Life Review and Ego Integrity
Identify an older adult age 65 +, use a 1st and last initial. Execute a therapeutic assessment interview with them for at least two interview sessions assessing their self-identified:
1.Demographics, lifetime education, and career/employment
2.Two most significant (positive) times in their lives
3.What past hardship or loss has the client successfully negotiated in the past?
4.Two personal strengths
5. Engage them in identifying what is healthy versus non-healthy coping skills
6. Inquire of 2 healthy coping skills they have used in the past and/or now
7. Three (3) pieces of advice they would give to their younger self if they could?
8. Support the client in taking the Geriatric Depression Scale.pdf
9. Support the client in taking the Fulmer SPICES Assessment.pdf
10. Perform a Mini Mental State Exam.pdf and Patient_Stress_Questionnaire.pdf (use dropbox)
11. Read the Hall, Hall and Chapman article and perform the assessment within the article.
12. Report the findings from the Geriatric Depression Scale, Fulmer Spices, Patient Stress Questionnaire, and the Mini-Mental Status Exam
13. Discuss your older adult’s level of ego integrity vs. despair as described by psychoanalyst Erik Erikson. If you had to rate them on a scale of 1-10, with 1 representing a full state of despair and 10 representing full ego integrity, what rating would you give your older adult?
14. Describe at least two nursing diagnoses for this client.
15. Create a plan of care for the client to include at least three nursing goals with two nursing interventions each.
The assignment should be written in an APA-formatted essay. The essay should be at least 1500 words in length and include at least two scholarly sources other than provided materials. Please have an introduction and conclusion paragraph.
Life Review and Ego Integrity
Life Review and Ego Integrity
Course Code and Name
Life Review and Ego Integrity
Aging is irreversible when previously robust bodily functions decline in their service. An individual gets characterized by memory loss, cognitive impairment, poor hand-eye coordination, memory loss, and sometimes, sudden physiological decline. A life review addresses the quality of life the elderly would have lived, and it is recommended for patients above the age of sixty-five years. The review could be hurtful for those surrounded by shortfalls or a celebration of a life well-lived for those who would have enjoyed every waking moment. This review thus follows the life of MM and attempts to find the appropriate nursing diagnosis to ensure her elderly days are filled with joy and laughter.
MM is an African female aged eighty years old. She had basic education and dropped out of school because her parents could not take her to school. She was thus a homemaker. She was married young and had ten children, three of whom died. She is a widow and lives in the ancestral land her husband left her. She was a subsistence farmer, but her back gave way, and she did not do most bending activities. Her grandchildren keep her occupied. She has lived her life with unremarkable medical history and was only hospitalized because of her back. She was treated for other illnesses via outpatient means.
Significant times in life
The most significant times in MM’s life was when she got married and saw her children grow old. She is also proud of her children, having bore five sons out of the ten children. She is also proud of her heritage because she tells beautiful stories about the forgotten culture and traditions.
MM has buried three daughters, all of whom were very dear to her. She feels lonely, lost, and hopeless because they were very close to her, and she loved them so much. She does not understand why it had to be those particular children, given that they took very good care of her. She says her other children do not treat her well and because of that, she feels neglected. No one comes to do basic chores unless she asks them to. She cries when she speaks of her children who passed away and has a far away look when she speaks of the last one. She starts singing a dirge; it is sorrowful, painful, and hard to listen to because she channels all her pain in it.
Two personal strengths
She is disciplined because she was able to do some projects to generate a flow of cash even after her husband passed away. She revels in her achievements as a woman and as a widow. She is also disciplined because she sticks to her routine from morning to evening. She wakes up, goes through her morning routine, and proceeds to make the most of her life. She rarely moves about because her back gives her a hard time.
The respondent is also patient because she waits for me to elaborate on the questions. She does not give me a hard time and uses a gentle tone to address my questions. She expresses herself using verbal and non-verbal cues of communication. When she smiles, the warmth reaches her eyes, and when she is sad, the atmosphere around her shifts.
Healthy and unhealthy coping skills
MM identifies healthy coping skills as methods she can use to relieve the stress she experiences or her sadness. The healthy coping skills MM perceives are singing traditional songs to express her feelings, whether joyful or sorrowful. She thinks that wailing to express frustrations and let it all out is also a healthy coping skill. She also thinks that meditating is a healthy coping habit as it helps to clear the mind and find balance in tough situations.
She identified unhealthy coping skills as methods that do not lead to any resolution but may result in many unhealthy behaviors like continuous smoking, isolation, drinking that may lead to addiction, and illicit drugs. She also thinks that resorting to comfort food is an unhealthy coping skill because too much comfort food may lead to individuals adding weight and a whole lot of medical issues.
Healthy coping skills used in the past
MM has used multiple coping skills to cope with loss, two of them being singing and meditation. She chooses her song based on the emotion she feels, and most of the time, it is a sorrowful song because she lost her daughter to a stroke. She loved her so much and did not believe at first that she was gone. She sings the songs to keep her sanity and observe the tradition of coping with loss. MM also meditates because she spends most of her elderly lifestyle in a sedentary predisposition.
The advice they would give to their younger self
MM has lived a hard life, and she has several regrets. She would advise her younger self to diversify her skillset from early on to embrace change as it came. A diverse skill set would also have enabled her to get formal employment and not depend on other family members when her husband died. She realizes that she would have been able to do many things with a diverse skill set, and she regrets having missed out on the opportunity to do all of that.
