Introduction and Background
Many diseases and especially chronic conditions require self-care from elderly patients. However, a range of factors affects their ability to provide self-care appropriately, among the most essential of which there are social, environmental, and genetic ones. From the view of nursing, it is critical to explore the issue of self-care in elderly patients, since the mentioned services play an important role in the effectiveness of nursing care and the expected outcomes. According to Sözeri-Varma (2012), only openness and collaboration between a nurse and a patient may bring the most beneficial health improvements. Understanding the needs of the older patients and accurately estimating their ability to provide self-care is paramount to determine the type and extent of the services required to treat them. It should also be noted that in old age, there is a change in personality saturated with a diverse set of qualities (Stanik-Hutt et al., 2013). Therefore, there is a need to consider various classifications of social and environmental factors and those factors that affect the way of life of people of the mentioned age. In this regard, this paper will focus on the identification of how the selected MSN program of Nurse Practitioner aligns with the issue supported by the detailed presentation of its aspects and evidence. Ultimately, the conclusion section will summarize the revealed assumptions and specify the expected outcomes of the project proposal.
Application to Selected MSN Program Specialty Track
Speaking of the application of such an MSN program specialty as a Nurse Practitioner, it should be stated that special attention is to be paid to the specific needs of elderly patients. Stanik-Hutt et al. (2013) consider that a nurse should perceive an elderly patient in not only as an object but also as a subject. This should help in the search and development of the internal resources of a patient, contributing to his or her self-realization, self-support, and self-protection. A special role in this is played by the professionalism of a specialist in promoting health care, his or her knowledge of the gerontological and psychological characteristics of age, and the ability to determine the belonging of patients to a particular social group.
The main thesis of this paper is that the essence of self-care has gradually lost or distorted over time. It is rather important to return this original essence and develop on this basis various strategies related to caring for a person. At the same time, Sözeri-Varma (2012) argues that a specific area of competence is to be highlighted. This remains unclear about nursing but should be clarified through reflection and the development of the science of nursing. In this regard, the prospect of providing nursing health care services to people of old age should be aimed at improving the quality and expanding the availability of services. In particular, in terms of prevention along with social and medical provision: to create such conditions in society, so that older people retain their social status, remain active, and be capable of self-care as long as possible.
Nursing Issue and Supportive Evidence
The identified nursing problem for this research is the influence of social and environmental factors on self-care in elderly patients, in comparison to genetic predispositions. As it stands, over 8,300,000 elderly patients require long-term care, with over 6,000,000 patients receiving help at home (Baumann & Dang, 2013). This makes a total of over 14 million patients, and this number continues to grow. All of these patients are practicing self-care in one form or another, as the vast majority of them cannot be assisted by nurses at all times. The degree to which the elders can implement self-care is limited by their physical and mental aptitude, competence, and mobility. Social and environmental factors play a great role in enabling elders to perform self-maintenance and self-care or preventing them from doing so. Enablers, such as the availability of equipment that allows the elders to perform certain actions, often motivate self-care. This can be seen in patients with limited mobility – the availability of ramps, handles, and specialized bathrooms enable them to perform these actions with little to no outside help. This is one example of how the environment could improve self-care in elders. Lack of these specialized options and tools, on the other hand, disables the elders from administering self-care and forcing them to rely on others (Baumann & Dang, 2013).
Societal and environmental factors are interconnected, as the former often affects the availability of the latter. In many US cities, the availability of self-care measures available to the populace both inside and outside of the hospital setting diminishes the further away one is located from the administrative and financial sectors. Hospitals located in the province show a tendency to have lesser quality and availability of equipment when compared to the facilities located in the capital or major state centers (Baumann & Dang, 2013). Thus, social and societal factors, such as community wealth, affect the capability for self-care in elders.
According to data from different epidemiological studies conducted recently, only one fifth can be regarded as healthy among older people, who suffer from various diseases. Almost every elderly patient has trouble in providing self-care, be it nutrition and physical activity or medical prescriptions and specific therapy. It is significant to note the characteristic multimorbidity of this group that implies the combination of several chronic diseases that are difficult to medicate (Holden, Schubert, & Mickelson 2015). Old age is not a disease, yet it is considered that dealing with elderly patients poses the need for medical care and, what is also important, significantly increases the need for self-care with age. Self-care performance barriers are composed of various factors. The status of elderly people in modern society is directly related to their experience and depends on several factors, including the level of education, marital status, income, place of residence, occupied place in the social and professional structure before retirement, the former status, and prestige. As the reasons for the self-care problems of elderly people in society, the following are highlighted in the scholarly literature: the termination of work, the low level of pensions, the absence of other sources of income, and assistance from relatives for the majority of elderly people. In their recent study, Siabani, Leeder, and Davidson (2013) discuss that “cultural beliefs and personal values might lead to a misguided conception of self-care processes such as difficulty with adherence to a healthy diet” (p. 325). At the same time, high expenses for housing and medical service, weak adaptation to new conditions of life, the inability to raise the level of education, the lack of demand in the labor market due to age, poor health, etc. create additional difficulties.
