Lessons 1-4

Question 1

What is health?

Answer 1

Objective process characterized by functional stability, balance, and integrity
“a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity” (WHO, 1947)
“the extent to which an individual or group is able, on the one hand, to realize aspirations and satisfy needs; and, on the other hand, to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living; it is a positive concept emphasizing social and personal resources, as well as physical capacities” (WHO, 1984)

Question 2

What is wellness?

Answer 2

A subjective experience or state of being
A state of health that is optimal for a person at any particular point in time
Includes physical, psychological, spiritual, social, and economic well-being
“The fulfillment of one’s role expectations in the family, community, place of worship, workplace, and other settings” (Smith et al., 2006)
Perceptions of well-being can define quality of life

Question 3

What is disease?

Answer 3

An objective state of ill health, the pathological process of which can be detected by medical science

Question 4

What illness?

Answer 4

A subjective experience of loss of health.

Question 5

Classification of health?

Answer 5

Health as stability
The maintenance of physiological, functional, and social norms, and encompasses views of health as a state, as a process, as adaptation, and as homeostasis
Health as actualization
The actualization of human potential. Within this concept, the terms health and wellness are often used interchangeably
Health as actualization
The actualization of human potential (health and wellness often used interchangeably)
Healthy as actualization and stability
The realization of human potential through goal-directed behaviour, competent self-care, and satisfying relationships with others, while adapting to meet the demands of everyday life and maintain harmony with the social and physical environments
Health as resource
Includes capacities to fulfill roles, meet demands, and engage in the activities of daily life (originally emerged in the Ottawa Charter for Health Promotion)
Health as unity
Reflecting the whole person as process and is synonymous with self-transcendence or actualization

Question 6

What are the dimensions of health and well-being? (What do you need to feel)

Answer 6

Feeling vitalized and full of energy.
Having satisfying social relationships.
Having a feeling of control over one’s life and living conditions.
Being able to do things that one enjoys.
Having a sense of purpose.
Feeling connected to community.

Question 7

What is the medical approach to health?

Answer 7

A stability orientation to health
Thought that medical intervention restores health
Health problems defined primarily as physiological risk factors
Focus on treatment of disease
Downstream thinking approach
Less focus on health promotion and disease prevention

Question 8

What is a behavioural approach to health?

Answer 8

Lalonde report: A New Perspective on the Health of Canadians (1974) resulted in a shift from a medical to behavioural approach to health
Defined health determinants as lifestyle, environment, human biology, and the organization of health care (health field concept)
Lifestyle behaviours contribute to chronic diseases and injuries
Places responsibility for health on the individuals – focuses on health promotion strategies like education and social marketing
Based on the assumption that if people know the risk factors for disease, they will engage in healthy behaviours

Question 9

What is a socioenvironmental to health?

Answer 9

Shift to the notion that health-related behaviours could not be separated from social contexts (environments)
Health is inextricably linked to social structures (e.g., poverty, air pollution, poor water quality, workplace hazards)
Responsibility of health on society, not just individuals
Upstream thinking (policy interventions)
Health disparities and inequities

Question 10

What are social determinate of health?

Answer 10

Income
Food
Gender
Social safety network
Housing
Indigenous status
Education
Social exclusion
Race
Unemployment and job security
Early childhood development
Disability
Employment and working conditions
Health services

Question 11

Equity vs. Equality

Answer 11

Equity- Same treatment.
Equality- The systemic barrier has been removed.

Question 12

What is primary prevention?

Answer 12

An intervention is implemented before there is evidence of a disease or injury.
Reduces or eliminates causative risk factors (risk reduction)
Good health habits
Diet and exercise
Smoking cessation
Vaccinations
Behavior management

Question 13

What is secondary prevention?

Answer 13

An intervention is implemented after a disease has begun, but before it is symptomatic.
Early identification through screening and treatment.
Testing such as mammograms and colonoscopy.
Screening such as diabetes, cardiovascular disease, or other disease.
Implement early changes to decrease any long-term effects and possibly eliminate the disease process all together.

Question 14

What is tertiary prevention?

