Psychiatric Discussion Board Assessment
Respond to these 3 discussion board posts in 4 different responses, do not combine the four.. 2 references for each. APA 7the required. Do in-text references in APA
The resilience of a dying patient
I had a few experiences with geriatric patients dying. As a new grad nurse, I worked in a small community hospital with many aging patients. There was a time that the patient in her 90’s, has stopped eating and drinking. The IV fluid is keeping her hydrated currently. This patient had dementia and has stopped responding to any verbal stimuli. She was still able to have a handgrip but very weak. The family had a dilemma if they sign her POLST to DNR and start her in comfort measures. This patient has a big family, and they were waiting on the oldest son to make the final decision. They were playing chants and put beads in her hand. They were praying so will stay alive. We gave the family the time and privacy to make their decision. The final decision was to put the patient on a morphine drip and wait for her to pass. I remember this patient because after we start the morphine drip, she stayed alive for three more days. She was on the cardiac monitor during her last moments since her respiratory rates are going down, and a pulse is barely felt. She was on the machine fighting until she became asystole and died peacefully.
Zanatta et al. (2019) stated that resilience results in multiple factors protecting individuals from the negative effects of stress and adversity. It is also defined as the responses a person or group gives to a traumatic and challenging circumstance. Some researchers said it is a personal strength originating from previous experiences and social support throughout a demanding and stressful period (Zanatta et al., 2019). According to Novotney (2018), most older adults have more stable health than younger adults, but physical and cognitive changes can challenge them. One concern is higher drug use or substance abuse.
Working with this age group has its wonders and struggles. I treat all my patients equally, and working with the elder is a tough job. Many fight to keep themselves alive; even with so many comorbidities, I have seen some of the strongest elders. The resilience would depend on the situation, but you can see them trying to get well, and they do not lose hope even with an acute hospitalization. The concern would be when the family does not accept the wishes of the patients. It is very conflicting since some still have the cognition to decide for themselves. Acceptance of a situation where a loved one is dying is a difficult transition.
My burning question is, “In the future, do you think the PMHNP will be utilized for both med management and therapy?” I asked this since additional training should be acquired to be a therapist, and most employers hire PMHNP’s for medicine management only. With my preceptors, I also found out that some of them were not required to do therapy or did not have a chance to experience it. One of my preceptors has her practice and does therapy. It has been on the back of my mind since we started this program back in May. I know the answer will vary, but I would like to know the thoughts of my classmates. I would appreciate the insight.
Novotney, A. (2018). Working with older adults. Monitor on Psychology, 49(11).http://www.apa.org/monitor/2018/12/working-older-a…
Zanatta, F., Maffoni, M., & Giardini, A. (2019). Resilience in palliative healthcare professionals: A systematic review. Supportive Care in Cancer, 28(3), 971–978. https://doi.org/10.1007/s00520-019-05194-1
SEXUAL ABUSE OF ADULTS
Sexual abuse is described as “nonconsenting sexual contact of any sort” is said to be the most concealed form of elder abuse and is the least recognized and told type of elder exploitation. Sexual contact with any person inept of giving consent is also deemed sexual abuse. The designation of sexual abuse comprises (but is not limited to) undesirable touching and all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing (Connolly M.-Tet al 2012). There was a male nursing assistant at my facility, who prefer to clean the patient without assistance, and he was very particular about Mrs. X private area bruises. He was the only one who always discover them on the same patient; one day we ask the patient about the origin of the bruise, and she said the NA did it. We then ask her permission to place a mini camera in her room and the result was appalling. Although the NA denied all allegations prior to the recording he was exposed. Sexual abuse of older persons crosses the traditional gender, cultural, and role boundaries for victims and perpetrators. There is a risk that sexual abuse against older persons is not taken seriously since they, due to ageism, may be seen as asexual (Connolly M.-Tet al 2012). Thus, many see it as unlikely that sexual abuse may occur. This is according to Connolly et al. expressed when health professionals avoid asking older people about sexual health and refuse to believe or respond to allegations of sexual abuse. Health care system, police, and the judicial system should, according to the authors, be trained on how to handle sexual abuse of the older persons in a way that respects and protects the victim and secures evidence and documentation.
Connolly M.-T., Breckman R., Callahan J., Lachs M., Ramsey-Klawsnik H., Solomon J. The sexual revolution’s last frontier: how silence about sex undermines health, well-being, and safety in old age. Generations. 2012;36(3):43–52. [Google Scholar] [Ref list
Resilience is the process of living well in the face of challenges, trauma, tragedy, threats, or significant sources of stress. (American Psychological Association, 2012). In addition, resilience and self-compassion were noted to mediate the effect of attitude towards aging and satisfaction with life on successful aging (Kunuroglu & Vural Yuzbasi, 2021).
My experience was with Mrs. KL, an 85-year-old African American male diagnosed with mild senile dementia, hypertension, arthritis, and histories of bilateral cataract surgery. Mr. KL was a veteran who believes in the adage that “old soldier never dies.” Mr. KL believed in doing things for himself. He had a home health aide but did not allow anyone after the evening shift. He persisted in driving himself to doctor’s appointments and grocery stores. He refused to go to an assisted nursing home as suggested by his family. He believed he could do things for himself.
