This page forms part of the Transcultural Health resource, published in 2004, and is preserved as a historical document for reference purposes only. Some information contained within it may no longer refer to current practice. More information
Transcultural health care practice: Foundation module
Section four: Practical application
Lifespan Approach
Lifespan means the 'extreme length of life regarded as biologically possible' (Webster's Comprehensive Dictionary, 1999).
Safarino (1990) describes the lifespan perspective as 'an approach whereby characteristics of a person are considered with respect to prior development, current level of development, and likely development in future' (Safarino, 1990, p.20). Safarino relates the lifespan changes that take place in biological development, psychological systems, and social relationships. Safarino states that 'The lifespan perspective adds an important dimension to the biopsychosocial perspective in our effort to understand how people deal with issues of health and illness'. (p.20).
Caraher (1997) has illustrated the concept of life span as periods of time in the lives of individuals. These periods of time are literally chronological ordering in the life of people, starting from birth and ending in old age and death. The potential for growth and development through the life span is enormous, and is characterised by key landmarks. The concept of life cycle also conveys similar ideas but breaks down the lifespan into age-specific groups and associated life events such as pregnancy. The use of a lifespan development model can enhance our understanding of the various life events during the various stages through which we develop. It can assist us to review many issues in health and health care, disease processes and mortality, economical and social independence, adoption of different lifestyles, social and cultural emancipation, access to services and facilities.
Ethnic Identity Development And Interethnic Communication
The individual's identity develops over time. As Robinson (1998, p. 10) is keen to point out '…identities are not rigid, fixed or unidimensional' and that 'identity development is a life-time process which takes place within specific social and political contexts.'
Robinson (1998) has considered the relationship between the processes of the black person's ethnic identity development and interethnic communication. Robinson (1998) and has reviewed several models of ethnic identity development: Cross's model of psychological nigrescence, Parnham's elaboration of Cross's model, Atkinson and colleagues' minority identity development model and Helm's people of colour racial identity development model. Robinson (1998) summarises the key stages of the models and discusses similarities and differences.
Robinson suggests that 'Cross' sees the individual going through five stages - Pre-encounter, encounter, immersion-emersion, internalisation, and finally internalization-commitment. Parnham adds the lifespan perspective to Cross's model because identity development is perceived as ongoing throughout the person's life. Robinson then describes a five-stage model proposed by Atkinson and colleagues. The individual is seen as progressing from conformity, through dissonance, resistance and immersion, to introspection and finally, synergistic articulation and awareness. Helm's model also has five stages, conformity, dissonance, immersion-emersion, internalisation and integrative awareness. Helm emphasises racism as a theme.
However, Robinson (1998, p.19) points out that 'A subject that has not been adequately researched is white racial identity development and its effect on interethnic communication'. She goes on discuss racism with reference to the above models.
(For a detailed discussion see Robinson, 1998, Chapter 1, p. 11-33)
Thus, identity development is influenced by personal experiences during the lifespan. For example, encounters in childhood may influence the kind views that are construed about one's ethnic identity at an early stage. However, as the person develops through the lifespan and is exposed to numerous other encounters, these views may change as the person adapts his/her values, beliefs and attitudes. The qualitative differences generated through these encounters reshape the cognitive, emotional and attitudinal aspects of identity formation. Some aspects of early identity perception may be reinforced and become an integral part of the person's ethnic/cultural identity, whilst other aspects may be given to changes over time and through acculturation. Thus, the developmental nature of personhood through the lifespan provides scope for the exploration of how personal and ethnic/cultural identity is moulded.
There are many instances when we relate or categorise events with reference to the time of their occurrence. The lifespan approach is a framework that allows us to consider age-related events. We make reference to and attach particular importance to these progressive developmental stages in relation to the individual's lifetime and the numerous transitions that mark each stage.
The lifespan approach may provide a framework to explore events and practices across cultures; for example, beliefs and practices following the birth of a child.
By describing a stage you are giving some of the key features of the stage. You may like to describe what precedes it, and what follows it. Occasionally, you may describe what happens or is likely to happen if any aspects of what makes the event what it is, is lacking in any way due to ill health or disability. Thus, the event and its relationship to the relevant time of its occurrence are important in order to explore its meaning and significance in the cultural context.