Answer 14

An intervention is implemented after a disease or injury is established.
Prevent sequelae, stop the disease process from getting worse.
Already have a chronic disease like diabetes or hypertension.
Measures are taken to reduce the impact of chronic diseases.
For example keeping glucose and blood pressure under control, reducing risk of comobidities.

Question 15

What are health promotion strategies? (BCSDR)

Answer 15

Build- health public policy.
Create- supportive environments.
Strengthen- community action.
Develop- personal skills.
Reorient- health services.

Question 16

What are the principles of primary health care?

Answer 16

Accessibility: availability of health services to all Canadians regardless of age or geographic location
Health promotion: process of enabling people to increase control over and improve their health (addresses the DoH)
Public participation: having people being active participants in making decisions about their health care and health of their communities
Interprofessional, interdisciplinary, and intersectoral collaboration: people working across professions and sectors to deliver the necessary care to address health and the DoH
Use of appropriate skills and technology: methods of care, service delivery, procedures, equipment that are socially acceptable and affordable

Question 17

Aging and health

Answer 17

Gerontology: The care of older persons
Canada, and the world, have an aging population
What are the issues with grouping all ‘older persons’ into the same category?
Life is likely very different for those at 60, 70, 80, 90
In Canada, those over 65 are often called ‘seniors’
You may also hear the term ‘older adult’ or ‘older person’
An Indigenous person over 65 is often referred to as an ‘elder’

Question 18

Aging and healthcare

Answer 18

Patient centred care
Understanding the factors influencing health and health care in aging.
Ageism
Attitudes, interest, experience, and confidence of students and HCPs.

Question 19

What are the factors associated with successful healthy aging? (6 words)

Answer 19

Social
Environmental
Cultural
Spiritual
Psychological
Biological

Question 20

Health promotion and aging

Answer 20

Nurses play a key role in helping older people to achieve their optimal level of wellness.
Nurses have the knowledge to provide support, and education, and empower older persons to strive for wellness.
Nurses have the skills to conduct comprehensive assessments and collaborate with older people and their families to develop person-centred plans of care.

Question 21

Terminology commonly used in health care around older afults

Answer 21

Gerontology: the multidisciplinary study of older persons concerned with the physical, mental, and social aspects and implications of aging
Geriatrics: a medical specialty focused on the care and treatment of older persons
Gerontological nursing: an evidence-based nursing specialty that addresses the unique physiological, social, psychological, developmental, economic, cultural, spiritual, and advocacy needs of older persons. Focused on the process of aging

Question 22

Common myths about aging

Answer 22

Older people aren’t interested in the outside world
Older people don’t want or need close relationships
Older people contribute little to society
As you age, you get more set in your ways
Mental and physical deterioration are inevitable in older age
Older people are impoverished
Older people are not interested in sex or intimacy
Older people can’t make good decisions about important issues
Older people lose their desire to live
Science has answered all of our questions about aging

Question 23

What are the biological theory of aging?

Answer 23

Error (stochastic) theories
- Explain aging as the result of an accumulation of errors in the synthesis of DNA and RNA
- Wear-and-tear theory
- Cross-link theory
- Oxidative stress (free radical theory)
Programmed aging (nonstochastic) theories
- Explain aging as a process that is predetermined or ‘preprogrammed’ at the cellular level
- Neuroendocrine-immunological theory

Question 24

What are sociological theories of aging?

Answer 24

Activity Theory
Continuity Theory
Age-Stratification Theory
Social Exchange Theory
Modernization Theory
Symbolic Interaction Theories

Question 25

What are the psychological theories of aging?

Answer 25

Jung’s Theories of Personality
Developmental Theories
Theory of Gerotranscendence

Question 26

What are developmental tasks of aging?

Answer 26

Adjusting to decreasing health and physical strength
Adjusting to retirement and reduced or fixed income
Adjusting to the death of a spouse
Accepting one’s self as an aging person
Maintaining satisfactory living arrangements
Redefining relationships with adult children
Findings ways to maintain quality of life

Question 27

Spirituality and aging?

