This study examines depression in the setting of the nursing home as a fundamental malady requiring effective treatment techniques that extend beyond pharmaceutical roles to address the caregiver relationship with elderly patients. Results of the research implement a number of studies examining the prominence of pain as a deterrent to open communication between the involved parties and reminiscence therapy as a key to reducing depressive symptoms. The elderly in the nursing home need cognitive stimulation that allows them to interact with others and press upon the limits of their perceived capabilities in mental exercise. Results show that such exertions provide for a healthy nursing home environment where patients feel open to express themselves in a setting that Henderson and Vespiri (1995) term as "everyday ethics."
Implementation of this research comes as a result of consulting caregivers currently in nursing homes in order to evaluate actual treatment techniques as compared with only those suggested in studies and books. In addition, patients with depressive symptoms in elderly care systems are interviewed in an effort to more clearly understand what techniques have been already implemented in support of their cognitive health. By observing these similarities and differences, multiple opportunities present to improve upon the existing system with updated directives that allow for a more broad implementation of ideas from both on-field and academic sources. Ultimately, patients displayed the greatest levels of improvement when they were given the opportunity to recount aspects of their life history in reminiscence therapy as well as learn new skills such as playing a musical instrument, learning a new language, or applying new computer skills, especially when used in the service of increased communication with loved ones.
The decision of moving into nursing always comes as a difficult one with a wide variety of options to consider. Once the elderly person's health requires daily hands-on maintenance, the writing is on the wall for many people. Such a decision can lead to therapeutic dysfunctions requiring the use of various forms of therapy to boost the morale of patients and eliminate depression at its root. Unfortunately today, the maintenance of patient morale comes at a premium as the elderly adjust to a new social environment separated from their familiar lives, thrust into a foreign environment with unfamiliar expectations. As such, elderly patient care requires an environment that fosters a happy and healthy progression in the golden years of life. In the face of this mission, caregivers must take care to sustainably foster a positive setting through various therapies in order to support the culture change for long-term care elderly patients.
Research shows that there are specific power dynamics that come into play between nurses and bed-ridden patients. The responsive nurse, in a position of control, will remain sensitive to such dynamics. Furthermore, studies show that nursing home residents will likely desire to receive care on their own terms in a setting where protocols and set procedures are largely implemented (Polit & Beck, 2012, p. 128). When the realization that there is a lack of authoritative equality between the patient and the nurse occurs even in terms concerning the patient's daily activity and fundamental well being, depression is likely to ensue. The patient may feel trapped. My hypothesis, in essence, claims that reminiscence therapy and cognitive exercises play a key role in effective health care for the elderly. In this act of engagement, nurses can act to promote a positive environment for the benefit of their patients.
Jean W. Lange (2012) reports that human beings spend one-quarter of their life growing up and three-quarters of it growing old (p. 341). By the time older adults reach the age of care in a nursing home, their aging process is quite advanced. One method proposed by Lange called Selective Optimization with Compensation Therapy focuses on creating a successful aging process by accentuating positive factors and remaining facilities in life while the caregiver fills in for areas of diminished ability. Lange relates "people need to select activities that meet their functional, cognitive, and emotional capacities" in order to "optimize their strengths and capabilities . . . while engaging in life pursuits" while providing a role for "compensation . . . to . . . functional or cognitive losses" (p. 341). Such compensatory strategies can include the implementation of walkers, glasses, and hearing aids, etc. in order to most fully profit from remaining capabilities.
Henderson et. al (1995) call for an environment fundamentally based on "everyday ethics" that provides respect for the cognitive and expressive abilities that remain. For example, a patient who may be confused and unsure of their location may know full well how they feel and have no trouble expressing those feelings (p. 82). In such circumstances, caregivers must take steps of persistence and patience to understand and respect the dynamics of individual people in the face of symptoms of "dementia, depression, confusion, dysphasia, deafness, . . . and telescoping" (p. 82). In doing so, caregivers can deal with patients on their own terms while still providing for their needs.
Carol A. Miller (2009) advocates that once relegated to the nursing home, older adults take responsibility for their own health to the greatest extent possible. Nurses carry the responsibility of finding "wellness opportunities" where they actively assist the patient in choosing areas to implement "brain fitness" activities into their lives (p. 193). Miller suggests five specific ways by which to make this ideal a reality. Nurses may promote novel opportunities to learn that challenge and appeal to the elderly with exercise continuing to play a key role in an active lifestyle. Miller also calls for situations where board games, musical instruments, dancing, or reading come into play as part of the daily exercise to maintain an active mental state. To balance daily concerns with long-term goals, there should be tasks that challenge the elderly to build on their current abilities. Acquiring computer skills or learning a new language could fill this role. Finally, and perhaps most importantly, Miller contends that maintaining strong ties with family and friends can provide for meaningful relationships that come as part of a healthy mental state (p. 192-193). Together, these interventions can lead to long-lasting wellness, ultimately leaving no time for depression.
