Chapter 14: Values and Beliefs

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Values and beliefs, they're sort of these invisible forces, aren't they?

They govern pretty much every health decision, especially when we talk about older adults.

Absolutely.

You can monitor a patient's vital signs all day long, but if you don't get what's going on in their inner world, their history, their culture, maybe their savings habits, their faith, you're missing a huge piece of the picture.

Exactly.

In geriatric care, that inner world, it's just as critical as their blood pressure reading, no question.

That internal programming, it really is everything.

We've basically distilled the core ideas from some key geriatric nursing texts, focusing right in on how values and beliefs form and how much they shape what happens in the clinic.

Our mission today is really to give you a kind of shortcut, a path understanding what it really means to practice patient -centered, culturally congruent care in this area.

It has to start with the basic concept, right?

Values, beliefs, these are uniquely human things.

They're fundamental to who we are, and they affect everything, how we see life, how we face death, and definitely how we understand and manage our health.

Here's the thing for older adults,

this system, this core,

it isn't really flexible anymore.

It's established,

sometimes set over eight or nine decades.

Wow.

Yeah.

It's this complex mix of religion, family, culture,

societal norms, all baked in over a lifetime.

What's fascinating is just how early that foundation gets laid down.

Okay, let's unpack that formation process then, because hearing you say how rigid geriatric values are makes total sense when you look at, say, Morris Massey's work on developmental periods.

Exactly.

Massey showed that most of our core values are locked in before we're even old enough to drive legally.

It's quite striking.

So what are those periods?

Well, the first one is the imprint period.

This goes up to about age seven.

And during this time, a child just absorbs things, beliefs, stimuli,

they see it as true.

Simple as that.

They're learning right, wrong, good, bad, mostly just through exposure.

Okay.

So just taking it all in.

Then what?

Then you hit the modeling period.

That's roughly ages eight through 13.

Right.

And this is where kids start imitating role models they admire.

Parents, maybe teachers, public figures from that era,

they act like them, do what they do.

And then finally, there's the socialization period, sort of 13 to 21.

The teenage years.

Yep.

And this is when peers, media,

they suddenly have this huge influence.

And the person starts figuring out their own values, finding their tribe, people who believe the same things.

So if you think about it, a 90 -year -old today is basically operating on programming established before they even hit 21.

That's essentially it.

That longevity, that deep -seated nature, because that's why these early values are so incredibly important in geriatric care.

And this is where communication can really break down, isn't it?

Oh, frequently, differences in values, they're one of the most common reasons for conflict in healthcare settings.

Yeah.

When a patient says, you know, they just don't understand me, it's often hitting that fundamental conflict and beliefs.

Could it be generational?

Could be cultural?

So what's the takeaway for the caregiver then, the nurse?

Well, the big thing, the mandate really, is therapeutic, non -judgmental communication.

And to do that effectively,

you first have to get really aware of your own values and beliefs.

Ah, self -awareness.

Crucial.

If you don't, you risk projecting your own expectations onto the patient.

Yeah.

And that leads to misunderstandings, poor relationships, maybe even poor outcomes.

Self -reflection isn't optional.

It's like a prerequisite.

Okay.

That's a powerful point.

Let's shift then to some specific common values we might see in today's older adults.

I mean, obviously it's a diverse group.

Hugely diverse.

But there are some shared threads, right, from those collective generational experiences, like let's start with economic values.

Right.

So many older adults today, they were kids during the Great Depression in the 1930s.

A defining experience.

Absolutely.

They were raised with this intense focus on being frugal, careful with resources.

It instilled this massive value on independence.

And how does that play out clinically?

Well, you often see difficulty accepting financial help,

even if they need it.

And here's where it gets really interesting for us, clinically speaking.

This frugality can mean they delay necessary care because of the cost.

Even if insurance, like Medicare, covers some of it.

Even then.

Or they might choose to skip medications altogether or, you know, take half a dose to make the prescription last longer to save money.

That's wow.

And that saving instinct, does it go beyond just money and medicine?

Oh yeah.

That drive to save rather than waste, it can sometimes cross into safety issues.

It leads to saving or even hoarding items.

Like what kind of items?

Sometimes things that are genuine health hazards, old food, used medical supplies,

things like that.

Because the value of saving outweighs the risk.

For them, in that moment, yes.

The value placed on saving can be stronger than the value placed on safety.

Caregivers really need to grasp that hierarchy.

But hang on.

There's a shift coming, isn't there?

The source material contrasts that depression -era mindset with the baby boomers who are now entering late adulthood.

That's right.

A very different upbringing.

More affluent times,

a consumer -driven world.

So they're more likely to value possessions and spend rather than save.

Generally speaking, yes.

