Examples Of An Elderly Interview

Elderly Interview
Yvette Rivera
Professor Buckman
N461 Summer 2014 Ms. Leiva is a 65 year old female born and raised in El Salvador. She immigrated to the United States in the 1960’s. It’s obvious Ms. Leiva overcame many adversities, from growing up in a broken family to teenage pregnancy to moving to a new country at a young age. Ms. Leiva speaks English very well and works as a Licensed Vocational Nurse at Solheim Lutheran Home, and has a second job as a hospice nurse. She currently lives in Riverside and commutes to Eagle Rock 4 to 5 days out of the week for work and is passionate about helping the elderly. She started at Solheim Lutheran Home in 1980, in the laundry department and followed her dream of becoming a nurse.
That dream became a reality in 2001. Ms. Leiva cares so much about the residents that she often takes trips to the pharmacy for them when their family members aren’t available. A huge part of Ms. Leiva’s life is revolved around work because she has the time. The interview took place in her office at Solheim Lutheran Home.
Developmental stages In young adulthood the person is self-sufficient and able to maintain an interdependent relationship with parents and peers. This person is making decisions concerning marriage, family and possible careers. The person is self-aware and their independence and dependence behavior is balanced. Some developmental challenges that may occur during young adulthood are maladaptive coping with stressful events. The person may ineffectively deal with a crisis (maturational/situational), triggering anxiety (Stuart p.181). There are three phases in a crisis response: in phase 1 the person copes successfully or anxiety increases which leads to phase 2 where the person tries new coping methods and if this does not work the person goes on to the next phase where severe anxiety may lead to psychological disorganization (Stuart p. 181). In managing someone who lacks effective coping strategies, a thorough assessment is essential, and identifying the precipitating event and needs (self-esteem, role mastery, dependency, and biological function) of the person (Stuart p. 185). It’s important to find out the persons opinion of the event, information about their support system and their successful coping mechanisms. As a nurse we want to remove the threat and mobilize the patient’s support system and push for quick resolutions (Stuart p. 185). In middle adulthood the persons children are leaving or have left the nest, they are able to nurture independence in others, they are self-reliant and there is a decrease in demands by children which allows this person more free time (Stuart p. 385). Developmental challenges that may occur in this stage of a person’s life are interweaved physiologically and mentally. The person may experience a “midlife crisis.” The person may be divorcing, changing jobs, or moving. Those who have maladaptive emotional responses during this stage believe they have not reached their goals in life and realize their youth is limited. Maladaptive emotional responses are depression/mania, delay grief reaction or suppression of emotions (Stuart p. 320). Managing a person in middle adulthood with maladaptive emotional responses involves an “effective nurse patient-relationship, physiological treatments, expression of feelings, cognitive strategies, behavioral change, social skill building, and family and group involvement and education” (Stuart p. 320). In later adulthood, physical, cognitive and social changes occur such as atrophy of muscles, slower reactions to stimuli, skin changes, bodily systems are less efficient, cognitive performance declines, many people retire and or become widowed. The elderly may become more dependent on their children or a care take but try to maintain as much autonomy as possible (Stuart p. 385). Developmental challenges that may occur are behavioral changes due to AD, depression and memory loss (Stuart p. 420). Management includes pharmacological approaches, structured activities, reinforcement of coping mechanism and family and community approaches (Stuart p. 432).
Stuart Stress Adaptation Model The seven elements of the Stuart Stress Adaptation Model consist of predisposing factors, precipitating stressors, appraisal of stressors, coping resources, coping mechanisms, continuum of coping responses and nursing diagnoses.
Predisposing factors are biological (genetic), psychological (intelligence) and or sociocultural (age, gender, background) in nature (Stuart p. 48). An example of a sociocultural predisposing factor is Ms. Leiva’s move to United States at age 17. Her cultural background differed from the norm and her level of social integration or relatedness was low. Precipitating stressors may differ in nature, or originate differently, timing is unique, and in number (Stuart p. 48). Precipitating factor is defined as “stimuli that are challenging, threatening, or demanding to the individual” (Stuart p. 48). Ms. Leiva’s immigration to the United States most likely created internal and external stressors (originate), she experienced stressors for a prolonged period of time (timing), and dealt with a number of stressors such as finding a job in a new country, taking care of a baby, learning English and working to support her family. Appraisal of stressors includes cognitive, affective, physiological, behavioral, and social responses (Stuart p. 49). Cognitively, Ms. Leiva was resilient to stress and used effective coping strategies in this time of her life. Resilient people are committed, handle challenge well, and have control. Since immigrating here she has
excelled successfully in many aspects of her life (peer relations, career, and family). Ms. Leiva had effective coping resources in place such as strong personal abilities, a somewhat available social support system (phone relationship with family), and a positive belief that she could succeed in the United States for her family’s sake. Although, she had minimal assets her first few years in the U.S., she was still able to cope adaptively with strict management of her finances. I can say Ms. Leiva has a constructive coping mechanism, she was able to resolve her anxiety in relation to the new environment and the challenges she faced in a new country as a young adult. As a student nurse my diagnoses of Ms. Leivas response to her many stressors as a young adult would be considered as adaptive. According to Stuart, “responses that support integrated functioning are seen as adaptive. They lead to growth, learning, and goal achievement” (Stuart p. 51). She was able to achieve her goal of owning a home, maintaining a successful career and she was able to provide for all of her children.
Applicability to Mental Health Ms.
Leiva’s most vivid memory of her childhood is working on a “finca” which is a coffee bean plantation. Ms. Leiva stated, “I had very little time to enjoy the wonders of being a kid because I was constantly working before and after school.” She described her childhood in El Salvador as difficult, they were a poor family and education was not a priority. Ms. Leiva’s work ethic was strong for a young child, however, she seemed to be missing a “supportive environment.” In this instance, there was an imbalance of dependence and independence among her few adult relations. In additional hardship Ms. Leiva encountered was at the age of 17, she became pregnant and her family asked her to leave. Thus she decided to cross the border with her 2 month old baby. She was facing a large amount of stressors (new country, new baby, no money) and was able to push forward, she is a resilient woman. She worked as a garment worker for years. She began taking English classes and soon after she received her GED and pursued a career in nursing. I believe her move to the United States would have affected her emotional wellbeing if she had maladaptive coping strategies. Ms. Leiva was isolated and had a weak support system, yet she was resilient enough to withstand the stress. In addition, in 2002 Ms. Leiva eldest son died at the age of 28. This was a major event in her life that could have affected her mental and emotional wellbeing as well. It could have led to depression and suicidal ideation.
However she informed me that her family was very supportive and there wasn’t a time she was alone. She was also able to talk to a psychiatrist about her sadness and looked for resources to help her cope.
Applicability to Geropsychiatric Nursing Caring for elderly patients is extremely challenging because of biological, physiological and social changes. Providing care for the elderly patient or aging patient is difficult because they generally have co-morbidities and the various drugs they are prescribed (polypharmacy) may cause atypical signs of infections or dementia. The Geropsychiatric nurse should thoroughly assess patients “cognitive, affective, functional, physical, and behavior status” (Stuart p.715). The nurse should be familiar as well as look for the 4 D’s: depression, dementia, delirium and delusions (Stuart p. 715). Treatment of the aging patient should include a therapeutic milieu, somatic therapies, and interpersonal interventions (Stuart p. 733).

References
Stuart, G. W. (2013). Principles and practice of psychiatric nursing (10th ed.). St. Louis,
MO: Elsevier Mosby.