Answer 27

Spiritual well-being can be considered the ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, or a power greater than oneself

Question 28

What are common physiological changes associated with aging? (Systems)

Answer 28

Integumentary System
- Skin becomes thinner, loses moisture and elasticity (with fat loss), glandular atrophy, spots may appear on the skin (pigmentation changes), skin becomes paler, hair loss, hair turning grey or white, nail thickening and hardening.
Musculoskeletal System
- Tendons, ligaments, joints dry and harden (less flexible), bone mass decreases, degenerative joint changes, sarcopenia, replacement of lean mass by adipose tissue, thinning of vertebral discs.
Cardiovascular System
- Stiffening of the myocardium and blood vessels, thickening of left ventricle, reduced blood flow, stroke volume, and cardiac output, decreased response to sudden changes in oxygen demand, blood vessel thickening, venous valve efficiency.
Respiratory System
- Loss of elastic recoil, stiffening of the chest wall, inefficiency in gas exchange, increased air flow resistance, fewer alveoli, decreased cough reflex.
Genitourinary System
- Blood flow, ability to regulate body fluids, loss of nephrons, decreased bladder capacity.
Endocrine System
- Changes in thyroid structure and diminished secretion of hormones.
Reproductive
- Female: changes after menopause, decrease in estrogen.
- Male: enlargement of prostate.
Gastrointestinal System
- Dry mouth (xerostomia), decreased saliva, vulnerable teeth, periodontal disease, presbyesophagus (less effective propulsion), decreased gastric motility and volume, decreased nutrient absorption in intestines
Neurological System
- Decreased number of neurons, sleep changes (loss of deep sleep), increased risk for injury (loss of nerve endings in the skin and changes in proprioception), sensory alterations (visual and auditory)
Immune System
- Decrease in innate immunity, adaptive immunity, and self-tolerance decreases T-cell function which can create an autoimmune response

Question 29

What are functional changes?

Answer 29

Functional status refers to the ability for an older person to safely participate in activities of daily living (ADLs)
- Often linked to independence
Physical, psychosocial, and cognitive health all impact functional status
Factors that promote function: diet, activity, regular visits to and follow-up with health care providers, meaningful activities, stress management and avoidance of substance use
A change in functional status can be an indicator of a change or decline in health

Question 30

What are ADLs?

Answer 30

Activities of daily living is a term used in healthcare to refer to people’s daily self-care activities.
Dressing
Ambulating
Bathing
Eating
Transferring
Toileting

Question 31

What are IADLs?

Answer 31

Instrumental activities of daily living (IADL) are those activities that allow an individual to live independently in a community.
Food preparation
Housekeeping
Doing laundry
Shopping for groceries
Using the telephone
Managing medications
Managing finances
Using transportation

Question 32

What are senses?

Answer 32

Sight (visual)
Hearing (auditory)
Touch (tactile)
Smell (olfactory)
Taste (gustatory)
Kinesthetic (proprioception)

Question 33

What is sensory experience? (3 step process)

Answer 33

Reception: stimulation of a receptor nerve cell
Perception: integration and interpretation of stimuli (in the brain)
Reaction: to meaningful and significant stimuli

Question 34

What are sensory alterations? (3)

Answer 34

Sensory deficits: loss in the normal function of sensory reception and perception
Sensory deprivation: inadequate quality or quantity of stimulation (reduced sensory input), elimination of pattern or meaning (strange environments), restriction of environment (bed rest)
Sensory overload: multiple sensory stimuli that cannot be perceptually disregarded or selectively ignored (excessive sensory stimulation)

Question 35

What are common visual defects?

Answer 35

*Age-related macular degeneration (AMD)
*Cataract
Diabetic retinopathy
*Glaucoma
Refractive errors
Dry eyes
Retinal detachment

Question 36

What are common sensory deficits? (2)

Answer 36

Taste
- Xerostomia: decrease in salivary production that leads to thick mucus and dry mouth. Can result in taste alterations and decreased food intake
Balance
- Benign peripheral vertigo resulting in vertigo or disequilibrium from vestibular dysfunction
- Impact balance, coordination
- In conjunction with peripheral neuropathy, can lead to falls

Question 37

What are common auditory defects?

