Preventing Abuse and Neglect of the Elderly - Essay Example

COMMUNICATING WITH MY PATIENT AND OTHER MENTAL HEALTH ISSUES INTRODUCTION Communication is a very important skill used in relating with people. This determines how well one can be a good leader or a functional team member. There is, however, the more common categorization of communication. This is passive, assertive, and aggressive. The passive style, which puts others first than the self, is indirect, hesitant and compliant. Its verbal style is apologetic and soft or tentative. The speaker tends to look down or away, sigh, nod a lot and complains instead of taking action. One potential consequence of this is pity or disrespect from others and feelings of inferiority. The assertive style believes in equality and value of each member. The speaker is an active listener and expresses self directly while checking the feelings of others. He is firm, realistic and action-oriented. With this, the team feels motivated and understood. The aggressive style usually displays self-centeredness. He is domineering and shows lack of appreciation. He often provokes feelings of fear, anger and resentment. Part One Studies recognize that people’s lives are “patterned as they age; groups and individuals differ from one another in later life” (Understanding Aging as a Social Process, 2005). Culture also plays a very important factor that affects aging. More often than not, the kind of culture one belongs to has great influence to the kind of thinking one has. Inaccurate beliefs and misconceptions about aging are taken into consideration in assessing one’s process of growing old. For the common, elderly person in America, their problems become more pronounced as they age. The elderly and aging population in the United States is increasing ever more and such ill-effects of old age occur more often such as injuries, disabilities, emotional pain and worst-case scenario, suicide. My patient is a 94 year old woman. I choose her as my patient. She fumbles with her hands and is quite mentally incapable of coherence. Constantly needing assurance, I help her to understand how her dress looks good on her and she beams radiantly at the compliment, eyes and face crinkling. She is forgetful every now and then, peering into my face and asking who I am even if we had been introduced a few days earlier. I am continuing my sessions with her. I have chosen verbal communication as my main way of connecting to her. I think she really needs to be talked to every now and then. She appreciates how I talked to her so kindly and considerately referring to the other nurses who just wave their hands or slightly nod their heads as she asks a question or two. Thus, I think I am in the right direction when I pick verbal communication for a patient I have come to temporarily regard as my Grandma. I call her Grandma every time I step in her room and I can instantly predict she will give me a Mona Lisa smile, as if remembering the days when her family was still with her. Now she is in this hospital for the aged after her family transferred to another city. They often visit her, but now I seem to have taken a liking to her and vive-versa. I am now her family and I know that verbal communication is all she needs at this time in her life—anyone to talk to her. She feels and acts like a child, often fixing herself in front of a small mirror saying that she is getting ready because her mother will be bringing her to school. She responds well as I ask more about her mother. I think that is what triggered the openness she gave me from the very start. I touched a chord in her that moved her being and made her gravitate to me, Every time I leave, she would ask me when I would be back. However, sometimes her mood swings and becomes silent. I try to talk her out of her silence. I know that the overall expectation for old age is gloomy. Typically, old people are portrayed as socially, psychologically and physically isolated, restricted and deteriorated. According to a recent Harris poll (Harris and Associates, 1975), the image of old people in America is that of “senile, lonely, used-up bodies rotting away and waiting to die.” The expectation is that old people should be leaving former roles and not thinking about entering new, age inappropriate ones. It is time to retire from work and assume the leisurely, more aimless role of retiree. Nevertheless, this Grandma seem erratically one moment and incoherent the next moment. But she senses my goodness of heart. Somehow she knew with whom she would open her heart out. In the initial session with the client, I focus on what the client needs in the helping process, how the client seems to be coping with her life, what sort of help the client is seeking, what sort of help the client may need, and my ability to participate in the helping process with her, given her needs. The first session focuses on understanding enough about my client to begin the planning of the helping process. I initially picked this patient because every time I would come up to her during the early stages of getting to know the patients, she would always refer to me as her Anna. She said Anna was her daughter who lived far from her after she married but who was very close to her even as a child. And then, on my part, I sensed a certain affinity with her as she resembled my Grandma