Nursing Care Plan (PCE) aimed at elderly patients with a feeling of loneliness PDF

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Old age is a life cycle that is characterized by the increased probability of suffering limitations due to deterioration in health, decrease in social networks, social rejection and death of family and friends. During this period there are certain problems...

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Nursing Care Plan (PCE) aimed at elderly patients with a feeling of loneliness. Old age is a life cycle that is characterized by the increased probability of suffering limitations due to deterioration in health, decrease in social networks, social rejection and death of family and friends. During this period there are certain problems, among which the most pressing that older adults experience with the development of old age are some feelings such as worthlessness, burden and isolation, which evolve generating a feeling of loneliness, social isolation, poverty and health problems in the elderly. These problems are developed and exacerbated by situations such as the death of the partner, grief, the absence of children, the loss of family traditions and customs, and low self-esteem, among others 1, 2. According to official IMSERSO data from 2015, there were 46,557,008 inhabitants, 18.7% of them being 65 years and over, that is, a total of 8,701,380 people. And of that group of people over 65 years of age, up to 6%, 2,792,613 inhabitants were 80 years or older 3. It is observed that the age structure of the population will age sharply, according to the data, and with greater increases in some specific periods; since people live longer, with the number of people aged 60 years or more being triple than in 1950. For the first time, the percentage of the elderly population exceeded that of the population of child age (0 to 14 years) in 2000 Since then, this percentage has not stopped increasing 3, 4 .

Loneliness is the subjective and anguished state of sadness or despondency resulting from being separated from others or from the lack of company and satisfactory human relationships, in which they feel that social needs are not answered in sufficient quantity or quality, with a notable discrepancy between the achieved level of preferred social contact and the actual 1, 4, 6, 7. Although it is not simply a result of losses associated with age, but loneliness can be experienced in all stages of life 4. By On the other hand, this feeling of loneliness is associated with

-1-

poor quality of life, health problems and higher mortality among the elderly, with the structure of the home, perceived health, and the social and family component being some of the most conclusive significant effects of loneliness 6, 8. These Older people tend to deny the presence of any feeling of loneliness, and thus delay the moment to continually ask for help, which also leads to a progressive deterioration of their health 9. Loneliness is considered one of the main determinants of health in developed countries. In these, its prevalence is between 20 and 40% of the elderly population 10, and specifically in our country, an average of 24% of the elderly show a feeling of loneliness (2006 surveys) 8. There is a close relationship between the feeling of loneliness, widowhood and health in old age, noting in the latter a feeling of helplessness, since they fear suffering an accident or sudden illness being alone at home, in addition to uncertainty about the future, about who will take care of them if they need care 11. These feelings help to activate the internal feeling of loneliness, which together with social isolation lead to higher mortality. The causes of the increase in this rate are especially cardiovascular and mental illness and depressive symptoms, as well as Alzheimer's disease, cancer, and suicidal ideation or attempts 1, 10-12. According to Weiss's classification of loneliness (1973), the loneliness condition is made up of two main characteristics: one emotional and the other social. The first refers to the feelings for the loss of a loved one, such as a close companion or a good friend with whom the person shared his life, absence of family values or customs. On the other hand, social loneliness is related to a state in which the older adult does not have a sense of social belonging, a social isolation, in which he lacks commitments with other people, friends, neighbors, appearing a decrease in their contacts with social groups and established relationships are deficient and unsatisfactory 1, 12.

Social isolation, on the other hand, is the separation of individuals or groups resulting

in

the

lack

or

reduction

of

minimal

social

contacts

or

communications, either with family or friends. Said separation can occur both physically,

as well as

by social

barriers or

by psychological

mechanisms, in which some type of interaction may occur, but not true communication 13, 14. On some occasions, isolation in the elderly has become a defensive defensive action that the individual adopts in the face of obstacles that he encounters throughout his life and in which processes such as the loss of a partner intervene in an accessory way , mourning, physical and economic transformations, which are often so difficult to overcome. Likewise, it occurs with the feeling of loneliness, people who live alone, with multiple pathologies, depressive symptoms, insomnia, in a situation of widowhood, retirement, unemployment or impoverishment are at special risk of presenting it 2, 13. Although from all this it is summarized that living alone does not necessarily imply suffering from social isolation or loneliness. People who live alone can enjoy an active family and social life, since true social isolation is totally involuntary 13. Both main concepts, both isolation and loneliness, are associated with increased morbidity and mortality. This mortality is predicted with the same consistency as many known risk factors. The risk of premature mortality increases 26% in people who feel lonely, 29% in people with social isolation and 32% in those who live alone. Although, despite these studies and conclusions, it is still not possible to draw important and truly relevant consequences regarding the importance for mortality in adulthood 4, 7, 13. To encompass all these concepts, and to be able to act correctly on patients who suffer from them, primary care teams have to promote the autonomy of these patients, facilitate their sociability and act on their maladaptive social thoughts that hinder their social integration through interventions group. These interventions

promote peer support and participation, improving cognition and quality of life for older people who feel lonely 6, 13, 15. Living alone as an older and even dependent adult is a growing reality and should be taken into account counts to a greater extent, both for society and families, and for health and care teams 9.