Answer 37

Conductive hearing loss
*Presbycusis (age related hearing lose)
Central auditory processing disorders
*Cerumen accumulation (earwax)
Meniere’s disease
Otitis media
Otosclerosis
Sensoineural hearing loss
*Tinnitus (ringing in the ears)

Question 38

What is delirium?

Answer 38

A serious, often preventable disorder
- Medical emergency
- Sudden onset, rapid fluctuations in symptoms
Most often the result of complex interactions among predisposing factors
Individuals with a diagnosis of dementia are at higher risk
Early recognition and immediate treatment of the underlying cause(s) are essential
- Often reversible
Characterized by fluctuations in cognition, mood, attention, arousal, self-awareness

Question 39

What are the predisposing factors for delirium?

Answer 39

Advancing age, male sex
Cognitive status
Functional status
Sensory impairment
Decreased oral intake
Medications
Coexisting medical conditions

Question 40

What are the precipitating factors?

Answer 40

Medications
Primary neurological disease
Intercurrent illnesses (infections, dehydration, etc.)
Surgery
Environmental
Pain
Emotional stress
Prolonged sleep deprivation

Question 41

What is dementia?

Answer 41

An irreversible state that progresses over years
- An umbrella term for major neurocognitive disorder
- Typically has a gradual onset, irreversible
Memory impairment (amnesia) and decline in other cognitive abilities that is severe enough to interfere with daily life
Other key features:
- Aphasia: loss of ability to express and understand language
- Apraxia: inability to carry out purposeful movement or perform familiar tasks
- Agnosia: inability to recognize common objects or familiar people
- Disturbances in executive functioning: difficulty planning, organizing, sequencing, abstracting
Approximately 6.9% of the Canadian population has a diagnosis of dementia (PHAC, 2021)
Prevalence tends to be higher in certain groups:
- Women
- Racial minorities
- Indigenous persons
Numerous subtypes: Alzheimer’s disease, Lewy body dementia, Parkinson’s dementia, vascular dementia, Creutzfeldt-Jakob disease (CJD) (Alzheimer’s Society of Canada)
Results in the loss of ability to perform activities of daily living (ADL) or functional decline

Question 42

What is depression?

Answer 42

The most common mental health issue in later life – not a normal part of aging
- A syndrome that includes numerous affective, cognitive, and somatic or physiological symptoms
- Older persons tend to report more somatic complaints like pain, changes in appetite
Prevalence of major disorder in older persons in Canada between 1.5% and 3.3% (2016)
- Higher in hospitalized persons or those residing in LTC
Prevalence of ‘milder’ depression between 4% and 18% (2015)
In general, prevalence of individuals with symptoms of depression is higher and individuals with persistent conditions have higher rates of depression
Often under diagnosed and undertreated
There continues to be stigma and negative attitudes towards depression and mental illness
Depression is associated with myriad negative outcomes including functional decline, decreased quality of life, malnutrition, substance use, etc.
Essential that health care provides assess and treat depression and depressive symptoms
Be aware of risk factors

Question 43

What are the predisposing factors in depression?

Answer 43

Female
Widowed or divorced
Major physical and chronic illness
Medications
Excessive alcohol consumption
Isolation and low social support
Family caregiving

Question 44

What are the precipitating factors in depression?

Answer 44

Recent bereavement
Moving to a LTC home
Adverse life events
Long-term stress
Persistent sleep difficulties

Question 45

What are common health concerns in again?

Answer 45

Cancer
Nutrition
Falls
Heart disease
Oral health
Sensory impairments
Smoking
Exercise
Pain
Substance use
Arthritis
Medication use

Question 46

What are considerations for assessment of older persons?

Answer 46

The inter-relation between physical and psychosocial aspects of aging
Effects of disease and disability on functional status
The decreased efficiency of homeostatic mechanisms
The lack of standards for health and illness norms
- Aging is unique for each individul
Altered manifestations of response to different disease processesSensory impairments (visual, auditory)
Memory changes (deficits)
Cultural aspects
Presentation of symptoms or disease
Early indicators of change or acute illness

Question 47

What is health promotions for older persons?