Lifespan As A Useful Learning Tool
Since the lifespan approach also helps us to focus our attention towards specific events associated with a stage of growth and development, it is useful in that we can examine issues about health, illness, and relate these to the stage of growth and development from the bio-psycho-social perspective. It adds to the understanding of age-related needs, behaviours and practices, and rites of passage that the person goes through. Life opportunities influence the person's ability to achieve personal and social goals, and assume diverse roles and responsibilities. Thus, the lifespan approach can assist in exploring the age-related resources that are necessary for health.
The lifespan approach is also useful when thinking about the structure, organisations and delivery of systems of health and social care services. For example, 'neonatal' units, Special Baby Care Units, Care of the Elderly, Children's Nursing, Adult Nursing.
Lifespan As A Continuum
In the lifespan approach one may see events as a single one-off occurrence, or a series of associated events. The lifespan approach places particular emphasis on the idea of a continuum. The continuum enables us to examine events along a time line. We can begin by thinking of the person as starting life as a foetus following conception, and through the life course achieve development and growth, and at the end of the continuum, death as a human event. There is no single set of stages that can be said to be universal because some of these stages are not clearly defined in terms of months or years. So, you may think of the human lifespan in terms of 'newborn', 'infancy', 'childhood', 'adolescence', 'adulthood', 'middle age', and 'old age'. However, there are many terms that you may be familiar with that point to a subtle emphasis on aspects of the stage of growth and development in question. For example, 'teenager', or 'older adult', which may also convey social and cultural influences on how these are perceived.
From a physical health perspective, the lifespan is marked by certain 'events' in relation to medical and nursing care, and the associated interdisciplinary services in the community. These may be age-related, lifestyle focussed, or gender specific. Examples of these include immunisation, screening for various genetically determined diseases such as sickle cell and thalassaemia disorders, cystic fibrosis and screening for cancers.
People's views about lifespan stages will vary, as will their perceptions and values. Whilst one can accept a degree of universality, ideas about everyday lifespan related events and situations might not be conceptually similar. For instance, pregnancy in a cross-cultural context may be celebrated in culture specific rituals, whilst the views of women and men about pregnancy may vary within and across cultures. Thus, an awareness of the diversity between and within cultures and well as gender differences is a useful principle.
In the cross-cultural context, the lifespan approach can provide a framework to explore culture-specific beliefs and practices about a developmental stage and its perceived significance in that culture. Hence, in congruence with the belief systems and religious practices, there are celebrations, festive occasions, social and religious events that mark the rites of passage. These may serve various functions at personal, family and social levels. Cultural expectations influence the practices that are observed in communities that have established themselves or in the transition of establishing themselves in Britain. Rituals of social transitions play an essential part in all cultures and are outward or public demonstrations of change from one stage to another. Some rites of passage are given below:
Rites of Passage include:
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Time And Events
Cultures vary in terms of time orientation. That is, some cultures are present oriented and this is reflected in the spoken language and symbolic expressions. Similarly, other cultures may be past or future oriented. Time also plays an important part in religious and cultural events. Time and its relation to customs, festivals, taboos and spiritual significance can be perceived in certain religions and cultures more than others.
In Islam, for example, the timing of sunrise and sunset is of particular importance in relation to prayers. The lunar calendar guides such decisions. This approach becomes particularly significant in deciding the actual day on which Ramadan (when the world over Islamic people fast) begins and ends. Since it is governed by lunar cycles, there is not a fixed date in the Gregorian calendar for the beginning and end of Ramadan. It may be different every year.
The lifespan approach can inform health profiles of individuals and assist the integration of cultural knowledge about people from diverse backgrounds.
Further Reading
- Helman CG (2000) Culture, Health and Illness 4th ed. Oxford: Butterworth Heinemann
- Henley A and Schott J (1999) Culture, Religion and Patient Care in a Multi-Ethnic Society London: Age Concern Books
- Narayanasamy A (1991) Spiritual Care: A resource guide Lancaster: Quay Publishing
Scenarios
Introduction
The scenarios presented here are not exhaustive in the use of the concepts and the framework being developed. Tutors may wish to devise their own scenarios, with emphasis on the issues they wish to explore.
