VN057 Gerontology 7 - PowerPoint Presentation

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VN057 Gerontology 7Slide2

Chapter 12

Roles and Relationships

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Normal Roles and Relationships

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Role

socially accepted behavior pattern

People tend to establish their identities & describe themselves based on the roles they play in life

Adult, senior citizen

Man, woman, husband, wifeParent, child, son, daughterStudent, teacher, doctor, nurse, mechanic, housewife

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Role (cont.)

many roles over a lifetime

often must attempt to play several roles simultaneously

Roles are identified, defined, & given value by the society in which a person lives

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Relationships

Connections formed by interaction of individuals who play interrelated roles

Parent & child

Employer & employee

The way individuals occupying each role interact describes their relationshipCan be short- or long-term, personal or impersonal, intimate or superficial Change over time & are affected by role changes of the people involved

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Homogeneous Society

all members share a common historical and cultural experience

Everyone knows the rules and everyone plays by the same rules

If you don’t-everyone also agrees that you aren’t playing by the rules

little confusion or conflict symbols, behaviors & relationships are perceived in the same way by all members of the societyEveryone knows the accepted roles and how people in each role are expected to relate to each other

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Heterogeneous Society

members of many diverse subcultures with different historical and cultural experiences must interact

subcultures may have their origin in race, religion, ethnic heritage, or age

There are rules, there are different sets of rules, not everyone knows the rules

Not everyone knows when someone’s not playing by the rules, nor does everyone agree that they are or aren’t Roles and role expectations not always clear lack of shared perceptions often leads to misunderstandings, confusion, and conflict

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…….France…..

Was homogeneous

Almost entirely French people

Birth rate constant

Minimal generational conflictSocial service entitlements [mostly] workedNow-[semi]suddenly heterogeneousLarge influx of non-French people/culture/religionNot everyone is playing by the same rulesUnfamiliar to origin culture-causes conflictExtremely high birth rate of new immigrantsGenerational & cultural conflictsEntitlements no longer sustainable Slide10

Roles, Relationships, and Aging

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Older Adults

adjust to many age related role & relationship changes

Retirement

Altered relationships with adult children

housingLoss of valued possessions & friends because of relocation or deathLoss of spouse to deathLoss of health and/or independence

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Older Adults (cont.)

May resent forced retirement

May resent need to continue working

The more roles and relationships a person develops when young, the better the ability to adjust when some roles and/or relationships are lost

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Retirement

To maintain part of the role + connection with working people, many retired older adults continue to think of themselves as a part of their occupation

There are some roles from which a person cannot officially “retire”

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Parenting

Older adults do not give up the role of parent just because their children are adults

Role conflict and altered family relationships are likely to occur when older adults attempt to continue to direct their children’s behavior long after the children are adults

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Grandparenting

role of grandparent

often described as being much more fun than being a parent

Allows older adults to share their wisdom and experiences with a new generation

grandparents often under less daily stress & are not the primary disciplinarians-usually more relaxed more time to spend on nonessential activities, such as conversation and play

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Grandparenting (cont.)

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Grandchildren

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Spouse/marriage

Many older persons have occupied the role of spouse for 30, 40, 50 or more years

successful long-term marriage requires a great deal of effort

loss of this relationship triggers EXTREMELY high levels of emotional distress

Grief can be so overwhelming surviving spouse can’t continue to perform normal ADL’sWidow-surviving wifeWidower-surviving husband

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Friends

loss of friends-changed roles & relationships

Death

disability

relocationOlder persons who outlive their families and friends often feel that their lives are without purpose

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Housing

Many change housing arrangements

Choice

Necessity

smaller sale or distribution of personal possessions accumulated over a lifetime

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Health and Independence

lose health and independence

lose control over their own destiny

at the mercy of others (either family or strangers) for care and sustenance

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Nursing Process for Dysfunctional Grieving

Grief is a strong emotion

A combination of sorrow, loss, and confusion that comes when someone or something of value is lost

Can come in response to the loss of a person, role, relationship, health, or independence

Dysfunctional when the person has an exaggerated or prolonged period of grief

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Nursing Interventions for Dysfunctional Grieving

Establish a trusting relationship to encourage verbalization of feelings regarding the change or loss

Assess the source and acknowledge the reality of the grief

Encourage older adults to participate in activities of daily living

Identify sources of support

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Nursing Process for Social Isolation and Impaired Social Interaction

Social isolation, the sense of being alone, is a common problem among older adults

