Acquisition, Struggles and Legacy.

According to her, “Graceful Aging” is dependent on positive

childhood acquisitions. It pertains to the quality of what you have
acquired from the beginning. An acquisition that starts from the
womb of the pregnant mother, the love and support of the father
to his family reflects good acquisitions to the person.  This
acquisition comprises how we acquired the manner of speaking,
talking and attitudes. The kind of acquisition from education also
plays a major role. She emphasized the importance of a good
school for better education which develops perseverance and
hard work in an individual and equips him or her when trials, crisis
or life struggles come in. She said, “If you have a very happy and
nice childhood, you will have a very fruitful aging, happy
retirement and ultimately Legacy.”  She defined legacy as an act
of giving, sharing, emblem of honesty and feeling of fulfillment
and motivation.

Acquisitions- Received education, positive teachings from parents, well

educated, God fearing, the learning or developing of a skill, habit, or
quality.

Struggles – problems you may face along, for example mag asawa,
good courtship and relationship, even in struggle they will hold on
because of the memories and love you have built, shared together.
Example doctors na susungit, because it is a challenge that they do not
have a good and positive acquisitions in childhood, spend time with
them they are the ones who need it most. You are equipped because of
the good childhood of you have experienced.

Legacy – the things you have left, you empart like teachings. Legacy is
about life and living. It's about learning from the past, living in the
present, and building for the future. From a purely practical
standpoint, if you don't pass on your life experience by leaving a
legacy, the wisdom you've gained through decades of difficult learning
will disappear as your physical body wears out. A legacy may take
many forms – children, grandchildren, a business, an ideal, a book, a
community, a home, some piece of ourselves. Our legacy naturally
intrigues us. It's perfectly understandable that we would want to know
how the world will remember us after we're gone. The world isn't
connected by molecules. It's connected by stories, traditions,
memories, hopes, and dreams. We are connected by the legacies
passed down from those who came before us and the legacies we pass
down to those who come after us.

Said English writer Dorothy Sayers, "Paradoxical as it may seem, to

believe in youth is to look backward; to look forward, we must believe
in age."

For children, legacy means learning from the past. It separates the
timeless from the transient. Children have a feeling of security and
continuity that comes from knowing that there are adults who care
about them. They come to realize that we all face choices in our lives,
often difficult ones, which helps them prepare for whatever may come.
They start developing a life plan as they see their life as a whole.
Learning about the whole of life as well as its end also helps them
establish their values and priorities. And instead of directly telling
children all of this, we need to tell them our life stories and our choices
and how we made our decisions. That's the way you get children to
learn from you and about you.

For adults, legacy means hoping for the future. It means developing
and passing on a timeless part of yourself. We feel valued and useful
no matter how old we get. We remember our priorities and make life
choices based on them. We come to terms with our accomplishments
and our disappointments. We create personal meaning and purpose.
We realize that as we do our bit in the grand scheme of things, our
tiny gestures multiply in significance. We understand that the world we
leave behind is the world our children and children's children inherit.
We know that we have an obligation to help make the future a little bit
better than the past.
For both young and old, the power of legacy enables us to live fully in
the present. You understand that you are part of a larger community,
a community that must remember its history to build its future. There
is caring combined with conscience. There is also wisdom to be found
in each other – linking action and reflection to deal with complex
problems.

Legacy is very much about life and living.

Application to Nursing

The theory of Sister Letty G. Kuan stated that without positive

acquisitions during childhood, the person (patient) will be “in a
pathological state” to delinquency. Now, this is the challenge that
nurses will face. The role of the nurse is to put back what they
have missed during childhood and to fill this gap. Nurses need to
let them acquire good things through setting an example and to
make them feel loved and important. The role of the nurse is to
become a therapeutic self and spiritual self by showing empathy
and compassion.
She quoted this:
“The Longer you stay in life, the more you have acquired, the
better you should be, the Legacy is given.”
Aging is pretty much feared by most people. It is something that is not well received and
may in fact pose negative health outcomes to patients. Letty Kuan's focuses on the key
elements needed to prevent negative adaptation to retiring and aging using both
philosophical and practical determinants so that everyone can relate.

