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Article Excerpt
Barrett (1998), Cowling (1997), and Butcher (2006) explored ways to apply Martha Roger's science of unitary human beings to their nursing research and practice. The theory and knowledge they developed can help nurses transform their careers into vocations which reflect reverence for all people, including older adults, with a deep commitment to human betterment through enhanced nursing practice (Butcher, 2006). The goal of this article is to help nurses gain additional expertise and confidence in assisting older adults with pain.
Effective nursing practice with older adults requires an appreciation of the contributions that older adults make to their families and society. Nurses also must provide elders with the information and resources they need to choose freely, and with awareness, ways to participate in reducing their pain and discomfort as well as increasing their functional ability. Nurses not only help older adults recover from acute illness or trauma, but also help them resume and explore meaningful social roles as grandparents, and/or cultural teachers and contributors.
Case Study: Gloria
Gloria is a 71-year-old retired married female who would like to work part-time and remain active in her grandchildren's lives, but she is constrained by pain in her lower back, knee, and foot. She sees herself as fortunate in many regards; she has remained trim, has a comfortable home, and has money to travel. She also is very involved in her church and community. She lives with her husband, who is a war veteran and retired police officer. Her two daughters and most of her grandchildren live in Florida. She enters the hospital for right knee arthroplasty; the knee has bothered her for many years and its condition recently has worsened. She is reluctant to use traditional pain treatments, and believes that prayer is the more important source of her healing and pain relief. She now is willing to consider surgery and a combination of traditional and non-traditional treatments so she can return to her family roles, church volunteerism, teaching classes, and working at a local craft store.
Longevity, Power, and Pain
While it is acknowledged widely that the world's population is aging, the benefits of longevity are less well recognized. Older adults have a great deal to contribute to their families and society. Thomas (2004), a Harvard-educated geriatrician, described the three plagues of elders as loneliness, helplessness, and boredom. He and others developed the Eden Alternative, a movement to reform nursing homes to make them true homes and communities, places where older adults want to live and other people, including children, like to visit. They accomplished this in part by bringing in birds, cats, and dogs, and by replacing the mowed grass surrounding the facilities with gardens. All residents were given responsibility for contributing to the care and maintenance of the animals and plants, and welcoming visitors. Loneliness was replaced by companionship, and helplessness and boredom by meaningful activities and responsibilities. The efforts of Eden Alternative homes have reduced the need for psychoactive and sedating medications, and reduced the number of bedfast residents and pressure ulcers (Thomas, 2004). Staff absenteeism, back injury, and turnover also are lowered. One principle of Eden Alternative homes can be applied in the acute care hospital: "medical treatment should be the servant of genuine human caring, never its master" (Thomas, 2004, p. 189).
Inadequate understanding and self-management of chronic pain is a barrier for many older adults to remain active and enjoy healthy aging. Nurses who work primarily with acutely ill, depressed, and disabled older adults, and in places unlike Eden Alternative facilities, easily can develop negative views of aging and older persons.
A Unitary Participatory View
Barrett (1998) used Roger's unitary theory to redefine power as knowing participation in change. She defined knowing as involving awareness, choices, freedom, and creating changes. She described two processes which can be applied in a nursing approach to older adults with pain. The first is the process of pattern manifestation knowing, which she explained as apprehending...
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