Vulnerable Population: Native Hawaiian Elderly The Native Hawaiian elderly are a vulnerable population. They are at risk because of several different factors. These factors can be divided into two main groups: general risk factors associated with aging and culturally specific risk factors (Browne et al., 2014). General factors associated with aging include cost associated with care, access to health care, and transportation associated challenges. Culturally specific risk factors include historical trauma, beliefs about sickness and health, discrimination, and loss of traditional healthy lifestyles (Braun et al., 2014). Historical trauma stems from the overthrow of the monarchy in 1893 (Browne et al, 2014). This trauma impacts the first generation; every generation after that feels the impact as well, according to the Historical Trauma Conceptual Model. Many Hawaiians relate sickness as an inability to balance responsibilities to the group, land, and spiritual world (Braun et al., 2014) and may not see an illness as just that, an illness. Discrimination is prevalent for all minorities, and the Native Hawaiians are no different. The loss of traditional lifestyles can be traced back to the monarchy being overthrown, and the Native Hawaiians having land, food, and their lifestyle taken away from them. Personal Awareness of the Population I believe that I do not have any biases toward the Native Hawaiian elderly population. I think that some general stereotypes that people may have of Native Hawaiians is that they are all hula dancers or surfer dudes. Another stereotype may be that all Native Hawaiians wear leis and are always friendly, living the aloha lifestyle. If I were to meet a Native Hawaiian elder, I am sure that I would treat them with respect and courtesy, just like I would treat any other elder of VULNERABLE POPULATION 3
any race. I would treat them as an individual and value them as such. I personally have never been to Hawaii and I do not know anyone from Hawaii, so I believe that this opportunity to study this population will help me to formulate an attitude of care towards this population. Demographics In Michigan there are 2,604 Native Hawaiian Pacific Islanders; the median age is 32 years old (Current Native Hawaiian, 2014). This signifies that as nurses, we may come across Native Hawaiians in our practice. According to Kaopua et al. (2011) Native Hawaiians make up 24.3% of the Hawaiian population, but Native Hawaiian older adults make up only 12.6% of the states over 65 population. The population drops by nearly half when the population ages. The average life expectancy in 2000 was 74 years of age (Ka'opua et al., 2011) for Native Hawaiians, while the average life expectancy of everyone in Hawaii was 81.3 years of age (Lewis & Burd-Sharps, 2013). Native Hawaiians make up 0.1% of the total US population, with 60% living in Hawaii (Browne, Mokuau, & Braun, 2009). 15% of Native Hawaiians hold a bachelors degree and 5% hold a graduate or professional degree (White House initiative, n.d.). This indicates that very few have received advanced education. Hawaiians are more likely than non-Hawaiians to get diabetes, and they have the third highest death rates from cancer in the United States (White House Initiative, n.d.). Native Hawaiian elders live within or below 100 199% of the poverty level (Ka'opua et al., 2011). This statistic is significant because it is clear why many do not seek out health care; they simply cannot afford the cost of modern health care. Effect of Research on Personal Attitudes My attitude towards the Native Hawaiian elderly has not changed due to my research on the population, partially because I had no opinion of them beforehand. I think that my research VULNERABLE POPULATION 4
has given me more of an understanding on where the population comes from and challenges that they face. I would like to think that my research has given me a base on which to stand, when I do meet someone from this population. Self-Reflection The perceptions that I had before doing research and the perceptions that I have now are very similar. Before my research I had never really thought about the Native Hawaiian elderly, therefore I did not have any opinion of them. I had no knowledge on any of the challenges that many of them face. My perceptions after doing this research have changed slightly, because I now have some information on which I can begin to form an opinion. I now know why there is such a disparity in the numbers of Native Hawaiian elders. Much of this population is poor; this prevents them from receiving adequate health care and thus will have an impact on their lifespan. I hope that this research will not sway how I treat any Native Hawaiians that I may come across, and that I will treat each patient that I come across as an individual and not a statistic. Impact on Health Care Knowledge of the Native Hawaiian elderly will have an impact on health care. This knowledge can be either positive or negative. A nurse could believe that because most of the Native Hawaiians are poor and have a shorter life expectancy than others, they do not deserve the best treatment and the best care that we can provide. On the other hand, a nurse could understand that because the majority of the population is poor, it is a big step for them just to come into a hospital and ask for help. The nurse could educate them on programs that could help them to pay for medical care. Knowledge of the culture will also help the nurse to provide VULNERABLE POPULATION 5
culturally competent care. It is important to remember that each person is an individual, and that as nurses, all patients should be treated equally.
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References Braun, K. L., Kim, B., Ka'opua, L. S., Mokuau, N., & Browne, C. V. (2014, August 18). Native Hawaiian and Pacific Islander elders: What gerontologists should know. The Gerontologist, 00(00), 1-8. doi:10.1093/geront/gnu072 Browne, C. V., Mokuau, N., & Braun, K. L. (July, 2009)Adversity and resiliency in the lives of Native Hawaiian elders. Social Work,54(3), 253-261. Retrieved from http://jsw.sagepub.com/ Browne, C. V., Mokuau, N., Ka'opua, L. S., Kim, B., Higuchi, P., & Braun, K. L. (2014, March 23). Hawaiian elders and 'ohana caregivers: Discussions on aging, health, and care preferences. Journal of Cross-Cultural Gerontology, 29(2), 131-151. doi:10.1007/s10823-014-9227-8 Current Native Hawaiian Pacific Islander population in Michigan 2013, 2014 by gender and age (2014). In Suburban Stats. Retrieved from http://suburbanstats.org/race/michigan/how- many-native-hawaiian-pacific-islander-people-live-in-michigan Ka'opua, L. S., Braun, K. L., Browne, C. V., Mokuau, N., & Park, C. (2011). Why are Native Hawaiians underrepresented in Hawai's's older adult population? Exploring social and behavioral factors of longevity. Journal of Aging Research, 2011, 1-8. doi:10.4061/2011/701232 Lewis, K., & Burd-Sharps, S. (2013). The measure of America 2013-2014 (American Human Development Report). Retrieved from Measure of America website: http://www.measureofamerica.org/measure_of_america2013-2014/ VULNERABLE POPULATION 7
White House Initiative on Asian Americans and Pacific Islanders. (n.d.). Fact sheet: What you should know about Native Hawaiians and Pacific Islanders (NHPI's). In White House Initiative on Asian Americans and Pacific Islanders. Retrieved 2014, from https://www2.ed.gov/about/inits/list/asian-americans-initiative/what-you-should-know.pdf