Biopsychosocial Model of Mary Jane, Interview Example

Abstract

The purpose of case studies are to provide a basis for clinical psychology. Students and others can learn from case studies from social factors, to psychological, and biological factors involved through studying patients with illnesses and disorders. As part of the service learning project is purposed with teaching, learning, and reflecting on the curriculum learned in the classroom, and knowledge gained through meaningful service. It incite lifelong civic engagement, civic responsibility, and ties to the community. The experimental education experience is used for students to learn and develop in organized service. This paper will include a summary of a health care interview and assessment conducted as part of the service learning project with Mary Jane Brown. From the interview and a use of two functional assessment tools will be applied including the Katz Index of Activities of Daily Living (ADL) and the Lawson Instrumental activities of Living (IADL) Scare. Using this information in combination with other tools for assessing Mary Jane’s history, this paper will provide a teaching component that will promote heath, and risk prevention that is beneficial to Mary Jane.

History

Mary Jane Brown is a nice, elderly women that frequents the local library. This interview was conducted over a period of 3 days visiting after class with Mrs. Brown near the romance section. Mary Jane is 66 year old, woman, retired school teacher, with naturally brown hair with a few strands of grey spread throughout her hair that stops midway in her back. She is mixed with African American and Panamanian, speaking Spanish and English. She lives with her husband of over 40 years, Richards, her 2 dogs. She has six children, split evenly, three boys and three girls, where the youngest she had 30 years ago. She proudly shows the pictures of each grandchild, as she is grandmother to 10 and one is on the way. So far it has been six boys and four girls. This interview was conducted to learn about her life, in regards to health, and how Mrs. Brown perceives the aging process.

Mrs. Mary Brown enjoys the aging process, it is viewed as positive experience so far, with not many red flags. Mrs. Brown is physically fit, and void of many of the psychological changes that affect others around her age. As she gets older she is aware that she will need to be cognitively alert about her health as well as her husband’s. Over her life span she has suffered from common illnesses such as flu, allergies, and in during her last pregnancy had gestational diabetes. Due to this she had emergency C-section, and monitored after. That was the last surgery she has experienced. She eats a healthy balanced diet of fruit and vegetables, and on occasion visit with her friends and take care of her grandkids. She is very independent, she doesn’t struggle with her vision, or gait. She doesn’t appear to be in her 60s and would guess she was in her 40s. Her voice is fluid, and her face is almost wrinkle free. Her teach are nice and white, with no signs of aging from her face to her feet. The major accidents she has been in was when she was school teacher she fell down a flight of stairs and broke her foot. It didn’t require surgery however she was forced to wear a cast for six months. It hasn’t affected her because she runs a mile each morning. She doesn’t take any medication, but daily vitamins each day (Women’s Health) in the morning, a gas tablet before meals, and aspirin before going to bed, she said to keep her heart healthy. As stated she regularly exercises every day in the morning running a mile with her husband, who is retired, and her two dogs. On Thursdays she goes to Yoga, and Friday night’s she and her husband go to weekly salsa class. On occasion she gets backed up, so she takes Metamucil in order to keep her regular, she doesn’t have problem with her bladder, and she drinks six bottles of water every day. Overall she is physically fit and doesn’t suffer from any major disorders.

Health Promotion

Mary Jane is a person that is actively engage in keeping her and husband healthy. Her last exam was actually three months before this interview, a week after her birthday. She scheduled all her appointments accordingly, since they were in close proximity. This includes, get a physical from her main doctor. The physical included her yearly mammogram, gynecological exam which came back negative, osteoporosis screening, and self-breast examinations. Mrs. Brown mother passed away at an early age from breast cancer, so she is well aware of her chances of developing the cancer, so she takes precautions to get screening as often as she can. Her hearing was positive, and blood work for cholesterol, blood pressure, diabetes, and other blood work was normal. Since she is older she had her colon cancer screening, checked for kidney problems, and hearth diseases. She received her influenza vaccine, and a TdaP. In her vision test, they tested her for glaucoma and if she needed glasses. During her dental visit she received a cleaning and brightening for her teeth. Overall she didn’t have anything out of the ordinary, she however takes precautions with breast cancer since it is prevalent in her family.

