stockholm sweden tina louise jordan, phd delaware state university department of social work
DESCRIPTION
AFRICAN AMERICAN BAPTIST ADULTS: THE DEGREE TO WHICH SELECTED SOCIAL AND CULTURAL VARIABLES INFLUENCE THE EXECUTION OF ADVANCE DIRECTIVES. Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work July 2012. Overview. Background of the Research Study - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/1.jpg)
AFRICAN AMERICAN BAPTIST ADULTS: THE DEGREE TO WHICH SELECTED
SOCIAL AND CULTURAL VARIABLES INFLUENCE THE EXECUTION OF ADVANCE DIRECTIVES
Stockholm Sweden
Tina Louise Jordan, PhD
Delaware State University
Department of Social Work
July 2012
![Page 2: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/2.jpg)
Overview
Background of the Research Study Statement of the Problem Statement of the Purpose Significance of the Study Research Questions Conceptual Model Theoretical Framework Literature Review Methodology Results Implications Recommendations
![Page 3: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/3.jpg)
Background of the Study
Issues surrounding the planning of end-of-life, which has caused resistance among African American Baptist adults have ranged from racism, cultural mistrust, lack of education, lack of resources.
These factors associated with the execution of advance directives have left family members with questions, economic contention, legal fees and guilt.
Conventionally, people plan for the distribution of material things upon their death. However, some do not consider leaving instruction for the medical intervention in the event that they could receive life sustaining treatment although incapacitated.
![Page 4: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/4.jpg)
Statement of the Problem
With the existence of the Health Care Decision Act(1993)and the advantages associated with the completion of an advance directives, the vast majority of African Americans, between 83.2% and 91.9% , never execute one.
An advance directive is a legal document that contains specific wishes of a patient regarding life sustaining treatment in the event of incapacitation.There are two types of advance directives-living will and the durable power of attorney. Living will allows the patient to place their instructions for medical treatment in writing ( advance directive).Durable power of attorney is an authorized representative to initiate an advance directive on a patients behalf.
![Page 5: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/5.jpg)
Statement of the Purpose
To examine the degree to which selected social and cultural variables influence the execution of advance directives amongst African American Baptist adults.
![Page 6: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/6.jpg)
Significance of The Study
The current research literature has an insufficient number of studies relevant to the degrees to which African American adults execute advance directives.
Additionally, few studies indicate the degree to which African Americans in the various religious denominations engage in the execution of an advance directive.
The United State Census Bureau (2005) contends that The National Baptist Convention has the largest African American denomination of Baptist adults.
The National Baptist Convention Association (2001) approximates over 2000 churches and over 2.5 million members.
To that end, it is paramount for a denomination of this extent of African American people in the United States to familiarize and execute one of the most important tools to manage end-of-life care decisions, an advance directive.
![Page 7: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/7.jpg)
Research Questions
RQ#1 To what degree do gender, age, educational status, socio-economic status, marital status, family composition, employment status and racism influence the execution of advance directives in the African American Baptist adult population?
![Page 8: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/8.jpg)
Research Questions and Hypotheses (cont’d)
RQ#2 To what degree do gender, age, educational status, socio-economic status, marital status, family composition, employment status and cultural mistrust influence the execution of advance directives in the African American Baptist adult population?
![Page 9: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/9.jpg)
Research Questions and Hypotheses(cont’d)
RQ# 3 To what degree do gender, age, educational status, socio-economic status, marital status, family composition, employment status and spirituality influence the execution of advance directives in the African American Baptist adult population?
![Page 10: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/10.jpg)
Research Questions and Hypotheses (cont’d)
RQ# 4 To what degree do gender, age, educational status, socio-economic status, marital status, family composition, employment status and cultural competence influence the execution of advance directives in the African American Baptist adult population?
![Page 11: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/11.jpg)
Research Questions and Hypotheses(cont’d)
RQ# 5 To what degree do gender, age, educational status, socio-economic status, marital status, family composition, employment status and the fear of death anxiety influence the execution of advance directives in the African American Baptist adult population?
![Page 12: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/12.jpg)
Research Questions and Hypotheses ( cont’d)
RQ# 6 To what degree do gender, age, educational status, socio-economic status, marital status, family composition, employment status, racism, cultural mistrust, spirituality, cultural competence and the fear of death anxiety influence the execution of advance directives in the African American Baptist adult population?