A result of many factors and can be unintentional or intentional

The more people are separated from family and friends, the greater the likelihood of social isolation will be

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Assess reason[s] for social isolation

Promote social contact and interaction

Spend one-on-one time with the person

Initiate referrals

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Nursing Process for Social Isolation and Impaired Social Interaction (cont.)Slide26

Maintaining Social Contact

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Nursing Process for Interrupted Family Processes

concern or confusion related to a change in roles or relationships

Assess family dynamics

Alterations in family processes can occur at any age

most common when an aging family member becomes dependent

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Nursing Interventions for Interrupted Family Processes

Assess interactions between older adults and their families

Encourage all family members to verbalize their feelings

Assist family members in identifying personal and family strengths

Encourage family members to visit regularly

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Nursing Interventions for Interrupted Family Processes (cont.)

Encourage the family to assist in care of older family members

Assist families in identifying factors interfering with normal interactions

Explore community resources

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Chapter 13

Coping and Stress

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Normal Stress and Coping

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Physical Signs of Stress

“Fight or Flight”

Cardiovascular signs

heart rate and amount of blood ejected from the heart during each contraction increase

Respiratory signsrate increases & bronchial passages dilate during stress to allow increased oxygen exchangeMusculoskeletal signsMuscle tension in the back, neck, and head increases with stress

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Physical Signs of Stress (cont.)

Gastrointestinal signs

Peristalsis & production of digestive enzymes decrease

Urinary signs

Decreased urine production but increased frequencyCognitive signsMild stress-increased state of alertnessSevere stress affects problem-solving ability“frozen”

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Physical Signs of Stress (cont.)

Emotional signs

Fatigue, tension, anxiety

Severe stress- people may have signs of clinical depression or even verbalize suicidal thoughts

Behavioral signsSome avoid all interactions or tasks that might increase their stress levelsome take on additional duties in an attempt to block out or distract themselves from the source of their distress

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DSM-IV-TR Symptoms of Depression

Changes in appetite

&

weight- < or >

Disturbed sleep - < or >Motor agitation or retardationFatigue and loss of energyDepressed or irritable moodLoss of interest or pleasure in usual activitiesFeelings of worthlessness, self-reproach, guiltSuicidal thinking or attemptsDifficulty with thinking or concentration

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Goals of Treatment for Depression

Decreased symptoms of depression

Reduced risk for relapse and recurrence

Improved quality of life

Improved medical health status

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Stress and Illness

both mental and physical illness cause stress & stress increases the risk for both mental and physical illness

Decreasing stressors or level of stress can prevent illness or improve a person’s ability to cope with existing illnesses

Stress has been shown to have negative effects on many body systems

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Stress and Illness (cont.)

Coping mechanisms are neither good nor bad

become dysfunctional when used excessively or inappropriately as a way of avoiding dealing with the stressors

Many different coping or defense mechanisms are used as part of day-to-day living

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Substance

Abuse

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Stress and Life Events

Although stress can cause physical illness, physical illness also increases stress

Stress can increase as a result of loss—the loss of friends, family members, and particularly a spouse can be highly stressful

Other life events, such as a change in residence or financial worries, can also contribute to stress

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Stress Reduction and Coping Strategies

Problem-focused coping strategies

Attempt to change or eliminate the stressful event or

threat

Very difficult because people often get “tunnel vision” and can only “see” their stressor and feel trapped-can’t see a way out. [self effacacy]Emotion-focused strategies Attempt to change the person’s response to the stressful event or threatOne effective way of reducing stress is to avoid or escape the stressor(s)

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Stress Reduction and Coping Strategies (cont.)

When stressors cannot be avoided, when their personal significance is high, or when the person believes he or she can affect the outcome, other methods can be used

Confrontational methods

Cognitive methods

Problem-solving methods

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Nursing Process for

Ineffective Coping

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Assessment

Does the person verbalize feelings of tension, stress, frustration, or depression?

Does the person complain of changes in eating habits?

Does the person complain of changes in bladder or bowel elimination patterns?

Is the person experiencing changes in sleep patterns?

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Assessment (cont.)

Does the person have difficulty making decisions or solving problems?

Does the person appear agitated, aggressive, angry, or hostile?

Is the person depressed or withdrawn?

Does the person smoke or consume alcohol excessively?Has the person experienced an increased frequency of illness or accidents?

