Aspen University Kelvin Costner Life Review and Ego Integrity Homework

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Assignment:

Identify an older adult age 65 +, use a 1st and last initial. Execute a therapeutic assessment interview with them for at least two interview sessions assessing their self-identified:

  • Demographics, life time education and career/employment
  • Two most significant (positive) times in their lives
  • What past hardship or loss has the client successfully negotiated in the past?
  • Two personal strengths
  • Engage them in identifying what is healthy versus non-healthy coping skills
    • Inquire of 2 healthy coping skills they have used in the past and/or now
  • Three (3) pieces of advice they would give to their younger self if they could?
  • Support the client in taking the Geriatric Depression Scale.pdf
  • Support the client in taking the Fulmer SPICES Assessment.pdf
  • Perform a Mini Mental State Exam.pdf and Patient_Stress_Questionnaire.pdf (attach here)
  • Report the findings from the Geriatric Depression Scale, Fulmer Spices, Patient stress questionnaire and the mini mental status exam
  • Discuss your older adult’s level of ego integrity vs. despair as described by psychoanalyst Erik Erikson. If you had to rate them on a scale of 1-10, with 1 representing a full state of despair and 10 representing full ego integrity, what rating would you give your older adult?
  • Describe at least two nursing diagnoses for this client.
  • Create a plan of care for the client to include at least three nursing goals with two nursing interventions each.

The assignment should be written in an APA-formatted essay. The essay should be at least 1500 words in length and include at least two scholarly sources other than provided materials. Note that when citing in text, authors with the same last names have to include their initials, and if they also have the same initials, you must spell out their names (page 176 in the APA manual for how to cite in text and list the reference). Note also that websites such as Healthypeople 2020, etc., and also web URLs such as healthypeople.gov or any URL ending in .com, .net, .edu, .org, etc., are not authors and are not people, so you cannot cite or reference them as an author of a source.