Appendix M within Polit et al. (2012) Resource manual for nursing research outlines research examining various factors of pain in older adults and how it shapes direct communication with caregivers. Results of this grant proposal suggest that "older adults asked about their pain with an open-ended question without social desirability bias will describe more important pain information" (p. 409). This directive guides the caregiver to search for unbiased communication with patients that will extend to situations where mental wellbeing is involved. By controlling chronic pain, the frustration and discomfort of daily living can make way for activities that allow for healthy cognitive function.
The studies by Karimi, Dolatshahee, Momeni, Khodabakhshi, Rezaei, and Kamrani (2010) play a pivotal role in a clear understanding of proper therapies for long-term health in the lives of elderly patients. In the study, the researchers encouraged the expression of the account of the individual life histories of twelve men and seventeen women with depressive symptoms ranging from mild to severe. Analysis of patient states before and after the intervention led to the conclusion that reminiscence therapy directly contributed to statistically meaningful reductions in depression (p. 886). As such, these findings contribute to a specific strategy for addressing depressive symptoms in patients.
The fundamental basis for my study will focus on finding opportunities to test options for minimizing depression in patients based on a variety of methods outlined above in the Literature Review. In the nursing home, the caregiver has a unique opportunity to interact with patients on a daily basis extending far beyond the administration of medication and measurement of vital signs. Nurses must take care of the whole person in order to make an account for long-lasting wellness.
The implementation of this study will consist of a reflection of the data gathered by Karimi et al. (2010) and Polit et al. (2012). In addition, it will take into account the specific suggestions given by Henderson et al. (1995), Lang (2012), and Miller (2009) in order to come to a comprehensive solution. This broad implementation of various resources will allow for a conclusion that takes into account a variety of factors from multiple angles in the health profession. In doing so, the design will relate a professional on-site strategy to verify existing evidence and provide a precedent for further developments in studying depression among the elderly.
The population will consist of a grouping of ten nurses and ten elderly patients in the process of contemplating patient benefit methods from the giver and receiver perspective.
In order to maintain patient confidentiality, stringent non-disclosure procedures must be followed. There is a serious legal obligation to protect personal information. In addition, nurses must be allowed to express their experiences and concerns with confidence that their divulgences will not be used against them.
After identifying patients with depressive symptoms, the standard operating procedure will involve a persistent and accommodating interactive process with those in elderly care to determine what steps have been taken to improve their cognitive well being via both pharmaceutical and therapeutic/non-traditional methods. Once permission to interview is obtained from employers, nurses will be invited to participate in an online survey that will maintain anonymity. The forum will solicit a direct understanding of current practices for the rehabilitation of patients with depressive symptoms and ask the nurses which therapy in place work most effectively. In order to encourage reliable and considered input, only nurses with intermediate to advanced work experience will be considered. Although there may be an overlap of data, patients and nurses interviewed will come from the same institutions in order to track prescribed solutions against patient relief.
Understanding the data will be contingent on reading notes taken from on-field interviewers and reading nurse responses filled out from the online forms. In the case of the patients, data-gatherers will consider pharmacological influences and natural supplements as well as the therapies proposed in the literature findings above to gain a broad understanding of what people are doing to combat depression. In doing so, researchers will better understand specifically what tactics are being used among recovering patients. Data interpretation based on online results submitted by nurses will depend on the categories of current treatments (pharmacological, natural, and therapeutic), perceived effects, and places for improvement.
In the end, caregivers who challenged and encouraged their patients to take responsibility for their own sense of well being found the most positive results. In successful cases related by nurses, this came as the result of a culture of respect (everyday ethics) and rehabilitation directed towards the patients. Often, patients reported that one-on-one interaction beyond the role of mere caretaker worked especially effectively in reminiscence therapy. Challenging patients to take on new abilities also encouraged them to stay engaged with the world around them. Significantly, few patients reported substantial improvement as a result of taking prescription drugs although some patients that took exclusively natural supplements accompanied by a healthy diet experienced moderate improvement.
What is an effective way to broadly implement these observed positive therapeutic results in the form of a policy? What steps can be taken to heighten Henderson et al. (1995) notion of "everyday ethics" into the collective mission of nursing homes (p. 82)? What collective emphasis should be placed on prescription drugs to combat depression among the elderly?
In spite of debilitative handicaps, the elderly expect to be treated like functioning adults by their caregivers. In order to best serve their needs, nursing home administrators must carefully examine levels of accommodating support with patients. Encouraging extended social time and planning sessions where patients reflect on life experiences and focus on learning new tasks will effectively minimize depression.
Henderson, J. N., & Vesperi, M. D. (1995). The culture of long term care: Nursing home ethnography. Westport, CN: Bergin & Garvey.
Karimi, H., Dolatshahee, B., Momeni, K., Khodabakhshi, A., Rezaei, M., & Kamrani, A. A. (2010). Effectiveness of integrative and instrumental reminiscence therapies on depression symptoms reduction in institutionalized older adults: an empirical study. Aging & Mental Health, 14(7), 881-887.
Lange, J. W. (2012). The nurse's role in promoting optimal health of older adults: Thriving in the wisdom years. Philadelphia: F.A. Davis Co.
Miller, C. A. (2009). Nursing for wellness in older adults (5th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Polit, D. F., & Beck, C. T. (2012). Resource manual for nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.