Forensic Nursing Chronicles

Nurses are actively involved in HIV/AIDS prevention, care, treatment and support. Their expertise and commitment positions them to effectively identify best practices and innovative strategies addressing the needs of individuals, families and communities.

Older adults, including those that are residents of residential facilities often continue to be sexually active. Why then has the profession neglected to identify the increased vulnerability of this population?

For many people working with older adults in residential facilities there appears to be an ethical dilemma surrounding this topic. Individuals have failed to acknowledge that “grandma and grandpa” might still be doing “it”, or prefer not to think about it. However, we have all learned about Maslow’s Hierarchy of Needs, yet when it comes to physical pleasures – kissing, cuddling or couples sleeping in the same bed or other forms of sexual expression; health care professionals and resident care workers, as well as, families chose to ignore this need in our elderly or older adults.

Working in health promotion in a college setting, I purchase approximately one-half million condoms each year, which are liberally distributed to students in the name of safer sex. Can the same be said for residential facilities for the older adult?

This ethical dilemma is one that many have faced. How to meet the needs of older adults by respecting their rights to chose behaviors that may conflict with the family’s need to ignore sexuality or protect the person and our need to always control the environment of institution – thereby refusing closed doors and privacy for intimacy, or making condoms available for individuals not able to obtain them on their own.

The face of the HIV epidemic has changed in recent years and it is important for nurses to be aware of the transmission risks of this population. Nurses have a role to play, both in advocating for the availability of condoms, providing information to clients that they may need to keep them safe and thirdly, to develop an open-mindedness.

Applying the Steps for Ethical Decision-Making will aid health care professionals recognize, discuss and hopefully develop tolerance of non-threatening behaviors.

In any campus survey today, youth indicate that the top factors affecting their academic performance are things like sore throats, headaches, feeling tired and run-down, non-descript abdominal, “stomach” or chest pain. These complaints in themselves could be a specific isolated illnesses, however they could also be a somatic complaint of an underlying condition.

Canada has a higher rate of youth suicide than many other countries, such as the United States or United Kingdom. It is the number one killer of men aged 25 to 29. Young men in the prime of life, often attending post-secondary institutions. Young men are not the only victims of suicide, however they are less likely than young women to seek counseling and due to the impulsivity and selection of more lethal suicide methods, they are four times more likely to succeed.

The front line workers or health care professionals in college/university health centers play a key role in identifying these young people through their understanding of youth and the problems that affect them. It is necessary for these professionals to obtain an accurate history, which includes physical, psychological, social, emotional, and family data. Listening with all your senses, not for the words singularly, but to body language, dress, hygiene, the overall demeanor and also to what is not being spoken.

When youth are suspect of a mental illness, stress, anxiety or depression, it is important not only to refer them to appropriate supports, but also to keep in touch and ensure that they continue to have a link with a caregiver who understands their situation. Since these individuals usually have recurring episodes it is important to keep in regular contact with them and if possible remain an active member of their care team – even just a quick hello and smile can be supportive.

The Registered Nurses Association of Ontario (RNAO) have recently introduced a new screening tool to assist health care professionals determine whether their female patients are being abused. As part of the RNAO’s Best Practice Guideline Program, experts reviewed the guidelines now in place for domestic violence and abuse and recognized that it was time for the existing guides to be updated.

The Status of Women Canada 2000 statistics revealed that abuse is prevalent, with 50% of women reporting at least one act of physical or sexual abuse from the age of 16+. This new tool is an effort to increase awareness among all groups, but especially among health care professional. With the introduction of this new screening tool, brings with it the discussion of adding more content of woman abuse into the nursing curriculum.

This guide specifically recommends that women should be routinely screened for possible abuse from the age of 12 years, with a particular focus on prevention.

A very sad and sobering reality in 2006.

The other recommendations and information on this screening tool can be seen in its’ entirety at the RNAO website.

I took great interest in an article in our local newspaper last weekend. It alluded to the fact that falls were causing an inordinate number of deaths in Minnesota and Wisconsin among senior citizens. At first glance, we might conclude that our winter weather with ice and snow was a
causative factor, but this has not proven to be the case.

There seem to be other factors in play here. Of 1564 minnesota elderly who died from falls, only 21 died of snow and ice related falls. Some of the theories being discussed are around the cold weather causing blood to become more viscous, thus contributing to the formation of clots
which then dislodge and deposit in vital organs.

Others speculate that the low light conditions of winter contribute to accidental falls, especially for seniors whose vision is declining or who may be wearing multiple focus lenses in their glasses. There is also speculation about the reactions to some medications, decreasing alertness in some and maybe causing dizziness and unsteadiness.

Those studying this issue stress that seniors should get help in their environment so that throw rugs and multiple barriers to safe walking are not contributing to falls. They also stress that slowing down and not hurrying are very important. And exercise so keep balance and joint
range of motion optimal is very important.

As to why this is all happening in Minnesota and Wisconsin, I offer the theory that we are an
independent breed of people, trying to do for ourselves without asking for help and maybe taking risks that aren’t necessary.

I can recall coming upon my 92 year old mother balancing on the arm of the couch to reach a tall cupboard. She was independent and hardy and also in very good health, but with the risks I saw her take, she was also a lucky lady not to have an incident that could have caused a decline in her health sooner.

All the normal factors of aging play into the broken bone theory, such as osteoporosis and unsteadiness. But thus far they are only theories and maybe further studies will yield answers in the future.

Any other ideas about what may be causing so many falls among seniors?