![Page 13: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/13.jpg)
Figure 1
Independent Demographic Predictor Variables and Independent Predictor Variables
= Dependent Variable
Conceptualization of the Relationship between Selected Variables
![Page 14: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/14.jpg)
Theoretical Framework
Broffenbrenner’s Ecological Theoretical Framework This theory is explored on the person and the environment and the continuous
interaction between the two. Environmental systems ( family, economic and political ) work continuously
together producing various results. Human growth (spiritual, physical, emotional, psychological, social ) are influenced
by a multitude of events that occur between the individual and the environment over the course of ones life( Germain & Gitterman, 1979).
![Page 15: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/15.jpg)
Conceptualization of the Theoretical Model of Social and Cultural Variables as it Relates to the execution of Advance Directives
![Page 16: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/16.jpg)
Figure 2
Theoretical Model of Social and Cultural Variables as it Relates to the Execution of Advance Directives
Cultural Mistrust
Cultural Competence
Advance Directive Gender Age
Educational Status Socio-Economic
Status Marital status
Family composition Employment status
Fear of Death Anxiety
Spirituality
Racism
Ecological Theoretical framework
![Page 17: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/17.jpg)
Review of Related Literature(Racism)
Bradley(2004)
Smedley(2003)
Chunn(2002)
Akbar(1996)
Washington (2007)
Martin & Martin ( 2002)
Posits that political, social, economic injustices and oppression have influenced that attitudes and behaviors of African Americans concerning end-of-life treatment (advance directives).
Contends that slavery and the extremely long catastrophic history of medical experiments of which African Americans were unwilling participants , has manifested to preclude many A.A’s from seeking and receiving equal levels of treatment from medical professionals.
Suggests that African American adults have xenophobic memories and distrust of Euro-American hospital and health care staff.
Racism is the fundamental impetus that has caused cultural, psychological, and emotional disruptions in the lives of Many African American adults.
![Page 18: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/18.jpg)
Review of related Literature (Cultural Mistrust)
Corbie-Smith (1999)
Benkert(2006)
Colfer, McDill, Natriello, Pallas
& Richardson (1990)
Washington (2007)
Munishi( 2007)
Noah(2002)
Jackson(2005)
Sharav(2001)
Contends that African Americans describe cultural mistrust of the medical community as a prominent barrier to participating in the execution of advance directives.
Documented racially motivated studies on A.A.’s have been the catalyst to cultural mistrust .
(1800) slaves inoculated with small pox
(1803)Placing slaves bodies in open pits
(1932) Tuskegee Syphilis Study
(1963) injection of liver cancer cells
(1990) KKI renting contaminated lead homes to A.A in Md.
![Page 19: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/19.jpg)
Review of Related Literature (Spirituality)
Dalmida(2006)
Munishi(2007)
Swanson,Crowther, Green
& Armstrong(2002)
Levin, Chatters & Taylor (2005)
The Joint Commission on
Accreditation of Organizations (2005)
There has been an influx of research, dialogue, and literature regarding the influence of spirituality and religion on health care outcomes.
Each hospital, health care facility must address the concept of spirituality with each patient.
Spirituality should determine the patient’s denomination beliefs and what spiritual practices are important to the patient.
![Page 20: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/20.jpg)
Review of Related Literature (Advance Directive)
The Patient Self Determination Act(1990) Act requiring most hospitals and healthcare facilities to ask patients whether they have an advance directive.
The main provision of the PSDA(1990) states that every hospital or healthcare facility, which receives (Medicare or Medicaid) funding from the federal government, must ensure that each incoming patients receives a statement of rights concerning the right to make healthcare decisions such as an advance directive.
![Page 21: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/21.jpg)
Review of Related Literature ( cont’d)
The Health Care Decision Act(1993) Rights to have the form discussed , presented and executed .
![Page 22: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/22.jpg)
Review of Related Literature (cont’d)
HCDA(1993) Delineated three situations, which would necessitate such directives. They are :
1. When death is imminent despite the application of life-sustaining procedures,
2. When a patient is in a condition of permanent unconsciousness typically referred to a a “vegetative state,” and
3. When an advanced end-stage condition is progressive, incurable and results in complete physical dependency
![Page 23: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/23.jpg)
Review of Related Literature (cont’d)
The Health Care Decision Act (1993) With the existence of the HCDA(1993) and advantages associated with having an advance directive , the vast majority of African Americans, between 83.2% and 91.7%, never execute one.
