Monday, July 25, 2016

Healthcare Stereotypes: Hispanics, American Indians, Others (Research, Video 1:31)

Many research studies indicate that stereotyping patients of various racial-ethnic groups by healthcare professionals contributes to health disparities. Hispanic Americans and American Indians are two examples of groups facing significant disparities. The following research study focused on healthcare stereotypes related to these two groups: 

1) Health-related stereotypes both nursing and medical students hold about Hispanic and American Indian patients
2)  Nursing and medical students' motivation to treat Hispanic and American Indian patients in an unbiased manner
Participants completed a questionnaire assessing their awareness of stereotypes that healthcare professionals associate with Hispanic and American Indian patients. They also completed measures of their own motivation to treat these patient groups in an unbiased manner. 
Even though they were highly motivated to treat Hispanic and American Indian individuals fairly, the majority of participants reported stereotypes associating these patient groups with noncompliance, risky health behavior, and difficulty understanding and/or communicating health-related information. These kinds of negative health-related stereotypes about patient groups have no place in patient-centered healthcare.

Patient-centered healthcare applies to all patients. This video shares patient-centered comments that present various issues encountered by patients and providers in healthcare settings.

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, July 18, 2016

Medical Marijuana Hospice Pros and Cons (Research, Video 2:00)

The number of states with medical marijuana laws in place continues to grow. Healthcare workers should be aware of the scientific rationale and practical implications for its use in treating diseases and relieving symptoms. According to Wikipedia (the free encyclopedia), the Cannabis plant (marijuana, Mary Jane, weed, pot, grass, herb, reefer, joint, blunt, etc.) has a history of medicinal uses dating back thousands of years across many cultures. However, its long-term effects are not clear, and its use for certain medical applications is insufficient for conclusions about safety or efficacy. Medical marijuana is used to reduce nausea and vomiting, to improve appetite in people with HIV-AIDS, and to treat chronic pain and muscle spasms.

Medical marijuana is also used for Alzheimer’sdisease. Of the 24 states and localities where medical marijuana is legal, dementia is a qualifying condition in 10 states primarily for agitation of Alzheimer's disease. Where information was available regarding qualifying certification conditions in five states, dementia was the indication for fewer than 5% of medical marijuana certifications. Although few applicants for medical marijuana list dementia as the reason for seeking certification, providers should be aware that dementia is a potential indication for licensing despite lack of evidence for its efficacy.

The literature on medical marijuana, which includes studies involving hundreds of patients, was reviewed by Medline  from 1948-March 2015. Their results reported that use of marijuana for chronic pain, neuropathic pain, and spasticity due to multiple sclerosis is supported by high-quality evidence. However, physicians and other healthcare workers should educate themselves because some uses of the drug medically may lack evidence to support treatment with marijuana. They should also educate their patients about medical marijuana to ensure that it is used appropriately and that patients will benefit from its use. Eating edible marijuana is more popular than smoking it.

Valley Hospice was the first hospice in the state of Arizona to use medical marijuana in their comprehensive hospice program. In this video, Dr. Margaret King and patients explain how the program started and concerns about the use of medical marijuana:

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.
Hospice and Nursing Homes Blog

Monday, July 4, 2016

Dementia Thirst Checklist (Research, Video 2:07)

The first thing I do as a hospice volunteer when I visit a resident’s room at a nursing home is look for a filled water glass. This is year-round, regardless of the weather. Because most of my hospice patients share a room with two or three other residents not assigned to me, I usually look for several glasses. Beyond looking for glasses, I also observe patients for clues about their overall condition, including dehydration.

Residents with advanced dementia are at a particular disadvantage when it comes to expressing thirst needs verbally. They often resort to communicating these needs through behaviors and psychological symptoms for caregivers and others to interpret. These expressions for making their critical thirst needs evident require accurate assessments to maintain their well-being. One way of doing this is with a checklist.

A research study on the thirst status of people with advanced dementia was created to develop a checklist. The initial items were developed through interviews with 10 professional nurses who were caring for these patients. Four experts in dementia assessed the content validity of these items. In addition, caregivers from eight facilities were then invited to complete the checklist based on their current advanced dementia patient care experience. Analysis identified these seven checklist items for determining thirst needs:
Checklist to Assess the Thirst Status of People with Advanced Dementia 
1)   Repetitive movements
2)   Squirming
3)   Restlessness or anxiety
4)    Persistent or unreasonable demands
5)    Pacing back and forth
6)    Repeating a sentence or question without purpose
7)    Slow reaction

Although the reassessed internal consistency reliability was .66, caregivers can still use this checklist as an aid to identify the thirst or fluid needs of people with dementia who are unable to communicate their needs effectively.

