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“Don’t ever get old”, my client said to me as I reached for her cane. As nurses, we should understand that aging comes with a lot of changes psychologically, cognitively, physically, and emotionally. Individuals become more vulnerable as they age, and their risks for injury and diseases increase. Older adults have different healthcare needs than infants and young adults because diseases and treatments affect them differently, thus they should receive care from health providers who are specially trained in geriatrics. As a future nurse, I have to understand and know how to apply specific practices in the care of older adults. Therefore, I conducted an interview to examine the life and daily activities of older adults, to apply my knowledge of the nursing process in their care, and to build my communication skills.
Mrs. A.P. was born in 1945 in the family of a Ghanaian farmer and an Italian. She is a Christian who describes herself as someone who loves to have fun, a woman who doesn’t like to settle for comfort, hardworking, ambitious, “not so smart but I try” and friendly. All of these she learned from her parents. She never misses a Sunday or Wednesday service at life Source Church. According to Mrs. A.P., the only religious practices she indulges in is the Easter and Christmas celebration, as she believes that these celebrations remind her of the love God has for her and her family. She has 3 children and lost her husband to cancer. Her children are all living, married, and with children of their own. Mrs. A.P. reflected and talked passionately about her memories with her siblings, her love for them, how she misses them, and how they died. In the course of telling me the story, she became emotional and cried till the end of the story. She is the first of 2 children of her parents. She takes much pride in her education, graduated from the University of Virginia with a degree in business administration, and graduated from the University of Maryland with a degree in Economics. Before getting these degrees, she had worked with a lot of small businesses and restaurants because she got her first big job with a small company. She worked there for a couple of years before she left and created her own business before retirement. My client manages her financial affairs herself, but she often seeks advice from her oldest son.
“At 75 I cherish the little things that I took for granted when I was young”, said Mrs. A.P. when I asked her about the important things in life. The time she gets to spend with her grandchildren and the times when the family comes together to celebrate the holidays together are the most important to her. She has a lot of significant events that have happened in her life, but she doesn’t remember them. She states her marriage as one of the events that she had vowed never to forget, hence why she has pictures of that day all over the living room and in some picture books on the bookshelf: “This is one day I wish to relive again”. As a person that hates surprises, Mrs. A.P. talked about the day her husband proposed to her and how she didn’t see it coming. She talked about the smile her father was wearing on his face when her husband got down on a knee and how it made her feel like her life had a purpose. However, losing her husband to cancer changed her life negatively. According to Mrs. A.P., his death was unexpected: “I always thought he would be here forever or I would go before him not him before me”. This changed her life as she started to do activities alone that they did together, which made loneliness and depression set in. The shock of his death has made her a daily visitor to the clinic nearby because she doesn’t want any health surprises.
Moreover, Mrs. A.P.’s children and grandchildren help her with grocery shopping, getting to appointments, and getting her prescriptions filled. She has a car of her own but doesn’t drive like she used to because of fear of road rage and her age. Whenever a worry or a difficult situation presents itself, she tends to call her oldest son to help, otherwise, she attends to it without help from anyone. She lives alone but gets visitors often. She is very independent and attributes the reason to always eating organic fresh foods and a little exercise, which made her strong over the years. Mrs. A.P.’s son moved her to a smaller house for fear that she might fall when climbing the flight of stairs that the other house had. He placed rugs in almost every part of the house, rails in the bathroom, a high toilet seat, perfect lighting, and space to reduce safety hazards and falls.
Mrs. A.P.’s typical day after breakfast, she reads a newspaper she finds on her lawn, watches TV, walks to her neighbor’s house who is also her friend, then returns to make dinner and watch some more TV. When her grandkids visit, she changes her schedule to revolve around them. She gets with her family at least 3 times a week, but they speak to her every day on the phone. To pass time, she reads books or newspapers, visits friends, and cooks. She loves to cook and wishes she had opened a restaurant where the chefs would use her recipes. She sees herself as that much of a great cook.
Furthermore, Mrs. A.P. defines health as a state of all-around well-being. Health to her means the presence and absence of sickness or anything that affects you as a person. In comparison to other adults her age, she feels she is doing better physically and mentally. She isn’t perfectly healthy but with her age comes a lot of obstacles health-wise that she has overcome or hasn’t experienced. Mrs. A.P. reports not having any difficulties performing instrumental activities of daily living, even though she uses a cane as she leaps. She gets constipated now and then with painful defecation because she doesn’t remember to always drink water, which is why she sees a doctor often. In the past, she was diagnosed with anxiety just months after the passing of her husband. Also, she talked about having trouble falling asleep. She takes over-the-counter laxatives that her son buys for her anytime she notices constipation.
