When visiting a client in his or her home, the home health nurse notes that the client frequently shifts the conversation to reminisce. Which of the following communication techniques would be most effective for the nurse to use with this client?
a. Restating
b. Changing the subject
c. Providing information
d. Asking about the client's life history
ANS: D
Older adults appreciate having the nurse provide structure to the history-taking interview by explaining the reasons for it and what it will involve. Asking clients to share something about themselves and their life history, apart from the reasons for the health visit or admission, helps to establish rapport and increases the client's comfort level. By relating their life stories and exploring options relevant to their current health situation, older adults are able to step back and look at their situation in the present from a broader perspective. Nurses get to know the client as a person rather than categorically as an "older adult." Ego integrity relates to the capacity of older adults to look back on their lives with satisfaction and few regrets, coupled with a willingness to let the next generation carry on their legacy. Integrity involves acceptance of "one's one and only life cycle" as something that had to be and that by necessity permitted of no substitution. Acceptance develops through self-reflection and dialogue with others about the meaning of one's life. Nursing strategies encouraging life review and reminiscence groups facilitate the process. Old age "is shaped by a lifetime of experience." Assessment of older adult clients begins with their story. As they relate their story, the nurse should look for value-laden psychosocial issues (e.g., independence, fears about being a burden, role changes, and vulnerability) and client preferences. These are significant issues for older adult clients that may not be directly expressed.
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