Module 14 Active Learning Guide PDF

NURS 3540 Module 14 Active Learning Guide Module 14 Active Learning Guide Chapters 34 - 35 Reading Focus Areas In the text, you will see essential boxes, such as Safety Alerts, which discuss issues related to the care of older adults. Research Highlights contain a summary of pertinent current resear...

NURS 3540 Module 14 Active Learning Guide Module 14 Active Learning Guide Chapters 34 - 35 Reading Focus Areas In the text, you will see essential boxes, such as Safety Alerts, which discuss issues related to the care of older adults. Research Highlights contain a summary of pertinent current research related to chapter topics. Resources for Best Practice provide suggestions for further information for chapter topics and tools for practice. Healthy People boxes refer to goals cited in Healthy People 2023 I. Loss, Death, and Grief 1. Discuss your feelings about death. Fear and Anxiety→ A lot of individuals are afraid of dying, both the act of dying and the unknown aspects of what happens after. This fear may be related to losing loved ones or the possibility of suffering. Acceptance and Peace→ Some people embrace death as a normal part of life and come to terms with it. Religious or spiritual beliefs that view death as a transition to an afterlife or another kind of existence frequently have an impact on this acceptance. Sadness and Grief→ Death frequently results in strong emotions of loss and melancholy, especially when a loved one has passed away. Nihilism or Indifference-> Some people have a nihilistic or indifferent perspective on death, considering it to be nothing more than the end of life with no inherent significance or afterlife. Hope and Reunification-> Death is viewed as an optimistic passage to an afterlife where people are reunited with departed loved ones and possibly a heavenly figure, especially in diverse religious contexts. Do your thoughts about death change in relation to the age of the person? Early Life and Teenage Years Young Children→ They frequently have a restricted comprehension of death. Because of fairy tales and cartoons, they might perceive it as transient or reversible. Elderly Kids and Teenagers: Start realizing that death is inevitable and permanent. They may begin to feel anxious about the death of parents and other loved ones, or they may begin to have anxieties about the unknown parts of dying. Young Adulthood→ Most young adults believe they are unbeatable and that death is far off. Their priorities are mostly on relationships, careers, lives, and personal accomplishments. But unexpected encounters with death, like losing a peer, might focus attention on mortality more acutely and instantly. NURS 3540 Module 14 Active Learning Guide Middle Ages→ Having lost parents and other senior citizens, middle-aged adults frequently have to deal with death more head-on. They might start reflecting more on their own wellbeing, impending death, and the legacy they want to leave behind. People may begin to really ponder their personal beliefs regarding what happens after death at this point. Older Age - Older Adults→ As people approach old age, they frequently see a rise in health issues and the passing of peers. This may cause one to become more fixated on death-related ideas but, more often than not, to come to terms with it. Elderly people might prioritize organizing their affairs, thinking back on their lives, and talking about their final desires. Extreme Old Age→ There may be a greater willingness and acceptance of dying. At this point, a lot of people concentrate on making sure that their relationships are in order and, depending on their beliefs, may even be looking forward to peace or reunions with loved ones who have passed away. Influences from Culture and Personality It's crucial to remember that different people's personalities, life experiences, cultural backgrounds, and religious views can all have a significant impact on these age-related perceptions. For example, a young person who has experienced life-threatening circumstances may grow in their view of death earlier than is typical. In a similar vein, a genuinely religious person, regardless of age, may always see death through the prism of their beliefs. When patients die, do you consider it a failure of the healthcare system? The healthcare system does not automatically view a patient's death as a failure. In many circumstances, death is unavoidable despite the best efforts of medical professionals; it is a normal part of life. What do you think are people’s greatest fears about death? Fear of the Unknown→ Because death is such a vast unknown, a lot of people are afraid of it. It might be unpleasant to wonder what, if anything, occurs after death. The many and occasionally incongruous perspectives that are put forward by different religions and ideologies have the potential to increase this dread. Fear of Non-Existence→ For many people, the thought of going extinct is horrifying. The difficulty of picturing a state of total non-existence following a lifetime of consciousness and experiences is the source of this terror. Fear of Pain and Suffering→ A big worry for many people is the possibility of experiencing severe bodily pain and discomfort throughout the dying process. It's normal to worry about a protracted illness or an agonizing death. NURS 3540 Module 14 Active Learning Guide Fear of Losing Control→ The ultimate loss of control is death, and many people find it extremely scary since they have no control over how or when they will pass away. Anxiety at the loss of one's own body and autonomy during a terminal disease is also included in this. Fear of Effect on Loved Ones→ People frequently worry about what will happen to their surviving family members when they pass away. Stress can be greatly increased by worries about the financial and emotional toll it will have on friends and family. worry of Living an Unfulfilled Life→ Another worry is dying feeling that one has not lived up to one's full potential or that significant things have gone unspoken or unfinished. Fear of Eternal Punishment→ Depending on one's religious views, there can occasionally be a strong and deeply established fear for those who believe in an afterlife, which is the fear of judgment and the potential for punishment. Fear of Separation→ This fear, which is linked to worries over whether or not awareness or identity survives death, is the terror of being cut off from loved ones and the life one knows. As nurses, we must deal with our own thoughts and beliefs about death before we can help someone with loss. 2. Discuss your thoughts about loss. What losses are expected as one ages? Physical Losses Strength and Mobility→As we age, our muscle mass and strength decrease, which may have an impact on our balance and mobility. Older persons are therefore more vulnerable to accidents and falls. Sensory Abilities→Hearing and eyesight are frequently declining. The aged are more likely to experience issues including cataracts, macular degeneration, and presbycusis, or age-related hearing loss. Health and Vitality→Growing older is linked to a higher risk of developing heart disease, osteoporosis, diabetes, and arthritis, among other health problems. Additionally, as the immune system deteriorates, infection resistance increases. Cognitive Memory Losses→While long-term memory may hold up well into old age, short-term memory typically deteriorates. This may have an impact on day-to-day tasks and the capacity to pick up new knowledge. Processing Speed→As we age, our cognitive processes tend to slow down, which can have an effect on our ability to solve problems and make decisions. Cognitive Flexibility→There may be a decline in the capacity to swiftly modify ideas and behaviors or adapt to novel circumstances. NURS 3540 Module 14 Active Learning Guide Losses to Society Loss of Loved Ones→Friends, partners, and peers pass away frequently as people get older. Feelings of isolation or loneliness as well as a diminished social network may result from this. Retirement→Making the move from the workforce to retirement may cause one to lose daily routine, social contacts, and a feeling of purpose or identity that was connected to their career. Independence→Loss of independence can occur as a result of cognitive and occasionally physical decline. This may make it more difficult for the person to drive, travel, or carry out everyday tasks on their own. Psychological and Emotional Losses Sense of Purpose→Retiring and losing social roles might cause people to reflect on their life's work and purpose. Self-Perception→A person's self-esteem and self-perception may be impacted by changes in their physical attributes and capabilities. Spiritual