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general assessment series Best Practices in Nursing Care to Older Adults From The Hartford Institute for Geriatric Nursing, New York University, College of Nursing Issue Number 4, Revised 2012 Editor-in-Chief: Sherry A. Greenberg, PhD(c) MSN, GNP-BC New York University College of Nursing The Geriatric Depression Scale (GDS) By: Sherry A. Greenberg, PhD(c), MSN, GNP-BC, Hartford Institute for Geriatric Nursing, NYU College of Nursing WHY: Depression is common in late life, affecting nearly 5 million of the 31 million Americans aged 65 and older with clinically significant depressive symptoms reaching 13% in older adults aged 80 and older (Blazer, 2009). Major depression is reported in 8-16% of community dwelling older adults, 5-10% of older medical outpatients seeing a primary care provider, 10-12% of medical-surgical hospitalized older adults with 23% more experiencing significant depressive symptoms (Blazer, 2009). Recognition in long-term care facilities is poor and not consistent amongst studies (Blazer, 2009). Depression is not a natural part of aging. Depression is often reversible with prompt recognition and appropriate treatment. However, if left untreated, depression may result in the onset of physical, cognitive, functional, and social impairment, as well as decreased quality of life, delayed recovery from medical illness and surgery, increased health care utilization, and suicide. BEST TOOL: While there are many instruments available to measure depression, the Geriatric Depression Scale (GDS), first created by Yesavage, et al., has been tested and used extensively with the older population. The GDS Long Form is a brief, 30-item questionnaire in which participants are asked to respond by answering yes or no in reference to how they felt over the past week. A Short Form GDS consisting of 15 questions was developed in 1986. Questions from the Long Form GDS which had the highest correlation with depressive symptoms in validation studies were selected for the short version. Of the 15 items, 10 indicated the presence of depression when answered positively, while the rest (question numbers 1, 5, 7, 11, 13) indicated depression when answered negatively. Scores of 0-4 are considered normal, depending on age, education, and complaints; 5-8 indicate mild depression; 9-11 indicate moderate depression; and 12-15 indicate severe depression. The Short Form is more easily used by physically ill and mildly to moderately demented patients who have short attention spans and/or feel easily fatigued. It takes about 5 to 7 minutes to complete. TARGET POPULATION: The GDS may be used with healthy, medically ill and mild to moderately cognitively impaired older adults. It has been extensively used in community, acute and long-term care settings. VALIDITY AND RELIABILITY: The GDS was found to have a 92% sensitivity and a 89% specificity when evaluated against diagnostic criteria. The validity and reliability of the tool have been supported through both clinical practice and research. In a validation study comparing the Long and Short Forms of the GDS for self-rating of symptoms of depression, both were successful in differentiating depressed from non-depressed adults with a high correlation (r = .84, p < .001) (Sheikh & Yesavage, 1986). STRENGTHS AND LIMITATIONS: The GDS is not a substitute for a diagnostic interview by mental health professionals. It is a useful screening tool in the clinical setting to facilitate assessment of depression in older adults especially when baseline measurements are compared to subsequent scores. It does not assess for suicidality. FOLLOW-UP: The presence of depression warrants prompt intervention and treatment. The GDS may be used to monitor depression over time in all clinical settings. Any positive score above 5 on the GDS Short Form should prompt an in-depth psychological assessment and evaluation for suicidality. MORE ON THE TOPIC: Best practice information on care of older adults: www.ConsultGeriRN.org. The Stanford/VA/NIA Aging Clinical Resource Center (ACRC) website. Retrieved July 2, 2012, from http://www.stanford.edu/~yesavage/ACRC.html. Information on the GDS. Retrieved July 2, 2012, from http://www.stanford.edu/~yesavage/GDS.html. Blazer, D.G. (2009). Depression in late life: Review and commentary. FOCUS, 7(1), 118-136. Greenberg, S.A. (2007). How to Try This: The Geriatric Depression Scale: Short Form. AJN, 107(10), 60-69. Harvath, T.A., & McKenzie, G. (2012). Depression in Older Adults. In M. Boltz, E. Capezuti, T.T. Fulmer, & D. Zwicker (Eds.), A. O’Meara (Managing Ed.), Evidencebased geriatric nursing protocols for best practice (4th ed., pp. 135-162). NY: Springer Publishing Company, LLC. Koenig, H.G., Meador, K.G., Cohen, J.J., & Blazer, D.G. (1988). Self-rated depression scales and screening for major depression in the older hospitalized patient with medical illness. JAGS, 36, 699-706. Sheikh, J.I., & Yesavage, J.A. (1986). Geriatric Depression Scale (GDS). Recent evidence and development of a shorter version. In T.L. Brink (Ed.), Clinical Gerontology: A Guide to Assessment and Intervention (pp. 165-173). NY: The Haworth Press, Inc. Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M.B., & Leirer, V.O. (1983). Development and validation of a geriatric depression screening cale: A preliminary report. Journal of Psychiatric Research, 17, 37-49. Permission is hereby granted to reproduce, post, download, and/or distribute, this material in its entirety only for not-for-profit educational purposes only, provided that The Hartford Institute for Geriatric Nursing, New York University, College of Nursing is cited as the source. This material may be downloaded and/or distributed in electronic format, including PDA format. Available on the internet at www.hartfordign.org and/or www.ConsultGeriRN.org. E-mail notification of usage to: hartford.ign@nyu.edu. Geriatric Depression Scale: Short Form Choose the best answer for how you have felt over the past week: 1. Are you basically satisfied with your life? YES / NO 2. Have you dropped many of your activities and interests? YES / NO 3. Do you feel that your life is empty? YES / NO 4. Do you often get bored? YES / NO 5. Are you in good spirits most of the time? YES / NO 6. Are you afraid that something bad is going to happen to you? YES / NO 7. Do you feel happy most of the time? YES / NO 8. Do you often feel helpless? YES / NO 9. Do you prefer to stay at home, rather than going out and doing new things? YES / NO 10. Do you feel you have more problems with memory than most? YES / NO 11. Do you think it is wonderful to be alive now? YES / NO 12. Do you feel pretty worthless the way you are now? YES / NO 13. Do you feel full of energy? YES / NO 14. Do you feel that your situation is hopeless? YES / NO 15. Do you think that most people are better off than you are? YES / NO Answers in bold indicate depression. Score 1 point for each bolded answer. A score > 5 points is suggestive of depression. A score ≥ 10 points is almost always indicative of depression. A score > 5 points should warrant a follow-up comprehensive assessment. Source: http://www.stanford.edu/~yesavage/GDS.html This scale is in the public domain. The Hartford Institute for Geriatric Nursing would like to acknowledge the original author of this Try This, Lenore Kurlowicz, PhD, RN, CS, FAAN, who made significant contributions to the field of geropsychiatric nursing and passed away in 2007. general assessment series Best Practices in Nursing Care to Older Adults A series provided by The Hartford Institute for Geriatric Nursing, New York University, College of Nursing EMAIL hartford.ign@nyu.edu HARTFORD INSTITUTE WEBSITE www.hartfordign.org www.ConsultGeriRN.org CLINICAL NURSING WEBSITE Fulmer SPICES: An Overall Assessment Tool for Older Adults www.managedhealthcareconnect.com /article/6911 Best Practices in Nursing Care to Older Adults from The Hartford Institute for Geriatric Nursing, New York University, College of Nursing Issue Number 1, Revised 2007 Series Editor: Marie Boltz, MSN, APRN, BC, GNP Managing Editor: Sherry A. Greenberg, MSN, APRN, BC, GNP New York University College of Nursing __________________________________________________________________________________________________________ WHY: Normal aging brings about inevitable and irreversible changes. These normal aging changes are partially responsible for the increased risk of developing health-related problems within the elderly population. Prevalent problems experienced by older adults include: sleep disorders, problems with eating or feeding, incontinence, confusion, evidence of falls, and skin breakdown. Familiarity with these commonly-occurring disorders helps the nurse prevent unnecessary iatrogenesis and promote optimal function of the aging patient. Flagging conditions for further assessment allows the nurse to implement preventative and therapeutic interventions (Fulmer, 1991; Fulmer, 1991). BEST TOOL: Fulmer SPICES, developed by Terry Fulmer, PhD, APRN, FAAN at New York University College of Nursing, is an efficient and effective instrument for obtaining the information necessary to prevent health alterations in the older adult patient (Fulmer, 1991; Fulmer, 1991; Fulmer, 2001). SPICES is an acronym for the common syndromes of the elderly requiring nursing intervention: S is for Sleep Disorders P is for Problems with Eating or Feeding I is for Incontinence C is for Confusion E is for Evidence of Falls S is for Skin Breakdown TARGET POPULATION: The problems assessed through SPICES occur commonly among the entire older adult population. Therefore, the instrument may be used for both healthy and frail older adults. VALIDITY AND RELIABILITY: The instrument has been used extensively to assess older adults in the hospital setting, to prevent and detect the most common complications (Fulmer, 2001; Lopez, et al, 2002; Pfaff, 2002; Turner, J., et al, 2001; NICHE). Psychometric testing has not been done. STRENGTHS AND LIMITATIONS: The SPICES acronym is easily remembered and may be used to recall the common problems of the elderly population in all clinical settings. It provides a simple system for flagging areas in need of further assessment and provides a basis for standardizing quality of care around certain parameters. SPICES is an alert system and refers to only the most frequently-occurring health problems of older adults. Through this initial screen, more complete assessments are triggered. It should not be used as a replacement for a complete nursing assessment. Fulmer SPICES: An Overall Assessment Tool for Older Adults Patient Name: Date: SPICES EVIDENCE Sleep Disorders/ ______________________________________ Problems with Eating or Feeding/________________________ Incontinence/_________________________________________ Confusion/_____________________________________________ Evidence of Falls/____________________________________ Skin Breakdown/_______________________________________ Adapted from Fulmer, T. (1991). The Geriatric Nurse Specialist Role: A New Model. Nursing Management, 22(3), 91- 93. © Copyright Lippincott Williams & Wilkins, http://lww.com. 1/2 MORE ON THE TOPIC: Best practice information on care of older adults: www.GeroNurseOnline.org. Fulmer, T. (1991). The Geriatric Nurse Specialist Role: A New Model. Nursing Management, 22(3), 91-93. Fulmer, T. (1991). Grow Your Own Experts in Hospital Elder Care. Geriatric Nursing, March/April 1991, 64-66. Fulmer, T. (2001). The geriatric resource nurse: A model of caring for older patients. American Journal of Nursing, 102, 62. Lopez, M., Delmore, B., Ake, J., Kim, Y., Golden, P., Bier, J., & Fulmer, T. (2002). Implementing a Geriatric Resource Nurse Model. Journal of Nursing Administration, 32(11), 577-585. Nurses Improving the Care of the Hospitalized Elderly (NICHE) project at the Hartford Institute for Geriatric Nursing, http: //www.hartfordign.org. Pfaff, J. (2002). The