Different situations that a person experienced in the course of his or her life becomes meaningful in connection with other situations that were experienced earlier and are expected in the future. This is what helps a person to cope with a particular situation. It is the comparison of a concrete situation with others in the temporal plan that enables a person to judge which situations can be considered stressful and in what exactly this stress is concluded (Siabani et al., 2013). Also, the correlation of a given situation with one’s life experience makes it possible to decide what are the best ways to handle the situation based on one’s life history and the general cultural context to which a person belongs to, as stated by Dickson, McCarthy, Howe, Schipper, and Katz (2013). The social level of this person opens up opportunities and at the same time puts limits on what opportunities and ways of getting out of various stressful situations at different stages of life can be used. As noted by Siabani et al. (2013), the life experience of each person composed of multiple social and environmental factors has a crucial influence on the decision making related to health, which is necessary and correct in this or that situation and context. In other words, health problems in elderly patients have a different impact on a person, namely, how he or she copes with the disease. At this point, among the stakeholders impacted by the problem, one may note a nurse, a patient, relatives, and friends of the latter, the hospital the patient belongs to, and nursing associated with geriatrics in general.
The analysis of socio-psychological problems related to self-care in elderly population conducted by Dong, Simon, and Evans (2012) regarding the different level of formation of a culture of the safety of life shows that persons with a low and a medium level more often neglect their health than those with a high level of awareness. In particular, patients with a high level of security culture were always aware of the possible impact of social and environmental factors on their health. The population with a high and a medium level of the culture of the safety of life activity is more often connects health problems with the impact of genetics. Holden et al. (2015) claim that “contextual or ‘environmental’ barriers have been studied with variable regularity and often reveal self-care difficulties due to lacking social, financial, and community resources (e.g., transportation, access to care)” (p. 134).
The geriatrics discipline that has developed in the framework of gerontology is engaged in this direction. Along with medication and health care services, elderly patients need increased attention and more careful care, since the incidence of the elderly generation is higher than that of the young. Most often, people of older age suffer from a decrease in mental abilities, such as sclerosis, marasmus, etc. that explains the complexity of the problem of organizing a network of medical and social institutions for the elderly. According to Dong, Simon, Mosqueda, and Evans (2012), the high degree of the need of the elderly for medical and social support is quite natural. In the process of aging, the adaptive capacity of the human body decreases, weakening vulnerable places in the system of its self-regulation, the mechanics that provoke age-related pathology. This partially explains that diseases in the elderly are characterized by a chronic character with the atypical course and partial exacerbation of the pathological process as well as a long period of recovery and provision of self-care services.
Another important issue is the presence of ageism. In scholarly literature, the concept of ageism manifests itself about the older age group with the lowest social status. Among young people and middle-aged people, ageism reflects a profound disregard for old age expressed in aversion to aging, illness, disability, and a sense of fear of helplessness, oblivion, and the approach of death (Dong et al., 2012). In this context, it is possible to draw a conclusion that ageism aggravates social and subsequently health care problems of elderly people. However, psychological peculiarities can also contribute to solving the life problems of an elderly client. This means that it is important for a nurse not only to know these particularities well but also to use them as a necessary potential for resolving difficulties related to self-care promotion in the elderly.
Thus, based on the evidence provided in this section, PICOT question for further research can be posed in the following way: In elderly patients, does social and environmental factors compared with genetic ones associate more with self-care problems?
To conclude, it should be stressed that social and environmental factors compared to genetic ones significantly affect self-care problems in elderly patients. However, the evidence shows that elderly patients tend to align their failure to provide self-care with social factors rather than with others. At the same time, most of the scholars also believe that contextual and social factors act as the key reasons in the mentioned issue. The expected outcomes of the proposed project refer to the identification of social, environmental, and genetic factors that influence the ability of elderly patients to care for themselves as well as the specification of the potential ways to address the issue.
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