especially when she crinkled her nose. They had the same mannerism of beckoning me to come near them, and sit beside them. She says, “Come closer my dear, I’d like to see your face well.” I managed quite well relating with her verbally most of the time. She had lucid moments at times but was quite conversant during other times which kept me on my feet in terms of history and other interesting topics she often brought out during our conversation. Talking with her involved an interactive process based on certain fundamental principles in counseling and communication. The interactive process with the elderly can be based on a generic model of helping such that of Egan (1975). His model for counseling and communications includes three stages wherein the client is expected to begin with self-exploration, move to deeper levels of self-understanding and finally to develop a plan of action. During the Stage 1 of my session with her, I encouraged self-exploration by offering a helping relationship characterized by emphatic understanding, genuineness and respect (Rogers, 1965). These are “receiving skills” and they are undergirded by concreteness—a focus on real happenings and their consequences. While offering these conditions, I begin to look diagnostically for the salient issues of elderly condition that relate to the patient’s concerns. While engaging her in an active verbal conversation, she describes her past life. I help her differentiate conditions of the past from conditions of the present so that a clearer understanding of attitudes and behaviors emerge. In the case of Grandma, as I fondly call her in this paper, I sense that sometimes, she tries to manipulate me into parental kinds of behavior, displaying either hostility or dependency (seeking solutions from me). During the first stage of counseling, I was able to build the trust needed in this kind of session, and at the same time help the client focus on concrete concerns. Then, I use that trust that has been built to get involved more potently in helping her understand herself. I now respond not just to what she says but also to what she implies. I help Grandma “reclaim” a part of herself that had been left behind at an earlier period in life (Parsons, 1975). Such reclaimed qualities can lead to additions of fulfilling activities. Grandma is in her elements every morning when I talk to her. I talk to her aloud and with my actions and gestures. She responds to me easily when I accompany my words with hand signals. She motions to me, “Stop doing that. You annoy me.” I am glad she relates to me straight. Sometimes, I do all sorts of talking to her trying to convince her to eat. I find myself getting quite edgy there because I know she’ll become weak. So, when I notice that I’m doing that, I stop. Then, I can find out what’s happening with her so I can talk to a place of her experience. When I broadcast at her like a radio announcer, I’m not speaking from a real place in me to a real place in her in a caring way. My tone of voice, my rhythm of speech, my lack of contact with where I am, or a feeling of distractedness may signal me that I’m talking at her. So, I listen to where I am, make eye contact if I haven’t been doing that, and start talking with her in a way that’s real for both of us. As I do that, my voice and my whole manner become different, and I relax. In the end, we had our bonding. I helped her become more amiable to everyone so she can get their support from them when I’m not around. Part Two As a mental health nurse, I learned several insights that are useful in the areas of adult nursing, children nursing, disability nursing and midwifery. For example, relating it to adult nursing, I recognized for a start that since adulthood was seen as a period of stability that followed the tumult of growing up, nurses who choose to work with an adult clientele will apply the principles of nursing here. There must be a foundation in the relationship and listening skills, goal setting, decision-making and planning. There must also be nursing awareness of the salient issues of adulthood to provide a structure for diagnostic understanding of adult concerns. There must be an awareness of the responsibilities adults bear in their daily experience and the relationship of these responsibilities to motivation for nursing. In a youth-oriented world, the nurse must work toward elimination of age bias in his or her work. As adults move through the life cycles, their roles change with respect to five main dimensions: vocation, intimacy, family life, community and inner life (Schlossberg, 1976). Over time, most people move from entry level jobs to more responsible jobs that usually involve the supervision of others who are often younger. Adults establish intimate relationships that often lead to marriage or other close associations. Adults experience change with respect to parental ands extended family and usually procreate their own children. They assume roles, sometimes committing considerable energy to the community. As a mental health nurse, I need to keep in mind that it is useful to keep these dimensions of change in mind as one considers the role of the passage of time in the life cycle. Neugarten (1976b) said, “Adults, carry in their heads, whether they can easily verbalize it or not, a set of anticipations of the normal, expectable life cycle” (p. 