Answer 47

Consider some of the unique psychosocial challenges: social isolation, cognitive impairment, stresses related to retirement, relocating, and loss
Emphasize the strengths of the older person, recognize resilience, identify the resources they have available to them
- Interventions aimed at promoting independence and supporting self-care and participation in ADLs.
The nurse’s role is to promote and advocate for each individual to reach their optimal level of health within their context
General lifestyle preventive measures:
Regular exercise (150 minutes/week)
Balanced nutrition
Management of hypertension and chronic disease
Smoking cessation
Immunizations
Dental care
Sleep
Therapeutic communication
Touch
Cognitive stimulation
Reminiscence
Body image interventions

Question 48

What are the three considerations in healthy aging?

Answer 48

Promote health, prevent injury, and mange chronic conditions.
Facilitate social engagement.
Optimize physical, cognitive, and mental health.

Question 49

What is growth?

Answer 49

Growth: “the quantitative, or measurable, aspect of an individual’s increase in physical measurements” (Astle & Duggleby, 2024, p. 345)

Question 50

What is development?

Answer 50

Development: “the (qualitative) progressive and continuous process of change leading to increased skill and capacity to function… the result of complex interactions between biological and environmental influences” (Astle & Duggleby, 2024, p. 345)

Question 51

What is growth and development?

Answer 51

People progress through the various phases of growth and development at individualized rates (not predictable)
Nurses should understand the ‘typical’ phases to be able to assess and identify any changes from expected patterns and develop plans of care accordingly
The developmental theories from natural, biomedical, social, and behavioural sciences can help us to understanding the impact of early experience on development throughout the lifespan

Question 52

What are factors affecting growth and development?

Answer 52

Heredity
Temperament
Family
Peer group
Health environment
Nutrition
Rest, sleep, exercise
Living environment
Political and policy environment
Life experiences
Prenatal health
State of individual health

Question 53

What are the biophysical developmental theories?

Answer 53

Describe and explain how the physical body grows and changes with age and in various stages of life
Changes can be compared against standardized norms
Gessell’s Theory of Maturational Development: G&D is directed by the activity of genes; fixed sequence; critical periods exist where presence/absence of experiences make a person functional/nonfunctional
Chess and Thomas’s Theory of Temperament Development: biologically derived temperament characteristics influence how children interact with others and their environment (Slow to warm child that needs more time vs the easy child)

Question 54

What are the cognitive developmental theories? (Generally speaking)

Answer 54

Focus on reasoning and thinking operations.
How people learn and understand the world they live in.
Emphasis on the interaction between the person and the environment.
- The person has an active role in the developmental process.

Question 55

What is Piaget’s theory of cognitive development?

Answer 55

Sensorimotor Stage: Birth to two years.
- Coordination of senses with motor responses, sensory curiosity about the world.
- Language used for demands and. cataloging.
- Object permanence is development.

Pre-operational Stage: Two to seven years.
- Parallel play.
- Symbolic thinking, use of proper syntax and grammar to express concepts.
- Imagination and intuition are strong, but complex abstract thoughts are still difficult.
- Conservation is developed.

Concrete Operational Stage: Seven to eleven years.
- Conservation: Understand both glasses can have the same amount of water.
- Concepts attached to concrete situations.
- Time, space, and quantity are understood and can be applied, but not as independent concepts.
- Revise the direction of thoughts.
- More comparative.
- Can describe tasks they are not currently doing.

Formal Operational Stage: Twelve and up.
- Theoretical, hypothetical, and counterfactual thinking.
- Abstract logic and reasoning.
- Strategy and planning become possible.
- Concepts learned in one context can be applied to another.
- Justice and other life things.
- Things might affect others.

You have to complete each stage to get to the next.

Question 56

What are psychological theories of development?

Answer 56

The development of personality, thinking, behaviour, and emotions
Development occurs with influence from both internal and external factors
These happen together

Question 57

What is Freud’s Psychosexual Stages?