In keeping with the learning outcomes and competencies, these scenarios aim to facilitate the application of the transcultural model of care by exploring issues of significance to the care of the individual and family. They also reflect some of the wider aspects involved in nursing care within a diverse society. The issues that emerge may range in their scope from being specific, person-centred concerns to broad issues about policies and practice. The examples are meant to act as triggers and you may generate others that are equally relevant and appropriate.
How you proceed to work through each scenario is very much a matter of personal choice. However, it may be useful to make some preparation beforehand. For instance, if you have come across patients from different ethnic and cultural backgrounds to yourself, you may spend some time reflecting on the main aspects of their care management. The stages of care delivery based on assessment, planning, implementation and evaluation may be helpful in organising the work you undertake.
You may choose to work alone or work in a group.
The issues that you raise for consideration should have a transcultural focus. You may wish to engage with others who have worked through the scenarios and share your ideas and knowledge. The initial list of resources provided is not exhaustive and you will no doubt add to it as you work through the scenarios.
Scenario 1: Conception And Pregnancy
Emma is 17 years old, white, English, and lives with her parents George and Megan, and her younger brother David in the London borough of Brent. George and Megan disapprove of some of Emma's friends whom they consider to be a bad influence.
George and Megan have lived in the same flat since they were married 20 years ago. George is 40 and works as a train driver for a national railway company and he expects to stay in his job until he retires. He belongs to a close-knit family that settled in the area over 3 generations ago from the north of England and many of them still live locally. He is a lay preacher at the local Pentecostal church.
Emma's mother Megan, also 40, works as a part-time nurse at the local hospital. Her parents originated from the south of Wales although she was born in London. Megan attends the same church as her husband where she is one of the Sunday school teachers.
Her other child, David, is 12 years old and attends the local comprehensive school.
Emma has a boyfriend Taiwo, aged 19 years, whom she has been going out with for one year. They have known each other for a long time; meeting at the church they both attend with their families. Taiwo was born in London to Nigerian parents and he has a twin brother named Kehinde (in the Yoruba culture these are names traditionally given to twins). Taiwo is at college studying to be a motor mechanic and he dreams of running his own business in the future. Emma's parents like Taiwo as they see him as a steadying influence on their lively, outgoing daughter.
Taiwo lives at home with his mother and twin brother and is content and secure within this family environment. He plays football in his spare time and looks forward to seeing Emma at weekends.
Abiola, Taiwo's mother is widowed and works as a supervisor in a supermarket. She has 2 married daughters who are both older than Taiwo and spends a lot of her time visiting them and the grandchildren. The family last visited Nigeria four years ago for the memorial ceremony marking the first anniversary of the death of her husband.
Recently Emma has been feeling very tired; however she put this down to the extra college work she had to undertake. Her parents too had even commented on how pale she was looking but agreed with Emma that it was probably due to the increased volume of her studies. There have been a few occasions when she has felt nauseous and the previous week she vomited several times whilst at home. Although her periods are not always regular, this month it is long overdue and she now wonders if she might be pregnant. Emma and Taiwo have only intermittently taken contraceptive action. On the way home from college she goes into the chemist's and buys a pregnancy testing kit. Once home she 'does the test', and the result is positive.
Learning Activities
The main issues that the scenario addresses are:
- Impact of pregnancy on both families, reflecting on transcultural perspectives, religious beliefs and attitudes of those within their social networks.
These issues will be explored through the following statements/questions:
- How is pregnancy and child bearing viewed across cultures?
- How is teenage pregnancy viewed in the UK?
The following learning activities will provide students or tutor opportunities to engage with the statements/questions:
- Pregnancy and childbearing across cultures:
· Explore pregnancy and childbearing from a 'European' or western perspective.
· Explore pregnancy and childbearing from an African or Nigerian perspective. - Attitudes to teenage pregnancy in the UK?
· Find out the statistics about teenage pregnancy.
