class two

Chapter 3: Diversity

1. Key Terms

  • Bisexual: A person sexually attracted to individuals of both sexes.

  • Culture: The shared beliefs and values of a group, including their customs, practices, and social behaviors.

  • Ethnic: Relating to a group sharing a common racial, national, religious, linguistic, or cultural heritage.

  • Ethnogeriatrics: The study of how ethnicity and culture influence the health and well-being of older adults.

  • Gay: A person who is sexually attracted to members of the same sex; also known as homosexual.

  • Lesbian: A woman who is sexually attracted to other women.

  • Race: A group of people sharing specific biological characteristics.

  • Transgender: A person whose identity, appearance, and/or behavior diverges from societal norms related to their assigned gender at birth; may also be referred to as transsexual or transvestite.

2. Introduction

  • The older adult population is increasingly becoming diverse in terms of race and ethnicity.

  • There is a notable increase in Hispanic and Black older adults within the U.S. population.

  • Providing culturally competent care is essential.

  • Understanding cultural and ethnic differences aids in eliminating stereotypes and biases.

3. Increasing Diversity of the Older Adult Population

  • The older population is becoming more ethnically and racially diverse. Based on projections:

    • The non-Hispanic White population is expected to decrease to 64% by 2060.

    • The Hispanic population will rise to 20%.

    • The Black population will increase to 13%.

    • By 2040, it is expected that 34% of the older adult population will belong to a minority racial or ethnic group.

    • There is also a growing number of LGBTQ older adults.

4. Essentials of Culturally Competent Care

  • Nurses must understand:

    • The experiences of people with similar ethnic/racial backgrounds.

    • The beliefs, values, traditions, and practices of various ethnic and racial groups.

    • The unique health-related needs, experiences, and risks associated with different groups.

    • Their own attitudes and beliefs regarding various ethnic/racial groups.

    • The influence of language barriers on communication.

5. Overview of Diverse Groups of Older Adults in the United States

  • Older adults often assimilate and adopt American ways, resulting in variations such as:

    • History

    • Language

    • Customs

    • Characteristics

    • Beliefs about aging and the elderly

  • It is crucial to recognize individual differences within ethnic groups to avoid stereotyping.

6. Factors Influenced by Ethnic Norms

  • Ethnic norms can influence:

    • Dietary habits

    • Compliance with self-care and medical treatments

    • Trust in healthcare providers

    • Responsibilities and roles assumed in old age

7. Hispanic Americans

  • Consist of various Spanish-speaking individuals, including immigrants from Spain, Mexico, Cuba, and Puerto Rico.

  • The Hispanic population in the U.S. is increasing, with differing immigration periods across subgroups.

  • Perspectives on health and illness may vary significantly.

  • Traditional healthcare practitioners include:

    • Curanderos (folk healers)

    • Sobadoras (massage therapists)

    • Espiritualistas (spiritualists)

    • Brujos (witches)

    • Senoras (women with traditional knowledge)

7.1 Older Adults' Perspectives

  • Older adults tend to view aging positively and anticipate that children will assume caregiving roles.

  • English may be a second language for many.

  • There is a lower likelihood of visiting physicians or obtaining preventive services, which may lead to difficulties in care access.

8. Black Americans

8.1 Demographics

  • Approximately 13% of the U.S. population is Black, with older Black adults constituting 9% of that population.

  • There is a strong commitment to family among Black Americans, particularly concerning aging relatives.

8.2 Health Disparities

  • Historical factors have contributed to lower standards of living and less access to healthcare, affecting health outcomes.

  • Lower life expectancies until reaching the seventh decade, after which they equal those of Whites.

  • Cumulative health problems are common throughout their lifetime.

  • Most prefer family involvement in decision-making over formal health service agencies.

  • Cautious while interacting with health care providers and utilizing health services.

8.3 Health Issues

  • Prevalent health issues include:

    • Hypertension

    • Heart disease

    • Cancer

    • Diabetes

  • Slightly higher rates of smoking and obesity.

  • Higher mortality rates from various diseases, including heart disease, stroke, diabetes, and more.

  • Nurses can aid by recommending lifestyle changes such as:

    • Good nutrition

    • Regular exercise

    • Effective stress management

    • Regular health screenings

9. Asian Americans

  • Comprising over 20 million individuals, making up more than 5% of the U.S. population.

  • This group includes individuals from various countries such as:

    • China

    • Japan

    • The Philippines

    • Korea

    • Vietnam

    • Cambodia

  • Asian Americans typically experience lower unemployment rates compared to the national average.

