Nursing Concept Analysis - Essay Example

CARE OF THE AGED and PRESERVING DIGNITY OF OLDER ADULTS (Nursing Concept Analysis) Introduction As people age, they are exposed to more and different life experience. The accumulation of these differences makes older adults more diverse than any other age group. As the nurse assesses the older adults, it is important to consider this diversity. The nurse should asses the client for perception of age in hospital as well as in community. Along with that an important function of community health nurse is to involve family members in care if aged instead of neglecting them and to help aged to live a confident, healthy life. Professional nurses provide health care services across the life span and in varied environments. It is concerned with promoting, maintaining, and restoring health. Nurses are committed to the goal of promoting an optimal level of functioning for all individuals, families and groups, thereby contributing to the health of the nation. It determines health status of individuals, families, and populations and makes clinical decisions regarding the appropriate action to be taken. 1 Nursing Concept Analysis 2 It is important that the nurse maintains the positions that aging is normal and is not related to disease. Age is a date in time and is influenced by many factors, including emotional and physical health, development stage, socioeconomic status, culture, and ethnicity. Ageism is a negative attitude based on age. It leads to discrimination in the care given to the older adults. The nurse who demonstrates negative attitudes may fear of his own aging process or be misinformed about aging and the health care need of the older adults. The care of the aged is provided mostly in institution. Care for an individual adult is delivered in a variety of quite different settings (e.g. privately run nursing home or government institution). The care of the aged is called clinical gerontology or geriatrics .Besides the needs and problems concerned with the psychology and physiology of aging the social aspect of aging a great challenge to the caring profession especially the nurse. This paper was done to explore the relationship between the dependency levels of older people who are part of the community nurse's caseload and the volume and nature of nursing input required. Background. Healthcare policy has consistently emphasized the reorientation of health services from hospital to community care. It is necessary to determine ways to use nursing resources appropriately to meet service needs of an increasing older population There are various approaches to address caring for the older adults. These are: 1) Family and welfare approach: Many of the aged are reluctant to go to institutions for the care of the aged. Thus family care is encouraged. 2) Medical approach: Many hospitals are now having special units for the care of the aged both in-patient and out-patient departments where health promotional and specific Nursing Concept Analysis 3 preventive measures such as health examination for early diagnosis and treatment are provided. 3) Community approach: The elders are encouraged to participate in activities that are beneficial to health and to avoid those that are injurious. These approaches would enhance trust of older adults to their environment especially to the nursing care involved. Dignity may be defined as a concept that relates to basic humanity. Dignity consists of inherent and external dimensions, which are common for all humans and at the same time are unique for each person, relating to social and cultural aspects. The attributes of preserving dignity are individualized care, control restored, respect, advocacy and sensitive listening. Method: In order to establish an appropriate nursing care for older adults, a quantitative study was conducted using the "Community Client Need Classification System". The community nursing team recorded the amount of care time spent with each individual client for over a 4-week period. Findings: They were assessed in low and high level of need. It was observed that as clients need level increased the consumption of community nursing time also increased. It is observed in many of the elders especially the very old that there is loss ability to manage one's own physical needs (washing, dressing, toilet, feeding). There is also the loss of ability to fulfill one's psychological needs (security, status, social interacting). In view of these problems assisting and teaching of self care are important. In institution or community, on initial assessment of the elderly person will identify his abilities and limitations, in relation to direct personal care (toilet, washing, cleaning feeding), and extended personal care (shopping, cooking, housework and socializing). Plan care according to individual's strength and limitations with Nursing Concept Analysis 4 frequent review of the situations must be given focus. It is important where possible to involve the relatives in the planning and providing of care. Thought at times difficulties will have to be faced when family members provide the care instead of encouraging self care, and the nurse must continue with her teaching by assessing, directing and encouraging constantly. Conclusion: The study was successful in cultivating between care needs levels of older adults and the type and amount of human resources required by each individual who need community nursing services. Lack of information regarding the demographic variables may hamper the transfer of these findings. It is also important for the nurse to gain knowledge, nursing skills and the right attitude in order to give skilled nursing care in the community. She should assess the immediate and long term needs/ problems of the aged and their families always teaching, supporting, advising and guiding. She should further plan with the family in providing total care as well as rehabilitation. As in any branch of nursing in the same of the elders the unique function of the nurse is "assisting the individuals in the performance of their activities contributing to health or its recovery, or to a peaceful death, that he would perform unaided if he had the necessary strength, will or knowledge". (Henderson. V. Basic Principles of Nursing Care, ICN, 1960). The patient's perspective What is an older adult Within