For those without an advance directive, healthcare decisions are made by medical personnel, family members, close friends or members of their religious community.
![Page 24: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/24.jpg)
Review of Related Literature (Cultural Competence)
Koenig(1997)
Martinez, Kind, Pezo & Pomerantz(2008)
Contends that culture the lens, as
well as the emotional filter, through which many view their world, can affect every decision that one makes.
Suggests that healthcare staff and practitioners must prepare for quality, sensitive healthcare by adopting empowerment and cultural competence skills.
![Page 25: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/25.jpg)
Review of Related Literature (Fear of Death Anxiety)
Kübler-Ross (1975)
Callahan (1999)
Lang (1998)
Death is a fundamental part of human life and is as expected as birth.
The fear of dying may be a possible barrier that prevents African Americans from executing an advance directive.
There are two types of death related
conflicts, they are :1. Predatory death anxiety2. Existential death anxiety
![Page 26: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/26.jpg)
Methodology
Variables Population Instrumentation & Data Collection Sampling Procedures Research Design Analyses of Data
![Page 27: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/27.jpg)
Independent Predictor Variables
Coded Labels Independent Variables
RACISM Racism
CULMIST Cultural Mistrust
SPRLITY Spirituality
CULCOMP Cultural Competence
FEARDTH Fear of Death Anxiety
![Page 28: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/28.jpg)
Research Instrument
The Jordan Advance Directive Measurement Scale The standardization results of The Jordan Advance Directive Measurement Scale
produced a Cronbach’s Alpha score of 0.87 and a test re-test reliability score of 0.83. Concurrent validity measurement results yielded an r value of 0.81. Predictive validity measurement results yielded an r value of 0.71.
![Page 29: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/29.jpg)
Sampling Procedures
The Stratified Systematic Random Sampling Design
![Page 30: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/30.jpg)
Research Design
Multivariate Analysis Non-experimental Correlational Quantitative
![Page 31: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/31.jpg)
Statistical Analysis of Data
Forward Stepwise Multinominal Logistic Regression Analysis
Logit (p) = a + b1 x1 + b2 x2 + b3 x3 . . .
![Page 32: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/32.jpg)
Statistical Analysis of Data (cont’d)
To test each null hypothesis the following statistical tests were computed:
![Page 33: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/33.jpg)
Statistical Results Generated for Each Hypothesis
Statistical results generated for each table :
Model Summary -2 Log-likelihood
Cox & Snell R2
Nagelkerke R2
McFadden
Classification Observed groups and predicted probabilities
Variable in the Equation Coefficient (B)
Standard error of B
Wald statistic
Degrees of Freedom
Estimated odds ratio exp(B)
Confidence interval for exp(B)
Significance
![Page 34: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/34.jpg)
Statistical Analysis of Data (cont’d)
The Predictor model was produced by computing the likelihood ratio tests
Which are included in the following table:
Likelihood Ratio Tests Model Summary
Model Chi Square
Degrees of Freedom
Significance
![Page 35: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/35.jpg)
Graphical Representation of Null Hypothesis One
Histo g ra m (S p re a d sh e e t3 9 v*3 3 1 c)
A DV A DIRT G E NDE R A G E E DUS T A T E CO S T A T M A RS T A T FA M CO M E M P S T A T RA CIS M
1 3 5 7 9 1 1 1 3 1 50
2 0
4 0
6 0
8 0
1 0 0
1 2 0
1 4 0
1 6 0
1 8 0
2 0 0
2 2 0
No
of
ob
s
A DV A DIRT = 3 3 1 *1 *n o rm a l (x, 2 .0 8 7 6 , 0 .8 0 2 4 )G E NDE R = 3 3 1 *1 *n o rm a l (x, 1 .3 7 1 6 , 0 .4 8 4 )A G E = 3 3 1 *1 *n o rm a l (x, 2 .3 2 3 3 , 1 .0 2 4 6 )E DUS T A T = 3 3 1 *1 *n o rm a l (x, 3 .4 8 9 4 , 1 .0 6 5 6 )E CO S T A T = 3 3 1 *1 *n o rm a l (x, 3 .6 9 4 9 , 1 .1 6 5 4 )M A RS T A T = 3 3 1 *1 *n o rm a l (x, 2 .9 6 6 8 , 0 .8 2 1 4 )FA M CO M = 3 3 1 *1 *n o rm a l (x, 2 .5 2 2 7 , 0 .5 6 2 9 )E M P S T A T = 3 3 1 *1 *n o rm a l (x, 4 .2 4 4 7 , 1 .0 3 4 5 )RA CIS M = 3 3 1 *1 *n o rm a l (x, 1 1 .2 2 6 6 , 2 .9 0 0 4 )
Graphical Representation to the response to the set of variables used For Null Hypothesis One. Graphical representation presents normal distribution.