The nurse is the major key player in providing health care to our patients. In terms of
Erickson's model of developmental stages, the primary goal of the nurse is to maintain
and promote ego integrity and avoid circumstances that would lead to despair. Health
teaching is very much important and in fact one of the most influential things to the
patient. Nurses, due to their close interaction with patients and patients’ perception of
their role , are an efficient channel for distributing health messages. For this reason,
nurses’ perception and opinions could have an important impact on patient (Corner,
1997). The role of the nurse as a constant entity present to help the client and reassure
the client that aging is a normal process which everyone has to go through. That is does
not matter if we grow older, as long as we age with grace.
Nurses and other health care professionals alike may provide quality care to our aging
patient by being perceptive of the clients needs. Nurses may do this from simple things
like allowing the patient to do what he is able to do to promote self autonomy and
confidence to something more complex like involving the families of patients in activities
where in the patient would feel that he is still an important member of the family. If we,
as nurses, assess both subjective and objective cues that our patients are afraid or
inability to accept the aging and retirement process, then we can come in and help
whatever way we can. Allowing the patient to open up to you for his concerns and for
the nurse to have an open ear for these concerns are important. It is also very much
important to allow the patient to seek relationships with other people his age, so that
that the patient can realize that this really happens to everyone. In this manner, he may
even be able to get advice and learn from the experience of other. In terms of severe
and drastic emotional or psychological disturbances, perhaps, we can seek the help of a
psychological referral. It is also to important to keep in mind that, as nurses, we must
not forget to administer maintenance medications of aging clients as well as to maintain
physical safety as they are at a high risk for falls, altered skin integrity and contractures
secondary to limited range of motion - these are all basic to caring for an elderly - and
are very much necessary to make sure that there is a easy transition on their part as
both physical and psycho-socio-emotional needs are important to take care of in terms
of giving holistic care to be able to allow the patient to age with grace.

I would not only advocate Kuan's theory to my patients, but also myself. Its universality
makes it so that it is even applicable to nurses and other people alike in the sense that
we all go through changes in life. Everytime we are forced to step out of our comfort
zone and experience hardship, no matter how minute or gradual, we are transformed to
become better people. By being prepared to face these changes, we are able to adapt
successfully and may even become inspiration to our clients in that respect.

Kuan's theory can very much improve the quality of life of aging people. It gives
healthcare professionals tried and tested tools which were not available in the past. It
gives people a preview of what to expect in the future and what is needed to be
prepared for this happening. There is also a great sense of security and comfort
knowing what to expect in the future as one of the worst fears of all time is the fear of
the unknown.

This theory, although applicable to the Philippine because of its universality, I believe
can be more useful in the Western world as most families there are small and work-
oriented. It is not uncommon there to see elderly members of the family enrolled in
resident villages for the elderly or homes for the aged. In this respect, it is more like that
these patients feel more ostracized and alienated in the fact the they are being secluded
- very much different from their previous lifestyles. In the Philippines, however, where
most of the families are big in the number of members and where most elderly people
find a new and fulfilling job as caregivers to their grandchildren, this is something less
necessary.

Upon retirement, a person enters a new phase of his life where he faces Ego Integrity
vs. Despair. Erikson posted that ntegrity is achieved as the aging person struggles to
maintain wholeness in strength and purpose despite the apparent degeneration of
physical capabilities. Havighurst suggested that two of the six tasks of retirees who are
in the late maturity stage are “adjusting to retirement and decreased income and
adjusting and adapting to social roles in a flexible way” (Hogstel, 2001). With the
physical changes and transition of role function, retirees do need holistic support from
family, friends and the health care system.

Nursing interventions are vital in helping aging people view retirement positively.
Physically, nurses should actively replace the energy lost by an aging client and should
prevent further degeneration of the body, as proposed by Levine’s Conservation Model
(Tomey, Alligood, 2002) for him to be able to enjoy retirement. Primarily, nurses,
together with other heath disciplines, should monitor the client’s body functions to
determine the extent of activities that he may engage into. It is essential to formulate a
diet with nutritional contents adequate for the client’s needs and general condition.
Encouraging and educating the client about and adherence to pharmacologic treatment
or supplements is also our task. Teaching the client exercises that are not too
extraneous will also prevent muscle wasting, and promote good circulation and over-all
energy. (Kozier, Erb, et.al, 2008)
The cessation of productivity for a person whose job was his source of interest, social
life and activities threatens his integrity. The major stressors of a retiree are declining
health and vigor, loss of family and friends, reduced income and, all leading to,
loneliness. The feeling of loneliness can immediately be addressed by the nurse by
listening. It is also reduced by encouraging aging clients to have pets, have some place
to go to and have something to look forward to. Psychological well-being can be
preserved by helping the client develop interests that are not related to his work,
volunteer for a cause, make new friends from all ages and stay active by keeping
himself busy. (Judd, 1983)
The way nurses are to deliver health education regarding interventions should involve
the family, in congruence to Kuan’s idea of Family Constellation. A retiree enjoys this
phase of his life mostly by being able to spend more time with family, especially his
grandchildren (Hogstel, 2001). Moreover, people working in groups succeed better in
goal attainment than a person working alone (Schultz, 2002).

