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Facts about the Elderly Is a unique population, the society is aging dramatically, living longer, income has changed, physical and cognitive limitations, retirement, loss of a spouse. SPICES S - sleep disorders P - problems with eating or feeding I - incontinence C - confusion E - evidence of falls S - skin breakdown Common Myths of the Older Adults (Ageism) (no signs behind this) Old age begins at 65 years. Most older adults are in long-term care facilities. Older adults are sick, and mental deterioration occurs. Older adults are not interested in sex. Older adults do not care how they look and are lonely. Bladder problems are a problem of aging.
Older adults do not deserve aggressive treatment for illnesses. Older adults cannot learn new things. Genetic Genes control "genetic clocks" lifespan is determined by genetic factors Immunity Focuses on the functions of the immune system; four organs that makes up the immune system; the thymus, spleen, bone marrow and lymph nodes Cross-linkage Chemical reaction produces damage to the DNA and cell death Free radical Free radicals formed during cellular metabolism that have adverse effects on adjacent molecules. Elderspeak a manner of communication to older adults using a slow rate of speaking and simple words or using baby talk based on the assumption that they are cognitively impared. Ageism A form of prejudice, negative perception, stereotyping, discrimination based on age Generalized upon older adults
Sexual Abuse Non-consensual sexual contact of any kind, coercing an elder to witness sexual behaviors. Exploitation Illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder. Basic Communication process Involves a source (encoder), message, channel, and receiver (decoder). The sender or source (encoder) of the message is a person or group who initiates or begins the communication process. Message is the actual communication product from the source. It might be a speech, interview, conversation, chart, gesture, memorandum, or nursing note. Channel is the medium the sender has selected to send the message. The channel might target any of the receiver's senses. Auditory spoken words and cues Visual sight, observations, and perception Kinesthetic touch
The receiver (decoder) must translate and interpret the message sent and received. Blocks to Communication Failure to perceive the client as a human being Failure to listen Nontherapeutic comments and questions Using clichés Using closed questions Using questions containing the words "why" and "how" Using questions that probe for information Using leading questions Using comments that give advice Using judgmental comments Changing the subject Giving false assurance Using gossip and rumors Using disruptive interpersonal behavior Intrapersonal communication self-talk, communication within a person. Communication is the process of exchanging information and generating and transmitting meanings between two or more people. Forms of Communication
context, approach and culture Consider personal space 18"-4' Cultural and personal variations Silence Indicates the nurse is listening and would like client to continue speaking Allows both nurse and client to reflect Allows client to explore his/her inner thoughts Be aware of facial expression/posture as silence may be sign of anger or unwillingness to continue conversation It takes time to be comfortable with silence, usually we fill empty space with words Eye Contact Suggests respect and willingness to listen/communicate In some cultures it is not respectful to make eye contact with a superior Asians and Native Americans view eye contact as an invasion of privacy Facial Expressions Individuals vary in their expressiveness Express interest in individual Useful in assessing client's affect, mood, pain Nurse needs to control their facial expressions in some situations
Body Movement Posture and gait carry nonverbal messages about health and attitude Gestures helpful in carrying or reinforcing a message Useful to augment communication with someone of different language or having a hearing deficit Avoid distracting body movements (shaking leg, tapping pen, pointing) The Helping Relationship Does not occur spontaneously Characterized by an unequal sharing of information Built on the client's needs, not on those of the helping person The nurse is the helper, and the client is the person being helped. Communication is the means used to establish rapport and help- trust relationships. Characteristics of the Helping Relationship Dynamic Purposeful and time limited Person providing assistance is professionally accountable for the outcomes and the means used to attain them Phases of the Helping Relationship Orientation phase Working phase Termination phase
conveys interest, trust, and acceptance. Observations comment on how they look, sounds, or acts Empathy the ability to understand and accept another person's reality Hope hope is essential for healing Offering self shows a willingness to spend time with the client. Humor it is a coping mechanism that adds perspective Feelings feelings are not right, wrong, or indifferent, also be aware of your own feelings Presenting reality This helps the client distinguish what is real from what is not and to dispel delusions, hallucinations, and faulty beliefs. Self-disclosure
This is not therapy for the nurse but a true personal experience about self. It shows the patient that the nurse understands their experiences (honesty, empathy) Communicating with an older adult: Control the tone of your voice. Be knowledgeable about the topic of conversation. Be flexible. Be clear and concise. Avoid words that might have different interpretations. Be truthful. Keep an open mind. Take advantage of available opportunities. Sit when communicating with a patient. Be alert and relaxed and take your time. Keep the conversation as natural as possible. Maintain eye contact if appropriate. Use appropriate facial expressions and body gestures. Think before responding to the patient. Do not pretend to listen. Listen for themes in the patient's comments. Use silence, therapeutic touch, and humor appropriately. Assessing Initial, focused, and ongoing assessment Collecting of data, validating data and communicating with patient
(optimal level of functioning wellness) Continue data collection and modify plan of care as needed, and document care Evaluating Evaluate a client's response to nursing interventions and forms a clinical judgment about the extent to which goals and outcomes have been met Identify the positive and negative factors that contributed to the client's success or failure Ask: were the planned outcomes met?; were the nursing interventions appropriate/effective?; should I modify the outcomes and/or interventions? Revise the Care Plan as needed or Terminate nursing care Client outcomes that are stated in specific, measurable terms are easier to evaluate Palliative Care Specialized medical care for clients with serious illnesses. Focuses on relieving symptoms, pain, and the stress of the illness. The goal is to improve quality of life for both the clients with life threatening illnesses and the family by the aggressive management of symptoms. Palliative care focuses on symptoms such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, difficulty sleeping and depression.