and Existential Losses Time→As people become more conscious of their own mortality and the limited nature of life, existential issues and contemplations about their legacy may arise. Are expected losses easier to bear than unexpected losses? Pros Benefits of Expected Losses → Preparation Time: People may have more time to emotionally and psychologically get ready when a loss is anticipated. This getting ready can involve accepting the inevitable loss, taking care of practical and emotional matters, and even starting the grieving process in advance of the loss. Chance for closure → Expected losses frequently present an opportunity for farewells, declarations of love, and the settling of outstanding matters, all of which can lessen emotions of sorrow and offer a sense of closure. Cons Anticipatory Grief → People who know they will soon experience a loss may experience anticipatory grief, which causes them to start mourning before the real loss happens. This may cause emotional strain and lengthen the grieving process overall. Extended tension→ Expecting a loss, particularly one that entails a protracted sickness, can cause long-term tension and anxiety, which can be detrimental to one's mental and physical well-being. Individual Variations In the end, there are big differences between people in terms of how easy they can handle a predicted or unexpected loss. While some may prefer it to the protracted suffering connected with anticipating a loss, others may find the suddenness of an unexpected loss to be too overwhelming. Various factors including as individual coping mechanisms, the significance of the NURS 3540 Module 14 Active Learning Guide loss, the existence of a comforting social circle, and past grieving experiences influence the way a loss is managed. Explain your answer to the previous question. It isn't always the case that expected losses are easier to accept than unexpected ones. The way that these losses are processed and dealt with varies depending on a number of variables, such as the person's emotional stability, their support networks, their past experiences with loss, and the specifics of the loss. 3. Differentiate between grief and mourning. Loss of any kind has the potential to trigger grief, mourning, and bereavement. Grief is the emotional response to a loss, and mourning is a socially and culturally proscribed behavior following and around the time of a loss, especially from death, such as wearing black or “sitting shiva” (Box 34.1). Bereavement is the period of time after a loss during which grief and mourning occur. Grief Loss is experienced inside as grief. It includes all of the various feelings, thoughts, and emotions that follow a loss. Bereavement is incredibly personal and differs greatly throughout individuals. It encompasses a range of emotional reactions, including confusion, despair, rage, sadness, and guilt. Grief can also have a physical effect on a person, resulting in somatic discomfort, changes in appetite, weariness, and sleep difficulties. Key Points about Grief Important Information about Grief → Grief is the private, personal processing of loss. Emotional Complexity→ There is a wide range of complex emotions involved, and they can change dramatically over time. Particular to Each Person: Individual differences exist in the length and intensity of the grieving process. Mourning Conversely, mourning is the outward manifestation of loss. It includes the norms, attitudes, rituals, and practices that a society dictates for publicly expressing mourning. Wearing particular clothing (like black clothing), taking part in rituals like funerals or memorial services, and exhibiting other forms of public grief can all be considered forms of mourning. Key Points about Mourning Social and Cultural conventions: Mourning determines how grief is exhibited in public and is impacted by social, cultural, and religious conventions. Rituals and Practices: It consists of certain exercises and customs meant to assist both people and groups in grieving and marking the loss. Adaptive Function: Mourning offers an organized method for grieving to be discussed and worked through with others' assistance, which promotes healing and reintegration into daily life. NURS 3540 Module 14 Active Learning Guide Relationship Between Grief and Mourning While mourning is the outward expression of sadness in accordance with social norms, grieving is an internal emotional process that an individual goes through. Though they function at separate levels, both are crucial to the healing process. While mourning enables societal acceptance of the person's loss and communal support, grieving lays the emotional foundation for recovery. By giving them a safe space to vent their emotions and a supportive network, grieving rituals can often assist people in processing their loss more thoroughly. 4. Identify and describe the different types of grief. Types of Grief Grieving takes enormous amounts of physical and emotional energy. It is the hardest thing anyone can do and may be especially hard for those who are experiencing multiple losses at the same time, such as while aging or after a catastrophic event such as a hurricane. The most common types of grief are anticipatory, acute, shadow, and complicated. Another type the nurse should be aware of is disenfranchised or unspeakable grief. Anticipatory Grief Anticipatory grief is the response to a real or perceived loss before it occurs—a dress rehearsal, so to speak. One grieves in preparation for a potential loss, such as the loss of belongings, moving, or knowing that a body part or function is going to change, or in anticipation of the death of a loved one. Anticipatory grief can be therapeutic if it facilitates planning and preparation for the loss, such as purposefully distributing belongings, estate planning, or preparing for burial. For others, anticipatory grief leads to increasing sleep disturbances and declines in a caregiving spouse’s self-reported health and immune health even before the death occurred, especially for those at lower socioeconomic and educational levels (Wilson et al., 2020; Wu et al., 2021). According to Pattison (1977), anticipatory grief of an approaching death (loss) also can result in psychological death, a premature detachment of others from the person who is dying (e.g., has Alzheimer’s), or sociological death, detachment of the dying person (or one facing a loss) from others, such as by cutting off relationships. In either case, the person who is facing a loss is no longer involved in the day-to-day activities of living and essentially suffers a premature loss or death. If the loss is certain but the timing is either uncertain or not occurring as expected, anticipatory grieving may be particularly difficult, not because the loss is desired but in response to the emotional ups and downs of the waiting, with the system staying in a state of disequilibrium. Glaser and Strauss (1968) describe this as an interruption in sentimental order; no one knows quite how to behave. Family and friends, and nurses as professional grievers, usually deal much more easily with known losses at a known time or in a set manner. Acute Grief NURS 3540 Module 14 Active Learning Guide Acute grief is always a crisis, regardless of the preparation for the loss. Somatic, functional, and emotional cues of distress occur in waves of varying lengths of time during the period of impact. During acute grief, preoccupation with the loss is a normal reaction and may feel like daydreaming and a sense of unreality. Depending on the situation, feelings of self-blame or guilt may be present and manifest themselves as hostility or anger: “If only I had forced him/her to see the doctor sooner!” “You did this to me/him/her and I will never forgive you.” Acute grief may lead to significant declines in the physical and mental health of all involved. It is most intense in the first 6 months and lessens over time. Many surviving spouses have been found to have significant sleep disturbances leading to impaired immune function during this time period (Wu et al., 2021). Shadow Grief Grieving takes time, but over the months the intense pain of the impact lessens as memories are reframed. However, the old memories never go away completely. Years later, shadow grief may persist (Horacek, 1991). It may temporarily inhibit some function but is considered a normal response to loss. While most often discussed in the context of perinatal death, shadow grief can occur at any age. It may be triggered by anniversary dates (birthdays, holidays, anniversaries) or by sensory stimuli, such as the smell of perfume, a color, or a sound (Carr et al., 2014) (Box 34.3). Complicated Grief Shadow grief is considered