![Page 36: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/36.jpg)
Graphical Representation of Null Hypothesis Two
Histo g ra m (S p re a d sh e e t1 9 v*6 4 0 c)
A DV A DIRT G E NDE R A G E E DUS T A T E CO S T A T M A RS T A T FA M CO M E M P S T A T CUL M IS T
-5 0 5 1 0 1 5 2 0 2 5 3 0 3 5 4 00
5 0
1 0 0
1 5 0
2 0 0
2 5 0
3 0 0
3 5 0
No
of
ob
sA DV A DIRT = 3 3 1 *5 *n o rm a l (x, 2 .0 8 7 6 , 0 .8 0 2 4 )G E NDE R = 3 3 1 *5 *n o rm a l (x, 1 .3 7 1 6 , 0 .4 8 4 )A G E = 3 3 1 *5 *n o rm a l (x, 2 .3 2 3 3 , 1 .0 2 4 6 )E DUS T A T = 3 3 1 *5 *n o rm a l (x, 3 .4 8 9 4 , 1 .0 6 5 6 )E CO S T A T = 3 3 1 *5 *n o rm a l (x, 3 .6 9 4 9 , 1 .1 6 5 4 )M A RS T A T = 3 3 1 *5 *n o rm a l (x, 2 .9 6 6 8 , 0 .8 2 1 4 )FA M CO M = 3 3 1 *5 *n o rm a l (x, 2 .5 2 2 7 , 0 .5 6 2 9 )E M P S T A T = 3 3 1 *5 *n o rm a l (x, 4 .2 4 4 7 , 1 .0 3 4 5 )CUL M IS T = 3 3 1 *5 *n o rm a l (x, 2 2 .5 5 2 9 , 5 .4 7 3 9 )
Graphical Representation to represent the set of variables used for Null Hypothesis Two. Graphical representation presents normal distribution.
![Page 37: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/37.jpg)
Graphical Representation of Null Hypothesis Three
M e a n P lo t (S p re a d sh e e t1 9 v*3 3 1 c)
M e a n M e a n ±0 .9 5 Co n f. In te rva l
1 2 3
A DV A DIRT
2 9 .6
2 9 .8
3 0 .0
3 0 .2
3 0 .4
3 0 .6
3 0 .8
3 1 .0
3 1 .2
3 1 .4
3 1 .6
3 1 .8
3 2 .0
3 2 .2
3 2 .4
3 2 .6
SP
RL
ITY
Graphical Representation to represent the set of variables used for Null Hypothesis Three. Graphical representation presents normal distribution.
![Page 38: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/38.jpg)
Graphical Representation of Null Hypothesis Four
Histo g ra m (S p re a d sh e e t1 9 v*6 4 0 c)
A DV A DIRT G E NDE R A G E E DUS T A T E CO S T A T M A RS T A T FA M CO M E M P S T A T CUL CO M P
-5 0 5 1 0 1 5 2 0 2 5 3 0 3 50
5 0
1 0 0
1 5 0
2 0 0
2 5 0
3 0 0
3 5 0N
o o
f o
bs
A DV A DIRT = 3 3 1 *5 *n o rm a l (x, 2 .0 8 7 6 , 0 .8 0 2 4 )G E NDE R = 3 3 1 *5 *n o rm a l (x, 1 .3 7 1 6 , 0 .4 8 4 )A G E = 3 3 1 *5 *n o rm a l (x, 2 .3 2 3 3 , 1 .0 2 4 6 )E DUS T A T = 3 3 1 *5 *n o rm a l (x, 3 .4 8 9 4 , 1 .0 6 5 6 )E CO S T A T = 3 3 1 *5 *n o rm a l (x, 3 .6 9 4 9 , 1 .1 6 5 4 )M A RS T A T = 3 3 1 *5 *n o rm a l (x, 2 .9 6 6 8 , 0 .8 2 1 4 )FA M CO M = 3 3 1 *5 *n o rm a l (x, 2 .5 2 2 7 , 0 .5 6 2 9 )E M P S T A T = 3 3 1 *5 *n o rm a l (x, 4 .2 4 4 7 , 1 .0 3 4 5 )CUL CO M P = 6 4 0 *5 *n o rm a l (x, 1 8 .8 8 4 4 , 5 .5 3 2 3 )
Graphical Representation to represent the set of variables used for Null Hypothesis Four. Graphical representation presents normal distribution.