1. OBJECTIVES. Main goal:  Develop a nursing care plan (PCE) for seniors who suffer from feelings of loneliness and notable social isolation.

Secondary objectives:  Detect loneliness and isolation in the elderly, as well as the most important problems that influence well-being when it appears.

 Modify, together with the patient, leisure activities, as well as an improvement or development of social relationships that solve or control problems as a consequence of loneliness in the elderly.

2. METHODOLOGY. To carry out this work, an update of the subject has been carried out, searching for information through the bibliographic review in specific databases of health sciences. The articles were searched using the MESH definitions and the descriptors of health sciences (DeCS), as well as the Boolean operators, in this case / AND / and / OR /, corresponding in each database. This review was carried out during the months of February and March 2020. The search was limited to databases in Spanish and English preferably and with a limit, in terms of the age of the articles, of 10 years, prioritizing those published as of 2015.

they selected those that allowed free full text, rejecting articles without access to full text. After in-depth research in the various available databases, the most prominent articles were selected for review. The most prominent were found in Medline, Pubmed, Scielo, Science Direct and Dialnet. To complement the information on these platforms, web pages such as the Institute for the Elderly and Social Services (IMSERSO), as well as the Health Sciences Descriptors (DeCS), were investigated. Finally, books of interest in the social health field and the specific books of the NANDA, NOC and NIC taxonomy were studied. The search for the articles selected for this study was carried out according to the process that is reflected in Table 1 below. Following the line of work, a Nursing Care Plan (PCE) has been carried out aimed at elderly people with Loneliness and Social Isolation, basing the assessment on the model of the eleven functional patterns of Marjory Gordon and using a standardized language through the use of the NANDA taxonomy, as well as the classification of NIC nursing interventions and the classification of NOC nursing outcomes.

3. DEVELOPMENT. 5.1 Assessment. The assessment of the patient must be carried out through an interview, the development of which will allow the collection of the necessary data using, as in any nursing action, active listening with the patient and the observation of this,

as well

as the investigation

of their possible

environment. All these data collected, together with those of the scales that are detailed later in this study, are recorded and ordered according to the eleven patterns of Marjory Gordon, obtaining necessary information of a physical, mental, social nature and the most relevant environment of the elderly, thus facilitating its analysis and accurate information for a correct Comprehensive Geriatric Assessment.

For the assessment, different scales should be used, both for loneliness and social isolation. These scales are those that will be given to the patient when they suspect the state of loneliness so that they can fill them in and thus obtain objective and subjective data about themselves. The perception of loneliness should be measured with the validated UCLA Loneliness Scale, which measures subjective emotional and relational loneliness, and consists of 20 questions. By means of these questions the patient will obtain a certain score: scores higher than 30 mean absence of loneliness, between 20 and 30 moderate loneliness, and less than 20 severe loneliness 10, 16 (ANNEX 1). Likewise, the patient will be provided with the modified ESTE-R scale, composed of 34 questions with 5 response options. These responses will allow the professional to assess the results according to the

categories in which family, conjugal, social loneliness or existential crisis are differentiated 17 (ANNEX 2). To assess the degree of social isolation of the elderly, the abbreviated version of the Lubben Social Network Scale, validated in Spanish, should be used. This scale consists of 6 Likert-type questions with a score range from 0 to 30, where 30 points indicate the absence of social isolation, 12 points or more, a low risk of social isolation and less than 12 points represent a high risk of isolation social 18 (ANNEX 3).

5.2 Diagnosis. The diagnostic labels of the NANDA taxonomy (North American Nursing Diagnosis Association) should be used. 19. According to the results obtained from the interview, observation and scales, these three main diagnoses will appear and be reflected: (00054) Risk of loneliness. Definition: Susceptible to experiencing discomfort associated with the desire or need for greater contact with others, which can compromise health. Belonging to pattern number 7, Self-perception - self-concept. (00053) Social isolation. Definition: Loneliness experienced by the person and perceived as imposed by others and as a negative or threatening state. It belongs to pattern 8, Role-relationships. (00241) Impaired mood regulation. Definition: Mental state characterized by changes in mood or affect, formed by a constellation of affective, cognitive, somatic and / or physiological manifestations that vary from mild to severe. It belongs to pattern 10, Coping-stress tolerance.

5.3 Planning. Once the diagnoses have been established, the objectives to be followed and the indicators will be selected to qualify the patient's condition according to the Classification of Nursing Objectives (NOC) 20. Each of them will be accompanied by certain interventions following the Classification of Interventions

of

Nursing

(NIC)

21.

