Journal of Gerontological Nursing

Endnotes: Advocates for Aunt Alice

Edith Hilton, RN, DSN, CS, ANP, CRRN

Abstract

At 80 years old, Aunt Alice needed emergency abdominal surgery. When I reached her bedside in the intensive care unit (ICU), the deterioration was apparent from our last v¿sit 11 months ago. Aunt Alice was always a proud and independent woman of amazing and varied interests and talents. Loving bright colors, she always dressed exuberantly and sought gatherings of others involved in education as she had been until her retirement 10 years ago. Now, she looked sick, lonely, sad, and confused. She had lost a substantial amount of weight; she looked emaciated lying under the immaculate sheets in the sunny ICU cubicle. The essence of her personality was apparent in her eyes, but she seemed disoriented and vague. Her other problems were compounded by her severe hearing loss that made communication very difficult. Her internist described her as being depressed, demented, and "very fragile."

My Aunt recognized me instantly, but was unable to understand the surgery she had undergone. Reaching out her hands to me she cried out, "Where am I? What has happened to me? Am I dying?" I knew her distress and confusion were profound, or she never would have revealed her vulnerability. Her ICU nurses anticipated her needs, and spent extra time with her in efforts to comfort and reorient her to her surroundings.

Total parenteral nutrition was started on the second postoperative day, but despite urgings, Aunt Alice refused to eat. The psychiatrist diagnosed Aunt Alice with an eating disorder, and recommended nursing home placement for "failure to thrive." Her weight hovered at 88 pounds. As the days passed, her small abdominal incision healed normally. Aunt Alice cleared mentally at times, but overall, she remained confused and overwhelmed. She was transferred to a general hospital unit after 4 days in the ICU, and placement of a gastrostomy tube was scheduled.

Then, unexpectedly, Aunt Alice's son died. She was broken-hearted over the loss of her son, and words of comfort seemed to bring little relief. The gastroenterologist was not enthusiastic about inserting the gastrostomy tube, but he reluctantly agreed, indicating his disapproval of inserting a feeding tube into this debilitated, confused, elderly woman.

The nurses in the special procedures area were a group of individuals who were well versed in care of the elderly. They immediately initiated a conversation with Aunt Alice, comforting and reassuring her that they would be with her and protect her all the time. Explaining every activity and constantly assessing her hearing and understanding of their actions, the nurses expertly cared for Aunt Alice. They focused on dealing with Aunt Alice, not the monitoring equipment. Holding her hand until conscious sedation was effective, Aunt Alice's nurse maintained a constant dialogue. Immediately after the procedure was completed, I was allowed to rejoin my aunt, and her nurses monitored her constantly until she was completely awake, supported her, and were active listeners as they encouraged Aunt Alice to "heal up fast and come back to visit us." Aunt Alice tolerated the procedure well.

Two months later, Aunt Alice had gained 22 pounds, and was eating well. The feeding tube was used only to supplement her own efforts. Her functional abilities had greatly improved. In the middle of her illness and sadness, the nurses supported and advocated for her survival giving her the opportunity to come to terms with her grief and discover a new chapter in her life.…

At 80 years old, Aunt Alice needed emergency abdominal surgery. When I reached her bedside in the intensive care unit (ICU), the deterioration was apparent from our last v¿sit 11 months ago. Aunt Alice was always a proud and independent woman of amazing and varied interests and talents. Loving bright colors, she always dressed exuberantly and sought gatherings of others involved in education as she had been until her retirement 10 years ago. Now, she looked sick, lonely, sad, and confused. She had lost a substantial amount of weight; she looked emaciated lying under the immaculate sheets in the sunny ICU cubicle. The essence of her personality was apparent in her eyes, but she seemed disoriented and vague. Her other problems were compounded by her severe hearing loss that made communication very difficult. Her internist described her as being depressed, demented, and "very fragile."

My Aunt recognized me instantly, but was unable to understand the surgery she had undergone. Reaching out her hands to me she cried out, "Where am I? What has happened to me? Am I dying?" I knew her distress and confusion were profound, or she never would have revealed her vulnerability. Her ICU nurses anticipated her needs, and spent extra time with her in efforts to comfort and reorient her to her surroundings.

Total parenteral nutrition was started on the second postoperative day, but despite urgings, Aunt Alice refused to eat. The psychiatrist diagnosed Aunt Alice with an eating disorder, and recommended nursing home placement for "failure to thrive." Her weight hovered at 88 pounds. As the days passed, her small abdominal incision healed normally. Aunt Alice cleared mentally at times, but overall, she remained confused and overwhelmed. She was transferred to a general hospital unit after 4 days in the ICU, and placement of a gastrostomy tube was scheduled.

Then, unexpectedly, Aunt Alice's son died. She was broken-hearted over the loss of her son, and words of comfort seemed to bring little relief. The gastroenterologist was not enthusiastic about inserting the gastrostomy tube, but he reluctantly agreed, indicating his disapproval of inserting a feeding tube into this debilitated, confused, elderly woman.

The nurses in the special procedures area were a group of individuals who were well versed in care of the elderly. They immediately initiated a conversation with Aunt Alice, comforting and reassuring her that they would be with her and protect her all the time. Explaining every activity and constantly assessing her hearing and understanding of their actions, the nurses expertly cared for Aunt Alice. They focused on dealing with Aunt Alice, not the monitoring equipment. Holding her hand until conscious sedation was effective, Aunt Alice's nurse maintained a constant dialogue. Immediately after the procedure was completed, I was allowed to rejoin my aunt, and her nurses monitored her constantly until she was completely awake, supported her, and were active listeners as they encouraged Aunt Alice to "heal up fast and come back to visit us." Aunt Alice tolerated the procedure well.

Two months later, Aunt Alice had gained 22 pounds, and was eating well. The feeding tube was used only to supplement her own efforts. Her functional abilities had greatly improved. In the middle of her illness and sadness, the nurses supported and advocated for her survival giving her the opportunity to come to terms with her grief and discover a new chapter in her life.

10.3928/0098-9134-20000601-09

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