Nursing Challenges and Adult Health

Adult Health as a Challenge

Nursing Challenges and Adult Health,Barriers Or Hurdles  ,WHO Ottawa Charter (Kaplan, 1992),(Stevenson, 1993), ,Dubos (1965)Pender (1996; 2002).

What is Adult Health 

    Human adulthood refers to the stages or phases of the life cycle after childhood and adolescence. It is the longest period of the life course. Physical, intellectual, educational, occupational, social, economic, spiritual, and health-related changes characterize the multiple stages of adulthood. 

Importance 

    The changes that take place in adulthood are of importance to nursing for two reasons. 

    1:First is that adults, especially older adults, comprise the largest population served by nurses. 

    2:Second is that adults are the parents or guardians of infants, children, and adolescents and the informal caregivers of elders. Adults make up the "family" that is the basic unit of nursing care, thus, they are the direct or indirect clients for essentially all of nursing care.

    Ideally, nursing care and client education about self-care would be designed to produce the maximum positive benefit for clients. However, nursing actions are rarely designed to fit within the specific life stage, developmental stage, or personal contextual reality of adult clients.

Researcher Contribution In Health Care

    The study of adult development is a 20th century phenomenon, ostensibly because people did not live long enough to merit inquiry in previous centuries. 

    One notable exception was a treatise by Quileute published in 1842, entitled A Treatise on Man and the Development of His Faculties. G. Stanley Hall and EL Thorndike were two early 20th century scholars of the adult years. In the mid-20th century, Erik Erikson (1959) published a set of life stages that expressed the middle-class norms of the 1940s and 1950s. 

    Fortunately, he lived long enough to revise them and add additional stages as people lived ever longer. From 1960 through 1980, Neu Garten (1968) and other investigators at the University of Chicago generated much of the work that serves as the foundation of extant theory on adult development.

Concerns of Researchers 

    The life-span perspective of adult development and aging is oriented to the scientific study of adult life stages and critical situations that most closely fits within the nursing goal to maximize quality of life for as much of the life span as possible. 

    The life-span perspective focuses on change, continuity, and discontinuity over the life course. Each stage of adulthood has normative patterns, and as one stage folds into the next, personal changes occur and integration of these changes is necessary. 

    This process may produce anxiety, anger, frustration, and physiological stress responses during the transition while the conflicts between the old and the new self are resolved and the changes are integrated into the self-system. These stress responses frequently present to health care providers in the form of accidents, chemical abuse, violence, or acute or chronic illness. 

    The conditions are rarely perceived or treated within the developmental context. Rather adults are decontextualized by health care professionals who treat the immediate symptoms or condition while ignoring the adult context in which it occurs (Stevenson, 1993). Furthermore, health researchers, including nurse investigators, do not study health or care phenomena within the context of the adult life course.

Adult Health With Community Health Organizations

    A conception of the health of adults that has wide appeal in the medical community is attributable to Dubos (1965), who defined health as a state of equilibrium, adaptation, and harmony. Dunn (1980) went beyond mere equilibrium and devised the new concept of higher-level wellness. 

    Dunn's concept of higher-level wellness embodied the idea of actualizing and maximizing human potential through the pursuit of three sub-goals: making progress toward higher level of functioning, having an open-ended expanding goal to seek a fuller potential, and progressing toward a more integrated and mature human existence through the entire life course. 

    Pender (1996; 2002) attempted to incorporate both Dunn's actualizing focus and Duboss 's concept of health as maintaining stability through adaptation to the environment. According to Pender's thesis, health is the optimization of inherent and acquired human potential through goal-directed behavior, informed self-care, and satisfying relationships with others. 

    Adjustments are made as needed to maintain structural integrity and harmony within the context of the environment. WHO representatives redefined health as a "resource for everyday life, not an outcome or end product to be obtained at some definable point in time. 

    According to the highly influential WHO Ottawa Charter (Kaplan, 1992), good health is viewed as a resource that goes hand in hand with social, economic, and personal development, and it is a critically important resource for attaining and maintaining a high-level quality of life for the entire life course. 

    The goal is to "live long and die short; this implies avoiding chronic diseases and disabilities and dying of old age at the natural end of human life span. The prevailing theories about physical normality and the adult stages have changed since the 1960s. 

    The prolongation of physical well-being has become a norm as humans are living ever longer, even in third world countries. Although the stages of adulthood differ by theorist, the middle stages have been expanded to accommodate the acceleration of longevity. 

    Young adulthood lasts from about 18 to about 29; the core or traditional middle years encompass the years from 30 to 50 (50 was the average life span in 1900); the new middle years cover the years from about 51 to either 65 or 70, depending on the theorist. 

    Young old age covers the period from either 65 or 70 to 75; middle old age extends to 85, and old-old age, or the frail age, is 85 and beyond. 

    The latter three ages are relatively new designations and are evolving. It is quite likely that during the first 3rd decades of the 21st century, as the baby boomers move into the higher age brackets, the old-old age designation will move upward and begin at age 90 or higher.

    Different aspects of development are dominant in different stages of adulthood. The biological self reaches its peak in the middle 20s, and then a very gradual decline in physiological efficiency in organ systems occurs during the next 7 or 8 decades. 

    The rate of change is mediated by genetics, lifestyle, and environment, but everyone experiences the decline. There is a rise in cognitive abilities in young adulthood that does not speak for most until middle age, and these abilities then decline at an even slower rate than the physical parameters. 

    Emotional and spiritual development is postulated to continue well into old age and to peak near death for the cognitively and emotionally healthy. Any of these norms may be altered for individuals by genetics, mental or physical illness, catastrophic emotional events, or other significant situations. 

    In the ideal world, health professionals would be cognizant of the developmental stage of each adult client and formulate care to match the needs and context of that stage (Stevenson, 1993).

Barriers Or Hurdles 

    Although much has been learned, there is great difficulty in trying to separate the impact of lifestyle from what is ultimately possible for adult health under ideal conditions. This is true not only for the biological possibilities but also for the socioemotional realm and for the development of intellect, creativity, and wisdom. 

    Much of the extant research is plagued by the inability of researchers to disentangle the overlay of familial and cultural expectations, cohort-specific life experiences, the environment, and idiosyncratic tendencies. 

    What is generally considered normal for men or women during the major stages of adult life is open to criticism as being tied to specific historical periods (eg, studies done in the 1950s or the 1980s), to expectations within an age cohort (eg , those whose childhood occurred during the early years of television versus the internet age).

    Gender differences that were influenced by prevailing values and expectations (eg, prewomen's liberation or sexual liberation), or to physical adult health status in light of varying mores about smoking, fat or carbohydrate intake, and exercise.

    Cultural, cohort, and gender-expectation biases can be overcome to some extent with cross-cultural or cross-sequential designs. Nurse researchers were challenged to do more of their adult health research contextually tied to the specific adult ages and stages of their subjects (Stevenson, 1993). 

    Even now, most nursing research either erroneously lumps three or more distinct adult stages into one group (eg, 25 to 60) or makes up anti-developmental age categories (eg, 25 to 45, 45 to 65, and 65 and above). Developmental and situational confounders abound in data categorized and analyzed in this anti-theoretical manner.

     Findings would be more valid and reliable, even about purely physiological phenomena, if scientifically based adult life stages were used as the grouping categories in research on adult health.