Therapeutic Nursing: Increasing Number Of Older People

According to Roberts (1970) older people are the whole of a generation who have survived to a certain age. They are not a deviant group or one small special section of the population. They are ordinary people who happen to have reached a particular age. There are several assumptions made about older people and their health. The first is that increasing age is always accompanied by increasing frailty and disability. As a result, the increasing numbers of older people in society are usually seen as a social and economic burden (Le Grand 1993). The second assumption is that age is that age is always accompanied by ill health. The negative images of aging and older people can be all pervasive and influence decisions about the health
and social care of older people which may not necessarily be in their best interest. As per the survey of United States census burro, in the year 2010, 30.8% of total population in Europe was older people aged over 65 years old. Among these, 8.4 percent over 75 years old and 4.9 percent were aged 80 or more than 80 years old. In the year 1990 it was 6.1% and 3.2% respectively, when the total old age population was 23% of total population. These figures prove that the old age population is increasing, and the problems related to old age as well. The first part of this assignment discusses some common issues related to old age. This part mainly focuses on the physical, mental and social problems of senior citizens. Then it goes through some reflective aspects of author. For that I pass through the theories and models of reflection also make an attempt to compare different models of reflection. Finally I examine one of my own experiences with an older person, by using one of the reflective models. Statistics shows that there will be an enormous increase in the ageing population over the next 20 year, particularly in those aged over 75, who will suffer most from illness, or some sort of disability. The population of Great Britain and most other countries is growing older and although this trend has largely been ignored for 2 centauries, it is now regarded as a major political and economic challenge for the future. This is because the last 30years seen a significant increase in the population of both number and proportion of people aged 65 and over. The greatest growth has been in those people aged 85 and over. The world population of older people over 65 will increase more than twice as fast as the total population of the world during the period 1996-2000. In every region, the population over 75 will increase at an even faster rate and those over 80 will increase faster of all. There are many health problems related to old age. As per the opinion of Hodkinson (1975) older people differ in three major ways from the young: in the type and number of diseases and accidents, in their reaction to disease and in special features to do with their background (Hodkinson, 1975). They often have a multiplicity of diseases, partly accounted for by the accumulation of non-lethal diseases such as osteoarthritis and deafness. They are more likely to fall than any other age groups, except the under-fives, often with serious consequences. (Department of trade and industry, 1995). Heart disease and stroke are particularly prevalent in old age and the majority of all deaths from heart disease and stroke occur in those aged 65 years and above.Whereas, as a recent study has shown, prevalence rates of most of the major health related behaviors such as smoking, alcohol consumption, sexual behavior and diet were commonly lower among older people (DoH central health monitoring unit, 2006). Psychological or emotional disorders in old people are too common, Older people themselves may be unwilling to seek help or reveal their feelings to others due to a fear of stigma or a lack of knowledge about the help available to them. Chronic diseases, psychological changes, malnutrition and medication can exacerbate psychological problems in the elderly. Poor eye sight, poor hearing and slower reactions all contributes to a lack of confidence and increased social isolation for some older people. Dementia and depression are the two general psychological disorders in elderly among this dementia is a higher prevalence. According to Victor (1989) it is difficult to accurately estimate the incidence of dementia within the population because of the problem of diagnosis, although unreliable evidence may lead us to believe that most of the population over the age of 65 years is ‘demented’. Aside from the physical and emotional influences accompanying aging, growing old can be a time of social and economic change. For some people in their 50s can be a rich and rewarding time where they can enjoy the fruits of their labors, hand over responsibility for their children and look forward to enjoying new tasks or activities (Gavilan, 1992). For others it may not be such a positive experience, affected by redundancy, financial insecurity, bereavement and the physical manifestations of aging. Retirement does not only affect an older person’s income but can also have a detrimental effect upon their social contact and status. Most of them consider retirement as a process of loss: loss of income, loss of status, and loss of purpose and routine. In this situation, Jerrome’s (1991) opinion sounds very relevant, he said that there seems to be a paradoxical situation where the state provides money and support for those who are considered too old for employment while those who are receiving the benefits would be happier carrying out a job of any kind. Caring older people is a challenging process, as it is different from caring a younger. When caring an older person it is necessary to observe them well to understand their feelings and emotions. Reflective thinking will help a health practitioner to achieve this. When reflection is considered as an effective tool in clinical practice, one should have a basic knowledge about the meaning of reflection. In fact, defining the terms proves challenging for anyone seeking to make clear the nature of reflection. There have been number of attempts, to define the term reflection by authors, poets and philosophers alike. Among those interpretations, a definition presented by Johns (johns 1995:24) is literally very near to the ‘word’ reflection; he explained reflection as the practitioner’s capability to evaluate, make sense of and learn through personal experience in order to secure more attractive, useful and satisfying work. Moreover, reflective practice has been developed in health care, especially in nursing, as a way of gaining and building up on that experienced knowledge. Before using Reflection as a tool in clinical practice one should (B .J. Taylor 2000:3) “throw back of thoughts and memories, in cognitive acts such as thinking , contemplation, meditation and any other form of helpful considerations in order to make sense of them and to make appropriate changes if they are required”. As per this suggestion nurses should analyze their day to day practice and secure the valuable knowledge to lighten their future practice. In other words, as an American philosopher Dewey (1963) suggested that one has to learn by doing and realizing what came of what they did.