healthy and restorative, and there is only a momentary disturbance in equilibrium, yet for others the shadows are debilitating. Those who are survivors of major tragedies, war, rape, abuse, the murder of a loved one, and other horrific events also are grieving, and the “shadows” are now recognized as the complicated grief of posttraumatic stress. Complicated grief also comes in the form of acute grief that does not significantly lessen over the months and even years after the loss. Obstacles interfere with the reestablishment of equilibrium; stability is elusive. The memories resist being reframed. Issues of guilt, anger, and ambivalence toward the person who has died are factors that will impede the grieving process until these issues are resolved, and resolution is not always possible. Reactions to grief triggers are exaggerated, and memories are experienced as if they are fresh, over and over again. It may trigger a new major depressive episode or cause one to reappear (Maciejewski et al., 2016). If the depression is manifested in cognitive difficulties, it may be misinterpreted as dementia, especially in the very frail (Chapter 26). Complicated grief requires the professional intervention of a grief counselor, a psychiatric nurse practitioner, or a psychologist who is skilled in helping one cope with complicated grief. Disenfranchised Grief The grief of a person whose loss cannot be openly acknowledged is called disenfranchised or unspeakable grief. The grief and mourning are hidden, or expression would result in stigma; it is socially disallowed or unsupported (Mortell, 2015). The survivor does not have a socially recognized right to mourn. The relationship is not recognized, the loss is not sanctioned, the NURS 3540 Module 14 Active Learning Guide griever is not recognized, and public mourning is not acceptable. The death may be one that is socially condoned, such as in capital punishment. Disenfranchised grief frequently occurs when partnerships or marriages are not acknowledged by others or the relationship is secret (e.g., extramarital), and the griever may not be able tell others of the meaning or depth of the attachment (Bristowe et al., 2016). It may follow the death of an estranged family member, death caused by suicide or AIDS, or the loss of a death row inmate (Beck & Jones, 2007–2008; Jones & Beck, 2007–2008). The person in late life can experience disenfranchised grief when family or friends do not understand the full meaning of the loss (e.g., a person’s forced retirement, the death of a pet, gradual losses caused by chronic conditions). Families coping with a member who has Alzheimer’s disease also may experience disenfranchised grief when others perceive the death as a “blessing” and fail to support the griever who has struggled for years with anticipatory grief and now must cope with the actual loss. 5. Describe factors that affect the ability to cope with loss and grief. Box 34.4 Factors Influencing the Grieving Process Physical  Number and status of concurrent medical conditions  Nutritional state  Quality of sleep  Physical activity  Nature of the loss or knowledge of illness  Presence or absence of related symptoms and pain  Current and projected functional abilities Emotional  Historical coping strategies and their effectiveness  Current and past mental health, risk for decompensations  Level of maturity  Previous experience with loss or death  Immediate circumstances surrounding loss  Perception of preventability  Perceived importance of the loss  Number, type, and quality of concurrent stresses, crises, and secondary losses Social  Social, cultural, ethnic, religious, or philosophical beliefs, rituals, and influences on expectations  Availability (and geographic proximity) of support systems and the acceptance of assistance  Education, economic resources, and occupation NURS 3540 Module 14 Active Learning Guide   Unfinished business and unresolved conflicts Quality of communication 6. Describe the person most likely to cope with loss effectively. Describe the person who is least likely to cope with loss effectively. Good Copers Psychiatrist Avery Weisman (1979) described those who are more likely to deal effectively with loss as “good copers”—those who have successfully navigated crises in the past (Box 34.5). In other words, they can acknowledge the loss, understand it to the extent possible, and communicate effectively when informing others. They can maintain composure when needed and express their emotions without becoming overwhelmed. Good copers generally can use good judgment and can remain optimistic and appropriately hopeful without denying the loss. Good copers seek guidance when it is needed and use the available resources to minimize functional disruptions. Bad Copers On the contrary, those who cope less effectively have few, if any, of these abilities. They tend to be more rigid, pessimistic, and demanding (Box 34.6). They are more likely to be dogmatic and expect perfection in themselves and others, and the loss may be viewed as a failure of themselves or others. Ineffective copers are more likely to live alone; socialize little; and have few close friends, an ineffective support network, and few if any resources. They may have a history of mental illness or have guilt, anger, or ambivalence toward the person who has died or that which has been lost. The person is more likely to have unresolved past conflicts or be facing the loss at the same time as other life stressors. In some cases they will have fewer opportunities as a result of the loss. They are the persons who are most in need of sensitive gerontological nurses to recognize their need for the expert interventions of grief counselors. At the same time, nurses need support for their own frustrations when caring for poor copers. 7. Describe grief assessment of the older adult. Assessment focuses on determining the presence, absence, and details related to the factors that influence grief and mourning and the cues that differentiate good copers who may need fewer interventions from poor copers at high risk for requiring intensive support and care (Table 34.2). Grief assessment in older adults involves evaluating how they experience and express grief following a loss, which is particularly important as the likelihood of experiencing significant losses increases with age. This process can help professionals understand the intensity and trajectory of grief, which may differ significantly among individuals, especially in this age group. Various factors including cultural, social, psychological, and physical dimensions need to be considered during the assessment. Here are key components and considerations in assessing grief in older adults: Understanding the Nature of the Loss NURS 3540 Module 14 Active Learning Guide Type of Loss: Older adults may experience a range of losses, including the death of spouses, peers, siblings, or even adult children. Non-death losses such as loss of independence, health, and mobility are also significant. Attachment to the Deceased: The depth of the relationship and the role that the deceased played in the older adult's life are crucial to understanding the potential impact of the loss. Physical and Cognitive Factors Health Status: Physical health can affect grief responses. Chronic pain or illness may exacerbate grief symptoms, while grief can also worsen physical conditions. Cognitive Functioning: Cognitive impairments can complicate the grieving process, as they may affect the person's ability to process and express emotions related to the loss. Emotional and Psychological Responses Symptoms of Grief: Common symptoms include sadness, anger, guilt, anxiety, and numbness. It's important to differentiate between normal grief and complicated grief, where symptoms are prolonged and severe, interfering with daily functioning. Depression: Depression is not uncommon in older adults who are grieving. Distinguishing between grief and depression is crucial because they may require different approaches to support and treatment. Social Factors Social Support: The quantity and quality of social connections play a critical role in the grieving process. Social isolation can exacerbate grief, while a strong support network can provide significant comfort. Cultural Norms: Cultural beliefs and customs around death and grief influence how emotions are expressed and managed. Understanding the cultural background of the older adult is essential in providing appropriate support. Previous Experiences with Grief Past Losses: How the individual has handled previous losses can provide insights into their coping mechanisms and potential challenges they may face with current grief. Assessment Tools and Techniques Structured Interviews and Questionnaires: Tools like the Geriatric Depression Scale or the Inventory of Complicated Grief can help quantify symptoms and identify the need for further intervention. Observational Assessments: Observing behavior and interactions can provide clues about the individual’s coping style and state of mind. Dialogue and Narrative Sharing: Encouraging the sharing of stories about the deceased and the loss can reveal the depth of the grief and the individual’s emotional state. NURS 3540 Module 14 Active Learning Guide Professional and Self-Help Interventions Referral to Counseling: Professional help may be necessary, particularly if complicated grief or depression is suspected. Support Groups: Connecting with others who have similar experiences can be beneficial. Family and Community Support: Engaging family and community resources can provide emotional and practical support to the grieving older adult. 