In this stage of her life, Mrs. A.P. has become reserved. Aside from visiting her friends, grandchildren, and her children, grocery shopping with the grandkids, doctor appointments, and attending family birthday parties, she enjoys her alone time. She loves the amount of time she has had since retirement. She doesn’t have to answer to anybody, she gets to wake up when she wants, plan her own schedule and execute it however and whenever she wants. Compared to her younger years, she is very happy and satisfied with her life except that she still feels sad about her husband’s death: “I live for my grandchildren and my children, they bring me so much joy”. Mrs. A.P.’s future plan or goal is to live a healthy life to the end.
Before this interview, I had been concerned about how my interviewee would react to the questions I had for her. Initially, I felt that she might not want to reveal a lot of information for fear of an invasion of privacy. In this period of the coronavirus, where people are being stigmatized after being sick, I felt that my interviewee might feel judged after telling her story. My major concern was that she was going to cancel the interview with me, and this made my anxiety level go up a little. During the interview, I was most comfortable when she was telling me about herself and her family. She talked about them with so much happiness and joy, smiling from ear to ear, you could tell how much love she has for them. When she spoke about her education and the jobs she had before retirement, I was comfortable here because I could relate to her. I believe knowledge is power and anybody that possesses it can rule the world if they choose to put it to good use. The way she spoke about her jobs and how she did anything to make sure her children went to good schools made me feel like I had to take up some responsibility in my life and this made me really comfortable. The area that made me least comfortable was when she spoke of the death of her husband. Anytime she mentioned her husband, this cloud of sadness engulfed the environment and she cried. I felt really bad because I was bringing up emotions that might have been buried or put aside. Although I offered my condolences and tried to comfort her, it still made me uncomfortable.
In a second interview, I would make the plans ahead of time in anticipation of disappointment. I would ask more questions that would make the interviewee feel safe and know that it is okay to open up. I would provide more privacy and create a good interactive field. I would provide some health promotion and education to enlighten my interviewee about some diagnosed health issues or ways to prevent those health issues.
Based on the interview data I collected from Mrs. A.P., my first nursing diagnosis is constipation related to decreasing in oral fluid intake as evidenced by painful defecation. My second nursing diagnosis is insomnia related to emotional discomfort, as evidenced by verbal reports of difficulty falling asleep. With the diagnosis of constipation, I would provide some interventions to my interviewee. I will teach and advise her to increase her intake of oral fluid to at least 8 glasses every day, this would prevent constipation and soften the stool. Also, I would advise her to increase her intake of dietary fiber because this would add bulk to the stool and make it easier. With the diagnosis of insomnia, I would encourage daytime physical activities and advise her to avoid strenuous activities at night time. This is because therapeutic activities can induce sleep, while strenuous activities increase stress and cause trouble falling asleep. Moreover, I would advise her to avoid taking daytime naps, as napping can change her normal sleep pattern.
Caring for older adults can pose a challenge because of the changes in their bodies due to aging. This interview will influence my nursing practice immensely. I am now aware that being in good health as an older adult is more than taking medications. They also require support to keep them going and give them hope. One of the specific practices I will include in my care for older adults is to assist with necessary good hygiene and also encourage self-care with activities such as hair care, mouth care, dressing, and bathing. I will collaborate with other healthcare professionals to provide information and excellent care to the patient and family. I will encourage the use of support systems such as family, friends, and pets. I will assess their swallowing ability to prevent aspiration. Ensure that the living environment is free of clutters or potential safety hazards to prevent falls or injuries. Discourage excessive napping in the daytime to promote a good nighttime sleep pattern. Include the patients and their families in the care plan to aid in speedy recovery.
Given these points, it is evident that my nursing practice toward older adults has been positively impacted by this interview. As nurses, our goal towards older adults is to assist them to be functionally independent and promote the patient to return to normalcy. I learned that medications and other treatments affect older adults differently than young adults, so as nurses we should be mindful of the pharmacological care, we render to them. By conducting this interview, I was able to build on my communication and interpersonal relationship skills. In my future nursing practice, I will actively listen to the concerns of my patients, build trust and rapport, and work towards goals that would benefit the patient. I have also learned that being sensitive to my patient’s experiences will make communication less challenging. Moreover, I am certain that the knowledge I gained from this experience would facilitate a positive contribution to my future nursing practice.
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