Depression

Today I was reminded how fragile life is when a colleague phoned to tell me one of our seniors in our community had jumped from a building committing suicide. My friend was devastated. According to the National Institute of Mental Health, in the year 2000, 5,306 persons aged 65 and older died by suicide. There is great concern about the alarming numbers of older adults who suffer from depression and thoughts of suicide, and -because they are too often undiagnosed and untreated- may go on to take their own lives. The years I worked in the psychiatric hospital gave me an appreciation for the seriousness of the situation when an individual makes a statement or exhibits behavior indicating they are considering taking their life. If you encounter an individual who you think my be thinking about suicide, take that next step and ask the tough question "Are you thinking about harming yourself, are you thinking about suicide?" Asking the question is not planting the idea of suicide, the idea was already there. If the individual admits to thoughts of suicide, get help. Call the mental health services in your area, they would be listed in the yellow pages under mental health, do not delay.

Sincerity

Sometimes when I have a geriatric client that I'm interviewing and they seem cautious or hesitant, I will talk for a little while about something I saw in the news or if I notice something in their home that is important to them I will ask them if they would tell me about the item. If they continue to be cautious or hesitant I will ask them what they had for breakfast and then follow the question with how are you feeling today? Geriatric patients respond to sincerity and sometimes it is a little bit before they can make the determination that you are sincere.

Interview

Once a rapport is developed with the individual, begin the questioning with inquiries that are the less intrusive, less threatening. Have a process by which you methodically interview so that you obtain all the pieces of information. Your process will be structured according to the goal of the interview. For example in the operating room as a circulating nurse I needed to verify, the patient's name with his name band. This was accomplished by introducing myself, then the patient would respond by telling me who he was. I needed to know if the patient had eaten anything in the previous 12 hours, so I would ask when did you last eat or drink? This would be followed up with when did you last have water? That question would be followed up with do you smoke, chew tobacco or chew gum? You get the idea, very direct questions for specific pieces of information. When interviewing a geriatric patient the questioning needs to go at a slower pace for two reasons. Sometimes the patient takes more time to process what you are asking or they may need more time to formulate an answer or you as the interviewer may need additional time to listen for clues in the response to determine what the next question needs to be. The skilled interviewer learns through experience when to stick with the interview plan and when to venture to secure additional information.

Most Misunderstood Theory

The nursing process is perhaps one of the most misunderstood nursing theories, and yet one of the most effective as well as practical. It takes time for students and new nurses to understand this process, and many fight it every step of the way, until one day a light bulb begins to burn brightly.
When performing the assessment part of the nursing process for a geriatric patient it is appropriate that the nurse is purposefully respectful. Many times elderly patients are not treated with respect, are dismissed, ignored or assumed to not be in control of their mental faculties. Addressing the client as Mr. or Mrs., until you establish or gain permission to address them differently, is the first step in establishing rapport that is so important in order to establish a trusting professional relationship. Many times an elderly client is able to respond to some questions but not others. One should not assume that because there is a deficit one presentation of an elderly individual that all areas are not functioning. Even the client residing on a specialty dementia unit, often is able to convey during an interview that they feel safe, they are treated with dignity and have choices when they are unable to remember the date, name of their home or the name of the town in which they live.

Protecting those who cannot protect themselves!

More and more we are hearing in the news abuse cases of vulnerable adults. How is vulnerable adult defined? A vulnerable adult is anyone who is limited in their ability to protect, provide or speak on their own behalf. An individual who is dependent on another person to provide the necessities of living. For the month of July we have been encouraged to wear purple ribbons to increase awareness for the prevention of abuse of vulnerable adults. If you know of abuse that is happening please call Adult Protective Services in your area. Sometimes to improve living conditions for another all it takes is that call.

Introduction

I am a professional registered nurse of 34 years. I have worked in many settings including hospital setting as a float nurse, in-service director, operating room circulating/scrub nurse, doctor’s office, psychiatric hospital, home health nurse, assistant director of nursing in a nursing home and as a nurse consultant for long term care. I knew from the time I was fifteen I wanted to be a nurse and have never regretted my choice of professions. I hope to share with readers some of my experiences, trials, successes, failures, and lessons.