8. Describe nursing interventions to assist the individual experiencing loss. Provide Emotional Support - Active Listening: Create a safe environment for the individual to express feelings and thoughts without judgment. Active listening involves being present, showing empathy, and using reflective techniques to confirm understanding. - Validation of Feelings: Acknowledge and validate the individual’s feelings, whatever they may be (sadness, anger, guilt, confusion). This validation can help the individual feel understood and supported. Assess Grief Responses - Identify Symptoms: Assess the emotional, behavioral, and physical symptoms of grief to determine the intensity and the impact on daily functioning. - Monitor for Complications: Look for signs of complicated grief or major depression, which might require more specialized mental health interventions. Educate About Grief - Information Sharing: Provide information on the grieving process, including common reactions and what to expect. This helps normalize the experience and can reduce anxiety about the intensity of their emotions. - Guidance on Coping Mechanisms: Offer strategies for managing grief, such as journaling, engaging in hobbies, or staying physically active. Also, guide them on the importance of nutrition and sleep. Promote Physical Health - Physical Care: Encourage regular medical check-ups and adherence to medical treatments, especially for those with existing health conditions that can be exacerbated by intense grief. - Encourage Self-Care: Stress the importance of physical activity, balanced nutrition, and adequate rest, all of which can be compromised during the grieving process. Facilitate Social Support - Encourage Social Interaction: Motivate the individual to stay connected with family and friends. Social isolation can worsen grief symptoms. NURS 3540 Module 14 Active Learning Guide - Support Groups: Recommend grief support groups where individuals can share their experiences and feelings with others who are facing similar situations. Spiritual Care - Respect for Beliefs: Understand and respect the person’s spiritual or religious beliefs and practices, as these can be significant sources of comfort and strength in times of loss. - Facilitate Spiritual Practices: Help facilitate access to spiritual or religious services and leaders, if desired. Create a Therapeutic Environment - Ensure Safety and Comfort: Make sure the environment is safe, comfortable, and quiet, which can help the individual feel more secure and at ease. - Maintain Presence: Being consistently present and available is reassuring and can help build a trusting relationship. Plan for Follow-ups - Regular Assessments: Continue to monitor the grieving process over time to adjust care as needed and to intervene promptly if signs of worsening or complications arise. - Long-term Support: Plan for long-term interventions, especially for those who might need ongoing support (e.g., anniversary reactions, persistent complex bereavement disorder). Coordinate Care - Multidisciplinary Approach: Coordinate with other healthcare professionals, including counselors, psychologists, social workers, and chaplains, to provide comprehensive care tailored to the individual's needs. Empower the Individual - Decision Making: Encourage participation in decisions about their care and daily activities to help regain a sense of control and self-efficacy. Nurses can contribute significantly to the family during a time of loss by knowing what types of questions to ask, such as: what cultural or familial rituals are important right now? Is there anyone who should be called at this time? Would a spiritual advisor (pastor, minister, priest, etc. be of support right now? Have funeral arrangements been made? 9. What would you choose if you had the power to choose the circumstances of your death (e.g., timing, manner, care, and support)? In my home surrounded by family. What do you fear about your death? The manner of my death. How will it happen? Will it be peaceful? NURS 3540 Module 14 Active Learning Guide How would you describe a dignified death? Being put away nice. My family not fighting over anything. Not leaving any burdens for my family to resolve or take care of. How could the nurse assist you in having a dignified or healthy death? Respecting Patient Wishes - Advance Directives: Ensure that any advance directives or living wills are known, understood, and followed. These documents specify the patient's wishes regarding medical treatment and interventions. - Communication: Actively involve the patient (if possible) and their family in discussions about care preferences, end-of-life decisions, and other concerns to ensure that their wishes are respected throughout the care process. Pain and Symptom Management - Comfort Measures: Provide effective pain management and symptom relief according to the patient's needs and preferences, which may include medication for pain, anxiety, or other distressing symptoms. - Holistic Care: Address non-physical symptoms, including emotional, psychological, and spiritual distress, recognizing these are just as important as physical symptoms. Emotional and Psychological Support - Empathy and Presence: Offer a compassionate presence, showing empathy and understanding. Being there for a patient can be one of the most comforting forms of support during end-of-life care. - Support for Families: Extend emotional support to the family, helping them cope with the emotional stress of impending loss, and provide guidance on how to interact with their loved one during this time. Spiritual Care - Spiritual Needs: Facilitate access to spiritual care services, such as chaplaincy or pastoral care, according to the patient's beliefs and desires. - Rituals and Practices: Assist in arranging or facilitating religious or spiritual rituals that the patient finds meaningful. Ethical Practice - Ethical Considerations: Adhere to ethical guidelines in all aspects of patient care, including respect for autonomy, beneficence, non-maleficence, and justice. - Advocacy: Advocate for the patient's needs and wishes, ensuring that their voice is heard and respected by the entire healthcare team. Creating a Peaceful Environment - Physical Environment: Organize the physical environment to be as peaceful and comfortable as possible. This might include adjusting lighting, noise levels, and room temperature, or personalizing the space with items that comfort the patient like photographs, music, or favorite blankets. NURS 3540 Module 14 Active Learning Guide - Privacy: Maintain the patient's dignity by ensuring privacy for personal care and moments with family and loved ones. End-of-Life Planning - Discuss End-of-Life Care: Encourage and facilitate discussions about end-of-life care options, including hospice care and palliative care settings, which focus on comfort and quality of life. - Coordinate Care: Work closely with palliative care teams and other healthcare professionals to ensure that care is seamless, integrated, and consistent with the patient’s end-of-life preferences. Post-Death Care - Care After Death: Provide respectful care of the body after death, honoring any specific cultural or personal practices requested by the patient or their family. - Support for Bereavement: Offer bereavement support to the family, guiding them to resources for grief counseling and support groups. 