Geriatric Resource Nurse Model: A culture change. Geriatric Nursing, 23(3), 140-144. Turner, J. T., Lee, V., Fletcher, K., Hudson, K., & Barton, D. (2001). Measuring quality of care with an inpatient elderly population: The geriatric resource nurse model. Journal of Gerontological Nursing, 27(3), 8-18. Permission is hereby granted to reproduce, post, download, and/or distribute, this material in its entirety only for not-for-profit educational purposes only, provided that The Hartford Institute for Geriatric Nursing, College of Nursing, New York University is cited as the source. This material may be downloaded and/or distributed in electronic format, including PDA format. Available on the internet at www.hartfordign.org and/or www.GeroNurseOnline.org. E-mail notification of usage to: hartford.ign@nyu.edu. A SERIES PROVIDED BY The Hartford Institute for Geriatric Nursing EMAIL: hartford.ign@nyu.edu HARTFORD INSTITUTE WEBSITE: www.hartfordign.org GERONURSEONLINE WEBSITE: www.GeroNurseOnline.org 2/2 Mini-Mental State Examination (MMSE) Patient’s Name: Date: Instructions: Ask the questions in the order listed. Score one point for each correct response within each question or activity. Maximum Patient’s Questions Score Score 5 “What is the year? Season? Date? Day of the week? Month?” 5 “Where are we now: State? County? Town/city? Hospital? Floor?” 3 The examiner names three unrelated objects clearly and slowly, then asks the patient to name all three of them. The patient’s response is used for scoring. The examiner repeats them until patient learns all of them, if possible. Number of trials: ___________ 5 “I would like you to count backward from 100 by sevens.” (93, 86, 79, 72, 65, …) Stop after five answers. Alternative: “Spell WORLD backwards.” (D-L-R-O-W) 3 “Earlier I told you the names of three things. Can you tell me what those were?” 2 Show the patient two simple objects, such as a wristwatch and a pencil, and ask the patient to name them. 1 “Repeat the phrase: ‘No ifs, ands, or buts.’” 3 “Take the paper in your right hand, fold it in half, and put it on the floor.” (The examiner gives the patient a piece of blank paper.) 1 “Please read this and do what it says.” (Written instruction is “Close your eyes.”) 1 “Make up and write a sentence about anything.” (This sentence must contain a noun and a verb.) “Please copy this picture.” (The examiner gives the patient a blank piece of paper and asks him/her to draw the symbol below. All 10 angles must be present and two must intersect.) 1 30 TOTAL (Adapted from Rovner & Folstein, 1987) 1 Source: www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdf Provided by NHCQF, 0106-410 Instructions for administration and scoring of the MMSE Orientation (10 points): • Ask for the date. Then specifically ask for parts omitted (e.g., "Can you also tell me what season it is?"). One point for each correct answer. • Ask in turn, "Can you tell me the name of this hospital (town, county, etc.)?" One point for each correct answer. Registration (3 points): • Say the names of three unrelated objects clearly and slowly, allowing approximately one second for each. After you have said all three, ask the patient to repeat them. The number of objects the patient names correctly upon the first repetition determines the score (0-3). If the patient does not repeat all three objects the first time, continue saying the names until the patient is able to repeat all three items, up to six trials. Record the number of trials it takes for the patient to learn the words. If the patient does not eventually learn all three, recall cannot be meaningfully tested. • After completing this task, tell the patient, "Try to remember the words, as I will ask for them in a little while." Attention and Calculation (5 points): • Ask the patient to begin with 100 and count backward by sevens. Stop after five subtractions (93, 86, 79, 72, 65). Score the total number of correct answers. • If the patient cannot or will not perform the subtraction task, ask the patient to spell the word "world" backwards. The score is the number of letters in correct order (e.g., dlrow=5, dlorw=3). Recall (3 points): • Ask the patient if he or she can recall the three words you previously asked him or her to remember. Score the total number of correct answers (0-3). Language and Praxis (9 points): • Naming: Show the patient a wrist watch and ask the patient what it is. Repeat with a pencil. Score one point for each correct naming (0-2). • Repetition: Ask the patient to repeat the sentence after you ("No ifs, ands, or buts."). Allow only one trial. Score 0 or 1. • 3-Stage Command: Give the patient a piece of blank paper and say, "Take this paper in your right hand, fold it in half, and put it on the floor." Score one point for each part of the command correctly executed. • Reading: On a blank piece of paper print the sentence, "Close your eyes," in letters large enough for the patient to see clearly. Ask the patient to read the sentence and do what it says. Score one point only if the patient actually closes his or her eyes. This is not a test of memory, so you may prompt the patient to "do what it says" after the patient reads the sentence. • Writing: Give the patient a blank piece of paper and ask him or her to write a sentence for you. Do not dictate a sentence; it should be written spontaneously. The sentence must contain a subject and a verb and make sense. Correct grammar and punctuation are not necessary. • Copying: Show the patient the picture of two intersecting pentagons and ask the patient to copy the figure exactly as it is. All ten angles must be present and two must intersect to score one point. Ignore tremor and rotation. (Folstein, Folstein & McHugh, 1975) 2 Source: www.medicine.uiowa.edu/igec/tools/cognitive/MMSE.pdf Provided by NHCQF, 0106-410 Interpretation of the MMSE Method Score Single Cutoff
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Running Head: LIFE REVIEW AND EGO INTEGRITY

