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Capstone Final
- 1. Amber Fortman ⌘ ⌘ ⌘ ⌘ ⌘ Capstone Presentation Psychology Department, Presbyterian College Capstone Advisor: Evelyn Hunter, Ph.D.
- 2. Compassion Accountability Respect Integrity Service ‘CARIS’ comes from a greek word meaning ‘grace’ Vision: Committed to being your world class hospice. Mission: Hospice care with grace.
- 3. Norman McRae Founder of Caris Healthcare “Near the end of life, Caris strives to provide care to patients in the locale of their preference by an interdisciplinary team made up of a nurse, aide, social worker, chaplain, and volunteer who are all supervised by a physician and supported by pharmacists and nurse practitioners. Our goal is to provide everyone who needs hospice an experience that is grounded in excellence by a team of caregivers who are available when needed, day and night, to respond with urgency.”
- 4. The Better Way All are held to this standard Explained to all patients and families Must be worn on badge Signed certificate
- 5. Learning Objectives 1) To gain invaluable, practical counseling experiences that will be used as preparation for graduate school and future employment. 2) To use the knowledge and techniques gathered and continued to be gathered in the classes taught at Presbyterian College and apply them in a practical, ethical way. 3) To expand my personal knowledge of other social, ethnic, and religious practices other than my own to serve the clients of Caris Healthcare and with future clients in graduate school and future employment with the best care and understanding possible.
- 6. Patient Volunteer Visit with patients each week Patient’s Three Most Important Things Above and beyond Documentation
- 7. Patient Demographics Six patients at NHC of Clinton One in Langston Place One at-home patient One Male, Seven Females Five Caucasian, Three African-American Dementia, Heart Disease, Stroke
- 8. Principles and Procedures of Counseling Dr. Evelyn Hunter
- 9. Why are Demographics Important to Consider? Cultural Considerations when “ADDRESSING” patients’ needs Age & Generational Influences Disabilities (Developmental) Disabilities (Acquired) Religion Ethnic/Racial Identity SES Sexual Orientation Indigenous Heritage National Origin Gender (Magyar-Moe, 2009)
- 10. Does Being Culturally Aware Matter? Sampled low-income African Americans (n=110) and non-Hispanic White Americans (n=119) Correlational Study Questionnaire measuring eight areas Study Conducted: Patient-Centered Culturally Sensitive Health Care: Model Testing and Refinement (Tucker, Marsiske, Rice, Nielson & Herman, 2011)
- 11. Provider Cultural Sensitivity African American White Trust in Provider 0.548*** 0.823*** Satisfaction with Care 0.725*** 0.789*** Health Promoting Lifestyle 0.238* 0.277** (Tucker, Marsiske, Rice, Nielson & Herman, 2011) RESULTS Significant correlation *** p<.001 ** p<.01 *p<.05
- 12. Psychology of Religion Dr. Jay Michaels
- 13. Religion All of my patients identify as Christian All have this in some aspect of Three Most Important Things Two are “new” Christians
- 14. Coincidence? Do older people need God? Church-based social support Focus on African-Americans Well-being with God-mediated control Can conclusions be made about the sick? (McFadden, 2005)
- 15. Biologically Inclined to Believe? Terror Management Theory All humans are aware of death Death knowledge causes great anxiety Managed by immersion something deemed meaningful (Rowatt, Shen, LaBouff, & Gonzalez, 2005)
- 16. Scared to Death? Osarchuk and Tatz studied change in belief in afterlife Mortality salience led to stronger religiosity (Jost, Kay & Thorisdottir, 2009)(Norenzayan & Hansen, 2006)
- 17. Psychology of Adulthood and Aging Dr. Brooke Spatta
- 18. Caregiver Burden Physical Problems Psychological Problems – Fatigue – Sleep impairment – Unhealthy behaviors – Lack of exercise – Unhealthy eating – Anxiety – Depression – Worry – Loneliness (Bevans & Sternberg, 2012)
- 19. Sandwich Generation They are responsible for all support Financial Support Children Parents Emotional Support Children Parents People, typically in their thirties or forties, responsible for raising their children and caring for their aging parents (Parker & Patten, 2013)
- 20. (Parker & Patten, 2013) Financial Stress and the Sandwich Generation Q: How would you describe your household’s financial situation? (%) Sandwich Generation Supporting parent 65+ Not supporting parent 65+ Live comfortably 28 41 Meet basic expenses with a little left over 30 31 Just meet basic expenses 30 17 Don’t have enough to meet basic expenses 11 10 • Unpaid caregivers provide 90% of long- term care • $5,531 on average caring for someone 50+ • Typical caregiver: 46 six year old, woman, more than 20 hours of care • 53% of caregivers report worsen health • 67% do not go to the doctor for family’s needs
- 21. What to do with this research and these statistics? Companies like Caris can use these to better serve the patients and their families. Be culturally aware to for best patient outcome Encourage patients’ faiths for best quality of end of life care Encourage families Cognitive care Time off Spiritual and cognitive family care Post Presbyterian College Goals Masters in Clinical Mental Health Specialize in hospice/trauma counseling Graduate thesis Work with underserved populations Galatians 5:13 “For you were called to freedom, brothers. Only do not use your freedom as an opportunity for the flesh, but through love serve one another.”
