Holistic Care of Older Adults - Research Paper Example

? Submit by 0800 Monday of Week 5. Overview: Life Review Analysis For this assignment, you will reflect on your interview with the older adult, introduce the individual to the reader, and respond to guiding questions to prepare an analysis paper. DO NOT INTERVIEW A FAMILY MEMBER UNLESS YOU OBTAIN COACH’S WRITTEN APPROVAL PRIOR TO INTERVIEW Your paper should include the following sections: 1. Introduction of Older Adult – This is the overall context of your interview but should not include the entire interview itself. 2. Analysis of the Life Review Interview – This includes your differentiation between a Life Review and ordinary remembering and your analysis of the degree of ego integrity reached by the older adult. 3. Student’s Reflections – This describes your personal experience during the process, any impact it will have on your clinical practice, and a projection of your own legacy. 4. References – This is a list of resources you used during your interview and analysis recorded in APA format. Use at least 3 in-text citations of your sources. Use APA format throughout paper and references as appropriate. The paper should be no longer than 6 pages (not counting Pages 1-3 of this document and your page of references). If you have questions, please discuss them with your Academic Coach. You must also scan, upload, and submit your Interview Consent Form in the appropriate assignment portal. This form counts toward up to 15 points of your Life Review Analysis score. Details about each section are given later in this document. Performance Objectives: Apply gerontologist nursing principles and standards in nursing practice across the continuum of elder care. Use current evidence and theories in care of older adults. Conduct a personal interview with an older adult for the purpose of documenting Life Review. Rubric Use this rubric to guide your work on the assignment, “Life Review Analysis.” Task Accomplished Proficient Needs Improvement Interview Consent Form (Total 15 points) Submitted on time (5 points) Complete, with signatures (10 points) Submitted late or not at all (0-3 points) Missing information or signature(s) (0 points) Introduction of Older Adult Confidentiality Selection process/criteria Biography Significant events Relationships Work and home Summary statements Organization/quality (Total 10 points) Older adult identified with initials only (2 points) Key information present (7 points) Well-organized/brief (maximum 1 page) (1 point) Sketchy, missing some information (5 points) Older adult’s name used (0 points) Missing critical information (2 points) Lacks continuity or is too wordy/long (0 points) Analysis of Life Review Goal and benefits of Life Review Similarity to remembering Difference from remembering Erikson Developmental Stage Description of client Ego integrity rating (1-10) Rationale for rating Citations regarding Erikson’s theory (Total 45 points) 4+ benefits (10 points) Comparison with 2+ examples (10 points) Contrast with 2+ examples (6 points) Theory with 2 specific examples (10 points) Rating present and plausible (3 points) Rationale clear from example (3 points) 1+ reference in text (3 points) 2-3 benefits (7 points) Comparison with 1 example (5 points) Contrast with 1 example (3 points) Theory with 1 specific example (8 points) 0-1 benefits (0-2 points) Comparison without examples (3 points) No comparison (0 points) Contrast without examples or no contrast (0 points) Loose connection between theory and client (3 points); Missing description of theory or no connection (0 points) Rating missing or implausible (0 points) Rationale unclear or example missing (0 points) No references in text (0 points) Reflections Value and reason Most significant point of interview Difficult/anguishing part Impact on clinical practice Personal legacy (Total 14 points) Statement(s) with 1+ reason(s) (3 points) Example(s) with 1+ reason(s) (3 points) Example(s) with 1+ reason(s) or statement of none (3 points) Example(s) with 1+ reason(s) (3 points) Definition, personal legacy (2 points) Statement(s) with no reasons (1 point) Example(s) with no reasons (1 point) Example(s) with no reason (1 point) Example(s) with no reason (1 point) Definition OR personal legacy (1 point) No statement of personal value (0 points) No statement of significant point (0 points) No statement of regarding difficulty(0 points) No statement of regarding impact (0 points) No statement regarding legacy (0 points) APA Forrmats List of references (end) References in body text (Total 10 points) APA format, 3+ references (5 points) APA format, 3 in-text references (5 points) APA format, 1-2 references (3 points) APA format, 1-2 in-) Incorrect APA format or no list of references (0 points) Incorrect APA format; no body text references (0 points) Spelling/Punctuation/Grammar (Total 5 points) No errors (5 points) 1-2 errors (3 points) More than 2 errors (0 points) Scope (Total 1 point) Within maximum of 6 pages (1 point) Over 6 pages (0 points) Total Points 100 -5% IF FAMILY MEMBER IS INTERVIEWED WITHOUT PRIOR COACH APPROVAL A. Interview Consent Form Upload and submit your Interview Consent Form (with elder’s signature) in the appropriate Week 4 assignment portal. This is due 0800 Monday of Week 5 along with your Life Review Analysis. B. Introduction of Older Adult When I first came to the United States, I was not very good in English, which made it very hard for me to go through school without encountering problems. My sponsor was able to realize this, and it when she recommended that I get a separate english tutor who happened to be D.A. I therefore, came to know about D.A. back when I was in school, he was a retired teacher and was willing to volunteer to teach us english. He was very kind and passionate about helping us understand the english language so that we can perform competitively as the other students in school. I