10. Discuss the importance of addressing spiritual needs in the care of dying patients and the nurse’s responsibility in meeting those needs. The responsibility of health care professionals to assess spiritual needs during the dying process is stressed. When needs are identified, nurses are expected to ensure that the needs are addressed. The nurse is reminded of the importance of attending to spiritual and cultural rituals that are important to the patient and family as a means of comfort and support (National Coalition for Hospice and Palliative Care, 2018). At the specific direction of the patient, nursing actions may involve calling the patient’s choice of a religious leader; sharing spiritual readings that are consistent with the patient’s beliefs; reciting meditative poems and playing music of the person’s choice; obtaining religious articles such as amulets, a Bible, or a rosary; or praying. The nurse is strongly cautioned that these actions must be at the express request of the patient and may not at any time be suggested based on the nurse’s own belief system. Reminiscence is one way of putting life in order, to evaluate the pluses and minuses of life and to think about the legacies that will be left behind (Chapter 35). It is a means of resolving conflicts if possible and making final goodbyes. Learning to say “goodbye” today leaves open the possibility of many more “hellos.” For some, transcendence while dying means coming to terms with the spiritual self, with the Great Spirit, Jesus, God, Allah, or Buddha—of that which has meaning to the person. If the patient has spiritual needs, arranging for pastoral care may be offered but should never be done without the person’s permission. The nurse fosters transcendence by providing patients with the time and privacy for self-reflection and an opportunity to talk about whatever they need to discuss, especially about the meaning of their lives and the meaning of their deaths. Selfactualization and transcendence will not be possible unless the nursing actions include expert NURS 3540 Module 14 Active Learning Guide symptom management, care coordination, clear communication, and understanding the patients’ priorities comes before all other actions. Nurses seldom recognize the small things they do, routinely and unconsciously, to impart hope. The act of helping with grooming conveys a quiet belief that the person matters. Pain relief and comfort measures show that the individual’s needs are recognized and reinforces the value of the person. 11. Differentiate between palliative care and hospice care. Palliative Care Definition and Scope: - Palliative care is specialized medical care for people living with serious illnesses. This type of care is focused on providing relief from the symptoms and stress of an illness, with the goal of improving quality of life for both the patient and the family. - It is appropriate at any stage of a serious illness and can be provided alongside curative treatment. Goals: - To alleviate symptoms and discomfort caused by illness, including pain, fatigue, nausea, loss of appetite, difficulty sleeping, and others. - To address psychological, social, and spiritual issues that affect the patient’s wellbeing. Who Can Benefit: - Patients at any stage of a serious illness, regardless of age or type of illness. This includes patients undergoing treatment for curable illnesses and those living with chronic diseases, complex disorders, and life-threatening illnesses. Setting: - Palliative care can be delivered in multiple settings including hospitals, outpatient clinics, long-term care facilities, and homes. Healthcare Team: - Typically involves a team of healthcare providers including doctors, nurses, social workers, nutritionists, and chaplains who work together to provide an extra layer of support. Hospice Care Definition and Scope: - Hospice care is a type of palliative care for patients who are nearing the end of life. It is typically reserved for when a patient is considered to have six months or less to live if the disease follows its usual course, as certified by two physicians. NURS 3540 Module 14 Active Learning Guide - The focus is on comfort care rather than curative treatment, emphasizing quality of life and symptom management. Goals: - To provide comfort and dignity near the end of life, managing pain and other symptoms so that a person’s last days may be spent with dignity and quality, surrounded by their loved ones. - To support the patient's emotional, spiritual, and cultural needs and those of their family. Who Can Benefit: - Patients diagnosed with a terminal illness and generally expected to have six months or less to live. Setting: - Hospice care can be provided at home, in hospice centers, hospitals, nursing homes, and other long-term care facilities. Healthcare Team: - Also involves a multidisciplinary team that may include doctors, nurses, home health aides, social workers, counselors, and chaplains, similar to palliative care but with more focus on end-of-life support. Key Differences - Timing: Palliative care can begin at diagnosis, and at the same time as treatment. Hospice care is used when it is clear that the person is not going to survive the illness and has a limited life expectancy, typically six months or less. - Treatment Goals: Palliative care does not preclude curative treatment alongside symptom management. Hospice care stops curative treatment altogether and focuses solely on quality of life. - Eligibility: Palliative care is available to any patient without any restrictions based on the prognosis. Hospice care requires a doctor’s certification that the patient likely has six months or less to live if the illness runs its typical course. 12. Describe nursing interventions for the dying patient. NURS 3540 Module 14 Active Learning Guide 13. Differentiate between the living will (LW) and the Physicians Orders for Life-Sustaining Treatment (POLST). a. Living Wills: Key Aspects of a Living Will: Treatment Preferences: - Life-Sustaining Treatments: Specifies whether or not the individual desires treatments that could extend life in cases of terminal illness, severe injury, or permanent unconsciousness. These treatments could include mechanical ventilation, artificial nutrition and hydration, resuscitation efforts, and other invasive medical interventions. - Pain Management and Comfort Care: Indicates preferences for pain management and palliative care, focusing on comfort rather than prolonging life. Circumstances Covered: - Terminal Illness: When recovery is not expected and the illness is expected to lead to death. - Permanent Unconsciousness: Conditions such as persistent vegetative state, where the person is not aware of their surroundings and unlikely to recover cognitive function. - End-Stage Conditions: Serious, advanced illnesses where treatment is no longer effective, and the condition will progress to death. NURS 3540 Module 14 Active Learning Guide Legal and Binding Nature: - Legality: A living will is legally binding in most jurisdictions if it meets local legal requirements, such as being witnessed or notarized. - Scope: Only comes into effect under the specific conditions outlined in the document when the person is unable to communicate their healthcare decisions. Considerations and Limitations: - Specificity and Clarity: Must be clearly written to ensure that healthcare providers understand the individual's wishes. Ambiguities can lead to confusion and delays in care. - Updates and Revisions: Should be reviewed periodically and updated to reflect changes in the individual’s health status, preferences, or advances in medical technology. Purpose and Importance: - Autonomy: Ensures that an individual’s healthcare preferences are respected, even if they are no longer able to voice these decisions. - Guidance to Family and Healthcare Providers: Provides clear guidance to loved ones and medical teams, potentially easing decision-making burdens during stressful times. b. DNR or AND: A do-not-resuscitate (DNR) order is a medical directive to health care professionals and first responders to refrain from initiating cardiopulmonary resuscitation in the event of a natural death. This may be found on the institutional medical record, a POLST form, or another document that is specifically recognized by a state. The nurse is often the one to facilitate this order is always available. c. POLST: A POLST (Physician Orders for Life-Sustaining Treatment) is a medical order designed to ensure that seriously ill or frail patients can choose and communicate the treatments they want or do not want to receive in emergency medical situations. Unlike a living will, a POLST is meant to be actionable as a medical order across various settings of care — hospitals, nursing homes, and at home. It is generally used by patients who are nearing the end of life or have serious and chronic illnesses, to guide emergency medical personnel and other healthcare providers. Key Features of POLST: Specific Medical Orders: - Resuscitation: The POLST form includes directions about whether or not the patient wishes to receive CPR (cardiopulmonary resuscitation) if