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Nursing Goals/Outcomes

Communicate feelings of stress

Identify personal strengths and effective methods of coping

Participate in decision making

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Nursing Interventions

Maintain continuity of care to develop a stable, trusting relationship

Encourage older adults to verbalize their feelings

Ensure that older adults receive adequate nutrition, rest, and pain

reliefOptimal ability to focus & functionAssist older adults in identifying personal strengths and previously successful coping strategies

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Nursing Interventions (cont.)

Explain a variety of stress-reduction techniques

Encourage older adults to participate in activities

Consult with mental health specialists, ministers, or counselors

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Nursing Process for

Relocation

Stress Syndrome

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Nursing Goals/Outcomes

Recognize the reasons for the move or change

Identify ways to maintain control and decision-making powers in the new environment

Verbalize concerns about new living arrangements

Identify methods for coping with change

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Nursing Interventions

Encourage verbalization of feelings, fears, and concerns about the move or change

Discuss the reasons for the move or change

Include older adults in care planning

Encourage a positive attitudeMaintain continuity of care to enhance feelings of trustReference familiar objects and belongings

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Chapter 14

Values and Beliefs

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Values and Beliefs

Values and

beliefs-

origins in

individual’s religion, philosophy, family, culture & societyAffect all aspects of lifeplay an important role in promoting health and coping with illnessmost values well-established by 10 years oldSub-generation dependentSub generation=increments of a generationBoomers-very different experiences Grew up in 50’sGrew up in 60’sGrew up in 70’s

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Values and Beliefs (cont.)

Values & beliefs-the glasses through which you see the world

use

this structure as a filter by which they judge other people and events

Misunderstanding & conflict occur when people with two different or contradictory sets of values interactDemocrat vs Republican vs Libertarian vs Green….

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Common Values and Beliefs of

Older Adults

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Economic Values

Many of today’s older adults were strongly affected by the Depression of the 1930s

They were taught the value of a dollar and to “waste not, want not

”

FrugalNot consumer drivenGREW UP BEFORE CREDIT CARDS…..Pre pension, pre social securityMay experience intense feelings of shame if forced to accept charityMany even considered social security charity

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Economic Values (cont.)

May save or

hoard-

even items that present health

hazardsvalue saving rather than wastingstore excessive number of personal belongings Clutter- safety hazardrefuse to see a doctor or wait until seriously illconcerned about the costGrew up without insurance, paid cash for med careLimited savings

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Older adults grew up in a more affluent world and are more likely to value material possession and spend rather than save.

True

False

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Intrapersonal Values

raised

valuing respect and

obedience

cannot understand why their families do not automatically accept what they say & follow directionsThe more divergent the values of various family members, the more likely there are to be misunderstandings and conflict

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Cultural Values

Shared cultural values

define

authority

structure establish norms for language and communicationestablish a basis for decision making and lifestyle choicesA heterogeneity of cultures creates a vibrant and dynamic society, but also creates many opportunities for prejudice and misunderstanding

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Cultural Values (cont.)

Many older adults have lived in this country for years but still identify more with their ethnic group or country of origin than with the dominant society

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Spiritual or Religious Values

Spirituality-recognition

that there is a relationship between the person and

something greater than ourselves

These beliefs give meaning to life and to all the positive and negative experiences that occur during a lifetime

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Spiritual or Religious Values (cont.)

Many of today’s older adults were raised in an organized religion that played an important role in the formulation of their values and beliefs

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Nursing Process for

Spiritual Distress

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Assessment

What is the person’s cultural background?

Does the person have any specific cultural or religious beliefs related to health?

Is religion or belief in a deity a significant factor in the person’s life?

Does the person attend religious services regularly?What is the person’s religious denomination, sect, church, etc.?

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Assessment (cont.)

Does the person have a preferred spiritual counselor? Does he or she see this person regularly?

Is the person interested in talking to a priest, minister, rabbi, or other spiritual advisor?

What religious books or symbols are meaningful to the person?

Has aging or illness had an impact on the person’s beliefs, values, or spiritual practices?

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Nursing Goals/Outcomes

Identify and verbalize sources of value conflicts

Specify the spiritual assistance desired

Discuss values and beliefs regarding spiritual practices

Express feelings of spiritual comfort

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Nursing Interventions

Determine whether there are special spiritual practices and/or restrictions

Identify significant persons who provide spiritual support

Determine whether there is any way that nurses can aid older adults in meeting their spiritual needs

Provide opportunities for the person to express spiritual needs and concerns

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Nursing Interventions (cont.)

Determine spiritual objects that have meaning to the person; obtain these objects, if possible

Provide opportunities for spiritual guidance with due respect for privacy

Encourage contact with a spiritual counselor in times of crisis

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