· Explore your own attitudes about teenage pregnancy and their implications.
The following resources will support the learning activities.
Books
- Henley A and Schott J (1999) Culture, Religion and Patient Care in a Multiethnic Society. A Handbook for Professionals London: Age Concern Books (See for example Chapter 39, Nigerian communities: history and traditional culture, pages 420-432)
- Schott J and Henley A (1996) Culture, Religion and Childbearing in a Multiracial Society. A handbook for health professionals. Oxford: Butterworth Heinemann
Useful Web Resources
Marie Stopes International
British Pregnancy Advisory Service
Scenario 2: Child With A Learning Disability
Mr and Mrs Amir Baksh have lived in the borough since 1987. Mr Baksh is 38 years old and came to England aged 10 years with his parents from the Punjab, Pakistan. Mr Baksh was educated in England and works in local government for the neighbouring borough. His parents live in the Midlands, as do his sister, brother and their families. Mr Baksh and his family as Muslims and practice their faith.
Mrs Fatima Baksh, aged 34 years of age, grew up and was educated in Pakistan. She came to England after her marriage to Amir. Mr and Mrs Baksh lived with his parents in the early days of their married life. The family moved to London 8 years ago when Mr Baksh obtained a job as a housing allocation officer in local government.
Mrs Baksh had a 'difficult' pregnancy with Amina, their first child. She regularly reported feeling tired, had little rest, and did not eat very well. At the time Mr Baksh was studying part-time, attending evening classes twice a week at the local college and helping with the family business. The family members were all supportive.
Amina is now 8 years old. She was diagnosed with epilepsy and cerebral palsy. She is physically able to help herself with her personal hygiene needs and dressing. However, she needs assistance with feeding and elimination. She can communicate with a few spoken words and gestures. Her mother cares for Amina at home. Amina attends the day centre. Sometimes her father takes her to the centre but generally it is her mother who takes her there and spends part of the day with her.
Mr and Mrs Baksh have a son, Faisal who is 12 years old and has started secondary school. He is outgoing, and has a network of friends from different cultural backgrounds. He is well liked at school. He plays football and cricket, and spends some of his leisure time playing computer games.
Since moving to London, Mrs Baksh has missed the everyday support of her extended family, in particular her mother-in-law. Soon after the birth of Faisal, she found it extremely difficult to cope with her daughter. She blamed herself for not being able to cope. She believes that she is depressed but is not willing to talk to anyone about how she feels not even her husband.
One morning, as usual Mrs Baksh brings Amina to the day centre. On this particular occasion she could not stay long with her daughter as she had an appointment with her General Practitioner, and did not want to be late. Soon after Mrs Baksh left, Amina has a series of epileptic seizures from which she recovers. However, she is incontinent and her clothing is wet and soiled. Amina is disoriented, agitated and lashing out. She is calling for her mother and shouting.
When Mrs Baksh returns to the centre two hours later she is distressed and wants to know what happened and why no one had contacted her on her mobile phone to inform her of Amina's fitting episode.
Learning Activities
The main issues that the scenario addresses are:
- Care for Amina's personal hygiene needs
- Communication with Amina
- Reassuring Mrs Baksh about Amina's health.
These issues will be explored through the following statements/questions:
- Care for Amina's hygiene needs.
· What factors would you consider prior to attending to Amina?
· How will you ensure that you meet Amina's hygiene needs in a culturally sensitive manner? - Communication with Amina.
· How will you communicate with Amina?
· How are you going to validate that she understands what you are communicating?
· What non-verbal communication will you use and why? - Reassuring Mrs Baksh about Amina's health.
· What will you do to relieve Mrs Baksh distress?
The following learning activities will provide students or tutor opportunities to engage with the statements/questions:
- Care for Amina's hygiene needs.
· Explore the cultural aspects of hygiene, washing and dressing in the Muslim traditional way of life.
· Explore professional practice with respect to Amina's gender, age, and sexuality. - Communication with Amina.
· Explore ways in which you might communicate with Amina.
· Reflect on the role of language in effective communication with Amina.
· List ways in which you would know that Amina has understood you. - Reassuring Mrs Baksh about Amina's health.
