

Monday, September 19, 2016

Hospital Wine for Terminally Ill (Video 1:40)

Quality of life for the terminally ill can be defined in innumerable ways. Depending on the person, it could mean something as extravagant as winning the largest lottery or something as simple as being hospitalized and having a glass of wine with dinner or visiting loved ones. The idea of being hospitalized and having a glass of wine is already being implemented by the palliative unit at a hospital that has a bar serving wine, whisky, and champagne.

Clermont-Ferrand Hospital, located in France where wine is a staple, provides additional quality end-of-life care for patients by serving medically supervised wine provided by local residents living in the area. After all, shouldn’t the pleasantries of living be available all the way through final days of our death journey? Patients are invited to drink wine at mealtimes. Caregivers are even encouraged to learn the basics of oenology, the science and study of wine and winemaking. A Roman playwright name Plautus said, “Let us celebrate the occasion with wine and sweet words.” Here’s to happy endings for all who are terminally ill! Cheers!

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, September 12, 2016

Financial Abuse and Older Adult Trust (Research, Video 2:36)

Are there people you really trust? Who are they, and why do you trust them? When mutual trust is achieved successfully in relationships, the experience can be beautiful and very beneficial to well-being. Unfortunately, knowing whom, when, and why to trust can be very difficult nowadays for anyone, especially older adults. Too often, their trust in social relationships goes unreciprocated and becomes exploitive.

Experts say older adult financial abuse will be the crime of the 21st century. Trust will play a major role. This became evident in a repeated trust game involving older adult financial abuse and including young adults investing real money with people they trusted at various levels (close, neutral, distant). Older adults were more likely than young adults to invest with all trustees. Older adults correlated higher intelligence with larger financial investments with the most trustworthy trustees. Better subjective financial untrustworthy well-being was associated with increased investing in the most untrustworthy trustees. Clearly, this presents potential dangers for older adults in the area of finance.

Are there ways for professionals who work with older adults, such as attorneys, law enforcement officials, and people who work at financial institutions to determine those at risk for being victims? Dr. Peter Lichtenberg, Director of the Institute of Gerontology at Wayne State University in Detroit, MI, is creating the Lichtenberg Financial Decision-Making Rating Scale for that purpose. This person-centered assessment will determine whether older adults are at risk for being victims of financial abuse and their ability to manage their money and other assets. The professionals would determine whether those surveyed are experiencing undue outside influence and whether they are competent in making good financial decisions. With this knowledge, they can better protect those most at risk for being exploited.

The National Adult Protective Services Organization website is a resource to help protect older adults from financial abuse while still allowing them their dignity. This website explains many common scams that are financially abusive to this population. Scammers include strangers, professionals, friends, and family members. Advice on the effects of financial exploitation and ways to address the abuse are also shared.

The rate of financial exploitation of the elderly is extremely high with millions indicating some form of perceived financial mistreatment occurring in the recent past. Dr. Natalia Tapia, Assistant Professor of Justice, Law and Public Safety Studies at Lewis University located in Midwest America, defines and discusses common forms of older adult financial abuse in this video: 

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Sunday, August 28, 2016

Hospice Mystery Solved By Nurse Assistant (Video Story 5:13)

“Little White Box” is a hospice mystery that has been circulating on the Internet for many years. I first posted this video story by Roger Dean Kiser on my blog back in 2007. Recently, after not seeing the video for several years, I read it again, regenerated the same warm feelings, and decided to repost it.

Sometimes a nursing home patient needs someone to solve a special problem. The urgency becomes especially important when the patient is in hospice care, and death is imminent. Perhaps some of you have been in that position before. I know I have.

Without giving away too much information, I’ll just say the story is about an older woman named Mrs. Mathers. Dying in a nursing home, she keeps saying, “Before I die, my little white box, please.” Unfortunately, no one knows exactly what she means. To her rescue comes a caring and determined nurse assistant who successfully solves the mystery. With Celine Dion’s breathtaking singing in the background, reading this story just might grab the handle of your heart and make you smile (or even laugh) at the surprising conclusion. Happy endings! 

This story reminds me of a hospice mystery in my own life as a hospice volunteer. In my “Christmas in May” story, I helped to locate a missing key for a beautiful “musicless” box. You can read that “other worldly” story here. 

"To the world, you may be one person. But, to one person, you may be the world."        Anonymous

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.

Monday, August 22, 2016

Wayfinding: Dementia, Alzheimer’s Help (Research, Video 1:48)

I continue to be amazed at how many people with or without mental or physical challenges make their way through busy airports in large cities. This kind of spatial problem solving for finding one's way is known as wayfinding. Even the cues to steer one’s way can be confusing. On occasions when I have asked for directions, I found myself thinking of better ways the information could have been conveyed. Signs, maps, and other graphic or audible methods can be very helpful if they are done to meet needs appropriately.

Imagine the frustration of people with dementia struggling to navigate rooms at home or long winding halls of institutions where a dark colored rug can bring the fear of a hole in the floor. After finding the desired locations, they are confronted with additional tasks of what to do and how to do it. Problems with wayfinding are sometimes early symptoms of Alzheimer’s. It’s important that people with Alzheimer’s maintain their independence with wayfinding assistance, especially in large residential environments.

senior residence, the impact of cues was examined with older adults who had normal cognition and those who had Alzheimer’s. Participants were asked to find their way to a location repeatedly in a virtual reality simulation of the senior residence. The two environments consisted of one with wayfinding cues and one without cues. Outcome measures included how often and how quickly participants found the target location in each cue condition. The results of this simulation experience study provide evidence for ways to make the environment more supportive for wayfinding for older adults with Alzheimer's disease.

Wayfinding signs can help people identify objects and find locations. They can be particularly helpful in warning them about dangerous situations and where to locate safety. There are many aids available to assist people with Alzheimer’s. In this video, a person with Alzheimer's explains how signs help him operate more independently in locating his clothes to dress himself.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.