Mental Health Concerns and The Older Adult
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a positive or negative connotation. If the elderly client reminds you of your loving grandparent, then you might take great care in meeting needs or risk breech- ing professional boundaries. If the older adult client reminds you of your abusive grandparent, then the client is at risk for decreased objectivity in assessment and possible degradation of care rendered. Both transference and countertransfer- ence can be combatted with awareness. The practice of self-awareness and the re- view of extenuating factors that contrib- ute to ageism, as discussed above, can also be applied to transference and coun- tertransference. Trust, empathy, and a fo- cus on professionalism place the health- care worker in the appropriate space for communicating and enhancing mental healthcare needs of the older adult. Theory of interpersonal relationship In 1952, Hildegarde Peplau created the first psychiatric framework for the nurse– patient relationship (Boyd, 2017). The systematic organization of the profession- al relationship she created can be gen- eralized to a wider spectrum for health- care workers meeting mental health needs. The framework consists of three phases of the professional relationship. The first phase is the orientation phase: the introduction and initial exchange of acquaintance and building of trust that can happen in minutes or may take months (Boyd, 2017). The older adult is seeking help and has identified unmet mental health needs. The therapeutic relationship begins with the first interac - tion and changes with every subsequent interaction. The healthcare worker uses the orientation phase to listen, establish boundaries, manage expectations, and use self-awareness to check for counter- transference (Boyd, 2017). The second
phase is the working phase: the space for examining existing problems and finding acceptable solutions to overcome them (Boyd, 2017). This phase is where the ma- jority of the interpersonal relationship for assessing, implementing, and evaluating take place. It typically happens over time. A sense of comfort is felt in this phase for the older adult and the healthcare work- er. The older adult has emotional safety in this phase and is able to address mental health struggles. The healthcare worker is cautioned that transference is common in this phase (Boyd, 2017). Goals toward recovery should be reached during this phase. The final stage of the framework is the resolution phase: the termination of the services and relationship take place in this stage (Boyd, 2017). Not all relation- ships will follow through to the resolu- tion phase. But if they do, the healthcare worker can say “good-bye” and reflect on the progress made by the older adult as well as the social support put into place for continued success (Boyd, 2017). The components of trust that build rap- port, culture consideration, empathy, and professional boundaries can be applied throughout Hildegarde Peplau’s frame- work. The healthcare worker can visualize the potential psychiatric therapeutic rela- tionship with the older adult client prior to initiation with the goal of improved interactions. The healthcare worker can also have an awareness for the progres- sion and evolution of the therapeutic rela- tionship, including its termination. COMMUNICATION AND LIMITATIONS WITH OLDER ADULTS Communication is a vital key for the healthcare worker to properly meet men- tal health needs of older adult clients. A healthcare worker can provide dignity and respect when the older adult client feels
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