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Praxis Note 2

Jobin Mathew

York University

NURS4525: Health and Healing: Community as Partner 4525 Tutorial

Clinical Course Director: Tanya Johnson

October 25, 2023

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Praxis Note 2

In this reflective praxis note, I will look back on a situation where I applied Falk-Rafael’s

theory of critical caring for a client. This paper will touch on the importance of acknowledging

stigma related to mental health and older adults.

To elaborate, I was speaking with the recreation team at Deerwood Creek about any

gaps in the system of delivering care to older adults. The consensus was that there was an

increase in mental health cases in the population and nurses are not quite trained to deal with

this increase. The team continued to explain that a 40-year-old resident had been admitted into

the long-term care and experiences mental health difficulties and therefore is at risk of social

isolation within the care home. They continued explaining, stating that many nurses feel

awkward as they may be older than this resident staying at a long-term care home, as well as

feelings of judgment towards the resident because of her mental illness. When hearing all this I

was alarmed for a second but realized, even in my externship for Trillium Health Partners, I

noticed the nurses all mentioning the same idea regarding mental health in specialized settings.

The nurses stated they felt prepared to deal with the acute issues of the clients but not the

additional mental health problems that come along with it. In honesty, after hearing there was a

40-year-old resident at a long-term care home in addition to mental health issues I too felt off

put by the situation. The idea of a 40-year-old resident perplexed me for some reason, which led

me to do some reflection as to what image I had regarding older adults. How does this image

impact my practice? The growth in mental health cases is increasing and thus needs to be

addressed. As a community health nursing student, I thought to myself “How could I possibly

address this situation and/or make an improvement”. The idea then arose to offer music therapy

as a possible way of bridging the gap for the resident, as music therapy has been shown to

improve mood, motivation, and enjoyment while also decreasing stress, anxiety, and depression

(Pearson et al., 2023). So, I decided to apply the Community Health Nurse's standards of

practice and advocate for this resident and provide equitable care by offering my services to the
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community through Music Share (Community Health Nurses of Canada, 2019). I achieved this

by explaining that Music Share is the ideal activity for this resident as the resident is at risk of

social isolation and the fact that I have experience working on a senior mental health floor at

Mississauga Hospital. The team agreed that Music Therapy was a great idea and thus reached

out to my preceptor regarding the situation, While I am not promised the role of providing music

therapy for this resident it made me think of the role stigma and mental health play in the

community. Research states that often individuals who belong to a stigmatized group, such as

mental illness, avoid seeking help, experience stigma-related distress that often worsens their

condition, or encounter overt discrimination in healthcare and social relationships (Sheehan &

Corrigan, 2020). Falk-Rafael’s theory of critical caring best exemplifies my new line of thinking,

it’s the relational way of being that fosters and safeguards human dignity and well-being, while

also addressing the political, social, environmental, and economic factors that impact health

(Iwamoto, 2023). I believe that if someone were to truly offer their truest selves to the resident

and develop trusting relationships and promote advocacy and capacity building, we could see

positive changes in the client’s health as well as the culture they are surrounded with (Iwamoto,

2023). The resident is 40 years of age and is in a transitioning period according to Erikson’s key

developmental stages. Intimacy vs Isolation is typically seen in early adulthood, 20-40 years

where the individual may actively seek intimate relationships that they can establish, keep, and

determine a close circle of people they can trust while also allowing them to acknowledge their

vulnerabilities (Maree, 2022). Ages 40-65 years focuses on the ability of the individual to care

for others as well as themselves, if achieved they will learn to care for others without needing it

to be reciprocated as this generates feelings of purpose and meaning (Maree, 2022). In the

resident’s case, it could be either or of the stages or just a transition period from one to another;

In any case, it highlights the increased need for trusting relationships to build the capacity to

work with others and to find a purpose and meaning to life. This situation has taught me that the

stigmatization of older adults with mental health is growing and is leading to worsening health
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conditions and can lead to social isolation. The importance of constant reflection yields new

growth and the possibility of change as I can shift my views to incorporate the clients’ views and

wishes as they are experts on their health. For further learning, I wonder what resources or

programs can be offered to nurses to help understand and care for older adults with mental

illnesses? How will I convince them to buy in? I aim to find this answer through a walking survey

of the community with this new perspective as well as speaking with nurses. This allows for a

broader idea and can allow me to take a precede-proceed model of thinking to work my way

backward and view possible solutions.

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References

Community Health Nurses of Canada. (2019). Canadian community health nursing professional

practice model & standards of practice

Iwamoto, S. (2023, January). Developing a Theory of Community Caring for Public

Health Nursing. In Healthcare (Vol. 11, No. 3, p. 349). MDPI.

Maree, J. G. (2022). The psychosocial development theory of Erik Erikson: critical

overview. The Influence of Theorists and Pioneers on Early Childhood Education, 119-

133.

Pearson, C., Sham, R., Gardner, S., Klapman, S., & Altschuler, A. (2023). Perceived

Quality of Online Music Therapy Sessions by Older Adults Aging at Home. Canadian

Journal on Aging / La Revue Canadienne Du Vieillissement, 1-14.

doi:10.1017/S0714980823000260

Sheehan, L., & Corrigan, P. (2020). Stigma of disease and its impact on health. The

Wiley encyclopedia of health psychology, 57-65.

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