their heart stops beating or they stop breathing. NURS 3540 Module 14 Active Learning Guide - Medical Interventions: Details the level of medical intervention the patient wants. Options typically include full treatment, selective treatment (limiting some interventions), or comfort-focused treatment (palliative care only). - Artificial Nutrition: Specifies preferences regarding the use of tools like feeding tubes for long-term nutrition and hydration. Legally Recognized: - Authority: As a medical order, POLST forms must be signed by a healthcare provider, making them immediately actionable, unlike advance directives that are more general in intent and need interpretation. - Recognition: POLST forms are recognized and respected across different care settings within the states where they are legally valid. Accessibility: - Visibility: POLST forms are usually brightly colored (often pink) and designed to be easily noticeable in a patient’s medical records or at their bedside. This ensures they are quickly seen by emergency medical services (EMS) and other healthcare providers. Flexibility and Portability: - Updates: A POLST can be revised and revoked by the patient at any time to reflect changes in their health condition or treatment preferences. - Cross-Setting Validity: The form is intended to follow the patient through different levels of care and settings, ensuring continuity in honoring their treatment preferences. Goal of Use: - Emergency Guidance: Primarily used to guide immediate clinical decisions during a medical emergency when a patient cannot speak for themselves. - Ensures Consistency: Helps avoid unwanted or ineffective treatments that are not consistent with the patient’s health status and goals of care. II. Self- Actualization, Spirituality, and Transcendence 1. Define self-actualization and give examples that are possible for older adults. Self-actualization is the highest expression of one’s individual potential and implies inner motivation that has been freed to express the most unique self or the “authentic person” (Maslow, 1959, p. 3). The crux of self-actualization is defining life in such a way as to allow room for continual discovery of self. A critical consideration in developing self-actualization is an underlying sense of mastery and a sense of coherence in the life situation. This effort depends to a large extent on individual attributes and self-esteem. In this chapter, we hope to expose the nurse to the myriad evidence of self-actualization in old age and suggest ways in which the nurse can assist older adults in seeking their own unique way of living, growing, and making NURS 3540 Module 14 Active Learning Guide meaning. The focus is on nursing actions that may encourage older adults to seek new possibilities within themselves. 2. Describe traits of self-actualized people. Box 35.2 Traits of Self-Actualized People Time competent: The person uses past and future to live more fully in the present. Inner directed: The person’s source of direction depends on internal forces more than on others. Flexible: The person can react situationally, without unreasonable restrictions. Sensitive to self: The person is responsive to his or her own feelings. Spontaneous: The person is able and willing to be himself or herself. Values self: The person accepts and demonstrates strengths as a person. Accepts self: The person approves of self, despite weaknesses or deficiencies. Positively views others: The person sees both the bad and the good in others as essentially good and constructive. Positively views life: The person sees the opposites of life as meaningfully related. Acceptance of aggressiveness: The person is able to accept own feelings of anger and aggressiveness. Capable of intimate contact: The person is able to develop warm interpersonal relationships with others. Discuss the relationship between creativity, self-transcendence, and aging. CREATIVITY Creativity is a bridge between the growing self and the transcending of self. Creativity may be the transit mechanism between self-actualization (the reaching of one’s highest potential) and the step beyond, to transcend the limitations of ego. “Creativity has always been at the heart of our experience as human beings... this need for creativity never ends” (Perlstein, 2006, p. 5). American culture has neglected to recognize the innate creativity of older adults, who are too often viewed as debilitated, dependent, burdensome, and the focus of societal problems. Promoting health in aging is more than targeting problems and developing interventions for health promotion and disease prevention. Aging encompasses potential and problems. A focus on creativity and aging and the positive impact of the arts on health, illness, and quality of life is gaining importance in our understanding of health and well-being among older adults. The National Center for Creative Aging (https://uclartsandhealing.org/resources_pages/national-center-for-creative-aging-ncca/) is dedicated to fostering the relationship between creative expression and quality of life for older adults. The Beautiful Minds: Finding Your Lifelong Potential campaign is an initiative from the Center that focuses on raising awareness of people who are keeping their minds beautiful and on the actions people can take to maintain the brain. Research suggests that there are four dimensions to brain health: the nourished mind, the socially connected mind, the mentally NURS 3540 Module 14 Active Learning Guide active mind, and the physically active mind. These dimensions stress the importance of healthy diet, social engagement, cognitive stimulation, and physical activity to brain health. Products of creativity are less important than creative attitudes. Curiosity, inquisitiveness, wonderment, puzzlement, and craving for understanding are creative attitudes. Much of the natural creative imagination of childhood is subdued by enculturation. As individuals age, some people seem able to break free of excessive enculturation and again express their free spirit when practical matters no longer demand their sole attention. Creativity is often considered in terms of the arts, literature and music, but a truly self-actualized person may express creativity in any activity. Breaking through the habitual or traditional mode into authentic expression of self is creativity, whether it is through cooking, cleaning, planting, poetry, art, or teaching. Creative expression does not necessarily mean that the older adult has to create a work of art. Subtler ways of expressing creativity are present even in the frailest of older adults. Consider Dr. Ebersole’s description of Catherine at 100 years old and living in a nursing home (Box 35.5). Box 35.5 Catherine: Another View of Creativity Catherine was self-actualized and creative to the best possible extent. Her physical constraints were enormous: she had no material assets, her range of activity was limited to her small cubicle in a skilled nursing facility, and her body was frail. However, her spirit was strong, and she knew and used her potential. Catherine’s creativity was expressed at each meal when she rearranged, mixed, and added to her food. She carefully chopped a pickle and sprinkled it on her cottage cheese and added a little honey to her applesauce. Each meal was a small adventure. Several friends would visit regularly and bring Catherine small items she enjoyed. They could always count on being entertained with creatively embroidered tales of the past. The gifts they brought were always used in extraordinary ways. A scarf might be tied around her head. Powder, perfume, books, and other things would be bartered for favors from staff members or given as gifts. Her radio brought news of the day interspersed with classical music. Catherine created a milieu in which she enjoyed life and maintained her self-esteem. That she was selfactualized was never in doubt. Her artistry overflowed in myriad small gestures. Creative Arts for Older Adults Maximizing the use of self in the later years in unique ways might be termed creative selfactualization. Many individuals will need the stimulus of an interested person to uncover latent interests and talents. Other adults will need encouragement to try new avenues of selfexpression—some will be fitting for them and others not. Wikström suggests that art and aesthetics “help individuals know themselves, become more alive to human conditions, provide a new way of looking at themselves and the world, and offer opportunities for participation in new visual and auditory experiences” (2004, p. 30). Several ideas are presented here for nurses working with older adults to encourage creative expression (Box 35.6). NURS 3540 Module 14 