behavioral management in chronically ill and older adults

7/31/2019 Behavioral Management in Chronically Ill and Older Adults

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1. Self-esteem enhancement

2. Self-responsibility facilitation3. Mutual goal setting

4. Decision-making support

5. Spiritualgrowth facilitation


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Nursing theorist Henderson has defined thenursing role as assisting and supporting the individual

in life activities and the attainment of independence.

Nurses must assist elderly patients set realistic

goals to achieve higher self-esteem and to accept

dependence on others, as appropriate. Facilitating an

environment and activities that willincrease self-esteem is also important in order to prevent

further depression and inactivity.


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Defined as encouraging a patient to assume more responsibilityfr

own behavior (Dochterman & Bulechek, 2004, p. 637).

Nurses must hold their patients responsible for their own

behaviors, encouraging independence but assisting them whenunable to perform, and encouraging them to take as much

responsibility for their self-care as possible. In order for

patients to regain some control in their lives, they must take

responsibility for and perform tasks that they are capable of

doing independently.


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Defined by Dochterman and Bulechek (2004) ascollaborating with a patient to identify and prioritize

care goals, then developing a plan for achieving those

goals (p. 506).

Activities specific to mutual goal setting include assisting patients

to identify realistic, attainable goals, assisting them to set realistic

time limits, focusing on the expected rather than desired

outcomes, and encouraging the acceptance of partial goal

satisfaction.


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Specific activities include facilitating the patients

articulation of goals for care, providing the information

requested by the patient and respecting their right to either

receive or not receive the information, and serving as aliaison among the patient, family, and other health care

providers.

Through these decision-making activities, trust can be

built among the nurse, patient, and family,miscommunication can be avoided, and the patients

wishes remain important and can be respected.


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Defined as the facilitation of growthin the patients capacity to identify, connect with, and

call upon the source of meaning, purpose, comfort,

strength, and hope in his/her life (Dochterman &

Bulechek, 2004, p. 663). Powerlessness is related to

spiritual health.

Performing activities such as offering patients individual

and/or group prayer support, encouraging them to examine

their spiritual commitment, based on their beliefs and values,

and referring them to support groups may help boost their

self-esteem and acceptance of their situation.


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Identify situational circumstances

Determine clients perception and knowledge ofcondition

Assess degree of mastery client has exhibited in life Determine if there has been a change in relationship

with significant others

Ascertain client response to treatment regimen.


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Listen to statements client makes

Note expressions that indicate giving up

Note behavioral responses including expressions of

fear, apathy, agitation, etc. Note lack of communication, f lat affect or lack of eye

contact


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Show concern for a client as a person

Make time to listen to clients perception and concernsand encourage questions

Accept expression of feelings, including anger andhopelessness

Avoid arguing or using logic with hopeless client

Encourage client to maintain a sense of perspective

about the situation


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Develop contract with client specifying goals agreedon

Treat expressed decisions and desires with respect

Discuss needs openly with client and set up agreed-onroutines for meeting identified needs

Support client efforts to develop realistic steps to putplan into action, reach goals and maintain

expectations Involve significant others in client care as appropriate


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Review familial and social history and physiologicalhistory for problems such as history of poor copingabilities

Note current familial, social, or physical situation ofclient

Determine coping behaviors and defense mechanismsdisplayed


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Note behaviors indicative of hopelessness

Determine coping behaviors previously used andclients perception of effectiveness then and now

Evaluate and discuss use of defense mechanism


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Establish a therapeutic and facilitative relationship

Discuss initial signs of hopelessness

Encourage patient to verbalize and explore feelings

and perceptions Discuss current options and list actions that may be

taken to gain some control of situation

Encourage significant others to express hope to the

client


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Provide positive feedback for actions taken to dealwith and overcome feelings of hopelessness

Assist client or family members to become aware offactors or situations leading to feelings of hopelessness

Facilitate clients incorporation of personal loss

Encourage client or family to develop support systemin the immediate community

Introduce client in a support group before individualtherapy is terminated

behavioral management in chronically ill and older adults

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