Assessment Tools

As people get older, assessments need to be conducted in order to gauge their health, physical independence, cognitive independence, and functionality. The following assessments tools were applied in order to test Mary Jane Brown functionality day to day. The Lawton Instrumental Activities of Daily Living Scale (IADL) is the appropriate mechanism to assess Mrs. Brown independent living skills, which are more complex than the basic activities of day to day living. The ability to use the phone she score 1 points, she takes care of all her shopping needs independently, plans and prepares her own food independently, maintains the hose alone or with her husband, does her own laundry, drives her own car, take medication independently when needed, and manages her own financial matters. For each category she scored 1, totaling 8 means she is high functioning and independent.

In another assessment to gauge functional status of Mrs. Brown’s ability to perform daily living activities independently, the Katz Index of Independence in Activities of Daily Living (ADL) is applied. In each category of bathing, dressing, toileting, transferring, continence, and feeding she scored 1 point as she required no supervision, direction, or personal assistance in either categories. Based on this assessments she is independent. Other functional assessments that were used for Mrs. Brown includes a psychological function that measures the cognitive mental and affective functions of independence. Mrs. Brown responses to the questions in the interview indicated that she has normal cognitive functioning, and was able to express her ideals, and thoughts logically, while also recalling past events with no trouble. Performing the ADLs without assistance and an active daily regime indicates she has no diminishing cognitive function. Although aware of her function social assessment of daily living. She is married for 45 years, leads an active social life in her community, and still works on the PTA for her grandchildren, goes to Salsa night every Friday with her husband, and they take monthly vacations around the world. Placing the Geriatric Depression Scale (Mood Scale) was just to assess her happiness. She scored positively with no signs of minor depression.

Physical Examination

Mary Jane is 66 years old, but doesn’t look her age at all. Throughout her adulthood she has taken great care of herself physically and mentally. She has great teeth, vision, and balance that allows her to get up every morning and run a mile. She stays actively fit, socially inclusive, and involved in her family and friends life. She lives a stress free life, and likes to come to the library for some reading. Although she older, her hair hasn’t begun to thin, and her pigment is still rich, with the occasional feet pain she gets from running she doesn’t have any underlying illnesses in her older age. Her appearance is well groomed, with fingernails and hair salon did, her clothes were neat and pressed, and her speech was clear with eagerness to answer my questions.

Mrs. Brown, made me very comfortable and after the second interview invited me to her home. We sat in the backyard on the patio, and engage first in small talk, and then she doted on her grandchildren. When I started to ask more questions from the interview she was happy to oblige. Mrs. Brown made me very comfortable and even fixed pastries to eat during the interview. There is nothing that I would do differently, as I was able to assess from being in her home of all the physical activities she could perform. She was a great story teller, and I was able to connect with her about nursing, since her mother that past was a Registered Nurse. These findings from the interview are the results that I am comfortable with.

Problems/Risks

Since Mary Jane Brown is a health conscious individual, there wasn’t a lot of risks or problems that I saw physically. In her diet, she eats fruits and vegetables, although maybe too much fruits, those that contain more sugar than most, and in her freezer was a lot of fish and chicken. She only partakes occasionally in sugar treats, including the pastries she baked during the interview. She exercises regularly and is great physical shape. In doing the home safety check list however, there were a risks that could lead to potential problems. If she doesn’t watch the type of fruits such as strawberries and others rich in sugar and acids, they could potentially erode the enamel on her teeth, and potentially cause her to have lower levels of insulin. Because she occasionally gets backed up, it seems she doesn’t get enough fiber in her diet and should eat more beans and fiber rich foods in her meals.

Although she has only once seriously injured herself, she has some health risks in her home. She has throw rugs that could potentially cause her to slip and fall. Since she looks after her grandchildren that vary in ages from toddler to school-age, her home isn’t all baby proofed. Her fireplace accessories are easily reachable, her cabinets are not childproof, and the edges of her furniture is a potential problem. Also in her bathroom, she needs a no slip mat, that will prevent her or her husband from slipping in the tub, and the medicine cabinet needs to be child proof. Other than a few safety precautions around her home she doesn’t not have a lot of problems to her physically.