- 22. Dr. Evelyn Hunter, Presbyterian College Internship & Capstone Advisor Lynn Downie, Presbyterian College Internship Coordinator Leigh Workman, Caris Healthcare Volunteer Coordinator
- 24. References 1.Bevans, M. F., & Sternberg, E. M. (2012). Caregiving Burden, Stress, and Health Effects Among Family Caregivers of Adult Cancer Patients. Jama, 307(4), 398– 403. http://doi.org/10.1001/jama.2012.29 2.Jost, J., Kay, A., & Thorisdottir, H. (2009). Social and psychological bases of ideology and system justification. Oxford: Oxford University Press. 3.Krause, N. (2004). Common facets of religion, unique facets of religion, and life satisfaction among older African Americans. Journal of Gerontology: Social Sciences, 59B, S109-S117. 4.Magyar-Moe, J. (2009). Therapist's guide to positive psychological interventions. Amsterdam: Elsevier/Academic Press. 5.McFadden, S. H. (2005). Old Persons, Old Age, Aging, and Religion. In R. F. Paloutzian & C. L. Park (Eds). Handbook of The Psychology of Religion and Spirituality (pp.198-212). New York:The Guilford Press. 6.Morris, S. M., King, C., Turner, M., & Payne, S. (2015). Family carers providing support to a person dying in the home setting: A narrative literature review. Palliative Medicine, 29(6), 487-495. doi:10.1177/0269216314565706 7.Norenzayan, A., & Hansen, I. (2006). Belief in Supernatural Agents in the Face of Death. Personality And Social Psychology Bulletin, 32(2), 174- 187. http://dx.doi.org/10.1177/0146167205280251 8.Parker, K., & Patten, E. (2013). The Sandwich Generation: Rising Financial Burdens for Middle-Aged Americans. Pew Research Center. Retrieved 1 November 2015, from http://www.pewsocialtrends.org/2013/01/30/the-sandwich-generation/ 9.Rowatt, W. C., Shen, M. J., LaBouff, J. P., & Gonzalez, A. (2005). Religious Fundamentalism, Right-Wing Authoritarianism, and Prejudice: Insights from Meta- Analyses, Implicit Social Cognition, and Social Neuroscience. In R. F. Paloutzian & C. L. Park (Eds). Handbook of The Psychology of Religion and Spirituality (pp.457- 475). New York:The Guilford Press. 10.Sue, D. (2015). Cultural Diversity and Microaggressions: Applications to Counseling. Hoboken, NJ: John Wiley & Sons, Inc. 11.Tucker, C., Marsiske, M., Rice, K., Nielson, J., & Herman, K. (2011). Patient- centered culturally sensitive health care: Model testing and refinement. Health Psychology, 30(3), 342-350. http://dx.doi.org/10.1037/a0022967.
Editor's Notes
- Caris is an acronym meaning: Compassion, Accountability, Respect, Integrity, and Service This is the basis for the company in which all employees and volunteers must uphold not only for our patients, but for their families “Caris” comes from the Greek word meaning ‘grace’ The vision and mission of the company embodies what Caris stands for and its origin Vision: committed to being your world class hospice We serve many patients and families, but we treat each patient as if they are our only one The Power of One Mission: Hospice care with grace
- Statement from the founder: “Near the end of life, Caris strives to provide care to patients in the locale of their preference by an interdisciplinary team made up of a nurse, aide, social worker, chaplain, and volunteer who are all supervised by a physician and supported by pharmacists and nurse practitioners. Our goal is to provide everyone who needs hospice an experience that is grounded in excellence by a team of caregivers who are available when needed, day and night, to respond with urgency.”
