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Maris N. Paculaba Cebu Normal University – College of Nursing Class 2013
Introduction Abuse of the elderly refers to any form of mistreatment that results in harm to or the loss of an elderly (National Committee for the Prevention of Elder Abuse [NCPEA], 2008). One type of elderly abuse, according to NCPEA, is physical abuse, referring to the physical force that results in bodily injury, pain, or impairment. Physical abuse can include hitting, beating, pushing, kicking, pinching, burning, or biting. It can also include such acts against the older person as over- or under-medicating, depriving the elder of food, or exposing the person to severe weather-deliberately or inadvertently.The personal losses associated with this form of abuse can be devastating, as they include poorer health, the loss of independence, shelter, life-savings, dignity, and security (Bain, Spencer, 2009). Most elderly abuse takes place at home (American Psychological Association [APA], 2012) where a great majority of older people live on their own or with their spouses, children, siblings, or other relatives. Family situations that can contribute to elder abuse include discord in the family created by the older person's presence, a history and pattern of violent interactions within the family, social isolation or the stresses on one or more family members who care for the older adult, and lack of knowledge or caregiving skills. Abuse has a significant impact on people at any age, but older adults can be especially vulnerable. In general, older adults have less physical strength and less physical resilience. Some older adults may be very frail, or already have disabilities or impairments that leave them particularly vulnerable. Physical injuries that may be a result from abuse includes sprains, dislocations, fractures, abrasions, burns, pain, bleeding, bruises and traumatic hair and tooth loss. When questioned about these injuries, the elderly and his/her family often provide implausible explanations (Bain, Spencer, 2009). Older adults also often experience worry, depression, or anxiety. These signs may be mistaken for memory loss or illness, when they are actually the effects of stress or worry. An older adult may also feel hurt, shame, guilt, or embarrassment that someone in the family or someone close has harmed them. As such, many abused elderly tend to be socially withdrawn impeding not only the elderly’s relationship with his/her family, but with the environment and society as well (APA, 2012). The elderly’s coping ability then plays a big factor in his/her ability to thrive. According to the World Health Organization (2011), around 21,000 to 72,000 elderly have experienced some form of abuse at home. As of June 2012, crimes of physical injury in the Philippines have amounted to 23,372 (National Statistics Office [NSO], 2012), but crimes pertaining to the elderly are not specified, giving indication that elderly abuse is given little recognition in our country, as such it becomes harder to identify. This is attributed to the fact that the elderly may not report such incidents, in
his/her personal relationship with others and his/her physical state. medical workers for a non-governmental organization (NGO) revealed that some elderly sought treatment for bruises and welts. despite being initially reluctant to reveal the true causes of their injuries. 2002). therefore. The three interacting factors in a Thriving continuum are the person. Courts &Tesh. The central purpose of this study. aside from having physical injuries. A physically abused elderly. the causes of which they could not provide a plausible explanation of. depending on the impact of the human environment and the nonhuman environment as the person . and nonhuman environment—a failure of engagement and mutual support.The Thriving Model. physical. However. 1992) due to discord between the elderly. the human environment and the nonhuman environment. There appears to be a failure to thrive (Newbern. the elderly eventually confessed. physical. and psychological resilience and growth. Barba. the person may be predisposed to thrive or not to thrive.Failure to Thrive occurs when there is discordance among the person. psychological. Furthermore. resulting in social. The Thriving Model (Figure 1) reflects the thriving continuum and the factors that influence an elderly person to achieve either thriving or the failure to thrive. is to guide nurses in promoting successful adaptation for the elderly who are physically abused utilizing the Theory of Thriving. human environment. The person is a complex social. Thriving is defined as the ongoing process of growing through continuous human environment interactions. Considering each of these contributions. Theoretical Framework Figure 1. and disharmony (Haight. in a survey conducted by Carlos (1999). faces psychosocial turmoil as his or her domestic relationships are also at stake. 2011).fear of damaging the reputation and privacy of their family (WHO. spiritual being in mutual process with the human and nonhuman environment.
feelings. 2002). natural and built surroundingsand economic. In a physically abused elderly. human environment. The elderly’s ability to access healthcare services and other social institutions should also be identified. In their published pocket guide. feel self-assured.travels along the life span. constitute the person. to achieve thriving. the nurse should promote emphasis on integumentary and musculoskeletal areas as signs of physical abuse are evident there. Nonhuman environment is the physical and ecological surroundings of the person. Failure to Thrive is described as the diminished ability of the individual to live with multisystem diseases. psychological. cognitive and social areas. 2007). If permissible. have discordance among the person. cope with ensuing problems. emotional. Due to caregiver stress. spiritual. values. older adults should be able to develop and maintain healthy relationships. This . hindering the elderly’s growth and development. cognitive and social domains. on the other hand. refers to the person’s external human surroundings and the person’s perceptions of the presence. psychological. Positive humans contribute to thriving through positive interactions with the person while negative humans predispose the elderly to failure to thrive due to negative interactions (Haight. et. In this case. The Theory of Thriving not only explains the thriving continuum but it also encourages the elderly to move (pag-uswag) towards promoting “pagkausa” or synergy of the three factors and in sustaining (pagsustener) that synergyto achieve successful adaptation. as previously mentioned. and generally satisfied with life.In physical assessment. The nurse should also assess the client’s familial role and usual daily routine as well as identify the client’s caregivers and the client’s relationship with them.The human environment is comprised of positive and negative humans. Failure to Thrive is an accepted nursing diagnosis by the North American Nursing Diagnosis Association (Doenges. The human environment.. to identify the degree of discordance. including finances. and nonhuman environment not only shape personality. 2010). and beliefs of other surrounding humans. In assessing the mental. including his/her coping abilities and physical injuries associated with abuse. and social influences/factors (Coddington. These three factors—person. the nurse could use therapeutic communication and observation techniques. home environment. Moorhouse&Murr. This is a contributing factor to the elderly’s failure to thrive. Theoretical Application in the Nursing Process The physically abused elderly. human environment. al. the client’s family could also be assessed through interview. Thus. the human environment and the nonhuman environment. the elderly. and manage his/her care. spiritual. mental. In this paper. and nonhuman environment come together to form a theory that has synergy. emotional. The many subtle interchanges of person. the human environment may be cold and uncaring. a history and pattern of violent interactions within the family and its resulting social isolation of the elderly. but also provide insight into current behaviors. proper and holistic assessment should be done involving physical. psychological. the human environment usually consists ofthe family. However. the determinant factor for a disharmonious nonhuman environment rests on the physical environment and the uneasy access of the elderly with which to avail of healthcare services.