Active Learning Guide Box 35.6 Ideas for Developing Creative Abilities Art Using oil pastels, create a drawing that represents self, or select three colors you like and three colors you dislike, using all six colors to create a self-portrait. Draw a representation of your world. Create a collage or mobile out of an assortment of materials and pictures that can represent subjects, such as the self, part of self you like or dislike, or the family. In small groups, use clay to create an art piece or a statement. Music Play a variety of music; focus discussion on imagery and any feelings that the music evokes. Discuss or have clients bring in music that elicits feelings of sadness, happiness, and so on. Show a picture (can be cut from a magazine) and ask members to see if they can imagine the sounds that might go with the picture. Express self or group through dance and movement to select music. Movement Create a movement to fit the way you are feeling while introducing self to group. Have members stand and initiate a slow, swaying motion (good exercise with which to end the group session). Have members mirror each other’s movements, such as hands or the entire body, creating a duet. Imagery Use guided fantasies and imagery to facilitate stress reduction and relaxation, awareness, the power of one’s own healing capability, and self-expression through symbols and symbolisms. Writing Encourage journals or diaries; set a group time available to write and share ideas. In small groups, create a group poem. Read selected poems or stories as a group, and then share reactions and feelings from the readings. Create a book to be distributed to the group consisting of a collection of members’ writings. 3. How can intergenerational activities help older adults, younger adults, and children? Describe some intergenerational programs and how they help the people involved. BRINGING YOUNG AND OLD TOGETHER Larson (2006) suggests that intergenerational programs can “help older and younger people look beyond their generational stereotypes and know each other (body, mind, and spirit)” (p. 39). Intergenerational programs can be those in which older adults assist younger people (tutoring, mentoring, childcare, foster grandparent programs); those in which younger people assist older adults (social visits, meal assistance); and those in which the young and old serve NURS 3540 Module 14 Active Learning Guide together. Benefits of intergenerational programs for younger people include increased selfesteem and self-worth, improved behavior, increased involvement and success in schoolwork, and a sense of historical and personal continuity. For older adults, contact with younger people can promote life satisfaction, decrease isolation, help develop new skills and insights, promote fulfillment, establish new and meaningful relationships, and provide a sense of meaning and purpose. Examples of such programs include Elders Share the Arts, Roots & Branches Theater company, and the Liz Lerman Dance Exchange. Recognizing the developmental significance of contact between the generations, some longterm care facilities have included children in their milieu in various ways: As residents (children with profound developmental disabilities or severe neurological disabilities): Older adults rock, stroke, and cuddle these children, providing stimulation for both. As a service to employees (daycare centers for children of employees): Older adults sometimes assist in the care and special programs for the children, such as reading stories or teaching basic skills (tying shoes, telling time). In adopt-a-grandparent programs: One child affiliates with a resident with periodic visits, cards, and inclusion of the grandparent in some special family events. Interesting intergenerational living programs in the Netherlands, France, and Cleveland, Ohio, offer rent-free living to college students in retirement and nursing homes. In the Netherlands, students are required to spend at least 30 hours a month acting as “good neighbors” by performing activities such as teaching new skills in use of email and social media, Skyping, walking dogs, watching sports, celebrating birthdays, and offering company. At Judson Manor in Cleveland, students from the Cleveland Institutes of Art and Music are integrated into the resident population. Students participate in the musical arts committee, assist staff therapists, volunteer at various events, and give quarterly performances to the residents (Hansman, 2015; Harris, 2016; Jansen, 2016). These innovative programs are featured in a short video (https://www.usatoday.com/videos/news/nation/2017/02/24/students-take-up-residenceretirement-homes/98342876/). Nurses in the community may want to explore potential intergenerational experiences that might be of interest to older adults. Area Agencies on Aging can provide information on intergenerational programs available in the community. Although there are benefits to intergenerational contact when desired by the older adult, certain pitfalls must be considered. Not all older adults will enjoy contact with children. Contacts with a very young, energetic child must be brief, or the older adult is likely to become exhausted and the benefits will decrease. In intergenerational programs, young people need consistent supervision, support, and training in the developmental aspects of old age. Similarly, older adults will benefit from education and support in understanding developmental tasks of children and effective methods of intergenerational communication. NURS 3540 Module 14 Active Learning Guide 4. How do nursing students learn about spirituality and spiritual nursing interventions? Recognizing and Analyzing Cues Assessment of spirituality is as important as assessment of physical, emotional, and social dimensions. A spiritual history opens the door to a conversation about the role of spirituality and religion in a person’s life. People often need permission to talk about these issues. Without a signal from the nurse, patients may feel that such topics are not welcome. Patients welcome a discussion of spiritual matters and want health professionals to consider their spiritual needs. The older adult may have a pressing need to talk about philosophy and spiritual development. Private time for prayer, meditation, and reflection may be needed. Nurses may neglect to explore this issue with older adults because religion and spirituality may not seem the high priority, and care focuses primarily on physical aspects. The individual should be assured that religious longings and rituals are important and that opportunities will be made available as desired. Nurses need to be knowledgeable and respectful about the rites and rituals of varying religions, cultural beliefs, and values (Chapter 4). Religious and spiritual resources, such as pastoral visits, should be available in all settings where older adults reside. It is important to avoid imposing one’s own beliefs and to respect the person’s privacy on matters of spirituality and religion (Touhy & Zerwekh, 2006). How important is spirituality in your own life? Spirituality is very important to me. I try and take out a moment in my day to say thanks or pick up my bible and read a couple verses. What activities might help develop your own sense of spirituality? Meditation, practice forgiveness and pray. How important do you believe spirituality is in the lives of older adults? I believe it is top of mind for older adults. They have lived and experienced the world. 5. Describe the nursing role regarding spirituality. An emphasis on spirituality in nursing is not new; nursing has encompassed the spiritual from its origin. The science of nursing was not seen as separate from the art and spirit of the discipline. Florence Nightingale’s view of nursing was derived from her spiritual philosophy, and she considered nursing a spiritual experience, “intrinsic to human nature, our deepest and most potent resource for healing” (Macrae, 1995, p. 8). Many nursing theories address spirituality, including those of Neuman, Parse, and Watson (Martsolf & Mickley, 1998). Nursing and medicine are beginning to reclaim some of the essential healing values from their roots. The essence of being spiritual is being whole or holistic, and attention to the spiritual needs of patients is a critical dimension of holistic nursing care. Yet surveys with practicing nurses suggest NURS 3540 Module 14 Active Learning Guide that most have had little, if any, education in spiritual care. Many nurses view spiritual nursing responses in religious terms and may feel that spirituality is a religious matter better left to clergy and religious leaders. Heriot (1992) suggested that nurses need to understand care of the human spirit both within and outside the context of religion. Goldberg (1998) asserted that the connection in the nurse-patient relationship is central to spiritual care but that most nurses are “carrying out spiritual interventions at an unconscious level” (p. 840). She called for education and research to help nurses become more aware of the importance of connection and use of self in relationships as ways of bringing the elements of spiritual care into conscious awareness. An evidence-based guideline for promoting spirituality in the older adult (Gaskamp et al., 2006) provides a framework for spiritual assessment and interventions. The guideline identifies older adults who may be at risk for spiritual distress and who might be most likely to benefit from use of the guideline (Box 35.8). Spiritual distress or spiritual pain is “an individual’s perception of hurt or suffering associated with that part of his or her person that seeks to transcend the realm of the material. 