Question

Case Study #1 Mr. S is a 79-year-old with multiple medical problems, but primarily suffering from heart disease. He is retaining fluid in his legs and feet, sometimes limiting his mobility. Mr. S has difficulty keeping his multiple medications organized and taking them as prescribed. He lives with his daughter, who is balancing the needs of her young family with her aging father. Mr. S hates burdening his daughter with his medical problems and tries to help by assisting with some of the daily house chores. He seldom leaves the house, as most of his friends have either moved away or have died. Most of the time he stays in his room to not get in the way of his daughter. Case Study #2 Mrs. M is a 90-year-old woman and has been a resident of a long-term care community since her husband died 8 years ago. Her health status is fair. She has DM2 (controlled by oral medication) and rheumatoid arthritis. At the community center, she has her own apartment, which she maintains with minimal assistance, receives one hot meal each day in a common dining room, and has access to a full range of services, such as a beauty shop, recreational facilities, and a chapel. She is generally happy in this setting. She has no immediate family nearby, and the cost of the facility was covered by a large, one-time gift from her now deceased husband. Recently, she has become weaker and has had difficulty walking, attending activities including meals, and doing some of her ADLs due to her RA.

Questions: As the NP and primary care provider (PCP) for these two individuals, compare your delivery of care for these two situations. Select a nursing theory or model for each case study, and apply their principles to these case studies.

Answer 1

According to a research in Year 1994 Older adults with self-determined motivational styles were better adjusted when they live in homes that provides opportunities for freedom and choice, whereas residents with less self-determined motivational styles were better adjusted when they live in high-constraint environment.

In the case of Mr. S he is having medical problems along with that he has to depend her daughter for each and everything. the complex of dependency works out during the old age but during the old age social isolation is a problem.

The care should be provided according to patients wish with specific precautions for independent care that let him feel self responsible and independent. He should be engaged in activities like walking, participating in social events, reading books and so on so as to get rid of the feelings of burden to her daughter and family.

On the Other Hand, Mrs M is living a competent life alone, with courage and discipline which make her unique besides her health issues. Her case can be well described by Activity theory, that describes the psycho social ageing process.

Activity theory emphasizes the importance of ongoing social activity.This theory suggests that a person's self-concept is related to the roles held by that person i.e. retiring may not be so harmful if the person actively maintains other roles, such as familial roles, recreational roles, volunteer & community roles. To maintain a positive sense of self she must substitute new roles for those that are lost because of age and type of activity should be according to her wish and not by age.

BIO PSYCHO SOCIAL MODEL- mainly involves the interconnection between the biological, psychological and social environment.

Client's physical health, emotional status and the society in which he / she leaves depends his adaptability to environment. These three will eventually leads to the acceptance of care provided and help to live a diverse life.

Mr. S- Motivational behavioral skills model can be applied, as he needs motivation and support to be cope with the feeling of isolation and be independent.

Mrs. M - Self determination theory can be applied, as she is a self determined with highly competent ideas for caring herself.