He has two children, six grandchildren, and five great-grandchildren. Despite his children’s insistent living in an assisted living facility, to stop self-driving and make use of a home health aide. Mr., KL remained resilient in doing things for himself. I am surprised by this patient’s kind of resilience, and I wonder if he has extraordinary power despite his age and life events.
He exhibited persistent energy and kept on moving with life. Positive energy is an attribute of psychological resilience. This type of resilience can help alleviate early symptoms of chronic diseases in active aging. However, it may not be sufficient to compensate for severe chronic conditions (Siltanen et al., 2021). Mr. KL’s attitude was motivational, but I am concerned about his safety. He has visual disturbances and still has an active driving license. On many occasions, he exhibited forgetfulness and can forget to take his medications. Still, he does not want to move to an assisted living facility. I love taking care of geriatric patients because I see them as a population that has endured the rigors of life. And that they need every support to overcome life challenges from providers, friends, and family. I remain empathic, patient, and compassionate when dealing with the elderly. However, I am concerned about him having a motor vehicle accident because of diminished cognitive reasoning and poor vision.
This patient is on various medications, including antihypertensive medication. My concern is what happens if he falls at home and cannot reach for the phone to call for assistance. Do I call adult protective services? Do I report him to the department of motor vehicles (DMV)? Or contact his children to continue to persuade him to go to the assisted living facility?
American Psychological Association (2012). Building your resilience.
Kunuroglu, F., & Vural Yuzbasi, D. (2021). Factors Promoting Successful Aging in Turkish
Older Adults: Self Compassion, Psychological Resilience, and Attitudes towards Aging. Journal of Happiness Studies: An Interdisciplinary Forum on Subjective Well-Being, 1–16.
Siltanen, S., Tourunen, A., Saajanaho, M., Palmberg, L., Portegijs, E., & Rantanen, T. (2021).
Psychological resilience and active aging among older people with mobility limitations. European Journal of Ageing: Social, Behavioral and Health Perspectives, 18(1), 65–74.
Neurocognitive Disorder: A Late-life Menace
Dementia is a neurocognitive disorder that is common in late life. It is a major cause of disability in the elderly, and does not alter the level of consciousness. However, it impairs the memory and cognitive functions, such as personality and behavior (Stahl, 2013). Individuals with dementia present with personality changes, memory loss, mood swings. Most forms of dementia are progressive and irreversible. About 30% of persons with dementia have psychotic symptoms, delusion and hallucination (Stead et al, 2011).
My encounter with a resilient demented elderly patient was when I worked in a nursing home. This particular patient had Alzheimers. She was full of life and energetic. Ignacia was in her 70’s. According to her family, she was very active in her younger years and enjoyed the outdoors. She went for her long daily walks as part of her keep-fit routine. Now, fastforward to having her in a nursing home. The disability stripped her of the ability to enjoy her daily routine. Her family reported that when the illness started, she used to wander off for hours and they would have to find her.
In the nursing home, Ignacia would always attempt to leave her room for the outside. None of the staff knew why. She would become aggressive each time she was prevented or stopped. Unfortunately, her aggression was misunderstood for psychotic symptoms. There were times she was chemically and even physically restrained with Ativan and a chair restraint. She was loved dearly by her family. Her children visited with her almost daily, and would bring the grandchildren on weekends. Although nonverbal due to the disease process, she would smile and play with them. It was during one of such visits that the family revealed how much she used to love the outdoors. Having that knowledge changed her care drastically. She was taken outside for walks daily. She enjoyed and looked forward to the walks. She became less aggressive and her response to treatment was significant.
Irrespective of the presence of negative and sometimes positive symptoms, majority of elderly person with dementia show zeal and tenacity to continue to thrive. This could be in the area of performing activities of daily living, driving, or going for walks (for those that were actively involved in outdoor activities). On social media the other day, I witnessed an elderly female driver driving her vehicle on the sidewalk. It was clear to the shocked bystanders that she had some cognitive impairment. When she got to the end of the sidewalk, she was heard asking some bystanders how she could get back on the street. One bystander was overheard saying she needed to have her license taken away because she was too old to drive. I think this is a classic example of resilience. Some elderly persons leave the home to visit a favorite spot or place, not realizing they are cognitively unable to do so. Many often go missing for this reason. When they are found, the story is always about them trying to get to a favorite place, spot or person.
My burning question:
Since we are on the topic of resilience; it is always a good thing to maintain an optimistic but realistic outlook. As a new PMHNP getting ready to venture into the workforce, how can one help a patient who requires emotional and cognitive flexibility, (finding a way to accept that which cannot be changed), in this case, mental illness?
Stahl, S. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical application. (4th, Ed.) Cambridge, United Kingdom: Cambridge University Press.
Stead, L. G., Kaufman, M.S., Yanofski, J. (2011). First aid for the psychiatry clerkship (3rd ed.). New York: McGraw-Hill
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