And that difference, that clash in values, it's likely to cause some friction.

Not just in the clinic, but economically, too.

How so?

Well, the source suggests this spending versus saving difference might even lead to delayed retirement for some boomers.

They might need to stay in the workforce longer than previous generations just to maintain their lifestyle.

Interesting.

Okay.

So if managing resources is such a strong generational thing, what about how they interact with people, like caregivers?

Does that formality instinct carry over?

That brings us to interpersonal values.

It absolutely does.

Many older adults were raised when communication was just more formal,

which is why they might prefer being addressed with titles, you know, Mr.

Evans or Mrs.

Ortega.

Using honorifics.

Exactly.

They often value the respect shown to elders and might expect a certain deference from younger staff.

And that expectation of deference, I can see how that could be a huge source of conflict.

It can be.

Yeah.

Especially if it causes friction with their own family members who might not automatically follow their directions anymore.

So what's the nurse's role there?

You can't exactly mediate family drama.

No, definitely not.

Your role is critical.

Be the patient's advocate.

Absolutely.

But you have to resist becoming a mediator in their personal relationships.

Sometimes, honestly, the best thing you can do is gently ask the family to step out for a bit.

Give the patient some space.

Yeah.

Allow them some quiet rest and give yourself space for that one -on -one therapeutic support without the external pressure.

That makes sense.

And this need for sensitivity, for cultural understanding, it's only getting more critical, right?

The older adult population is diversifying rapidly.

Incredibly so.

Projections show the proportion of minority populations aged 65 and up is set to increase by something like 115 % by 2040.

It's a massive shift.

Wow.

So caregivers absolutely must be prepared for this diversity.

No question.

Let's make sure we're clear on the terms here.

We hear phrases like cultural competence thrown around a lot.

How do the foundational texts define the steps, like the hierarchy of getting skilled in this?

Right.

It's helpful to think of it as a progression.

It starts with cultural awareness.

That's basically having the knowledge, appreciating a group's unique features, their history, customs, health beliefs.

Just knowing about it.

Kind of.

Then you move to cultural understanding.

This is where you actively try to apply that awareness to build therapeutic relationships.

Okay.

Using the knowledge.

Exactly.

And then the peak is cultural competence.

This is about a consistent set of behaviors.

It means understanding the deep impact of culture while also being aware of your own values and how they affect how you see things.

Maintaining that self -awareness we talked about.

And what's really vital here, the source highlights this as a QSE consideration,

is avoiding stereotypes.

Right.

Because everyone's an individual.

Precisely.

You might know general cultural traits, but every single patient is unique.

Culturally congruent care isn't just nice to have, it's mandatory.

Research shows it leads to better adherence, better outcomes.

And keeps people engaged with the healthcare system.

Yes.

It's not just about avoiding assumptions, it's about effective care.

And this also means tackling health disparities, right?

Which often hit minority groups because of economic issues or language barriers.

Correct.

And that means we need to assess for, and whenever possible, incorporate complementary health approaches.

Okay.

Like what?

This includes things like folk medicine, traditional treatments that are deeply rooted in a patient's culture and history.

So don't just dismiss something because it's not in the latest drug guide.

Exactly.

You need to understand its significance to the patient and see if it can safely coexist or be integrated with the medical plan.

Okay.

Let's shift gears a bit now to something deeply personal.

Spirituality and religious values.

We often hear spirituality and religion used almost interchangeably.

How does the source material distinguish them for patient care?

Yeah, that's a really important distinction.

Spirituality is defined more as that deeply personal inner experience, a connection with something higher, a sense of purpose.

More internal.

Right.

Whereas religion is typically the structured path, finding that spirituality within a specific community with traditions, formal systems.

Got it.

So spirituality is the what.

Religion is often the how.

That's a good way to put it.

And it's essential to remember everyone has a spiritual nature, whether they follow a specific religion or not.

So even someone who identifies as atheist or agnostic has spiritual needs.

Absolutely.

An atheist doesn't believe in a higher power and agnostic feels it can't be proven either way.

But that doesn't mean they lack a spiritual dimension or needs related to meaning, connection or peace.

Don't make assumptions based on affiliation or lack thereof.

And these spiritual beliefs, they must have a huge impact on how people cope with life events, especially big health crises.

Massive impact.

They're often a huge source of strength.

And frequently that need for spiritual connection actually grows as people age, especially as they face mortality.

Which brings us to things like religious rituals.

Yes.

Those formal observable ceremonies that affirm faith.

Specific prayers,

maybe chanting, anointing, things like that.

And sacred texts too.

The Bible, the Quran, the Torah.

Profoundly comforting for many.

Just having them present can be huge.

And for older adults who might not be able to read anymore, having someone read those texts aloud, that can be essential for their well -being.