Life Review and Ego Integrity
Student’s Name
Institution
Date

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LIFE REVIEW AND EGO INTEGRITY

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Kelvin Costner (K.C.) was born on 18th January in 1955 in Lynwood from California. K.C. has
grown up in Campton, California state of America. Kelvin is among the three sons of Sharon
Rae, whereby he is the youngest of them. His father was William Costner, who was an
electrician. His father later becomes a utility executive at his favorite working place, Southern
California Edison.
After completing his high school education, K.C. went to further his education to the California
State University in Fullerton, where he pursued Business Administration and marketing. In the
year 1978 is when he earned his first bachelor's degree. After a while, as he was working as an
administrator at a local firm in his home ground, Campton started to gain some interest in acting
while he was Cal State. He found out that he had some love and passion for acting. K.C., at some
point he accidentally ran into Richard Burton as he was returning from a trip in Mexico for his
honeymoon. Therefore, Burton told K.C. that he would be fine as an actor where he took it as a
sign, and the rest became history.
He has been married twice, three children from his first wife, a child with a girlfriend, and at the
moment, he has three children with the woman he's staying with as a wife, Christine
Baumgartner, who is a model in German and she too designs handbags.
In discussion with K.C., he told me that he made his film debut known as 'Hot Malibu Summer'
in the Sizzle Beach film, USA. He has been acting for the better part of his life, which has made
him famous in the U.S. and the world at large. He has also appeared in a different commercial
like for example, the Apple Lisa as well as the Table for Five in his early ages. K.C. has also
performed as director chair in 2011, for the first time in 7 years with a film known as an 'A little
War of Own.' Finally, he has been able to appear in the television series known as ‘Yellowstone’
which is his first role in a regular television series in his entire career.

LIFE REVIEW AND EGO INTEGRITY

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Kevin had emerged a very high appeal when he was filming 'Black and White,' where he showed
a great performance and attracted the attention of many people across the world. He was able to
receive various interviews in both the local and international media across the globe. Because of
his upcoming performance in the Brian De Palma's 'The Untouchables' and also on the baseballthemed successful as 'The Bull Durham' as well as the 'Field of Dreams,' Mr. Costner won
various awards in the Academy Awards after been nominated three times in writing, directing
films and starring in the movie called 'Dances with Wolves.' (SHERMAN, 2019).
Irrespective of the fact that these movies did not launch him as superstardom, he has been able to
have some significant time in his life, whereby he has established himself as a very different kind
of leading person. He said that he doesn't attract a lot of attention, and the materials that he offers
are not always worthy of his talent, but through this, his charisma and charm have always left a
mark.
K.C. has had financial hardships in his life. He has different occasions where he lacked financial
support to finance his projects. In 2012, the FOX entertainment company gave him a project to
write a script of a film which was to be shot in the mid-year. Still, at that time, he had some
commitments with his money, which saw him lacking some funds to pay for the materials
necessary for his project, and he ended up losing the project to someone else. In acting, he has
also experienced high competition from other actors who mostly play a role like his. At some
point, he has to go through auditions to be able to be featured in some movies and T.V. series.
During the year 1992, when he was making his most expensive and the hardest movie in the
history of cinema, K.C. saw his 16-year-old marriage end. He described to me that this was one
of the hardest years of his life. He was no longer with his wife Cindy, who was her partner since
childhood. He spends the most time making the movie thinking about the tough time he was

LIFE REVIEW AND EGO INTEGRITY

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experiencing after the end of his marriage. Which was conspired by a series of events at that
time, and the issue brought a lot of hurt to him funs, claiming that the marriage ended because of
his failure.
K.C. has possession of great talent in creativity. He's outstanding in expressing himself. He can
accomplish his tasks on time and has a very high cramming power to catch his script on his
fingertips. Mr. Costner is also witty and has possession of a gift for savors and gapping the
limelight. He is very optimistic and can master the resilience of overcoming various setbacks that
may come across his career path.
In an engagement with K.C. on healthy and unhealthy coping skills, he argued that s...


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