18). She states that it is not until adulthood that one creates a sense of the life cycle and that the ability to create a sense of a personal life cycle differentiates the healthy adult personality from the unhealthy. As a mental health nurse, I need to make the adult patients realize that transitions can and usually do occur without crisis. The potential for crisis is higher at some times during adult life than at others, but it is by no means predictable that all persons of a given age and sex will be experiencing the same thing at the same time. Some transitions are pleasant, some may be neutral, others moderately stressful. Thus, as the nurse, I should be aware of these issues that beset the adult in order to fully be equipped in dealing with his or her particular needs. It helps in a very large scale to have people like me who have a better understanding about mental health concerns. Mental health issues related to the adults are best handled in a positive light by those who have a clear grasp of such issues. The health professions can affect the adult’s health in positive ways. One way or the other, they affect positively the world in a much bigger picture. Considering that health nursing, as one mental health practitioner states, the field “encompasses prenatal care through death and dying, it is perhaps the most wide-ranging collaborative specialty in the nursing profession.” The mental health nurse provides a selfless contribution to the world today. As people are faced with ever increasing health problems, with or without medicines to cure them, we are still left with a choice to see such problems as positively as we can. Let these concerns be the concerns of the future mental health nurses like me. Every action must be aimed at trying to alleviate the burden of those suffering adults. It is our duty to bring light to these people--- to make them well, to let them feel and be assured that life is worth living no matter what condition of life they may be in. As a mental health nurse, I should be extra sensitive to the needs in the area of child nursing who comes to treatment with a history of successes and failures, traumas and satisfying experiences; a person with a culture that influences values, beliefs, and norms; a person with psychological archives that have shaped the individual's personality and patterned his or her interactions; a person who lives in an environment that imposes conditions on the quality of life; a person with an enduring drive to bring order to the world, to reduce the anxiety that accompanies psychological unrest, and to experience competence in valued activities. These dimensions of a person's life, singularly and in interaction with each other, constitute the "baggage" of the child must all be considered in the assessment process of a good mental health nurse. The attempt to deal with a client's difficulties, whether he is a child, an adult, and a disabled without taking stock of this larger context will probably result in ineffective treatment strategies because the clinician's understanding of the client's problems will be incomplete and the treatment plan will lack relevance. The study of the human mind is carried on chiefly by psychologists and in its medical aspects by psychiatrists. By every means, this is of increasing importance in modern civilization. There are diseases of the mind as well as other portions of the body – mental disease, in which the connection between the body and the outside environment is distorted. The greatest challenge for mental health is when they actually encounter patients who are extremely depressed that can lead to a threat in their own lives. A good mental health nurse must know why someone is depressed or anxious? Can't they just think their way out of it? These symptoms manifest themselves within people all the time, but when they get to a point where they interfere and hinder daily life for an extended period of time, then they become a serious problem. As a mental health nurse, I also need to address the needs of the disabled and understand the best form of health care that will suit these individuals. There are individual differences, including lifestyle decisions that spell distinctions among disabled people. For instance, some disabled would still be able to handle normal tasks and would insist on pursuing a healthy lifestyle through daily exercise and proper diet, while others would be frail and weak, or even handicapped due to diseases. The mental and emotional condition of disabled people is also a major issue in designing for the welfare of the elderly. Often, aging is associated with the following characteristics: increased depression loneliness lower self-esteem It becomes apparent that facilities and environments created specifically for the disabled should promote mental and emotional well-being, aside from addressing the general health and medical needs of these people. The mental and emotional condition of the disabled is also a major issue in designing for the welfare of the elderly. Their condition comes with an increased depression, loneliness and lower self-esteem as disabled people are unable to do the simple activities. It becomes apparent, therefore, for the mental health nurse to facilitate the environment created specifically for the disabled which should promote mental and emotional