In searching different studies and opinions about the process reflection, we can find out different opinions about the aspects, styles and ways of using reflection as a tool in professional practice. Schon (1983) offered two main aspects of reflective practice those are; being reflection on action and reflection in action. Reflection on action is a recollection process of thinking and meditating on an action with the aim of making sense of the incident and using the results to improve future doings. It would be helpful, if nurses and health care workers make this theory real in their clinical practice. But the next one, ‘reflection in action’ is quite strange and had some arguments around it. As per the opinion of greenwood (1998) reflection cannot be recognized before action. In contradiction, Reed and Procter (1993) said that, reflective thinking about a situation, which is likely to happen, in advance is an important precursor to introduce clinical leadership and supervision. In other words thinking through a particular situation may help to make a prediction and give a chance to take some precautions for a future occurring issue.

When considering the role of reflection in nursing profession, Taylor (2004) suggested that reflection can be used as a system of thinking which helps the nurses to maintain vigilance in caring especially when caring an older person. Freshwater (2002) raised almost similar opinion he said that, reflection helps to encourage a holistic, individualized approach to care. When go through these opinions, we can understand that reflection helps a lot to give good care to the patient by productively making rapid changes in the clinical approach, in other words, it provides an opportunity for a rapid and progressive refocusing of work activity (Smyth, 1992). Before I make an attempt to assess my reflective account, which has given me a different outlook about old age, I should choose one model of reflection to analyze my experience. There are few theories, help one to explore his/or her clinical experiences or some incidents in which they have taken part a role of a leader, such as Gibbs’(1988) model of reflection, Johns’ model of reflection and Driscoll’s model of structured reflection. Comparing these models, Gibbs’ and Drisoll’s(2000) models raises some questions that are focused on describing, analyzing, evaluating one personal experience and reach a conclusion, from which finally makes an action plan for the future. Though Johns’ (2002) model appears more complicated and passing through lot of self examine questions, this model fails to draw an action plan which is considered as the vital process of reflective thinking. Even though Gibbs’ and Drissoll’s models are almost same in frame work I like to choose Gibb’s model as it gives me a chance to recollect my feelings and thoughts about my experience, as well as evaluate the good and bad about it. Since we are human beings it is important that our thoughts and feelings are to be memorized and evaluated, according to Taylor (2006) humans have the ability to think and to think about passed emotions, as we are offered with the gifts of memory and reflection. I believe that Gibbs’ model has a good frame work and moreover, for me, it is easily applicable in my experience as it is straightforward in nature and it allows me to answer the questions that arise from the practicalities of my clinical experiences.