In

addition,

with

the

aim

of

complementing these interventions, specific related activities will be developed. This process on the diagnosis of Risk of loneliness explained above, is shown in detail below. Taking into account the individual characteristics of the patient, the NOCs and the relevant indicators will be adapted, as reflected in Table 2, in order to evaluate both the initial level of the patient and the level that is intended to be achieved at the end of the development of the plan. care. The same will happen with the decision of the NICs and their corresponding activities that are observed in Table 3. Table 2: Loneliness Risk: NOC and indicators.

NOC

(1203) Severity of loneliness.

INDICATORS

[120307]

Sensation

of

Pre

Tar

viou

get

s

lev

level 1

el 5

Social

isolation. [120312]

Difficulty

1

5

1

5

1

5

1

5

for

establish contact with the rest. [150311] Participate in leisure activities (1503) Social

[150317] Establish new relationships.

involveme nt.

[150318] activities.

Own elaboration.

Attend

to

group

The levels of the indicators of the Severity of loneliness (1203) are quantified according to the 14 scale, being: 1. Severe, 2. Substantial, 3. Moderate, 4. Slight or 5. None. On the other hand, the NOC indicators of Social Involvement (1503) are valued according to the 13 scale, in which: 1. Never demonstrated, 2. Rarely

demonstrated,

3.

Sometimes

demonstrated,

4.

Frequently

demonstrated and 5. Always proven. Table 3: Loneliness Risk: NIC and Activities.

NANDA

N IC

ACTIVITIES

(5100)

Foster relationships with people who have

Empowerment

common interests and goals.

of socialization. Encourage to

to the

patient

change

of

environment, such as going for a walk or a movie. Determine the need for limitation of visits, such as, for example, too many visitors, that the patient is impatient or

(0005 4)

(7560)

tired or his condition

Facilitate

physical does not allow it.

visits.

Risk

Evaluate the patient's response to family visits.

of loneli

(5440)

Determine the suitability of existing social

ness.

Increase

networks.

support systems.

Encourage the patient to participate in social and community activities.

(4362) Behavior

Help

to the to identify

patient the

modification:

interpersonal problems derived from deficit of social ability.

social skills.

Provide feedback (praise or rewards)

to the on

patient

the realization of

the desired social skill. Own elaboration. For the second diagnosis, that of Social isolation (00053), the NOCs and the indicators in Table 4 have been selected, which will make it possible to assess and obtain the necessary information for the patient's evolution. Likewise, the NICs and the interventions reflected in Table 5 will be highlighted to work with the patient in a satisfactory way. Table 4: Social Isolation: NOC and Indicators. NOC

INDICATORS

(1502) Social interaction skills. (0121)

adult. Own elaboration.

Tar

viou

get

s

lev

level 1

el 5

[150203] Cooperate with others. [150212]

I know

1

5

1

5

1

5

relates

with the the rest. [12145] Shows loneliness.

Developme nt: older

Pre

[12112] Maintains relationships with close family members.

Regarding the NOC indicators for Social Interaction Skills (1502) and the indicator (12112) “Maintains relationships with close family members”, the previous levels and the target levels are assessed according to scale 13, where 1 is Never demonstrated, 2. Rarely, 3. Sometimes demonstrated, 4. Frequently proven and 5. Always proven.

Unlike the indicator (12145) “Shows loneliness”, which is evaluated according to the 19 scale, being: 1. Always demonstrated, 2. Frequently demonstrated, 3. Sometimes demonstrated, 4. Rarely demonstrated and 5. Never demonstrated.

Table 5: Social Isolation: NIC and activities. NANDA

N IC

ACTIVITIES Help the patient to identify feelings that impede the ability to interact with others

(5000)

(anger,

Elaboration

anxiety, hostility or sadness).

of complex relationships

Support the patient's efforts to interact with others in a positive way.

.

Help the patient identify a specific change goal. (4470) Help in modifying (0005 3)

yourself.

patient to determine the degree of support for the desired behaviors. Assess the impact of the life situation of the

Soci al isola tion.

Assess the social and physical environment of

(5230) Improve coping.

patient in roles and relationships. Encourageto the patient develop

to

relations. Foment

the

activities

social

and community. (5820)

Explain all the procedures, including the

Decreased

possible sensations to be experienced

anxiety.

during the process.

Own elaboration. And finally, regarding the diagnosis of Impaired mood regulation (00241), the NOCs and indicators referenced in Table 6 will be compiled. Next, in Table 7, the NICs and the activities proposed to correctly develop the project and the consequent improvement of the patient.

Table 6: Impairment of mood regulation: NOC and indicators.

NOC

INDICATORS

[160402] Feeling of satisfaction (1604)

Pre

Tar

viou

get

s

lev

level 1

el 5

with leisure activities.

Participation in

1

5

1

5

1

5

[160403] Use of appropriate social interaction skills.

recreational activities. [120112] (1201) hope

Establishment of

objectives. [120114] Use social support.

Own elaboration. Regarding the NOC indicators of Hope (1201) and Participation in leisure activities (1604), they are valued according to the scale 13, in which: 1. Never demonstrated, 2. Rarely demonstrated, 3. Sometimes demonstrated, 4. Frequently proven an...