well-being, aside from addressing the general health and medical needs of these people. In the area of midwifery nursing, client assessment is the cornerstone of treatment and care. Because assessment is so critical to the practice of mental health nursing, clinicians must be certain that the models or principles that guide the data collection and analysis lead to the richest possible view, of the client as a person. The dimensions of a person's life, singularly and in interaction with each other, constitute the "baggage" of the client that must be considered in the assessment process. Some of these are: a person who comes to treatment with a history of successes and failures a person with a culture that influences values, beliefs, and norms a person with psychological archives that have shaped the individual's personality a person who lives in an environment that imposes conditions on the quality of life a person with an enduring drive to bring order to the world, to reduce the anxiety that accompanies psychological unrest, and to experience competence in valued activities A mental health nurse’s role is by every means of increasing importance in modern civilization. There are diseases of the mind as well as other portions of the body – mental disease, in which the connection between the body and the outside environment is distorted. It is important that a mental health nurse knows about the effects on the adult, children, disabled and in midwifery. SYNTHESIS AND CONCLUSIONS The needs of the individuals vary from person to person, and concerned authorities, builders, medical professionals and nurses especially in the field of mental health are all investing valuable time and effort to meet those varying needs. As of the present time, as a mental health nurse, I need to plan ahead and develop more effective and efficient means to deliver the appropriate services to the people as the world is seeing further increases in the population of people needing special health care. Mental health patients are undeniably covering a greater bulk of the world’s population. They make up a huge chunk of justifiable and valid claims that mental health nurses must seriously take into consideration. There is a need to create a solid foundation carefully formulated, designed and implemented to manage the concerns of people who need help in the area of mental health. REFERENCES gan, M and Bobgan, D. 1987. Mental Illness is Not a Disease. Mental Illness. Greenhaven Press. Bocknek, G. A developmental approach to counseling adults. The Counseling Psychologist 1976 6(1), 37-40. Burns, N. & Still, E. (2003, June). Pharmaceutical care – a model for elderly patients [Electronic version]. Hospital Pharmacist, 10, 266-268. Clinton, H, and Hyman, S. Mental Illness is a Disease, Opposing Viewpoint Series. Greenhaven Press. 2000. Washington, D.C. Depression and Heart Disease, National Institute of Mental Health, Article Accessed: 19 March 2006 at: http://www.nimh.nih.gov/publicat/depheart.cfm Graham, Gerald. 2002. “What is your communication style?” Applied Management Newsletter. National Association for Management. Guralnik, et al. “Change in Physical Performance Over Time in Older Women: The Women's Health and Aging Study.” The Journals of Gerontology. Harris, L. L. & Associates. The myth and reality of aging in America . Washington. D.C. National Council on Aging, 1975. Hillary Rodham Clinton, The White House. Article Accessed 19 March 2006 at: http://www.whitehouse.gov/history/firstladies/hc42.html Johnson RJ, Wolinsky, FD. “The structure of health status among older adults: disease, disability, functional limitation, and perceived health.” 1993. 19 March 2006 at: Kobbe, Anna. “Preventing Abuse and Neglect Of The Elderly”. National Resource Center on Elder Abuse 2005. Retrieved on 19 March 2006 at: http://www.utextension.utk.edu/publications/pbfiles/pb1414.pdf Lawler, K. (2001, October). Aging in place: Coordinating housing and health care provisions for America’s growing elderly population. Joint Center for Housing Studies of Harvard University & Neighborhood Reinvestment Corporation. O’Keeffe, J. (n.d.). Creating a senior friendly physical environment in our hospitals. Retrieved 19 March 2006 from http://rgapottawa.com/english/Senior-friendly-fulltext2.pdf Neugarten, B.l. The psychology of the aging. An overview. Master Lectures on Developmental Psychology. Washington. D.C. 1976. Parsons, W.R. Gestalt approaches in counseling. New York: Holt, Rinehart, 1975. Patel, Mamta. (2005) The Elderly Victim. Indian Journal of Gerontology, Volume 19, No. 1, pp. 69-76 Rogers, C.R. The interpersonal relationship: Core of guidance, In Mosher et al. (Eds.), Guidance: An examination. New York: Harcourt, Brace & World. Schlossberg, N.K. The case for counseling adults, The Counseling Psychologist 1976. 6(1). 33-36. Sharma, K. L.(2005) Book Review on Good Bye to Old Age. Indian Journal of Gerontology, Volume 19, No. 1. Retrieved on 19 March 2006 at: http://www.gerontologyindia.com/IJG-19-1.doc Varner, A. & Drago, R. (2000, November 1). The changing face of care: the elderly. Penn State University Department of Labor Studies and Industrial Relations. Retrieved 19 March 2006, from http://lsir.la.psu.edu/workfam/eldercare.pdf Understanding Aging as a Social Process. (2005) Retrieved on 19 March 2006 from http://www.roxbury.net/esgch1.pdf Read More