Team of doctors, nurses and other specialists who work together with a patient's other doctors to provide an extra layer of support. Palliative Care - focus is on prevention, relief of symptoms, pain, and stress throughout the entire course of an illness. Common with clients who have chronic disease, young or old. Hospice Care Special kind of healthcare that focuses on keeping the client comfortable once the client and physician have decided that the underlying disease can no longer be treated or cured. Helps the client, their families, and other caregivers and can occur in a variety of settings. It neither hastens nor postpones death and is focused on the belief that quality of life is as important as length of life. Hospice staff members help manage pain and symptoms and provide emotional and spiritual support so patients can make the most of each day. Hospice - is a philosophy of care and a model of care of the terminally ill. It is a patient-family centered approach to care. The focus is on keeping the client comfortable by managing pain and providing emotional and spiritual support to patients and the family. Approaching Death Specific signs of approaching death may be observed, which indicate that death is approaching nearer.
Respirations may increase, decrease, or become irregular and labored Congestion may occur causing a rattling sound or cough When a person is just hours from death, breathing often changes to a new pattern called "Cheyne-Stokes" breathing (rapid breaths followed by a period of no breathing - apnea) Incontinence (urine and bowel) Swallowing becomes more difficult as weakness increases Social withdrawal Increased restlessness, confusion, disorientation, agitation, inability to stay content in one position Physical weakness, lack of energy, and loss of interest in everyday things Decreased intake of food and liquids Increased periods of sleep and lethargy Sensory changes Misperceptions Sleepiness and loss of consciousness Active Phase of dying Pre-active phase symptoms worsen in the active phase. Inability to arouse patient (coma) Severe agitation Dramatic changes in breathing Severely increased respiratory congestion or fluid buildup in lungs Cheyne-Stokes breathing (death rattle)
Breathing through a wide open mouth Mucus collecting in large airways Mottling (hands and feet may become blotchy and purplish) Pupils no longer reactive to light Blood pressure dropping dramatically Marked decrease in urine output Patient's body is held in rigid unchanging position Patient may state they are going to die May not speak, even when awake Jaw drop (may drop to the side their head is lying towards) Eyes have glassy fixed stare with large pupils Pasty gray color Incontinence Spiritual Needs Need for meaning and purpose Need for love and relatedness Need for forgiveness Spiritual needs that underlie all religious traditions and are common to all people: need for meaning and purpose, need for love and relatedness, and need for forgiveness Meeting Spiritual Needs Offering a compassionate presence Assisting in the struggle to find meaning in the face of suffering, illness, and death
Developmental considerations Family Ethnic background Formal religion Life events Nursing interventions to implement spiritual care Ethical and Professional Boundaries Offering Supportive or Healing Presence Facilitating the Practice of Religion Nurturing Spirituality Praying with Patients Praying for Patients Counseling Patients Spiritually Contacting a Spiritual Counselor Resolving Conflicts B/W Spiritual Beliefs and Treatments Nursing, Religion, Conscientious Objection Assist patient to feel connected or reconnected to a higher power Establish a "caring presence in "being with" the client (and family) Support a healing relationship Support religious rituals (Icons, music, prayer, devotional reading and so forth) Support restorative care (prayer, meditation, grief work and so forth) Facilitate visit from clergy Therapeutic Communication
Encourage writing feelings/resolutions in journal Display empathy/empathetic listening Use of touch, maintain an attitude of caring, refrain from personal issues and stories, accept tears, allow silence, attend to nonverbal messages, use client's terminology when forming responses, be fully present Spiritual health: spiritual well-being, is the condition that exists when the person's universal spiritual needs for meaning and purpose, love and belonging, and forgiveness are met. Enhancing Spiritual Health—The Patient will: Identify spiritual beliefs that meet needs for meaning and purpose, love and relatedness, and forgiveness Derive from these beliefs' strength, hope, and comfort when facing challenges of illness, injury, or other life crises. Develop spiritual practices that nurture communion with inner self, with God/higher power, and with the world. Express satisfaction with the compatibility of spiritual beliefs and everyday living Express feelings about his/her usual and current spiritual beliefs Identify areas of ambivalence and conflict resulting from current situation State one fearful aspect of situation FICA