· Explore possible ways in which Mrs Baksh might have expressed her distress.
· How might you express care and empathy, as well as inform Mrs Baksh about Amina's health.
The following resources will support those learning activities:
Books
- Ahmad WIU and Atkin K (eds) (1996) 'Race' and community care Buckingham: Open University Press
- Atkin K and Rolling J (1992) Community care in a multi-racial Britain: a critical review of the literature London: HMSO
- Barnes C and Mercer G (1996) Exploring the divide: Illness and disability Leeds: The Disability Press
- Council for Disabled Children (1995) Help starts here: a guide for parents of children with special needs 3rd ed. London: National Children's Bureau
- Gates B and Baecock C (1997) Dimensions of learning disability London: Bailliere Tindall
- Gummit RJ (1995) The epilepsy handbook: the practical management of seizures 2nd ed. New York: Raven Press
- Holland K and Hogg C (2001) Cultural Awareness in Nursing and Health Care An Introductory Text. London: Arnold
- Hopkins A and Appleton R (1998) Epilepsy: the facts 2nd ed. Oxford: Oxford University Press
- Lamb B and Layzell S (1994) Disabled in Britain. Behind closed doors: the carer's experience London: Scope
- Shah R (1995) The silent minority. Children with disabilities in Asian families London: National Children's Bureau
- Sheikh A and Gatrad AR (eds.) (2000) Caring for Muslim patients Abingdon, Oxon: Radcliffe Medical Press
Articles
- Emerson E, Azmi S, Hatton C, Caine A, Parrott R and Wolstenholme J (1997) Is there an increased prevalence of severe learning disabilities among British Asians? Ethnicity & Health, 2 (4): 317-321.
- Tizard Learning Disability Review (1999) Special issue on Race, Ethnicity and Learning Disability Volume 4, Issue 4
Reports
- Mir G, Nocon A and Ahmad W with Jones L (2001) Learning Difficulties and Ethnicity London: Department of Health
- Steele B and Sergison M (2001) Improving the quality of life of Ethnic Minority Children with Learning Disabilities Huddersfield: Huddersfield NHS Trust
Video
- Davis H and Russell R (1989) Physical and mental handicap in the Asian community: can my child be helped? London: National Children's Bureau
Useful Web Resources
British Institute of Learning Disabilities
Epilepsy Imaging Group
Royal National Institute of the Blind
Disability Unit
Learning Difficulty Links
MenCap
BBC Asian Life
Scenario 3: Adult With Sickle Cell Anaemia
Mark Singer, aged 17 years, lives with his parents and his 15-year-old sister in a semi-detached house in a quiet suburban area. Mark and his sister were both born in England but his parents emigrated from Jamaica over twenty years ago. He was diagnosed as having Sickle Cell Anaemia at eighteen months following painful swelling of his hands and feet. His parents and sister have sickle cell trait and his older brother Dean, aged 18 years, died two years ago from chest syndrome, a complication of sickle cell anaemia.
Over the years, Mark has learnt to live within the limits of his illness and has coped very well in managing his symptoms. However, he has lived with the fear that, like his brother, he may die during a sickle cell related illness.
Mark has a very close school friend Jonathan, with whom he spends much of his leisure time. Jonathan is also 17 years old and is of mixed ethnic background. His mother is of Malaysian Chinese origin and his father is from a white English background. Mark is a very able student, who is currently studying for his 'A' level examinations. This has placed added stress upon Mark as he is hoping for good grades to enable him to study medicine at University. Mark has forgotten to drink adequately and has now become dehydrated. Whilst studying at home with Jonathan, he suddenly experienced severe abdominal and rib pain. Knowing his condition and the levels of pain associated with a sickle cell crisis, he presented along with Jonathan at the local hospital Accident & Emergency (A & E) department demanding Diamorphine. New staff on duty did not know Mark and he gave them the impression of being a drug addict. In order to get a more effective response, Mark became aggressive and more demanding, but this further convinced the medical and nursing staff that he was not in pain, but a drug user.
