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Nursing Considerations in Caring for the ElderlyResearch Paper

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¶ … elderly people in the United States in the near future, and identifying opportunities to improve the quality of their lives has assumed new importance and relevance today. Professional nurses are in a good position to assist the by providing interventions that promote the maintenance of the quality of life and independent living among the elderly who still live at home, but many lack the knowledge and experience needed to fully understand these needs. These points became especially evident following an interview with A.W., a 72-year-old disabled veteran who lives at home but is experiencing problems with his day-to-day living needs, his growing reluctance to depend on others for care and relevant research concerning these issues. The purpose of this paper was to provide a summary of the face-to-face interview with A.W., a comparison of his situation with recent research in this area, followed by a description concerning how these findings can affect nursing practice for elderly adults.

Interview Summary

Born on July 6, 1943 during the height of World War II, A.W. has been married three times, but has been married to his current wife for more than 40 years with whom he lives. The interviewee reports having a good relationship with his two daughters (aged 49 years and 46 years), one of whom is a registered nurse at a local hospital and the other a librarian. Both daughters live in Tulsa as well and A.W. has three grandchildren between these two daughters. The interviewee reports that he has not been to church since he left the Army.

The interviewee graduated from high school in Tulsa, Oklahoma in 1960. The interviewee affably boasted that he was good friends with the entertainer Patti Page and actor Gaylord Sartain when they attended his high school and generally recalls his high school experiences fondly. The interviewee also completed 2 years of community college in Tulsa on a part-time basis where he obtained an associate's degree in business management at age 22 years. After failing to secure meaningful employment in a business-related position to his liking, A.W. decided to follow in his World War II veteran father's footsteps and joined the U.S. Army in age 24 years where he completed basic training and was subsequently trained as an administrative assistant during his advanced individualized training. Thereafter, A. W. quickly rose through the ranks to become one of the youngest staff sergeants (pay grade E6) in the U.S. military and he worked exclusively for general officers.

The interviewee states that he had planned on making the military a career and expected to spend at least 20 years or active duty in order to obtain a pension. These plans were cut short, though, when A.W. was driving a jeep while assigned to the 101st Airborne Division at Fort Campbell, Kentucky which flipped over on a sharp curve, severely injuring the interviewee in the process. The injuries experienced by A.W. included two broken ankles, a broken right femur, a fractured mandible, a lacerated pancreas (apparently from impact with the jeep's gear shift) and a severe traumatic brain injury (STBI).

After several months in a military hospital, A.W. received a medical discharge from the Army with an initial 10% disability rating from the Department of Veterans Affairs which was thereafter increased to 80%. A.W. underwent a number of orthopedic surgeries in civilian as well as VA facilities over the next several years. Following several years of claims and appeals, A.W. was finally awarded a 100% total and permanent service-connected disability rating by the VA in 2001 based on the residuals from his injuries and this award is currently sufficient for the couple's living needs.

The interviewee reports that he has experienced a loss of mobility due to problems with both legs and ankles and following several falls at home, he now started using a walker. Although the interviewee reports that they used to enjoy a fairly active social life including dinners and bridge tournaments with friends, A.W. notes that many of their friends have died in recent years and they no longer participate in these gatherings. In addition, A.W.'s wife, aged 62 years, has also experienced debilitating physical problems including arthritis and peripheral neuropathy and she has become unable to provide the same level of daily care needs that she has in the past and A.W. is concerned that at some point in the near future, one or both of them will be forced to move into an assisted living facility, making the need for an informed and timely nursing intervention to help this couple live safely at home paramount. Nevertheless, based on a lifetime of largely independent living, A.W. expressed serious concerns over his increasing dependence on others despite his growing needs for ongoing nursing care and made it clear that he was reluctant to accept this type of home-based care unless it became absolutely necessary.

Relevant Research

Following the completion of the interview with A.W., a search was conducted to locate a relevant nursing journal article that could help improve his ability to adapt to his new circumstances in ways that would allow him (and his wife) to remain in the family home with their daily living needs met for as long as possible. After ruling out a series of outdated or irrelevant journal articles, an appropriate study was located. The purpose of a study by Piredda, Matarese, Mastroianni, D'Angelo, Hammer and DeMarinis (2015) was to provide a systematic review of recent research concerning the experience of elderly patients with respect to their growing dependence on nursing care in order to determine how best to improve this care.

These researchers used a qualitative metasynthesis method drawing on an established model to locate and analyze the results of relevant studies in this area including Medline, PsychINFO, the JBI CONNECT and PROSPERO databases as well as the Cochrane library using various relevant search terms and filters. All told, Piredda et al. (2015) identified 15 studies that satisfied their inclusion criteria out of 8,835 records and inter-rater reliability was established for each study.

All of the studies selected for the metasynthesis were based on primary research using an individual interview methodology and only patient findings were reported. Ten of the studies selected for the metasynthesis used a phenomenological methodology, three employed a grounded theory approach, two used other qualitative methods and one study used a mixed methodology but only the qualitative elements were used. The researchers then synthesized their findings according to various themes which were presented in tabular form and interpreted narratively.

The study found that patients experience dependency as "a relational process, where relations with the self and others change" and resulted in five major themes: (a) the experience of dependency reveals the reality of the embodied person; (b) dependency is a path for the development of the person; (c) dependency leads to finding new balances; (d) dependency is defined by the net of relationships surrounding the person and by the context of care; and (e) dependency causes suffering (Pireddo et al., 2015, p. 398). The most relevant finding to emerge from the Pireddo et al. (2015) study for A.W.'s purposes was that there are both negative and positive outcomes that are associated with increased dependency on others as people grow older. In this regard, Pireddo et al. report that, "With dependency one learns to rely on the care of others. Dependency was associated with surrendering to being cared for by others with both negative and positive meanings" (2015, p. 399).

On the one hand, the negative meanings that are associated with increased dependency due to aging relate to the lack of choices that are available to the individual, especially when those who provide care for them do not treat them with the respect they believe they have earned after a lifetime of effort and sacrifice. As Pireddo and her associates put it, "The negative meaning stemmed from having no other options than to surrender when self-care was no longer possible and feeling powerless when the caregivers appeared disrespectful" (2105, p. 399).

On the other hand, though, nurses in general and those specializing in gerontological care in particular who provide compassionate and thoughtful care can help these individuals overcome their reluctance to benefit from the caregiving services provided by professional nurses in ways that will promote their quality of life and adherence to treatment plans. For example, Pireddo et al. add that, "The positive meaning came from having trust in the competence and knowledge of carers who acknowledged patients as persons. Patients learned that they could rely on nurses who were able to detect patients' needs, cared about them, and provided help" (2015, p. 400).

Implications for Nursing Practice

Several of the themes that emerged from the interviews synthesized in the Pireddo et al. (2015) study had significant implications for nursing practice including A.W. treatment plan. Although some elderly individuals experience the same types of reactions to the aging process as A.W., when appropriate levels of nursing care were offered and delivered in an age-sensitive… [END OF PREVIEW]

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