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?

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