Drinking enough water daily is something that we all should do. Experts recommend that we drink 8 cups of 8 ounces of water daily. Unfortunately, over 40% of Americans drink fewer than 4 cups, and 7% report drinking none daily. 
This video shares five surprising benefits of drinking water:

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, June 27, 2016

Hospice Inpatient vs. Home Care: Family Views (Research, Culture Video 2:26)

No matter where people receive hospice care, the quality will always depend on the context in which the care is given. Families consider communication and support when they evaluate the kinds of experiences they and their loved ones have had. In order to determine family experiences in evaluating care in inpatient hospices such as nursing homes vs. home hospice care in their own homes, research of the two settings was done with comparisons made. The following study was done to compare inpatient and home care hospice family satisfaction in the two settings.

Survey data from bereaved family members of approximately 1600 patients from a nonprofit, midsized hospice in western Pennsylvania were used. Responses were separated into two groups including general inpatient hospice care and routine home hospice care. Both settings indicated three variables associated with greater overall family satisfaction:

1)   Being kept informed about the patient's condition
2)   Being provided with clear/consistent information
3)   Having the perception that patients were provided with  adequate treatment for anxiety

The following two variables indicated greater satisfaction in routine home hospice care only:

1)   Having sufficient discussion with hospice team members  concerning family members' religious or spiritual beliefs
2)   Being provided with the correct amount of emotional support  after the patient's death

 These results conclude that good communication is strongly associated with greater family satisfaction across hospice care settings. Hospices must ensure that they provide patients and families with consistent information and support.
An important part of communication includes the culture of the hospice families. In a society increasing rapidly in diversity, hospices and other healthcare providers must make every effort to be sensitive and proactive in providing ways to improve communication so a common language can be facilitated. VITAS Innovative Hospice Care demonstrates that in this video in which a patient's family talks about what it means to have a Creole-speaking caregiver bring home care to their 116-year-old patriarch.

Are you curious about who leaves hospice alive? Discharges can occur for several reasons:

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, June 20, 2016

Childhood Sexual Abuse Health Impact on Older Adult Survivors (Research, Video 3:29)

"If you tell anyone, I will kill you." Childhood sexual abuse is an extremely under-reported crime that often includes a threat of serious harm to victims or their families. Many victims choose not to discuss the abuse with anyone. A major concern is that 90% of these sexual abusers target children they know. The stigma and shame of sexual abuse fester inside, impacting females and males for years as they age through adulthood. 

Numerous older adults live with long-term mental and physical repercussions from being sexually abused as children. According to the Centers for Disease Control and Prevention, children who are abused or neglected are at higher risk for health problems as adults. These problems include alcoholism, depression, drug abuse, eating disorders, obesity, high-risk sexual behaviors, smoking, suicide, and certain chronic diseases.

This study reported in International Psychogeriatrics examined the long-term association between childhood sexual abuse and mental and physical health of 8,178 older adults. These were the results:

1)  Six percent of respondents reported childhood sexual abuse with little variation by gender.
2)  A significant association was found between childhood sexual abuse and mental health with victims more likely to have depression, anxiety, worry, loneliness, and low quality of life. Poor self-reported health, lung disease, arthritis, peptic ulcer, chronic pain, and high levels of total cholesterol and low-density lipoprotein were associated with childhood sexual abuse.
3)  Those who reported childhood sexual abuse were more likely to report doctor and hospital visits than those without that history.

This study concludes that childhood sexual abuse can have long-term mental and physical consequences for older adults. RAINN (Rape, Abuse, and Incest National Network)  is the nation’s largest anti-sexual assault organization. The National Sexual Assault Telephone Hotline  800-656-HOPE (4673) can connect callers with trained staff members from sexual assault service providers in the callers’ areas and provide a range of free services.

Sexual abuse of boys has particularly been neglected by the media and in general conversations. Pressures from society teach boys that real men are not victims. But 200 brave men came forward on the Oprah show to publicly acknowledge that sexually abusive adults who were often relatives or friends of their families victimized them as children. The men share their stories 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.