9.1 Chinese Americans

  • Historical prejudices have led to the establishment of “Chinatowns” as safe havens.

  • Significant populations reside in states like California, New York, and Texas.

  • Traditional Chinese medicine emphasizes concepts like “Yin and Yang,” using sensory perceptions for diagnosis (touch, hearing, smell) and includes acupuncture, herbal remedies, and massage.

  • Older adults in this culture are respected and may be reluctant to engage with service agencies.

9.2 Japanese Americans

  • Include individuals from Japanese immigration waves.

  • Similar to Chinese Americans, they exhibit lower unemployment rates and have a higher percentage of professionals.

  • Most reside in California and Hawaii and tend to preserve their cultural traditions.

  • Family caregiving for the elderly is an expectation as older adults are viewed with respect.

9.3 Other Asian Groups

  • Communities from the Philippines, Korea, Vietnam, and Cambodia often share similarities:

    • Strong family networks

    • Families taking on the roles of caregivers for older adults

    • Low rates of nursing home admissions

10. Jewish Americans

10.1 Cultural Identity

  • The Jewish community holds a strong sense of identity marked by shared beliefs and values.

  • Immigrants come from varied countries, each contributing different customs.

  • Education is highly valued within this community, as evidenced by a 60% college attendance rate.

10.2 Religious Practices

  • Observance of the Sabbath (sundown Friday to sundown Saturday) and adherence to dietary laws (Kosher) is common, which prohibits certain foods and combinations of dairy and meat.

10.3 Respect for Elders

  • Older adults are held in high regard, with specific rituals and traditions surrounding their care, including clothing choices and fasting during particular holidays. Engagement with religious leaders like rabbis may be sought.

11. Native Americans

11.1 Demographics

  • The Native American population is steadily increasing, comprising over 500 tribes spread mostly across:

    • California

    • Oklahoma

    • Arizona

    • New Mexico

    • Texas

  • The Indian Health Service provides free healthcare on reservations.

11.2 Cultural Beliefs

  • There is a deep reverence for the Great Creator and beliefs surrounding good and evil forces as well as punishment for wrongdoings.

  • Family bonds are strong, and traditional views may lead to discomfort with the nursing assessment process, especially regarding probing questions and documentation.

11.3 Wellness Challenges

  • Accepting assistance can conflict with traditional beliefs of self-sufficiency.

  • Elders are viewed with respect and as leaders in their communities, but cancer survival rates among this population are the lowest in the U.S.

  • There is a rise in preventable diseases such as heart disease and diabetes, necessitating enhanced health education and early screenings by nurses.

12. Muslims

  • Customs are deeply influenced by religious beliefs derived from the Quran.

  • Older adults are treated with high regard, often cared for by family.

  • Specific dietary restrictions, such as halal food, and practices including fasting are common.

  • Patients may prefer care from same-sex practitioners, and there is limited physical touch allowed from nursing staff due to cultural norms.

13. LGBTQ Older Adults

13.1 Growing Awareness

  • There is a growing awareness of and acceptance toward LGBTQ individuals, yet minimal attention is paid to the challenges they face as they age.

  • Many are fearful of rejection by caregivers and neglect in healthcare settings, often leading to avoidance of care.

13.2 Health Challenges

  • Nearly one-third report poor health and lack of a regular medical provider.

  • Higher incidence of poor physical and mental health issues, plus elevated smoking and alcohol consumption rates, have been noted.

  • Over 40% report having a disability.

  • Nurses should avoid stereotypes and inquire sensitively about partners that patients may wish to involve in their care to ensure non-discriminatory treatment.

14. Nursing Considerations for Culturally Sensitive Care of Older Adults

14.1 Understanding Diversity

  • Recognizing unique histories, beliefs, and practices is essential.

  • Respect for diversity should be central, with accommodations made for dietary and practice preferences.

  • Nurses should adapt their approaches to align with health practices and ensure culturally and linguistically appropriate services are provided.

14.2 Managing Nurses’ and Patients’ Attitudes

  • A nurse's initial impressions and feelings can influence care; personal feelings must not interfere.

  • Patients may come with previous biases against healthcare providers, possibly due to past negative experiences.

  • The patient’s needs and desires should be prioritized, requiring nurses to ask appropriate questions to tailor care accordingly.

15. Nurses’ Responsibility

  • Nurses are responsible for ensuring that cultural, religious, and sexual differences are acknowledged and respected among older adults.

  • Cultural sensitivity is fundamental in honoring older adults’ histories and preserving what is important to them, thereby preventing the loss of ethnic or cultural significance in care efforts.