In desperation, Jonathan used his mobile phone to contact Delma, the Clinical Haemoglobinopathy Nurse Specialist who supports Mark and is based at the hospital. Delma immediately visited Mark, recognised the distress he was experiencing and instantly briefed the A & E staff. Their attitude changed to a more positive approach in respect to meeting Mark's needs. A speedy assessment was undertaken by the medical registrar, followed by administration of prescribed analgesia. Mark was then transferred to the medical unit for a more detailed assessment and investigations. This was followed by medical and nursing interventions involving an interdisciplinary approach i.e. Consultant Haematologist, Clinical Haemoglobinopathy Nurse Specialist, Nursing Staff and other appropriate members of the Multidisciplinary Team.
Learning Activities
Main issues the scenario addresses:
- Sickle Cell Anaemia and its effects on the body
- Social and cultural background
- Health practices
- Spiritual beliefs
- Communication issues
- Nursing care - critically ill
The issues will be explored through the following statements/questions:
- How will you/the nurse meet Mark's personal hygiene needs?
- Ensure that Mark's nutritional and hydration needs are met.
- Explain the causes of sickle cell anaemia.
- Facilitate the meeting of Mark's spiritual, psychological and cultural needs whilst he is in hospital.
- Encourage the family to sustain their close relationship and remain a close unit.
- Assess how effectively Mark's pain is managed.
- Identify the appropriate statutory and voluntary agencies that can offer support to Mark following his discharge.
The following activities will provide the student or tutor with opportunities to engage with the above statements and questions.
(Students will undertake (a) a literature review and (b) access web pages such as those listed below to provide background information to enable them to discuss issues related to the scenario):
- Mark's personal hygiene needs.
· Explore issues about privacy, dignity and modesty. - Mark's nutritional and hydration needs.
· What factors will you take into consideration about preferences and choice?
· What measures will you take to encourage a satisfactory intake of food and liquids? - Causes of sickle cell anaemia.
· Describe the genetic inheritance of sickle cell anaemia with reference to the family tree. - Mark's spiritual, psychological and cultural needs whilst he is in hospital.
· How will you assess these needs?
· What factors will you consider so as not to stereotype? - Sustaining close family relationship.
· Consider the role of family support and cohesion. - Assessment of the effective management of Mark's pain.
· What will you observe for and what questions might you ask?
· How will you confirm non-verbal signs of pain? - Appropriate statutory and voluntary agencies that can offer support to Mark following his discharge.
· Explore the resources and their availability.
· Find out about the roles of statutory and voluntary agencies.
The following resources will support those learning activities:
Books
- Anionwu EN and Atkin K (2001) The Politics of Sickle Cell and Thalassaemia Buckingham: Open University Press
- Serjeant GR (2001) Sickle Cell Disease 3rd ed. Oxford: Oxford University Press
Articles
- Alleyne J and Thomas VJ (1994) The management of sickle cell crisis pain as experienced by patients and their carers Journal of Advanced Nursing 19: 725?732.
- Atkin K and Ahmad WIU (2000) Living with a sickle cell disorder: how young people negotiate their care and treatment In W.I.U.Ahmad (ed.) Ethnicity, Disability and Chronic Illness. Buckingham: Open University Press
- Atkin K, Ahmad WIU and Anionwu EN (1998) Service support to families caring for a child with a sickle cell disorder or thalassaemia Health 2(3): 305-327
- Davies SC and Oni L (1997) Management of patients with sickle cell disease. British Medical Journal 315: 656-660
- Maxwell K, Streetly A and Bevan D (1999) Experiences of hospital care and treatment seeking for pain from sickle cell disease: qualitative study. British Medical Journal 318: 1585-1590
- Nichols R (1996) Pain during sickle-cell crises American Journal of Nursing 96: 59-60
- Thomas VN, Wilson-Barnett J and Goodhart F (1998) The role of cognitive-behavioural therapy in the management of pain in patients with sickle cell disease. Journal of Advanced Nursing, 27(5): 1002-1009
- Tigner R (1998) Handling a sickle cell crisis RN, 61: 32-36
Organisations
Sickle Cell Society
54 Station Road
Harlesden
London
NW10 4UA
Tel: 020 8961 7795
Useful Web Resources
Sickle Cell Society
A useful site for obtaining information about sickle cell disorders and trait that is aimed at lay and professional audiences. It also contains details of NHS sickle cell counselling centres and local support groups within the UK.