- The Better Way is the way we hold ourselves accountable to provide the best services to patients and families The Better Way is comprised of 20 “I promise to” All promises must be carried out each day and when encounter every patient All employees and volunteers have to pledge to uphold all of these promises and each receive a signed certificate We must keep the promises (as employees) with us at all time as a reminder There is a daily call for every office in the country from headquarters Each morning there are real life examples of how different employees from different offices have upheld these promises
- To gain invaluable, practical counseling expereinces that will be used as preparation for graduate school and future employment. To use the knowledge and techniques gathered and continued to be gathered in the classes taught at Presbyterian College and apply them in a practical, ethical way. To expand my personal knowledge of other social, ethinic, and religious practices other than my own to serve the clients of Caris Healthcare and with future clients in graduate school and future employment with the best care and understanding possible.
- Learning objective #1 1 practical counseling skills My position within the company was a patient volunteer My main task is to visit with each patient Pay special attention to the Patient’s 3 most important things They can be anything and everything One patient I pray with before I leave Another is having her nails painted Another is KFC chicken wings Remembering the power of 1, I try to go above and beyond with my patients Example: one of my patients turned 104 I brought her a birthday card and flowers Her family was touched and even called the office for thanks KOJO points are assigned when employees go above and beyond The companies way of recognizing its employees and volunteers I have to complete documentation each visit This keeps me and the company accountable I have to document the time I was there and what we did and how I included 3 most important things Documentation has to be signed by either a nurse or caregiver (at home) for accountability Accountability ensures that our patients get the best care Going back to vision and mission
- Six patients at NHC of Clinton One in Langston Place One at-home patient One Male, Seven Females Five Caucasian, Three African-American Dementia, Heart Disease, Stroke
- Learning Objective #3 – Learn about other ethnic, cultural issues Addressing Model of Cultural Assessment Developed by Pamela Hayes Intended to help therapists conceptualize indignities across different dimensions Completed inventory for me and for patient Allows me to understand my own background that comes with beliefs and identity that may different than my patients The areas in which I mostly different with at least one of my patients Age (young vs. older) Disabilities Later in life (including physical and cognitive/psychological) Ethnicity SES Gender I have to make myself aware of these differences so when I am with each patient, I am making sure that I am catering to their specific needs and not just what I assume or I think I would want Example: Most of my patients have lived through the roaring 20s and then through the great depression Lived with technology advances that I take fore granted
- Study published and accepted by US National Library of Medicine National Institutes of Health Objective: Explain and improve health care for ethnically diverse patients seen in community-based primary care clinics Total 229 participants Areas included: Provider cultural sensitivity trust in provider patient interpsonal control patient satisfaction physical stress health promoting lifestyle diet adherence medication adherence
- Significant correlation *** p<.001 ** p<.01 *p<.05 What does this mean? - the study found support for a postive correlation - The more the provider was cultural sensitive, there was a higher trust in provider, satisfaction with care, and having a health promoting lifestyle
- “New” christians meaning that they are new in faith. Bot patients agreed that they always believed there was some sort of God but did not become believers until they became sick
- Church-based support are associated with a sense of well being for the older adults, not necessarily sick adults Study was on African American adults but found it to be true across all races Another study showed that particularly in african american christians show better outcomes in well being when they embrace idea of God-mediated control There needs to be more research, but it seems logically to hypothesize that the especially older, sick individuals use belief of God being in control
- Religiosity is very important Religion often buffers death anxiety John 3:16
- In participants, there was a greater change (more beleif) in the afterlife after the participants were exposed to Death threat condition It is important to note that this study has not been replicated, however, it is often sighted as preliminary foundation for other studies Mortality salience is when an individual becomes aware that his or her death is inevitable Participants responded to 2 questions How religious are you How strongly do you believe in God Death motivates religiosity, more specifically in a higher power
- Anxiety Depression Worry Loneliness Fatigue Sleep impairment Unhealthy behaviors Lack of exercise Unhealthy eating
- People, typically in their thirties or forties, responsible for raising their children and caring for their aging parents
- Financial Stress Live comfortably 28% as opposed to 41% Meet basic expenses with a little left over 30 vs 31% Just meet basic expenses 30 vs 17% Don’t have enough to meet basic expenses 11 vs 10% Unpaid caregivers provide 90% of long-term care $5,531 on average caring for someone 50+ Typical caregiver: 46 six year old, woman, more than 20 hours of care 53% of caregivers report worsen health 67% do not go to the doctor for family’s needs
- Learning Objective #2 – Use PC’s skills