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Monday, 18 November 2013
Learning Objective 1: By the end of the session, the learner will identify how cognitive decline threatens older women’s rural identity and cultural preservation.
Learning Objective 2: By the end of the session, the learner will discuss the significance of nursing approaches for enhancing the patient-centeredness of rural healthcare delivery.
Older, rural women with cognitive decline delay seeking formal medical treatment resulting in loss of their functional independence, safety, and health. This study addresses a research gap describing how the rural life course influences older women’s construction of reality surrounding cognitive decline and the acceptability of formal healthcare delivery approaches for its management. The purpose of this study was to describe older, rural women’s health-illness experiences and decision-making patterns surrounding cognitive decline as reinforced over their life course. An ethnographic design guided one year of cultural immersion in a rural, farming county on the Northern Plains. Based in the constructivist framework of Culture Emergent Theory, methods included series of in-depth life history interviews with older women; participant observation; reflective field notes; and review of cultural artifacts. All interviews (n=24) were transcribed verbatim and member checked allowing in-depth, case-focused analysis and robust understanding of the rural context. A central finding was that cognitive decline threatens one’s rural identity as a “good woman” by minimizing independence, self-determination, and decision-making capacity to maintain health practices. Healthcare delivery approaches for treatment of cognitive decline conflict with rural cultural practices in ways that are considered unnatural and insensitive, and are thus avoided. Accessing formal healthcare for treatment breaks the protective silence traditionally built around cognitive decline that helps maintain a woman’s resilient rural identity and her informal social support network. Cognitive decline results in fear and a sense of loss of one’s life purpose. Nursing interventions supporting older women’s identity, self-preservation and traditional rural practices may improve the acceptability of rural healthcare delivery aimed at treating cognitive decline. Nurses can also advocate for older, women’s voices in the development of future rural health policy- broadening our understanding of historical and cultural influences on rural healthcare quality and access.