![Page 39: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/39.jpg)
Graphical Representation of Null Hypothesis Five
M e a n P lo t (S p re a d sh e e t1 9 v*3 3 1 c)
M e a n M e a n ±0 .9 5 Co n f. In te rva l
1 2 3
A DV A DIRT
2 0 .0
2 0 .5
2 1 .0
2 1 .5
2 2 .0
2 2 .5
2 3 .0
2 3 .5
2 4 .0
2 4 .5F
EA
RD
TH
![Page 40: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/40.jpg)
Graphical Representation of Null Hypothesis Six
3 D B o x P lo t (S p re a d sh e e t1 1 3 v*3 3 1 c)
M e d ia n ; Ra n g e : 2 5 % -7 5 %
![Page 41: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/41.jpg)
Graphical Representation of Null Hypothesis Six
3 D S e q u e n ti a l G ra p h (S p re a d sh e e t1 1 3 v*3 3 1 c)
![Page 42: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/42.jpg)
Combined Confirmation Results
Comparison of Three Mean Clusters
P lo t o f M e a n s fo r E a ch C lu ste r
C lu ste r 1 C lu ste r 2 C lu ste r 3
G E NDE RE DUS T A T
M A RS T A TE M P S T A T
CUL UM IS TCUL CO M P
V 1 4
V a ri a b l e s
-1 0
-5
0
5
1 0
1 5
2 0
2 5
3 0
3 5
4 0
![Page 43: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/43.jpg)
Implications
As the need for progressive initiatives increases, professionals such as social workers, nurses, clinicians, physicians and health care providers should prepare a plethora of information to distribute to the African American Baptist adult population on the benefits of completing an advance directive.
Additionally, professionals should strategically prepare to communicate and
engage clients in the area of death and dying, in a way that offers empowerment and increases autonomy. This discourse would allow questions, concerns, anxieties and barriers that impede the progress of completing forms that are beneficial to African American Baptist adults to be recognized.
Social workers and practitioners must begin to analyze the environment from which patients reside. This practice will give an insight on effective ways to introduce the concept of the completion of an advance directive in the African American Baptist community.
![Page 44: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/44.jpg)
Implications (cont)
Trainings in reference to the benefits of the execution of an advance directive should be incorporated in the continued educational process. More importantly, to become more effective change agents the emphasis to expand knowledge on end-of-life care choices, concerns, beliefs and contention must be recognized by the social work profession.
Social work curriculum dealing with the following areas: racism, fear of death anxiety and cultural mistrust could infuse how those variable influences the execution an advance directive and other health care documents as it relates to the African American population.
![Page 45: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/45.jpg)
Recommendations
Conduct future studies that obtain additional data describing different demographic, social and cultural variables and the degree to which they influence the execution of advance directives.
Replicate the current study on African American adults that are not affiliated with the Baptist denomination, but other religious denominations.
Establish a better working relationship between medical professionals and patients to allow for the discourse of the topic of end-of-life care.
Offer professional credits (CEU’s and certification of completion) for professionals who attend trainings in reference to the completion of advance directives/ end-of-life care planning.
Conduct future studies on ways to minimize the fear of death anxiety as it relates to African American Baptist adults and the execution of advance directives.
![Page 46: Stockholm Sweden Tina Louise Jordan, PhD Delaware State University Department of Social Work](https://reader035.vdocument.in/reader035/viewer/2022062803/568146b4550346895db3d304/html5/thumbnails/46.jpg)
Recommendation (cont’d)
Create culturally sensitive programs that encourage end-of-life planning.