healthcare, old age is determined not by how many years an individual has lived, but by the position that they assume on the continuum existing between the end of their working and child-rearing life and what is described as a state of frailty and dependency. This includes differences in what patients and nurses regard as important, indicating that Nursing Concept Analysis 5 where patients valued the nurse simply spending time with them and being with them, nurses tended to spend time "just being" with the patient only when other, and what they considered to be more essential, nursing work has been completed. It has also been indicated that there is conflict between nurse's perceptions of what is important for their older patients, and what the patient's they consider to be important. Why might assessment of an older adult be difficult Assessment of the older adult is laden with difficulty because complex health problems may arise associated with age-related mortality and pathologies. For example, establishing a reliability and validity can be difficult in people with depression or cognitive impairment. At times, nurses may lack the necessary skills and knowledge to recognize health needs in their early stages and many older people may receive inappropriate care due to inadequate assessment of their abilities and needs. The person being assessed may be unable or unwilling to contribute to the assessment process because the patient may dislike or distrust the nurse and be influenced by their communication skills (or lack of them) or by their conduct. Making an assessment will rely on the nurse obtaining information about their patient. This information may be a direct result of the nurse's observations, or alternatively they may obtain information from patient notes or conversations with the patient, his or her relatives, or other healthcare professionals. Assessment may be formal or they may be an informal response to an incident or change in the patient's condition. Assessment tools when used effectively, can positively enhance the consistent provision of patient-centered care, and may be used in conjunction with informal methods of assessment to Nursing Concept Analysis 6 provide and invaluable profile of the patient and their needs. Promoting Spirituality in Older Adults: Spiritual Support Spiritual support is defined as "assisting the patient to feel balance and connection with a greater power" (Dochterman & Bulechek, 2004). Interventions relevant to the care of the older adult are facilitating forgiveness, instilling hope, and praying. The process of promoting spirituality in older adults includes the nursing intervention of active listening. By actively listening to the client the nurse is able to hear, understand, interpret, and synthesize what is being said. In addition, the nurse establishes a trusting relationship and provides sufficient time for the clients to interpret their own feelings and experiences. Listening actively includes the nursing actions of: being present for the client, use of touch, assisting the clients in finding the meaning of life events, and encouraging reminiscence about their life. Presence. Presence is described as "being there" and "being with" the client in meaning ful ways. "Being there" encompasses much more than physical presence; it includes a relation- ship with sincere communication. In "being with" the client the nurse is fully available to hear and understand the client's difficulty and suffering. As a nursing action for older adults, being present requires knowing and being comfortable with oneself and connecting with the person through affirmation, valuing, vulnerability, empathy, serenity, and silence. This type of presence doesn't take more time but necessitates the nurse being completely focused on the client Touch. Caring touch is an important nursing action for promoting spirituality in older adults. As a foundational aspect of nursing practice, caring touch, such as hand holding or touching an arm or shoulder, facilitates communication between the nurse and client. As a Nursing Concept Analysis 7 nursing action for older adults, caring touch conveys acceptance, concern, comfort, and reassurance especially during stressful periods (Bush, 2001; Fredriksson, 1999). Using an experimental design she found caring touch significantly improved the women's perception of their self-esteem, well-being, health status, life satisfaction, and faith (Butts, 2001). Meaning. Meaning for the older adult can refer to a clear understanding of the significance of an illness, the death of a loved one, or the loss of independence (Golsworthy & Coyle, 1999; Johnson, 2003; Siegel & Schrimshaw, 2002). Meaning can also refer to the spiritual concept of meaning and purpose in life, which is the capacity to find a sense of personal worthiness in one's life (Frankl, 1988; Meraviglia, 1999). For the older adult, finding the meaning of critical life events or the meaning in life can be a challenging process wherein the nurse can have significant influence. This is especially important for older adults who experience difficulty finding meaning because research has shown they have a higher incidence of depression and suicidal thinking (Buchanan, 1993; Moore, 1994; Reker, 1997; Thompson & Pitts, 1993). The nurse can facilitate an older adult's search for meaning by asking probing questions, offering additional explanations, and reframing, when necessary, maladaptive interpretations of life events. Through the process of finding meaning, the older adult often grows spiritually. In addition, several research studies have shown that a sense of meaning in life was associated with improved psychological well-being, satisfaction with life, and overall quality of life.. Reminiscence. Reminiscence is the recalling and sharing with another person past life events. The process of reminiscence can facilitate the aging process and improve meaning making by rethinking and clarifying previous experiences. Reminiscence is making spiritual Nursing Concept Analysis 8 links by expressing personal beliefs that represented inner resources for living through difficult life events. Nurses are in a unique position to facilitate reminiscence by developing long term relationships with older adults. Reminiscence, either alone or in a regular group, has positive benefits such as successful