am very thankful for his work back then as it is one of the factors that have enabled me come this far with my education. D.A. is an 88 year old white male living with his wife and two grandsons in Forest Hill, Texas. He was born in Anniston, Alabama the third born of four children. After the demise of his father, D.A’s mother moved them to Abilene, Texas. His childhood was tough following his father’s demise and his mother lack of a better job. His education, however, was secured due to his best grades, which landed him several scholarships. He became a high school teacher in Abilene, where he also met his wife and was blessed with three children. He had not experienced significant illness in his life apart from one time when he was diagnosed with Tuberculosis at age 63, but he was able to get the right treatment. Aside from his childhood family struggles D.A. is content that, he has lived a good and successful life. C. Analysis of the Life Review Interview Through science, we are able to learn that the human body undergoes various changes as we age. This knowledge is necessary to the nursing profession as it offers more information on how nursing care should be assessed, planned, and delivered (Nursing Center, 2013). In the current health care setting, nurses are caring for more adults, aged 65 and above, more than any other age group. This situation, therefore, requires that more nurses be equipped with extra knowledge and skills; to be able to care for this population. This however poses a huge problem as less than one percent of nurses are taught these skills in school (Nursing Center, 2013). Recent reports of research indicate that most of the past approaches to care used in gerontology have become obsolete and new evidence-based practices have been established that need to be routinely adopted by caregivers that would lead to high quality and safer care for the older adult. Among these practices, we have elder adult assessment, which involves having a clear understanding of the patients life review as they narrate their stages of development. There are several benefits to carrying out a life review activity as part of gerontology. For a start, life review can be used in terminal care as a form of treatment to bring closure in cases of withdrawal or confusion (Birren & Cochran, 2001). Life review, with another person or in a group has also been proven therapeutic; because the process of sharing helps, some individuals have some sense of self-worth and integrity. The process is also attributed to promoting self-actualization and understanding (Texas A&M AgriLife Extension Service, 2010). In other research results, the process is referred to as oral history; therefore, serving as means of preserving collective and personal history for the older adults at the same time it reinforces coping mechanisms (Conway & Pleydell-Pearce, 2000). Another advantage of life review is that, one is able to sum up his or her life and have a clear picture of how they coped at each stage of development, which can lead to a better understanding of their last stages of life, ego integrity, or despair. As a gerontology nurse, one has to have current skills in older adult assessment, and one of these skills is being able to differentiate between life review and ordinary remembering. In most cases, the two may be connected, but each has its own share of differences. A good explanation of life review can be given as the focus on a person’s life bringing out details from their early life through to their present life. The depth and details of the interview are drawn upon the interviewer’s genuine interest, and curiosity directed into questions about experiences and thoughts of the person being interviewed (Brown, Nolan, Davies, Nolan, & Keady, 2008). It is common for people to think about past events and anticipate future events. In life, we all get to realize that change is eminent; therefore, the best way to cope with our daily lives is to draw upon events in the past, to try to cope with the current world. In other words, we use most of our past life experiences to solve and manage the present (Texas A&M AgriLife Extension Service, 2010). Life is a key tool for shaping our image to the society and defining our purpose in life. While carrying out a life review, it is also important to take note of the interviewee’s instances of ordinary remembering. Though remembering is what builds a life review, as a profession, it is important to differentiate it from instances of ordinary remembering; this therefore calls for the utmost attention of the nurse or caregiver. According to Bartlett, (1932) describes remembering as pure reproduction or re-excitation. He draws his conclusion from the research results “when any specific event occurs some trace, or some group of traces, is made and stored up in the organism or in the mind”. From Bartlett’s definition, it is clear that remembering is a major factor in life review, however, how we narrate the outcome is what differentiates ordinary remembering to life review. In the life review interview I carried out D.A. gives certain events that were significant to his life from childhood to adulthood. For example, D.A., remembers his father’s death so well, as it can be traced from these statements, “My father died when I was 12 years old, and our last born sister was only 3 months old”, “It felt as if the world had ended, keeping in mind that my mother did not have a substantial income”. The above statements are both part of D.A.’s memory. The first statements can be termed as ordinary remembering while the second statement is a clear statement of life review. Both statements depict a similar event and therefore, can show that both life review and ordinary remembering portray similar events the difference is the tone. There are also some clear differences between life review and ordinary remembering. For example, D.A’s life review shows