The Concept of Life Review and Ego Integrity
Aging is an irreversible process expected physiological in which the strength of the mental and physical of a person decreases suddenly and without a rebound. During the process of aging, research shows several types of aging theories changes that affect the quality of life of the elderly. Nowadays, due to the increased population in old age, it is one of the most challenging problems in the domain of health and welfare. “Life stories become more important among the elderly life as they face the last chance, to sum up, their life and its meaning” (Keisari &Palgi, 2017). Butler first presented the idea of life review in his 1963 article. Where he described life review as a retrospection of the past life accomplished in older adults, allow them to analyze, evaluate, and achieve a more profound self-concept. According to Erik Erikson, life review could be therapeutic or hurtful for certain people because it leads individuals to a sense of integrity, gratitude, and acceptance of life, and may to avoid a sensation of regrets, guilts remorse. That is the reason life review may not apply to everyone. The present study direct to explore the effectiveness of life review therapy on the quality of life of the elderly NP A.S
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Theories of aging, a process was developed to assist the healthcare providers in leading holistic adult assessment. The tool can facilitate comprehensive, best practice decisions in caring for hospitalized older adults 65 years or more. The theories of aging divided into several types, such as the secondary theory of aging, which is natural in all groups of human beings and deteriorates with age. Still, it can be reversible or preventable depends on the choices and lifestyles of the person. Another theory of aging is maladaptive, defines as the autonomic responses due to the development of multiple mental health issues noted in one person at the same time, that individual unable to cope with certain situations and declining force of natural selection with age. With maladaptive theory, reproduction is not as effective as expected, which leads the organisms to adapt to a shorter lifespan. The assisted death theory of aging defines as a faster reproduction, and genetic variability of a species is crucial for adaptability for a population (Angelo and Van Gilt, 2009). Assisted death tend to cause harm to organisms. Senemorphic can be beneficial or harmful depends on environmental conditions. Senemorphic aging theory is the combination of assisted dying (detrimental) and secondary (beneficial) aging. As a result, an individual can adapt to both and deal with any environmental changes.
NP A, age of 66 years, has had multiple sclerosis for about 28 years. She accommodates by taking injection for multiple sclerosis, using a wheelchair for lifestyle changes. She raised in a family of three children. She enjoyed her childhood and graduated from high school. Later, she had a master’s degree in nursing. She practiced nursing for 18 years and got married. She got pregnant and had a miscarriage after 13 weeks. She then diagnosed with multiple sclerosis MS. A few months later, she became pregnant with another child born with some complications of seizure and was depend on meds and died when she was a teenager. A few years later, NP A., had a third pregnancy with a healthy child without complications. Due to multiple sclerosis, NP A. was unable to take care of herself, and she was mistreated and abandoned by her husband and put her in an assisted living. She got divorced, where her husband raised her daughters without her acknowledge. Her daughters took their father's side, never come to visit NP A.
NP A. parents used to take care of her before their death. Now her sister supports and takes charge of NP A. As a nurse, she understands her illness and copes positively. She loves to read, watch movies, enjoy bingo. She is very active with recreation and goes out when necessary. She is taking anti-depressive medications. Due to her disease, she developed a pressure sore to the left gluteal with stage four. She grew bladder issues and had a suprapubic catheter in place and became incontinent of bladder and bowels. Her two important positive things in her life were her childhood and her career. Her two-hardship past was the loss of children and her incurable disease.
Using the assessment tool of Fulmer spices, geriatric scale, patient stress questionnaire, and mini-mental status, the psychologic finding, NP A, is adjusting very positively with the developmental tasks associated with her age. She refused to be mistreated by her husband and got her divorce and regain her independent lifestyle. She believes maintaining self-actualization continues to be her priority goal. Sociological, she is fully engaged in the community, be a leader of the resident council. She attends church regularly and participates with recreational activities such as trips, movies, bingo. She has successfully coped with the death of the first two children and deal with the decision of the alive child. NP A. accepts her current health status and believes her life has continued to be fulfilling in her retirement. NP A. understands her illness by having injection three times a week and using her wheelchair for mobility. She is confident, she will enjoy improved health and expected one day she would be free of the pressure sore. NP A. has a firm personality, copes well with problems, and has a strong work ethic. She lives with significant events like depression. NP A. loves to read and always wants to know about her health to involve in promoting wellness and prevent further illness. She discussed the time frame for her wound to be healed. The nurse should presume a plan of care for NP A. require any teaching her risk factors regarding constipation, pressure sore, fall risk, depression. The nurse recognizes a fiber diet, repositioning every two hours, Range of motion can promote a healthy status. It is vital to encourage NP A. to go to therapy, drink plenty of fluids, and ask for help when needed, encourage her to express her feeling due to her depression.
Erik Erikson’s stage theory of development proposed eight stages of life in which the individual needed to accomplish the specific developmental tasks that would facilitate task accomplishment in later stages (Harder, 2012). His primary focus is on the individual’s ego structure or sense of self. It is the way and how society shapes its progress. In that stage, it becomes to tackle the issues in the end-life. According to Erikson NP A., the onset of her phase is often triggered by the loss of her children, facing incurable illness, injury of career. During the integrity versus despair stage, NP A., reflects on the life she has lived and presents with an attitude of a sense of fulfillment from experience well-lived or knowledge of regret and despair over a life misspent, which is life review. According to Erikson, people who are successfully resolving the crisis at this stage leads to the development of ego integrity.
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People can look back at their life with a sense of happiness and confront the end of life with a sense of prudence and no regrets. But those who feel proud of their accomplishments will feel a sense of integrity. There are some people successful completing this phase means looking back with few regrets and a general feeling of satisfaction. These people will experience wisdom, even though when dealing with death. The ones who are unsuccessful during this stage will feel that their life has wasted and will experience many regrets. The person will leave with a feeling of bitterness and despair. In the case of NP A., 66 years old received her disability 28 years ago and retired. As it begins to reflect in her life, she finds that she experiences both feelings of satisfaction as well as few regrets. She enjoyed her childhood, and her career as a nurse practitioner spanned about two decades. She has some regrets like her illness, the loss of children. She feels proud of her accomplishments by achieving ego integrity. While she realizes that some things might have done another way if she had the possibility. Even with multiple sclerosis, she feels an overall sense of pride. After the assessment, the nurse can rate NP A. with a score of seven. Now she made valuable contributions to the community she lives; she copes positively with her illness and able to face what is ahead with a sense of wisdom and proud.
The findings of life review of aging in older adults are useful because they help patients to cope positively with their current life and overcome any regrets in the past life. The life review tool can be beneficial for healthcare providers that guide them to new vision to promote the health of planning care for the elderly population. The overall assessment tool of Fulmer Spices, geriatric depression scale, mini-mental state examination, patient stress questionnaire can lead to appropriate implementation to the elderly needs. Nurses should consider also apply Erikson's theory because it correlates with life review. That way, the nurse can evaluate which stage the patient is in, whether ego integrity or despair and intervene according to patient’s conditions, and promote the patient’s well-being. As a recommendation, all nursing homes should use that tool of life review to improve health.
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