Teaching Project

Based on the client’s assessment the teaching project was developed around her over indulgence on fruit, and her home safety risks that could lead to potential problems such as falling, or accidents with other members in the home. The rationale for choosing a teaching project that focuses on her fruit intake, is that some of the health risks, such as digestive problems that she experiences is contributed from too much fruit intake. In combination with fruit intake, is home safety focus, which will decrease/prevent falls in the bathroom, in the home in general, and protect her grandchildren from hazards in the home.

Meeting with Mrs. Brown on the third day, she was presented with the teaching project developed for her from the interview and assessment. The materials used in presenting to Mrs. Brown the teaching project included, videos on YouTube demonstrating the home safety concerns, articles based on how her fruit intake may be the cause of her digestive problem, a home safety check list, and nutritional guide. In watching the YouTube videos, videos were used to demonstrate the importance of a no-slip mat in the tub, by actually bringing a mat to place in her tub, I demonstrated the difference. The throw rugs were moved, as she commented that she has slipped from time to time, but nothing to serious. Other videos included, were on child proofing. Her grandchildren mean a great deal to her, so along with the videos and doing a walkthrough through her home, we were able to show all the areas of concerns

Using the home safety checklist, she was able to check off the aspects of her home, and with the items that were brought placed them in their respective locations. The fruit intake part, was an eye opener, using nutritious guide, I was able to show how her love of strawberries was causing havoc on her digestive systems. Previously, I felt she wasn’t getting enough fiber, but the case was she was getting to much fiber that caused her gastrointestinal discomfort, and constipation. Since she had diabetes when she was pregnant, eating too much fruit can elevate the blood glucose, and more importantly misplace essential nutrients to the body, needed for older adults.

Mrs. Brown, was surprised at the information. The handout given to Mrs. Brown included the home safety checklist, and nutrition checklist for older women. The feedback from the teaching session was positive, and she felt it was more than helpful for her and her husband that suffers from diabetes. Her response was surprising since she really enjoyed her fruit, however, she said when it comes to her and her husband’s health she wants to make sure she passes on these habits to her grandchildren. She listen intently for both focuses, and made changes immediately from the home safety checklist, and making a list for the grocer.

Final Thoughts

Overall, the service learning project was enjoyable. Not only did I meet a very lovely person, but was able to discuss past events, and see a picture of health well into her 60s. At first I was apprehensive about finding an older adult to interview, but it proved to be an enriching experience. Not only was I able to interview her in her home, but I met some of her family, her dogs, and impact her and husband lives. She gave me positive confirmation that I was doing a good job, and wished me well in my educational endeavors. I thoroughly enjoyed engaging in conversation with Mrs. Brown, and it reaffirm my dedication to nursing. Mrs. Brown, is a very physically fit woman, which in comparison to others in her age group, is on another level. She doesn’t need assistance, she enjoys exercising, dancing, and taking care of herself. She regularly gets her nails and hair done, and makes it a point to get screenings for breast cancer. She said she wanted to enjoy life while she can, and that is her secret to remaining youthful. I felt that we both learned a lot from each other, and I was able to gain more knowledge on nutrition and assessments for adults as we get older, and the limitations that we might have as we age. This experience has proven to be beneficial, and look forward to more opportunities such as this.

References

Galio, Joseph. (2006). Handbook of Geriatric Assessment. Jones & Bartlett Learning. Massachusetts.

Home Safety Check List. (n.d). Real Simple. Retrieved from http://www.realsimple.com/home-organizing/organizing/home-safety-checklist-00000000000945/

Katz Index of Independence in Activities of Daily Living and Lawton Instrumental Activities of Daily Living (IADL) Scale. (2007). Maine Health. Retrieved from http://www.mainehealth.org/workfiles/mh_PFHA/Katz%20ADL_LawtonIADL.pdf

White, Kristen. (2010). Can You Eat Too Much Fruit in a Day? LiveStrong. Retrieved from http://www.livestrong.com/article/283666-can-you-eat-too-much-fruit-in-a-day

Zelman, Kathleen. (2013). Healthy Foods Checklist. Source4Women. Retrieved from http://www.uhc.com/source4women/health_wellness_tools_resources/nutrition/healthy_foods_checklist.htm