APoGI Project
APoGI (Accessible publishing of genetic information) provides data on nearly all haemoglobin disorders. This includes material on sickle cell disorders and carrier states. It provides an excellent source of information.
Black Information Link (BLINK)
A UK site for minority ethnic issues and includes informative pages on finance, business, legal matters disability, education, Europe, human rights and arts and culture. Its health information section has useful sickle cell links
The Georgia Sickle Cell Information Centre
This American Website provides information for the sickle cell patient, their families as well as welfare practitioners. It is an impressive site that covers both health and social care issues.
Scenario 4 Elderly Person And Bereavement
Maeve Donnelly is a 78-year-old woman born in County Cork Ireland, the oldest of 8 children. Maeve came to England at the age of 24 to seek work and obtained a job as a chambermaid in a west London hotel. It was here that she met her husband Patrick, a porter at the hotel, and they settled down in the suburbs. To their distress, they never had any children.
Maeve worked her way up to the position of deputy manager of the hotel and stayed there till she retired at the age of 60. Patrick, who could not come to terms with having no children, eventually migrated to America 20 years ago and Maeve has not heard from him since. Maeve lives alone in a three-bedroom house and she has paid off the mortgage. However she has very little savings and finds it hard to make ends meet on her state pension and a small pension from the hotel. Apart from occasional telephone calls Maeve has very little contact with her family in Ireland.
Maeve has been finding it increasingly difficult to carry out the activities of daily living due to steadily worsening arthritis in her knees and hips. The anti-inflammatory drugs she has been prescribed reduce the pain slightly but she still finds stairs and sustained walking extremely difficult. She has told her doctor that she does not want to have an operation on her hips or her knees.
Her best friend is Joyce, aged 70 years, who was born in Scotland of Irish parents and came to England 50 years ago. Joyce met Maeve at church 25 years ago and visits her regularly, about twice a month. She suggests to Maeve that she should apply for the Attendance Allowance. Maeve does not want to accept something that she views as a 'state handout.' More recently she has found it difficult to get up the stairs to the toilet. To her mortification she is occasionally incontinent and is also constipated due to her medications. Her doctor, aware of the latter problem, had advised her to take a laxative daily but when she did it resulted in diarrhoea and she has not taken them since. To compound the problem she can no longer get into the bath and says she feels 'smelly and dirty'. Maeve has never told anyone about this and due to her fear of disgracing herself has stopped making her regular attendance at church despite the offer of a lift.
Maeve has also become dehydrated due to reducing the amount of fluid she drinks in an effort to stop her incontinence. Her arthritis has affected her food intake. She had been used to 'a good Irish stew' but now finds it hard to prepare vegetables and her diet consists mainly of sandwiches, tea and cakes. When her doctor suggested a home help she refused, saying that she wanted 'no strangers in her house'. Joyce sometimes brings a casserole for them to share but Maeve discourages her from bringing too much because she knows that Joyce is on a limited income.
One day Joyce did not turn up as expected and Maeve, worried about this, finally rang Joyce's daughter Kathleen to be told the news that she had died of a heart attack the week before and had already been cremated. Kathleen said she had thought of ringing Maeve but had been somewhat overwhelmed with all the funeral arrangements and was under the impression that Maeve was quite disabled. Maeve is devastated by this news and becomes ill the next day. She rings her doctor who comes to the house and finds Maeve very tearful. She finally swallows her pride and tells her doctor of the incontinence problem. The doctor says he will send the nurse round to 'sort her out'. The nurse arrives to find Maeve still grieving and feeling that life is not really worth living. She is also quite angry about Joyce's death and when the nurse suggests ringing the Priest, Maeve says prayer never did much for her and that she thinks God has deserted her.
Learning Activities
Main issues the Scenario addresses:
- Cultural influences on the lives of older people.
- Biographical approaches to care of older people.
