85-year-old woman, Helmi, has widowed recently. Her adult daughter lives far away, the distance is 400 km. Helmi lives in a rural area, in a remote aging village, from which to the centre of the nearest village is 20 km. An elderly neighbour lives nearby and visits Helmi weekly.
Previous home care visits have been made a month earlier by a home care nurse. Necessary diagnostic examinations have been carried out after the home care nurse identified Helmi’s forgetfulness and difficulties to follow conversation. Helmi has been diagnosed with Alzheimer’s disease and a medication has been started on it. This is a home care visit where Helmi’s daughter, a nurse and a nurse student are present. The aim is to assess Helmi’s psychosocial well-being and managing at home.
Helmi does not yet have any home care services. Until now, she has independently coped with her daily activities. She wants to live at home, where she has been living more than 60 years.
At the meeting, Helmi seems depressed and tearful. She perceives life as meaningless. Helmi says, that the days are always repeated similarly, there are no friends and no relatives, everyone has passed away. She says, that the only close ones are Otto, her neighbour, and a daughter, even though she has a life of her own. In the conversation it turns out that Helmi experiences her days long, she is also scared to be home alone, but she insists that her own home is the best place.
The nurse and nurse student gather information of Helmi’s psychosocial well-being and managing at home by discussing and observing following:
- Helmi’s mood and presence of depression (applying GDS-15)
- The loneliness experiences (applying Perceived loneliness -scale)
- Hearing the daughter’s concerns
Remind the goals.
Emotion phase:
• Ask about the feelings during the exercise: first the client and daughter, then the nurse and nurse student.
Fact phase
• What happened – describe what happened step by step.
• What went well?
• Feedback from observers on verbal and non-verbal interaction and critical activities.
Analysis phase
• Why specific decisions were made?
• How it should / could be done (ideas are generated by students, the tutor leads to the conclusions)?
• What to do to make it better?
• Students’ questions.
• What do you remember from the exercise (each student says 1 item – preferably everyone should say something different)?
• What should happen (select 3-4 items here that should always be discussed with students regardless of whether they happened or not)?
• Point out step by step what the students’ behavior should look like – exemplary.
• Motivate students to think reflectively while deceiving strengths and correct paths.
Cultural competencies
• How was the client encountered as an individual? How the client’s rights were taken into account?
• How the nurse demonstrated cultural sensitivity in interaction with the client?
• How the client’s experience of loneliness was handled during a home visit?
• How the role of a family member was realized and taken into account during home visit?
TOPIC
Older person’s coping in a changing life situation: loneliness
PREBRIEFING
Introduce:
– scenario topic
– the procedure that will be practiced in the scenario
– prerequisites (what the student should know)
– learning outcomes to be realized
– what the division of tasks will be
– scenario execution time
REFERENCES, MATERIALS FOR CLASSES
- WHO: Social isolation and loneliness among older people: advocacy brief. https://www.who.int/publications/i/item/9789240030749
- Alzheimer’s society UK. The Dementia Statements and rights-based approaches. https://www.alzheimers.org.uk/dementia-professionals/dementia-experience-toolkit/dementia-statements-and-rights-based-approaches
- The 15-item geriatric depression scale GDS-15:
https://geriatrictoolkit.missouri.edu/cog/GDS_SHORT_FORM.PDF - Perceived loneliness, loneliness questions: https://fetzer.org/sites/default/files/images/stories/pdf/selfmeasures/Self_Measures_for_Loneliness_and_Interpersonal_Problems_UCLA_LONELINESS.pdf
PREREQUISITES
- Theoretical studies of gerontological nursing.
- The student has knowledge of changes in the functional capacity of older people.
- The student has the ability to encounter the older person and interact with him/her.
INTRODUCTION
Same client, as in scenario 1. 85-year-old woman, Helmi, has widowed recently. Her adult daughter lives far away, the distance is 400 km. Helmi lives in a rural area, in a remote aging village, from which to the centre of the nearest village is 20 km. An elderly neighbour lives nearby and visits Helmi weekly.
Previous home care visits have been made a month earlier by a home care nurse. Necessary diagnostic examinations have been carried out after the home care nurse identified Helmi’s forgetfulness and difficulties to follow conversation. Helmi has been diagnosed with Alzheimer’s disease and a medication has been started on it. This is a home care visit where Helmi’s daughter, a nurse and a nurse student are present. The aim is to assess Helmi’s psychosocial well-being and managing at home.
Helmi does not yet have any home care services. Until now, she has independently coped with her daily activities. She wants to live at home, where she has been living more than 60 years.
At the meeting, Helmi seems depressed and tearful. She perceives life as meaningless. Helmi says, that the days are always repeated similarly, there are no friends and no relatives, everyone has passed away. She says, that the only close ones are Otto, her neighbour, and a daughter, even though she has a life of her own. In the conversation it turns out that Helmi experiences her days long, she is also scared to be home alone, but she insists that her own home is the best place.
The nurse and nurse student gather information of Helmi’s psychosocial well-being and managing at home by discussing and observing following:
- Helmi’s mood and presence of depression (applying GDS-15)
- The loneliness experiences (applying Perceived loneliness -scale)
- Hearing the daughter’s concerns
CURRENT CLINICAL CONDITION
85-year-old woman, has widowed recently, lives alone in a rural area. Adult daughter lives far away. Neighbour visits weekly. Client has been diagnosed with Alzheimer’s disease and a medication has been started on it. Client does not yet have any home care services. Until now, she has independently coped with her daily activities. She wants to live at home. Client expresses feelings of depression and loneliness.
INTERVIEW
The students’ gather information of client’s psychosocial well-being and managing at home by discussing and observing following:
- Client’s mood and presence of depression (applying GDS-15)
- The loneliness experiences of the client (applying Perceived loneliness -scale)
- Hearing the daughter’s concerns