Answer 57

Stage: Oral
Age: Birth to one year
Erogenous Zone: Mouth
Pleasure: From feeding, using mouth, can cause healthy oral relationships.
Conflict: Oral fixation if not fed well, like smoking.

Stage: Anal
Age: One to three years
Erogenous Zone: Bowel and bladder control
Pleasure: Potty training, easy going parents, not pushing it.
Conflict: If parents are too pushy, turn into control freaks about things or very erratic behaviour.

Stage: Phallic
Age: Three to six years
Erogenous Zone: Genitals
Pleasure: Expose and understand the body; boys are attracted to their mothers and fear fathers so they mimic their masculine traits. It’s the reverse for women.

Stage: Latent
Age: Six to puberty
Erogenous Zone: Libido inactive
Pleasure: No interest in sex or pleasure, more interested in peers and sports etc.

Stage: Genital
Age: Puberty to death
Erogenous Zone: Maturing sexual interest
Pleasure: Intimate and sexual relationships
Conflict: Not able to maintain healthy monogamous relationships (sluttly behaviour)

Question 58

What is Erikson’s Theory of Eight Stages of Life?

Answer 58

Infancy- Trust vs Mistrust; meeting basic needs, present attachment to caregiver, gives trust.

Early Childhood- Autonomy vs Shame and Doubt; ability to potty train at their own pace, choose own clothing, help in the kitchen, supportive, can led to self-doubt.

Preschool- Initiative vs Guilt; be creative, play, interact, always saying no.

School Age- Industry vs Inferiority; confidence, sports and music they like, be with friends, making them feel they have to do things.

Adolescence- Identity vs Role Confusion; who we are, what do you like, supporting them, don’t put them in a box.

Young Adulthood- Intimacy vs Isolation; finding a romantic partner and intimate relationships. The inability to do so may result in isolation.

Middle Adulthood- Generativity vs Stagnation; always moving forward. Do you feel fulfilled, support community, doing something meaningful? Becomes depressed.

Maturity- Ego Integrity vs Despair; older people need to feel satisfied. Share memories.

Similar to Fraud’s school of thinking. Always a conflict to be resolved, positive or negative.

Question 59

What are the moral developmental theories? (Non specific)

Answer 59

Morality is a code of conduct that guides our actions and thoughts based on our background, experiences, culture, religion, or philosophy
Moral development is a gradual change in the understanding of morality
As a child develops, and evolves, they apply their knowledge and understanding to making the ’right’ decisions (even when it’s inconvenient for them)
Becomes less black and white

Question 60

What is Piaget’s Theory of Moral Development? (4)

Answer 60

Premoral Stage: Child feels no obligation to follow rules.
Conventional Stage: Child follows the rules set up by people in authority.
Autonomous Stage: Moral judgements based on mutual respect for the rules and considers the consequences of a moral decision. Starts to consider information related to subjective intent.

Moral maturity is the internalization of principles: the desire to weigh tall of the relationships and circumstances before acting or making a decision.

Question 61

What is Kohlberg’s Moral Development Theory?

Answer 61

This is not considered useful as it was only studied in young boys.

Stage One: Punishment and obedience orientation. It is okay to do what you do if you don’t get caught.

Stage Two: Instrumental. Relativist orientation, it feels good, do it.

Stage Three: Good boy, nice girl. Do it for me. (He should do it because he loves his wife.

Stage Four: Law and order orientation. Do your duty. (Saving a human life is more important than protecting property)

Stage Five: Social contract orientation. It is the consensus of thoughtful men. (Society has a right to insure its own survival. I couldn’t hold my head up in public if I let her die)

Stage Six: Universal ethical principles. What if everybody did that?

Question 62

What is Maslow’s hierarchy of needs?

Answer 62

People are motivated to meet certain needs
Generally, people need to meet the lower needs before they can attend to the higher needs
However, the needs/levels are not rigid
The most basic need is physical survival
Original hierarchy included 5 levels of needs, but has been updated to include 8 levels
Cannot meet needs higher without the bottom meet.

