ELEMENTS OF PSYCHOSOCIAL WELL-BEING
Every nursing home serves residents with diverse needs. You will serve individuals who have physical disabilities and cognitive impairments, those who are recovering from a short-term illness or injury and those who are impacted by chronic conditions and co-morbidities, folks who will return to their homes and those who are receiving care in the last home.
While each individual experiences and copes (or fails to cope) with their health condition differently, everyone is subject to the impact their physical health may have on their emotional health and psychosocial well-being. As a caregiver in a nursing home, you are expected to understand the potential psychosocial needs of the residents with whom you work AND to follow the care plan and provide services that will help them attain and maintain their highest practicable level of psychosocial well-being.
IMPACTS ON PSYCHOSOCIAL WELL-BEING
Quite frankly, no one looks forward to living in a nursing home. While individuals who are receiving short-term services to enable their return to home may view a short-stay in a nursing home as little more than a milestone in their recovery, the are still subject to changes in mood and well-being as they examine their physical health or decline, as they see long time friends who are receiving long term care, as they are separated from the familiarity of home and their normal routine and as they experience separation for family and loved ones. Individuals who are experiencing a long-term stay, face all the same stressors coupled with the reality of spending the remainder of their days in place very few long to be. As a caregiver, the way you approach your job and the people you serve has a dramatic impact on their psychosocial well-being and on your own. Every interaction you have with each resident is an opportunity to address their complete well-being. While performing the physical tasks of your work, please make an effort to address the emotional and psychosocial needs of the person receiving your care. A residents’ sense of self is not composed simply of how they see themselves. How they see others seeing them can have a devastating or affirming influence—please make your influence the later.
INDICATORS OF PSYCHOSOCIAL WELL BEING
There are many indicators of psychosocial well-being. One researcher identified the following:
Self-acceptance—the degree to which a person has positive attitudes about themselves, their past behaviors, and the life they’ve lived
Relationships with others—the degree to which a person has positive relationships with, and feels connected to, others
Autonomy—the degree to which a person feels independent and in control of their person
Growth and Development—the degree to which a person feels they continue to live life to their fullest potential
Purposeful life—the degree to which a person feels they continue to live a life that has meaning and they contribute in some way to the world around them
REINFORCING PSYCHOSOCIAL WELL-BEING
As stated previously, your responsibility is to assure the care and service you provide helps each resident reach their highest practicable level of psychosocial well-being.
Regarding a resident’s self-acceptance, helping a resident reminisce about the life they’ve lived may enhance their self-acceptance. Listening to what residents say about themselves and noticing the way they’ve decorated their personal space is an excellent way to identify ways you can reinforce their self-acceptance. Take what you see and what you hear and engage the resident in conversation that helps them verbalize their self-worth. For a resident who is stuck in a place of self-worth, see if there are cues in their environment you can use to help them move to a place of self-acceptance based on the life they have lived.
Regarding a resident’s relationships with others, look for opportunities to converse with residents about their friends, families and loved ones. For residents who have limited or strained relationships with the friends, families and loved ones, look for opportunities to engage them in conversation about acquaintances among residents and staff at the nursing home. The overwhelming majority of residents have made a connection with someone at the nursing home. Talk with the resident about how you feel being new at the nursing home and ask them how they’ve adjusted to living in their current home. Remember, this isn’t an interrogation. Its an exercise in reinforcing a resident’s relationship with someone else.
Regarding autonomy, the Federal and State nursing home regulations require caregiver empowerment of residents. Respecting their autonomy—their right to say yes and no, now or later, etc—enhances their psychosocial well-being. Choice and control are exercised by residents even in the most advanced stages of dementia. Tune in to what residents are “telling” you through their actions and behavior. An angry response to you efforts to provide care is a demented resident’s effort at exercising control over the time and manner in which they will accept that care.
While it may be challenging to help a nursing home resident feel that they continue to grow and develop as a person at the same time they increasingly need the help of others, it is critical to their well-being that you help them identify the ways in which they are living life to their fullest potential. Recognizing that a person’s potential is different at different points in their life can be helpful. When a person was young, living to their potential may have involved being active in sports or the performing arts. As they grew older, their fullest potential in those areas may have been geared more towards bowling than football, or more towards setting an example for their kids than performing on a stage. As they continued to age, their athletic needs may have been satisfied by walking the dog. Further declines late in life may limit them even further but still offer you the opportunity to praise their potential for safe transfers or waling to the bathroom or dining room. Almost universally, people respond to praise for an accomplishment. The comments you make regarding how well a resident transferred may not invoke the adrenaline rush or a stadium cheering a great play but the smile the resident returns in response to your kindness lets you know the sound of praise stirs the pride of even the most dependent resident.
Perhaps the most challenging and unfulfilled psychosocial need is of living a purposeful life, especially when a person has become totally dependent on the work of others to complete an ADL. It must be hard to feel one’s life has purpose when help is needed with the most intimate care and they can’t remember their most recent meal. But their life does have purpose even if that purpose is little more than teaching a care giver how to honor the dignity of others during the provision of care. You will certainly work with residents who continue to be actively involved in life in the community and their business helps them see that their life has purpose. For other residents, you may well need to help them see and hear how their life has purpose by thanking them for the honor of serving them
SIGNS OF PSYCHOSOCIAL DIS-EASE
Not “disease” in the diagnostic sense, we are talking now about discomfort or uneasiness that prevents a resident from reaching their highest practicable level of psychosocial well-being. Indicators you should be alert to, and possible interventions you might use to support a resident, include:
Agitation, Aggression, Anxiety—STOP what you are doing that maybe provoking the response, give the resident time and space to self-soothe, gently re-engage allowing lots of time for the resident to become receptive to your efforts to comfort and support
Social Withdrawal or Reduced Social Contact—gently encourage the resident to socialize through attendance at desired activities and social settings such as meals; offer to remain present during the social setting, if possible, and to “rescue” them if they begin feeling uncomfortable; if arising from medically-appropriate isolation, assure extra efforts are made to spend 1:1 time in the room with the resident and engage in social interactions while there
Feelings of Shame—share is a reaction to an inner experience of being “not wanted”; it is a feeling that one is bad, and therefore rejected; approach the resident with acceptance of their personhood and personal dignity; provide care reverentially; close your encounter by sincerely expressing the hope that you can be of service again
Sleeplessness—interruptions of normal sleep cycle patterns may be related to fear, anxiety and nervousness; offer opportunities to verbalize their fears and provide reassurance that you and others will keep the resident safe
As a caregiver, you must be tuned in to these indicators of psychosocial needs and to possible care plan interventions the facility has created to support a resident experiencing some level of dis-ease.
As a caregiver, it is your ethical responsibility to provide care that enables a resident to reach their highest practicable level of psychosocial well-being. It is every caregivers’ responsibility to honor the humanity and dignity of the person to whom they are providing care. Quite simply, caring about a resident is as much your responsibility as providing care to a resident. Doing that consistently will help assure a resident’s psychosocial well-being.