he went through school and performed very well, “I was the best in class, and I felt proud when I received scholarships…” He also recalls a time when he was diagnosed with Tuberculosis, which was one of his worst moments in life. On the other hand, D.A. remembers never having a significant illness that caused him to neglect his duties or miss school. From these examples, there are clear differences between how he recollects his past life to his conclusion on never having a terminal illness in his childhood, and how he narrates when he was diagnosed with Tuberculosis. From the responses and personal assessment of D.A’s life review, I would rate his ego integrity a 9 on a scale of 0 to 10. Erikson’s stages of psychosocial development, give eight stages through, which a human is expected to pass through from infancy to older age. Each stage a person encounters new challenges with each stage building up from the successful completion of the previous stages. Erikson describes the first stage using psychosocial crisis of “Basic trust vs. mistrust” (Erikson, 1959). Erikson’s explains this stage to be where a person first learns if to trust or not to trust depending on the closest people he or she grows up around. For D.A., his good relationship with older siblings and parents especially his mother shows he passed this stage successfully. This is also eminent in his entire life, as he did not have significant problems with trusting people he relied on throughout his life. A look at D.A. current life it also shows content and satisfaction a positive virtue according to Erikson’s eighth stage of development outcomes, “Ego integrity vs. Despair” (Sheehy, 1976). D.A is happy, still together with his wife, and has united family. From these factors, it is clear that he has ego integrity in his last stage of life a virtue many people do not get to experience due to the numerous challenges one faces in life. D. Student’s Reflections The interview experience was an enlightening experience to me, and I believe D.A also enjoyed it, as well. Through the interview, I was able to experience firsthand information and interaction with an elder adult besides the classroom learning. It was also enlightening considering the fact that we bonded well and I was able to receive all the necessary information that was essential to the assessment. This is in both a professional way as well as ensuring a friendly environment with D.A. despite the fact that we are not associated professionally or personally. The most significant point about the interview was his childhood. Having grown up through a difficult childhood, I am always curious to understand other people’s childhood experiences, such that, if they had problems, I would learn how they coped. I D.A’s case, he also had a difficult childhood though not similar to mine, but some of the decisions he took such as ensuring that he finished school closely relate my life story, which explains my keen interest at this point. The difficult part of the interview was when D.A. narrated about losing his father at a very young age. His sister was only three months old then it was such as sad moment, I could see the sadness in his eyes, which took me back to when I also lost my parents and felt as if the world had ended. I felt sorry for D.A. as well as myself, an issue, which made me, realize that no matter how old you get, the loss of a parent at a tender age will always remain a sad memory in one’s life. After this experience, I intend to use life review as part of therapeutic approach to my elderly patients. I believe that this can be an appropriate way to engage with my patients and try to understand what they are going through besides their medical conditions. As I have come to realize, despair is a major factor in worsening some health conditions, and besides administering medication listening and encouraging my patients is a virtue I opt to embrace. In my own opinion, legacy is a life well lived that is accompanied with personal and professional achievements that will benefit those you love and society for a long time even in the absence. I would love to leave a legacy of a happy family that is caring and productive to the society. Professionally, my legacy would be related to gerontology, whereby I will establish a health care system that provides care for the elder adult both medically and nonmedical care whether they are financial able or not able. I believe, it will be a worthy legacy, as it will benefit many people, from those close to my family to the whole society. E. References Bartlett, F. (1932). Remembering: A Study in Experimental and Social Psychology. Cambridge: Cambridge University Press. Birren, J. E., & Cochran, K. N. (2001). Telling the Stories of Life Through Guided Autobiography Groups. Baltimore, Maryland: Johns Hopkins University Press. Retrieved from Growth House: http://www.growthhouse.org/lifereview.html Brown, J., Nolan, M., Davies, S., Nolan, J., & Keady, J. (2008). Transforming students' views of gerontological nursing: Realising the potential of "enriched" environments of learning and care: A multii-method longitudinal study. International Journal of Nursing Studies, 1214-1232. . Conway, M., & Pleydell-Pearce, C. (2000). ‘The Construction of Autobiographical Memories in the Self-memory System’. Psychological Review, 261–88. Erikson, E. H. (1959). (1959) Identity and the Life Cycle . New York: International Universities Press. Nursing Center. (2013, August 8). Nursing Care of Older Adults. Retrieved from Wolters Kluwer Health LWW: http://www.nursingcenter.com/lnc/static?pageid=730388 Sheehy, G. (1976). Passages: Predictable Crises of Adult Life. New York: E.P. Dutton. Texas A&M AgriLife Extension Service. (2010, July 26). Reminiscence: An Important Task for Older Adults. Retrieved from Family and Consumer Sciences: http://fcs.tamu.edu/families/aging/reminiscence/reminiscence_important_task.php Read More