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

Alzheimer's Dementia Thirst Checklist (Research)

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. 

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.