Okay.

The really tough area is often end of life care, isn't it?

Spiritual beliefs can heavily influence those decisions.

What happens if a patient's spiritual choice means refusing a life -saving treatment?

How do nurses balance respecting autonomy with, you know, the drive to preserve life?

That's the ethical tightrope.

The source material is quite clear.

For a coherent patient, their informed choices must be respected, even if those choices conflict with the caregiver's own values or beliefs.

Even if it means not surviving.

Yes.

For some older adults, adhering to a deeply held spiritual belief might be far more important to them than simply extending biological life.

Their right to make that choice, based on their values, has to be honored.

That's a heavy responsibility.

Okay, let's look at the flip side.

What happens when these spiritual needs aren't met?

The source calls this spiritual disconnection.

Right.

And you might see this show up as hopelessness, a lack of peace,

maybe anger, feeling abandoned.

Like the example given, Mr.

Quinn, 85, hospitalized after a fall, suddenly angry, feeling God has turned his back on him.

That's a classic presentation.

And Mr.

Quinn, in that scenario, is facing several risk factors that the source outlines.

What kind of risk factors lead to this?

Things like major life stressors, the severe illness being in the hospital,

recent significant loss, maybe a change in role, having values different from caregivers or the dominant culture.

Or being isolated from support.

Exactly.

Removal from their familiar spiritual support system.

Even loss of financial independence can contribute.

So to assess someone like Mr.

Quinn properly, nurses need a structured approach, right?

The source mentions the spirit mnemonic.

Yes, it's a really useful tool for a comprehensive spiritual assessment.

Okay, let's quickly break down that acronym for our listeners.

S is for spiritual belief system.

Basically identifying their religious affiliation, if any.

Personal spirituality,

getting at their personal beliefs separate from formal religion,

integration into a spiritual community, who are their supports, ritualized practices, what do they do daily, are there restrictions, how important are these, implications for medical care, how can we incorporate their spiritual needs into the care plan,

terminal event planning, their views and wishes regarding end of life.

Okay, so using that spirit framework helps you understand Mr.

Quinn's needs.

What actions, what interventions follow from that?

Well, the first step is always to determine his specific practices and restrictions,

diet,

health behaviors,

fasting,

things like that.

And if there's a conflict with the medical plan?

The goal is always to find acceptable compromises, talk it through, involve the patient.

What about support people?

Crucial, actively identify significant spiritual support figures, a priest, rabbi, imam, chaplain, whoever it is for them, and facilitate contact if they want it.

Don't wait to be asked sometimes.

And privacy.

Non -negotiable, providing privacy for prayer or meditation, maybe access to a chapel or just a quiet room, that's not a nicety, it's a vital intervention.

Okay, what else?

Making sure any spiritual objects they have, maybe a Bible, a rosary, an icon, are visible and treated with respect.

Never just tidy them away into a drawer.

Good point.

And especially in times of crisis, like Mr.

Quinn's initial anger, or if death is near, really encourage contact with a spiritual counselor,

and pay close attention to any specific death -related rituals that are important in their faith, confession, anointing, specific post -mortem practices.

And when you take these steps, the goal is to see the patient reach a better place.

Exactly.

The patient goals for spiritual disconnection are things like they can verbalize the sources of their conflict.

They can specify what help they want.

They can discuss their beliefs openly.

And ultimately, they express feelings of spiritual comfort and trust, moving from that anger like Mr.

Quinn to a sense of peace.

That's the aim.

Which really brings us back full circle, doesn't it?

It does.

Back to that core message.

Everyone's values are unique, shaped by culture, education, religion,

society, all of it.

And these values, they are the absolute bedrock for every choice, every behavior you see in an older person.

And if those differences between the patient and the care team, or even the family, aren't actively identified and understood.

You get misunderstanding, confusion, conflict.

Inevitably.

So the nurse's ongoing job, really, is to keep communication open, to commit to learning about all this diversity, social, spiritual, cultural.

It's a continuous process.

It has to be.

So as you, the listener, move forward in your practice or your studies, you've seen just how deeply woven a patient's personal history is into their health decisions.

So next time you encounter a choice that seems illogical on the surface, maybe a patient refusing a vital treatment that costs a lot, or maybe hoarding supplies because wasting them feels unbearable,

don't just label it non -adherence.

Pause and ask why.

Exactly.

Ask yourself, what historical value, what cultural belief, what spiritual conviction might be more important to this person right now than just physical survival?

And then,

how can you honor that belief while still advocating for the best possible health outcome within their framework?

That's the question, isn't it?

A profound question that really frames the entire practice of true patient -centered care.

It really does.

Thank you for joining us for this Deep Dive.