6. What factors may lead to the nursing diagnosis of spiritual distress? Box 35.8 Identifying Older Adults at Risk for Spiritual Distress Individuals experiencing events or conditions that affect the ability to participate in spiritual rituals Diagnosis and treatment of a life-threatening, chronic, or terminal illness Expressions of interpersonal or emotional suffering, loss of hope, lack of meaning, need to find meaning in suffering Evidence of depression Cognitive impairment Verbalized questioning or loss of faith Loss of interpersonal support 7. Describe transcendence and how it is expressed. Describe three ways of achieving transcendence. Describe a transcending experience/peak experience that has happened to you. TRANSCENDENCE Transcendence is the high-level emotional response to religious and spiritual life and finds expression in numerous rituals and modes of cosmic consciousness. Rituals provide a means of connecting with everyone through the ages who has observed similar rituals. These modes of thinking and feeling are sometimes unfamiliar to individuals who are immersed in the necessary materialistic concerns of young adulthood, yet moments do occur throughout life when one is deeply aware of being part of a larger scheme. Although some of the material in this chapter may be obscure, it is the springboard for learning to appreciate the full life cycle. The privilege of briefly walking alongside an older adult on the last great journey can be truly inspiring. Transcending is roused by the desire to go beyond the self as delimited by the material and the concrete aspects of living, to expand self-boundaries and life perspectives. “Transcendence NURS 3540 Module 14 Active Learning Guide involves detachment and separation from life as it has been lived to experience a reality beyond oneself and beyond what can be seen or felt” (Touhy & Zerwekh, 2006, p. 229). Creative thought and actions are vehicles of both self-actualization and self-transcendence, the bridge to universal expression and existence. Self-transcendence is generally expressed in five modes: creative work, religious beliefs, children, identification with nature, and mystical experiences (Reed, 1991). This section of the chapter deals with various mechanisms by which one transcends the purely physical limitations of existence. 8. What is hope? A feeling of expectation and desire for a certain thing to happen. How can the nurse foster hope? Box 35.14 Hope-Promoting Activities Feel the warmth of the sun. Share experiences children are having. See the crystal blue of the sky. Enjoy a garden or fresh flowers. Savor the richness of black coffee at breakfast. Feel the tartness of grapefruit to wake up the taste buds. Watch the activities of an animal in a tree outside the window. Benefit from each encounter with another person. Write messages to grandchildren, nieces, or nephews. Study a favorite painting. Listen to a symphony. Build highlights into each day such as meals, visits, Bible reading. Keep a journal. Write letters. Make a tape recording of your life story. Have hope objects or symbols nearby. Share hope stories. Focus on abilities, strengths, and past accomplishments. Encourage decision making about daily activities; foster a sense of control. Extend caring and love to others. Appreciate expressions of caring concern. Renew loving relationships. 9. What is a legacy? List five examples of legacies. LEGACIES A legacy is one’s tangible and intangible assets that are transferred to another and may be treasured as a symbol of immortality. The purpose of legacies is to supersede death. Courage, wisdom, and insights that we perceive in older adults become part of their legacy. The desire for meaning and immortality seems to be the basic motivation for leaving a legacy. Extending one’s authentic self to others can be an important activity in the last years. Throughout life, shared NURS 3540 Module 14 Active Learning Guide experiences provide satisfaction, but in the last years this exchange allows one to gain a clearer perspective on how one’s movement on earth has had an impact. Box 35.15 Examples of Legacies Oral histories Autobiographies Written or video histories Shared memories Taught skills Works of art and music Publications Human organ donations Endowments Objects of significance Tangible or intangible assets Personal characteristics, such as courage or integrity Bestowed talents Traditions and myths perpetuated Philanthropic causes Progeny children and grandchildren Methods of coping Unique thoughts: Darwin, Einstein, Freud, Nightingale, and others Application Questions or Case Studies The following case studies were retrieved from the textbook: Touhy, T. A., & Jett, K. F. (2023). Ebersole & Hess' toward healthy aging: Human needs & nursing response (10th ed.). Elsevier. Before Ernie passed away at the age of 83, his wife and two sons used a cassette player to record his stories of World War II. “The Bear,” as his wife affectionately nicknamed him, suffered from Alzheimer’s disease for about 6 years before his death related to sepsis and pneumonia. Ernie also suffered from urinary retention and had an indwelling catheter that required monthly changes by a home health nurse. Ernie was a pillar of faith in his community, where he served as pastor of a Presbyterian church for over 30 years. Along with his wife and two sons, he was dearly loved by a large family consisting of more than 40 nieces and nephews. As Ernie’s disease progressed and his memory faded, he remained steadfast in his faith and enjoyed sharing his biblical knowledge with visitors in his home. His home health nurse attended the same church that Ernie had pastored and looked forward to her monthly visits to his home because he still had a way of providing spiritual comfort to anyone around him. During her last visit to his home before being hospitalized, Ernie insisted on praying with his nurse before she left. She hesitated because she felt pressured to get to her next patient, but she paused and sat on the edge of his bed while holding his hand and listened attentively, not realizing that she would not see her patient and beloved former pastor again the following month. The home health nurse NURS 3540 Module 14 Active Learning Guide attended “Bear’s” memorial service, which became a beautiful tribute to his legacy. His tape-recorded war stories were retold, as well as stories of annual summer vacations spent with his wife, sons, and extended family visiting countless ballparks and national parks. As she listened to the service, she was thankful that she took a moment to demonstrate a spiritual response at the end of her patient’s life. 1. What is the purpose of a legacy? The concept of a legacy involves the lasting impact, influence, or contributions that a person leaves behind after they pass away. It can encompass a wide range of elements, from tangible assets and financial wealth to intangible values, lessons, and memories. The purpose of a legacy can vary depending on individual beliefs, values, and desires, but several common themes generally define why people are concerned about their legacies. 2. Did Ernie leave tangible or intangible assets? Ernie left tangible (voice recordings) and intangible (his fellowship and family memories). What specific type of legacy did he leave? Personal Possessions, Autobiographies and Life Histories. 3. During her last home health visit, how did the nurse demonstrate a spiritual nursing response? She hesitated because she felt pressured to get to her next patient, but she paused and sat on the edge of his bed while holding his hand and listened attentively, not realizing that she would not see her patient and beloved former pastor again the following month.