- How major events in society as a whole and a person's life affect the way they deal with growing older, their beliefs values and attitudes and their adaptation to changing abilities and circumstances. Older people as individuals with the right to personal choices.
- Communication with older people.
- Spiritual needs.
- Dealing with grief and loss.
These issues will be explored through the following statements/questions.
- What are the cultural influences on Maeve's life and the ways in which she views the world?
- How would you approach Maeve on the subject of her incontinence and poor mobility? What are the main principles of sensitive communication?
- How can a nurse help a person who is grieving?
The following learning activities will provide student or tutor opportunities to engage with.
- Cultural influences on Maeve's life and the way she views the world.
· List all the cultural factors that may have shaped and influenced Maeve's life and beliefs, values and attitudes. - Approaching Maeve on the subject of her incontinence and poor mobility and main principles of sensitive communication.
· Think how you would prepare to raise the subject with Maeve.
· What factors would you take into consideration? Make a list of these.
· Who else might you involve?
· How will you deal with Maeve's reactions? - How can a nurse help a person who is grieving?
· Consider how the nurse can help Maeve to begin to work through her grief.
· Explore whether Joyce's family and the doctor approached Maeve with sensitivity.
· Explain why they may have behaved in the way they did.
· List the different ways in which bereavement and grief are manifested.
The following resources will support the learning activities:
Books
- Bartlett H (1998) 'Cultural perspectives on ageing' in: S Pickering and J Thompson (eds) Promoting Positive Practice in Nursing Older People London: Bailliere Tindall Chapter 2: 22-38
- Ginn J and Arber S (1993) 'Ageing and Cultural Stereotypes of Older Women' in J Johnson and R Slater (eds.) (1993) Ageing and later life Buckingham: Open University Press Chapter 13: 60-67
- Herbert RA (1999) 'The Biology of Human Ageing' in S Redfern and F Ross (eds) (1999) Nursing Older People 3rd ed. London: Churchill Livingstone Chapter 4: 55- 77
- Kelleher D and Hillier S (1996) 'The health of the Irish in England' in D Kelleher and S Hillier (eds.) Researching Cultural Differences in Health London: Routledge. Chapter 6: 103-123
- Le May AC (1999) 'Communicating Challenges in Old Age' in S Redfern and F Ross (eds.) Nursing Older People London: Churchill Livingstone Chapter 11: 183-193
- Narayanasamy A (1998) 'Religious and spiritual needs of older people' in S Pickering and J Thompson (eds.) Promoting Positive Practice in Nursing Older People London: Bailliere Tindall Chapter 8: 128-151
- Neuberger J (1999) Dying well: a guide to enabling a good death Hale: Hochland & Hochland
- Norton C (1999) 'Eliminating' in S Redfern and F Ross (eds.) Nursing Older People 3rd. ed. London: Churchill Livingstone Chapter 24: 395-412
- Scrutton S (1995) Bereavement and Grief. Supporting Older People through Loss Buckingham: Open University Press
- Scrutton S (1995) 'Bereavement, older age and ageism' in S Scrutton (ed.) Bereavement and Grief. Supporting Older People through Loss Buckingham: Open University Press Chapter 1: 1-21
Articles
- Costello J and Kendrick K (2000) Grief and older people: the making or breaking of emotional bonds following partner loss in later life Journal of Advanced Nursing 32 (6): 1374-1382
- Govier I (2000) Spiritual care in nursing: a systematic approach Nursing Standard 14 (17): 32-36
- Martsolf DS and Mickley JR (1998) The concept of spirituality in nursing theories: differing world views and extent of focus Journal of Advanced Nursing 27 (2): 294-303
- Narayanasamy A (1996) Spiritual care of chronically ill patients British Journal of Nursing 5 (7): 411-416
- O'Gorman SM (1998) Death and dying in contemporary society: an evaluation of current attitudes and the rituals associated with death and dying and their relevance to recent understanding of health and healing Journal of Advanced Nursing 27: 1127-1135
Videos
- Waiting for the Telegram by Alun Bennett, with Thora Hird. (LRC)
- Loss and Grief - Part 1 & 2 (LRC)