MM also said she would advise her younger self not to be afraid of asking for help. She was a proud woman and saw asking for help as a sign of weakness. In so doing, she ended up burning out even before she advanced. She literary broke her back at an early age after she was widowed and had to rely on the establishments she had made. Of course, they did not sustain her entire lifestyle, but asking for help would have gone a long way to reduce the pressure she felt of being both parents to her children.
MM also says she would advise her younger self to start putting money into savings as early as possible. Saving money is a timeless skill that people have to learn right from the beginning, as it prepares one to handle any rainy days that decide to pour profusely. Small as it may seem, savings provide a financial safety net in the future, especially for items that would come in handy to advance stills like books. Additionally, savings help individuals reminisce on the times and quality of life they lived. MM regrets having started saving the money late and would thus advise her younger self it is never too early to start saving money.
Findings from assessments
The results from the Geriatric Depression Scale indicate depression, as she scored 15 out of the possible 15. The Fulmer Spices assessment indicates MM is likely depressed because she has problems with her sleep, feeding, and memory and has a breakdown in her skin, sometimes unstable and reclusive. Mini-mental status exam results 21. The single cutoff is below 24, meaning it is abnormal. The range is 21, meaning it is decreased odds of dementia. The education falls at 21, meaning it is abnormal for 8th grade. The severity is mild cognitive impairment as it falls between 18-23. The assessment for the Patient stress questionnaire places the patient in a masked depression in the elderly because she has lost weight, experiences multiple somatic complaints, is hopeless, lost her motivation, feels like she should be left for dead, and is easily irritable and lost interest in personal care.
Level of integrity
As described and expected by Erik, the level of integrity denotes that individuals increase in their integrity level as they hit sixty-five and proceed to death (Lewis, 2020). They contemplate their achievements and accomplishments and develop a sense of integrity as they proceed with life. Individuals that reflect on their lives with respect and feelings of completeness and satisfaction have full ego and integrity. They continue with a life full of wisdom and accept death without fear. A human being cannot go through life without experiencing any despair, but what people do to overcome despair defines their definition of accomplishment. However, individuals who contemplate their lives and have feelings of regret experience despair and a sense of lost time (Mcleod, 2018). They have misgivings, and their ego falls. Ultimately, an accomplished life alternates between ego, integrity, and despair that moderate the expressions of humanity.
Applying the theory on MM, when she contemplates her life, she has regrets, despairs, and lacks ego. Given a chance, she would rewrite her life to achieve what she desired and restore the ego she lost. Her dissatisfaction seeps into her grief, and together they result in depression and hopelessness. Ideally, had she been successful in her life, she would have had a positive result on the assessment scales to denote positivity, happiness, and overall wellness. She would have had enough sleep, found wisdom when she looked back on her life, and experienced completeness and closure in the life she lived. This elderly patient would thus receive a rating of 1 because she is in a full state of despair compounded with depression.
The nursing diagnosis for MM would be grieving, hopelessness, and impaired social interaction (Martin, 2022). Grieving is characterized by anger, changes in her activity level, detachment, depression, sleep deprivation, confusion, and psychological distress. Hopelessness is characterized by loss of interest in everyday activities, sleep disorders, and decreased affect. Impaired social interaction is characterized by a lack of social contact and prefers seclusion.
Plan of care
The plan of care for the patient to address grief would be to discuss how the patient views grief. The rationale would be that she would elaborate on how she feels. The therapeutic meaning behind talking about the feelings would be to allow MM to recognize that her feelings are valid (Martin, 2022). Expressing those feelings in a non-threatening environment could help her handle any unresolved issues that may be responsible for her depression. The therapy session should also discuss and educate MM on the normal stages associated with grief and accept the reality of feelings that it comes with, like hopelessness, anger, confusion, and powerlessness. The desired result would be that MM acknowledges the normal feelings and works on ways of moving past them.
The plan of care for hopelessness includes allowing MM to express her perceptions, express hope to the patient, and assist her in determining what aspects of her life are within her control. The plan also includes allowing MM to assume responsibility to care for herself by setting achievable goals and making independent decisions (Martin, 2022). The goal would be that MM expresses feelings of acceptance for events she has no control over. She should also demonstrate independence in her problem-solving and take control of her life.
Life review helps elder adults reflect on their choices and feelings of accomplishment. It also results in feelings of accomplishment for those that achieved all they set out to do and elicits feelings of despair for those that did not achieve what they wanted. Ultimately, a life review enables nurses to diagnose potential masked depression in the elderly population and devise methods of addressing them with realistic goals. MM is a patient with masked depression, and the healthcare provider should thus address it before it morphs into something else.
Lewis, R. (2020, April 28). Erikson stages of psychosocial development in plain language. Healthline. https://www.healthline.com/health/parenting/erikson-stages#summary-chart
Martin, P. (2022, March 18). 9 major depression nursing care plans. Nurseslabs. https://nurseslabs.com/major-depression-nursing-care-plans/
Mcleod, S. (2018). Erik Erikson | Psychosocial stages | Simply psychology. Study Guides for Psychology Students – Simply Psychology. https://www.simplypsychology.org/Erik-Erikson.html