The major role of a nurse in an aging client’s retirement and role discontinuity is to be
the resource person.
According to Hall, nursing requires and interdisciplinary approach in preserving a
client’s wholeness (Tomey, Alligood, 2002). The nurse’s hands-on care is the amalgam
that holds all the contributions of different professions and disciplines to the adaptation
of a patient. A nurse’s role in an aging person’s transition does not only involve
collaboration with physicians, dieticians and physical therapists to maintain physical
wellness. Ideally, nurses should be able to offer retirees access to community-based
psychological health services, outreach programs, volunteer work, support groups,
activity and recreation centers and other institutions that will help him discover a new
dimension to self awareness and productivity. (Judd, 1983)

As a nurse, I would advocate Kuan’s theory because it has positive impact to the quality
of life of aging persons.
Kuan’s theory supports the ideas that nursing should promote wholeness (Rogers,
Levine), adaptation (Roy), patients’ discovery of himself and insight (Peplau), and
patients’ empowerment (Orem). It also shows that there are difficulties and needs that a
nurse should anticipate when a patient is transitioning into retirement stage. This
anticipation allows the nurse to intervene with the overt issues that a person is dealing
with (Abdellah). (Tomey, Alligood, 2002)
The goal of aging is “to enter into the last half of life determined to make the most out of
it” (Judd, 1983). Remaining involved with significant others, interests and benevolent
work allows a person to welcome the next stage of his life with confidence, contentment
and a balanced perspective. Somehow, Kuan was able to contribute a framework by
which a retiree may have a better chance at a quality life.

However, Kuan did overlook some important considerations and there are points of
improvement for her theory.
In determining how a person may deal with retirement, his past experiences should also
be assessed. Erikson posited that an adult’s completion of past developmental tasks
affects his behaviour toward later maturity and retirement (Hogstel, 2001). Personal
experiences are unique. Their impact on the lives of people would need to be
approached differently. Some aging clients may have had more challenging lives than
others and they may need more help. Some retirees may have been more productive
than others and may be able to adapt faster. This is something that I would explore so
that i may be able to address my client’s facets of insecurity with higher priority. Hence,
preparation for retirement should be highly individualized.
Looking at retirement in a positive light may also be more beneficial for an aging person.
In Achtley’s Continuity Theory, he proposed that continuity is more potent than role
discontinuity. He said that even after retirement, a person does not lose his job-related
identity, but the identity of a retired person adds up to it (Hogstel, 2001). For example, I
would orient an aging client that the values of being hardworking and committed that he
gained from being employed will be enhanced if he utilizes his availability in soliciting
donations and goods for orphanages. After all, people adapt more with a positive
perspective.

Kuan’s theory may not be applicable with the current health care system, but it may find
hope in the inherent Filipino characteristics.
Blaming substandard nursing practice on understaffing is a cliché, and sadly almost a
norm. With many diseases and patients flocking in hospitals, health care has been
focused on curing physical illness. Nurses are required to do more with less – less time,
less resource, less manpower. This scenario belittles the importance of addressing the
concerns of those who are not physically sick, such as retirees undergoing identity
crisis. To provide holistic assistance to aging persons is almost impossible with our
health care system.
What can we do? Educate the primary people in the lives of retirees of Kuan’s theory
and similar ideas.
The beauty of the Filipino people is that we are adaptive, quick to learn and highly
family oriented. We take care of our elders and we let them live with our own nuclear
families. If not, we keep them in close proximity whether literally, on a regular schedule,
or by constant communication. Sharing nursing knowledge about the needs of aging
persons with their significant others, would increase the probability that they would be
assisted during their transition because they are in constant interaction among each
other.

Kuan’s “Retirement and Role Discontinuity” does not only provids a picture of ideal
nursing care for the aging. On a larger perspective, it reminds us that people who retire
once contributed to the economy that sustains us, no matter how barely surviving it is. It
is their right to have their unique needs recognized and holistically met.

SOURCES:
“Fundamentals of Nursing Concepts, Process and Practice 8th Edition”, by Audrey
Berman, Shirley Snyder, Barbra Kozier and Glenora Erb, 2008
“Nursing Care of the Adult”, by Eloise Judd, 1983
“Gerontology: Nursing Care of the Adult”, by Mildred Hogstel, 2001
“Psychology and Work Today”, by Duane Schultz and Sydney Ellen Schultz, 2002