adaptation to growing old and decreasing depression (Jones & Beck-Little, 2002). Numerous research studies have found reminiscence was positively related to increased psychological well-being, self-esteem, and ego integrity (Brooker & Duce, 2000; Reddin, 1996; Wilhoite, 1994). In addition, stimulation of cognitive function and a sense of validation for the life lived were reported by several researchers (Watters, 1995; Wilhoite, 1994) A person's world-view provides the foundation for their belief system about the nature of God, people, and reality, thus determining their understanding of the interplay between the physical, emotional, social, and spiritual dimensions. It is essential for nurses and spiritual support persons working with the older adult to assess each person's belief system to effectively care for their spiritual needs. Whether the nursing intervention is assisting with forgiveness, encouraging hope, reading scripture or other texts requested by the older adult, each action taken must be carefully planned and evaluated. Forgiveness is the act of giving or receiving pardon for an offense, debt, or obligation. It entails making a decision to no longer feel resentment towards another person for their offense. Oakes encourages the use of forgiveness to promote constructive change in a person's life, and stresses the therapeutic value of a person's spiritual and religious orientation, faith development, and transcendence in facilitating forgiveness (Oakes, 2000). Nursing Concept Analysis 9 Forgiving behaviors have been shown to give a person a sense of renewal, reaffirmation, and reconciliation with God, church, and one's inner being (Solari-Twadell & McDermott, 1999). This area is known as pursuing spiritual integrity and allows a person to maintain or regain meaning from their spiritual and religious beliefs. Additionally, research has shown that groups emphasizing learning about forgiveness, sharing experiences of forgiveness, and prayer smooth the progress toward forgiving others (Wuthnow, 2000). Older adults frequently need to experience healing of relationships. Improving a broken relationship through forgiveness. n addition, older adults experience traumatic events such as widowhood, retirement, and loss of home or pet, which cause them great distress. Nurses can enhance older adults' lives by encouraging forgiveness of others and themselves. Through forgiveness older adults can discover new meaning and continue the development of the spiritual self. Nursing actions that facilitate forgiveness in the older adult include being available, listening especially when the person expresses self-doubt or guilt, providing guidance in the forgiveness of others and self, and offering to contact another person if intensive spiritual support is indicated. For example, the nurse may offer to pray with the older adult to ask for forgiveness, or ask the older adult if he or she is ready to forgive someone else. Instilling Hope Hope is an "expression of a positive orientation, faith, and will to live" (Keeley, 2004). It is defined "to wait or to look forward with eager expectation. Also hope is a confidence in regard to a good and beneficial future. In order to understand hope as a nursing intervention, it must be differentiated from feelings of hopelessness. "Hopelessness is a subjective state in which the individual sees limited or unavailable alternatives or personal choices and is unable to mobilize energy for problem solving on his or her own. Spirituality is often identified by older adults as a bridge between their feelings of hopelessness and a renewed sense of hope and meaning. (Frankl, 1988; Heriot, 1995; Hicks 1999; Keeley, 2004; Koenig 2002). Prayer Prayer is a devout petition to, or any form of spiritual communion with God or an object of worship. Prayers may include adoration and expressions of love, confession, thanksgiving, or supplication and asking for help. Older adults are vulnerable to feelings of isolation and loneliness, which can be relieved through supporting their prayer beliefs and practices. Nurses can participate in prayer with older adults to enhance their trust, self-worth, and hope. Additionally, research has demonstrated a positive relationship between the use of prayer and feelings of general well-being (Meraviglia, 2001; Payne, 1990; Poloma & Pendleton, 1991). In conclusion, while there is a rise in the number of elders in the community very little is being done in planning and providing care for the aging population. Care of the elders is briefly mentioned in this manual so as to increase awareness and develop desirable attitudes in this area of concern among the nurses, care providers and the community at large. Community health nurses should increase their knowledge and participate in research in aging and in age-related physical and mental disorders. It is worth to remember that the aged are included in the population at risk. The follow up of hospitalization and the type of domiciliary care provided by the nurse will enable her to get successful support from the community and thus initiate innovative care programmes for the senior citizen. Nursing Concept Analysis 10 References. Dochterman JM, Bulechek GM, editor(s). Nursing interventions classification (NIC). 4th ed. St. Louis (MO): Mosby; 2004. Bush E. The use of human touch to improve the well-being of older adults. A holistic nursing intervention. J Holist Nurs2001 Sep; 19(3):256-70. [36 references] PubMed Butts JB. Outcomes of comfort touch in institutionalized elderly female residents. Geriatric Nurs2001 Jul-Aug; 22(4):180-4. PubMed Frankl VE. The will to meaning: foundations and applications of logo therapy. New York: Meridian Books; 1988. Golsworthy R, Coyle A. Spiritual beliefs and the search for meaning among older adults following partner loss. Mortality1999; 4:21-40. Meraviglia MG. Critical analysis of spirituality and its empirical indicators. Prayer and meaning in life. J Holist Nurs1999 Mar; 17(1):18-33. [78 references] PubMed Buchanan DM. Meaning-in-life, depression and suicide in older adults: a comparative survey study. In: Dissertation Abstracts International, AAT 9400098. 1993. Brooker D, Duce L. Wellbeing and activity in dementia: a comparison of group reminiscence therapy, structured goal-directed group activity and unstructured time. Aging Ment Health2000; 4:354-8. Read More