Here I make an attempt to assess one of the main issues of old age on the basis of my own personal experience. I do like to choose Gibbs’ model as a criterion to analyze it. In the first step, as per Gibbs’s model of reflection, ‘description’ of the event includes, what was the event? Where it happened? Who were with you then? What you did? And what were the results and draw backs; the description of my reflective experience is that while I was working in a psychiatric hospital in India, where I have got many different experiences with older people. I considerer all of them as my reflective accounts and it all help me to understand the old age and its complications. The incident is that, there was one patient in our ward he was about 78 years and had some psychological problems. He was very calm and quite almost every time, but occasionally he became very aggressive and violent. In that hospital, a custom was prevailing that inform relatives when a patient become very aggressive. So we used to inform his relatives when he got out of control. After meeting with his son or daughter, his condition would have become significantly normal. And he seemed very happy and comfortable with them. But when they left him there, he was again going back to a depressed mood. When I noticed this events many times I was really interested in that patient and I tried to make a good relationship with him. Finally I succeed; he used to speak with me a lot even about his thoughts and feelings. And one day he told me that he really did not have any serious psychological disorders. He was acted as a psychotic person so that he could see his family. And he told me that he really did missing them. He never liked to be there. It was one of my mind blowing experiences I encountered during my clinical practice. The reflective account I explained above point out to one of the main problems of old age which is nothing but ‘loneliness’, Social seclusion and loneliness have long been recognized as problems linked with old age (Sheldon 1948; Halmos 1952). Loneliness has been defined as an unpleasant emotion state in which the older person feels apart from others. As I completed the description of the event, I go in to the next process; ‘feelings’. In this stage one should recall the situation and try to find out that what he/she thought and felt when they went through the experience? Considering my reflective experience, there were many thoughts passed through my mind. Old age is certain for every human being. Everyone has to pass through that period. At that time I thought about his feelings. He might have been working hard to raise his children, but when he became unproductive he was thrown to the miseries of loneliness. I felt empathy to the patient because after I came to know him more I could thoroughly understand his feelings. And I thought about the reasons of the seclusion of old age. The third stage is ‘evaluation’. As per this stage I should evaluate my experience and find out the good and bad about it. When driving back my memory through my reflective experience, I can say that the main good aspect of that situation was that I could be a good listener of that man. I think he might have experienced some relief when he shared his burden of feelings with me. That awareness gave me a great amount of satisfaction. Moreover I could realize some skills which must have possessed a care worker such as patience and being a good listener, which I had never realized until then. One the other hand, there are some bad aspects too I could find out. Even though I had been working in the same department for about six months I was a little late to realise his problems, I had to find out his feeling of loneliness earlier. It shows, at that time, I have lack of ability to identify the problems of the patients. Analysis of the event is the next stage. In this stage I have to think about what sense can be made of the situation which I faced. The first sense which I could make about this incident is that the main reason of the psychological problems present in older people is because of their social seclusion and loneliness. And the important thing I learned from this incident is the severity of loneliness in older people. They would even act as insane to get rid of their loneliness. They need rather love and care than treatment. As per the Gibbs’ frame work ‘conclusion’ is the next stage. In this step I conceder my faults which I had got when I deal with that incident. In that sense I could have realised the patient’s problem of loneliness earlier. If I came to know about this earlier I could invite the attention of his relatives to this issue. Now I understand that it is necessary to mingle with them and caring them in order to make them comfortable in the surroundings of an old age home. The final and important stage is ‘action plan’. Here I should think about what I would do if I go through the same situation. Undoubtedly I would act differently because, now I know the draw backs of old age and what they are expecting from others. So if i would be in the same situation I would understand the problem of the patient earlier and help him reduce his feeling of loneliness. Next time I would find out more ways to escape the older patients from being lonely. In order to achieve this, encourage them to busy with some hobbies or learning some new skills, such as the use of the computers. I think they would enjoy learning computers and having great fun sharing their new skill. The next and important thing is that, I have to improve my communication skills. I would make sure that all the elderly inmates in my ward get communicated and listen to their problems. I will consider this as one of my important responsibilities in the clinical area, Because Duffy. K. and Hardicre (2007) suggested that Caring for the elderly patients is a necessary element of the nurse's role as well as a professional commitment. In conclusion, loneliness is the major issue of old age. It is different from solitude because older people can be lonely while living with other people such as residential care. Loneliness can be a symptom of depression but can be prevented by the encouragement of physical and mental activity and being socially active; the saying ‘use it or lose it’ cannot be overemphasised. After all, when considering this essay as my reflective writing, it helps me to secure more awareness about my caring older people. Besides that I have got a clear out look about using models and theories to analyses my experiences. Finally, this reflective thinking makes me more confident to face and deal with difficult situations.