Bottom
Physiological needs- air, water, food, shelter…
Safety needs- person security, employment…
Love and belonging- friendship, family, intimacy…
Esteem- respect, status, freedom…
Self-actualization- desire to become the most one can be.
Top

Question 63

What is Maslow’s hierarchy of needs 2.0?

Answer 63

Bottom:
Basic needs; (Deficiency needs)
Physiological needs
Safety needs
Belonging and love needs
Esteem
Ongoing needs; (Growth needs)
Cognitive needs
Aesthetic needs
Self actualization
Transcendence
Top

Question 63

Developmental Theories and Nursing

Answer 63

Understanding the process of human development can:
Help us to plan patient/client care
Help us to assess and treat a person’s response to illness
Provide a framework for examining, describing, and appreciating human development
Understand growth and development and processes in which sociocultural, biological, and physiological forces interact with eachother over time

Question 64

What is communication?

Answer 64

The exchange of information between individuals through a system of signs, symbols, speech, and behaviour
Communication is the most important ability of human beings (Boscart et al., 2023)
Allows us to express thoughts, feelings, likes, dislikes
Verbal and nonverbal
Communication is an essential skill for nurses
We must ensure the messages we send are interpreted as we intended; conversely, we must ensure that we clearly understand and interpret the messages sent from others
Communication can be impacted by a variety of factors:
Personal/perceptual biases
Use of non-therapeutic techniques
Alterations in sensory and neurological functions
The ‘normal’ aging process can affect communication
Communication involves numerous techniques and strategies that must be consciously practiced in order to ensure effective therapeutic nurse client relationships
Meaningful communication and active involvement in society can contribute to:
Healthy aging
Improving longevity
Improving the older person’s response to interventions
Maintaining optimal function

Question 65

What is therapeutic communication?

Answer 65

Standard Statement 1: Therapeutic Communication

Nurses use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish and terminate the nurse-client relationship.
Basic therapeutic communication strategies are applicable when communicating with older persons
Attentive listening
Authentic presence
Nonjudgemental attitude
Cultural competence
Clarifying
Providing information
Seeking validation of understanding
Keeping focus
Using open-ended questions

Question 66

Ageism and communication

Answer 66

Ageism
A term used to describe prejudice expressed toward older persons through attitudes and behaviours
Found cross-culturally, but prevalent in the Western world
Elderspeak
A common speech style used when talking to older persons that presupposes their dependence, incompetence and control by the speaker
Includes baby talk, using terms or petnames like ‘honey’ and ‘dear’, and speaking louder and more slowly

Question 67

The life story

Answer 67

Can be an important component of communication
Tells us a great deal about the person
Important part of the assessment process
It takes time, and patience
It is a gift and an honour to hear someone’s story
They are hoping that you are listening and interpreting their story ‘correctly’
Constructed through reminiscence, journaling, life review, or guided autobiography

Question 68

Life review

Answer 68

A critical analysis of a person’s past life, with the goal of facilitating integrity
Often occurs as an internal review of memories, therefore, it is often a very personal and private reflection
Considered more of a formal therapeutic technique than reminiscence – meant to guide a person through their life in chronological order

Question 69

Reminiscing

Answer 69

Any recall of the past
Considered the most important psychological task in older age
May enhance socialization and connectedness with others
Can cultivate:
1) a sense of security through the recounting of comforting memories
2) a sense of belonging through sharing
3) self-esteem through the confirmation of uniqueness

Question 70

Communicating with Older Persons with Hearing Impairments

Answer 70

Ensure you have the persons attention. Do not approach from behind or startle
Face the person and sit or stand at eye level
Ensure the person has any sensory aids in place
Speak slowly and articulate in a normal tone of voice
Rephrase as opposed to repeat information
Speak towards the unaffected ear (when appropriate)
Ensure that others team members are aware of the hearing impairment (documented in the plan of care)

Question 71

Communicating with Older Persons with Visual Impairments

Answer 71

Ensure you have the person’s attention before you begin speaking
Clearly identify yourself and others with you
Speak normally, but not from a distance
Do not lower or raise your voice
Use the analogy of a clock face to help locate objects
Do not change room arrangement
Ensure the person has their glasses/visual aid prior to initiating communication

