the bond whenever possible. Healthcare organizations can also strive to decrease ageism by offering educational activities that dispel misconceptions and prejudices while addressing intergen- erational concerns of the older adult (WHO, 2021). Ultimately, the Cultural care To understand the older adult more completely, the healthcare provider must enter the therapeutic relationship with the under- standing that cultural beliefs and practices impact care. The older adult client may identify with a particular culture, and the health- care provider needs to assess that identification in order to pro - vide quality mental health services. The healthcare worker needs to understand the definition of culture, its application, and how to extend cultural acceptance. Definition of culture (American Psychiatric Association, 2022c): 1. The distinctive customs, values, beliefs, knowledge, art, and language of a society or a community. These values and concepts are passed on from generation to generation, and they are the basis for everyday behaviors and practices. 2. The characteristic attitudes and behaviors of a particular group within society, such as a profession, social class, or age group. The healthcare provider must assess each older adult client with openness using cultural competence and cultural humility. Cultur- al competence is the knowledge, skill, and awareness the health- care provider possesses (Boyd, 2017). Cultural humility is the Empathy In the healthcare profession, empathy has nineteenth-century historical beginnings. Florence Nightingale is the most notable advocate as a result of her role in bringing compassion and em- pathy to patients. She is credited with unifying science and skill with compassion and empathy (Magpantay-Monroe, 2015). Ex- hibiting empathy can be thought of as an individualistic portion of healthcare with artistic freedom. There is more than one correct and therapeutic way to connect with older adult clients when as- sessing, intervening, and delivering treatment—especially when meeting mental health needs. The healthcare worker addressing mental health concerns can utilize and modify various approaches Professional boundaries for the mental healthcare worker While meeting the needs of the older adult mental health cli- ent, the healthcare worker is cautioned to maintain professional boundaries. Ethical topics such as abuse can be of concern with older adult mental healthcare, and they warrant a review of appro- priate interaction. The National Council of State Boards of Nurs- ing (2018) defines professional boundaries as the area between the healthcare worker’s “power and the client’s vulnerability.” Mental healthcare assessments and interactions depend on the healthcare worker’s aptness within this delicate scope. The focus during the interview should always be the client. Keeping the per- spective of the client’s recovery goals can guide the healthcare worker to maintain appropriate balance. The healthcare worker should avoid self-disclosure whenever possible. Self-disclosure is defined as personal information a healthcare worker shares with a client (Boyd, 2017). Using honesty and redirection can give the healthcare worker the ability to shift questions or comments about themselves back in line with the therapeutic relationship. Remem- ber, the goal is to help the older adult client through professional interactions and work to improve their quality of life. Transference and countertransference are two sides of the same coin. The healthcare worker meeting mental healthcare needs for the older adult should use acute recognition/awareness for the hindrance of either element. Transference is a client placing Theory of interpersonal relationship In 1952, Hildegarde Peplau created the first psychiatric frame - work for the nurse–patient relationship (Boyd, 2017). The sys- tematic organization of the professional relationship she created can be generalized to a wider spectrum for healthcare workers meeting mental health needs. The framework consists of three phases of the professional relationship. The first phase is the ori - entation phase: the introduction and initial exchange of acquain-
healthcare worker must foster a therapeutic relationship nurtured in rapport and trust in order to meet the mental health needs of the older adult.
healthcare provider’s ability to self-reflect on potential bias and possible factors that could interfere with providing mental health- care (Stubbe, 2020). It places emphasis on a continuous learning process for the healthcare worker. Both concepts are defined and designed to aid the healthcare worker in their interactions with older adult clients and provide cultural acceptance. Techniques for the healthcare worker to extend cultural accep- tance (Stubbe, 2020) include: ● Review your agency’s policies and practices toward culture. ● Find out if your agency provides accommodations for lan- guage. ● Simply ask the client how they identify their culture. ● Take notes on specific practices, customs, and beliefs the cli - ent discusses. ● Avoid assumptions. ● Ask about discrimination, bullying, or possible harassment re- lated to culture. ● For validation, reword and repeat what is being shared. ● Give the client permission to speak up when they are feeling misunderstood. to communication to elicit trust and rapport that enrich the en- vironment for information exchange, often of a sensitive nature. The healthcare worker can use originality with the empathetic ap- proach, with the goal of maximizing the dialogue with the older adult client. This is important for the older adult client because the WHO (2021) notes empathy as a method for combatting age- ism. With trust and empathy, the healthcare worker can increase interpersonal connection enveloped in empathy with the older adult client, making it easier to assess, intervene, and treat mental healthcare needs. the thoughts, feelings, or behaviors they associate with someone else onto the healthcare worker (Boyd, 2017). This can be heard when a client says things such as “You remind me so much of my son/daughter” or “You look like a girl/boy a grew up with.” While these comments are not infallible indicators, they should prompt the healthcare worker to follow up on the association the client is making. The association can be favorable—or an obstacle to overcome. Countertransference is when a healthcare worker knowingly or unknowingly places their own feelings or attitudes onto the client (Boyd, 2017). This term can present in a positive or negative connotation. If the elderly client reminds you of your lov- ing grandparent, then you might take great care in meeting needs or risk breeching 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 countertransference can be combatted with awareness. The practice of self-awareness and the review of extenuating factors that contribute to ageism, as discussed above, can also be applied to transference and coun- tertransference. Trust, empathy, and a focus on professionalism place the healthcare worker in the appropriate space for com- municating and enhancing mental healthcare needs of the older adult. tance 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 rela - tionship begins with the first interaction and changes with every subsequent interaction. The healthcare worker uses the orienta- tion phase to listen, establish boundaries, manage expectations, and use self-awareness to check for countertransference (Boyd,
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