Reference List:

Department of trade and industry; consumer safety unit (1995) home accident surveillance system: report on 1993 accident data and safety research, DTI, London.
Dewey, J. (1963) Experience and education, New York: Collier books.87-89.
DOH central health monitoring unit (1996) health related behavior: an epidemiological over view, HMSO, London.
Driscoll, J. (2000) practicing clinical supervision, London: Bailliere Tindall.
Duffy, K. Hardicre, J. (2007) ‘Supporting failing students in practice 1: assessment’, Nursing Times, 10(4): 28-29.
Freshwater, D. (2002) Therapeutic nursing: improving patient care through reflection, London: Sage.
Gavilan, H. (1992) ‘care in the community for older housebound people: institutional living in our own home?’ Critical public health, 3(4): 18-23.
Gibbs, G. (1988) Learning by Doing: A guide to teaching and learning method: Further Education Unit, Oxford: Oxford Brookes University.
Greenwood, J. (1998) ‘The role of reflection in single and double loop learning’, Journal of advanced nursing practice, 27(5): 1048-53.
Halmos, Paul (1952) Solitude and Privacy: A Study of Social Isolation, Its Causes and Therapy. London.

Hodkinsin, H. (1975) an outline of geriatrics, academic press,
London.
Jerrome, D. (1991) social bonds in later life. Social and psychological gerontology, clinical gerontology, 1: 297-306.
Johns, C. (1995) ‘Framing learning through reflection within carper’s fundamental ways of knowing in nursing’. Journal of advanced nursing, 22: 226-34.
Johns, C. (2002) Guided reflection: Advancing practice, Oxford: Blackwell science.
Le Grand, J, (1993) ‘can we afford the welfare state’? British medical journal; 307(6911): 1018-1019.
Reed, J. and Procter, S. (1993) Nurse education: a reflective approach, London: Edward Arnold.
Roberts, N. (1970) our future selves: care of the elderly, Allen and Unwin, London.
Schon, D. (1983) The reflective practitioner: how practitioners think in action, New York: Basic books.
Sheldon, J. H. (1948) The Social Medicine of Old Age: Report of an Inquiry in Wolverhampton, Oxford University Press, London.

Smyth, J. (1992) ‘Teachers’ work and the politics of reflection’, American education research journal, 29(2): 267-300.
Taylor, B. (2004) ‘Technical, practical and emancipator reflection for practicing holistically’, Journal of holistic nursing, 22(1): 73-84.
Taylor, B. J. (2003) ‘Emancipator reflective practice for overcoming complexities and constraints in holistic health care’, Sacred space, 4(2): 40-5.
Taylor, B. J. (2006) Reflective Practice: A guide for nurses and mid wives, 2nd edn. UK: Open University press, Milton Keyness.
Victor, C. (1989) ‘the myth of the woopie: poverty and affluence in later life’, geriatric medicine, (19)12: 22, 25-2