Question 72

Impaired Verbal Communication

Answer 72

Persons with neurological disturbance may experience impaired verbal communication arising from:
1) reception: impaired by anxiety or related to a specific disorder, hearing deficits, or altered level of consciousness
2) perception: distorted by stroke, dementia, delirium
3) articulation: hampered by mechanical difficulties such as dysarthria, respiratory disease, cerebral infarction

Question 73

What is aphasia and how to communicate

Answer 73

A communication disorder that can affect a person’s ability to use and understand spoken or written words
Can affect a person in more than one way: speaking, understanding, reading, writing, gesturing
Involving a Speech Language Pathologist (SLP) is imperative to develop a plan of care
Alternative or augmentative speech aids may be used
Alphabet or picture boards
Electronic boards and computers (can be voice activated)
Explain situations, treatments, or anything else that is pertinent to the person
Treat the person as a person (adult)
Be patient, allow time for communication, provide a quiet environment
Speak naturally and slowly, ask one question at a time (consider using close-ended questions)
Include the person in social gatherings and conversations
Ensure the person has access to sensory aids
Use visual cues, objects, pictures, gestures, and touch in conjunction with words when appropriate
Encourage all speech, give the person the opportunity to complete their thoughts and struggle with words
Do not be too quick to finish their sentences or assume what they are trying to communicate
Use any augmentative devices available
Minimize external noise when communicating (e.g., radio, TV)

Question 74

Dysarthria and communication

Answer 74

A speech disorder caused by weakness or incoordination of the muscles used for speech
Impairment in the ability to articulate words as a result of damage to the speech mechanism controlled by either the central or peripheral nervous system
Pay attention to the person speaking, and watch them as they talk
Allow more time for conversation, and provide a quiet environment
Be honest, and let the person know if you have difficulty understanding – don’t pretend to understand
If the person’s speech is very difficult to understand, repeat back what they said to ensure you understood
Ask the person how you can best support them (e.g., guessing, finishing sentences, or writing)

Question 75

Dementia and communication

Answer 75

Cognitive impairment that affects memory, speech, and communication
Individuals may have difficulty expressing their ‘personhood’ in a way that is easily understood by others
Communication requires special skills and patience
Anomia (difficulty with word finding)
Difficulty expressing thoughts and emotions
Difficulty with expressive and receptive communication
Limits with verbalization may occur in later stages
Do not assume that they can not understand you
Continue to communicate with them – verbal and non-verbal
Learn about the person
Ask questions and provide time for response
Meet the person where they are at
Recognize and respond to feelings, thoughts, behaviours
Provide care and connect with respect and dignity

Question 76

What is Gibbs’ reflective cycle?

Answer 76

Description-
A detailed description of the situation
What happened?
When and where did it happen?
Who was present?
What did you and the other people do?
What was the outcome of the situation?
Why were you there?
What did you want to happen?

Feelings-
Exploration of the thoughts and feelings during the experience and how they may have impacted the experience
What were you feeling during the situation?
What were you feeling before and after the situation?
What do you think other people feel about the situation now?
What do you think about the situation now?

Evaluation-
Evaluate what worked and what did not work in the situation (trying to be as objective as possible)
Focus on the positive and negative aspects of the situation
What was good and bad about the experience?
What went well?
What did not go well?
What did you and other people contribute to the situation (positively or negatively)?

Analysis-
An opportunity to make sense of what happened – looking for meaning in the situation
What did things go well?
Why didn’t things go well?
What sense can I make of the situation?
What knowledge – my own or others – can help me understand the situation?

Conclusion-
Make conclusions about what happened
Summarize learning and highlight what could improve the outcome in the future
What did I learn from this situation?
How could this have been a more positive situation for everyone involved?
What skills do I need to develop for me to handle a situation like this better?
What else could I have done?

Action Plan-
Plan for what you would do differently in a similar/related situation in the future
Plan not only what you would do differently, but how you would do it differently
If I had to do the same thing again, what would I do differently?
How will I develop the required skills I need?
How can I make sure that I can act differently next time?