educating the elderly about available health and social services.F. Nursing care is focused on treating the injuries sustained. M. Articles: . Evaluation should be done frequently to assess the movement or the pag-uswag of the 3 factors towards synergy or pagkausa. human environment and nonhuman environment.Frequent evaluation could also determine an ineffective intervention. emotional. Interventions should be consistent with the different nursing diagnoses and goal/s identified. involvement of the client’s significant others and family members is highly encouraged and should be included in the goal to achieve synergy of the human environment. M. Problem identification. will not only revolve around the physiological. and socioeconomic aspects as well.C. 12th edition. If the goals are met. This tells the nurse that the client has achieved positive thriving and is equipped with positive coping abilities. References Books: Doenges. Several nursing care plans could be made with more specific goals that address physical. cognitive and social aspects separately. spiritual. different nursing care plans could be implemented simultaneously. The plan of care should be based on the prioritized nursing diagnosis and identified concerns related to thriving. and not solely based on the nurse’s perspective. However. teaching ways to promote a safe physical environment. FA Davis Company. encouraging recreational/social activities. but with the psychological. the nurse is encouraged to explore other possible options and consequently implement proper prioritization of identified nursing problems. Prioritized Interventions. the nursing care plan/s could be modified accordingly. Since positive thriving entails synergy of the person. (2010). done in cooperation with the client. accompanying and/or perceived complications and actual problems of the individual. the human environment and the nonhuman environment in order to achieve positive thriving.. In this regard. Moorhouse. If permissible.. reinforcing safety measures and maintaining proper quality of life of the elderly. engaging the involved parties in family therapy. Nurse's Pocket Guide: Diagnoses. goal/s should be both short-term and long-term. spiritual. The general goal of care is to minimize discordance between the person. evaluation may function as a factor in assessing sustainability or the pagsustener of the health teachings implemented by the nurse. The plan of care should take into consideration the age-related changes. the nurse and the client should have a collaborative approach in identifying the goal/s to be achieved. It is important to diagnose a problem based on the subjective and objective cues exhibited by physically abused elderly. and Rationales. in diagnosing the physically abused elderly. preventing complications. it would be best if the nurse encourages the client to engage in long-term goals. In which case.diagnosis may be applied to the situation. A. emotional. mental.E. psychological. Since responses to physiological and psychosocial concerns vary. Murr. In planning. It is also done to assess the efficacy of the interventions performed.
28(3). Courts. J.uncg. 18(8).proquest. Vol.B.. 14-22. Elder Abuse and Neglect: In Search of Solutions. Toward a theory of thriving.com/pqcentral/docview/304723239/abstract?accountid=14 1440 Haight.ca/police/TakeAction/elderabusefacts/FactSheet_4. Minnesota). United States.Carlos. K.org/elderabuse/ Newbern. (2012). Barba. E. Spencer. B. Retrieved September 23 2012 from http://www. Thorofare. Slack Incorporated. Retrived October 2 2012 from http://libres. Failure to Thrive: A Growing Concern in the Elderly.org/pi/aging/resources/guides/elder-abuse. A. V. (2008). Journal of Gerontological Nursing.A. Journal of Gerontological Nursing.aspx# Bain. P. ISSN-1655-2539 Internet: American Psychological Association.nos.(2012).. Clarita R. &Tesh.edu/ir/uncg/f/B_Barba_ThrivingALife_2002. Abuse of Older Adults: Signs and Effects. What is Elder Abuse?.com/pqcentral/docview/1021724727/1398EB7F86E4028A 1B0/5?accountid=141440 World Health Organization. Retrieved September 22 2012 from http://www.winnipeg.int/mediacentre/factsheets/fs357/en/ .Thriving: A Life Span Theory..proquest..Republic of the Philippines National Statistics Office. B. (2002). (2007).(2011).Philippine Social Sciences Review. Canadian Network for the Prevention of Elder Abuse.pdf Coddington. (2009). Retrieved October 2 2012 from http://search. N.ProQuest Dissertations and Theses. S. F. (1992).who.pdf National Committee for the Prevention of Elder Abuse.(Doctoral Dissertation.apa. Retrieved September 23 2012 from http://www. 21-25. (1999). Philippines in Figures 2012. Elder Maltreatment. 56. C. Retrieved October 4 2012 from http://search. Concerns of the Elderly in the Philippines. Capella University.preventelderabuse. Retrieved October 2 2012 from http://www. January-December 1999 National Statistics Office. 1-4.
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