CASE STUDY: An Older Immigrant Couple: Mr. and Mrs. Arahan Mr. and Mrs. Arahan, an older couple in their seventies, have been living with their oldest daughter, her husband of 15 years, and their two children, ages 12 and 14. They all live in a middle-income neighborhood in a suburb of a metropolitan city. Mr. and Mrs. Arahan are both college educated and worked full-time while they were in their native country. In addition, Mr. Arahan, the only offspring of wealthy parents, inherited a substantial amount of money and real estate. Their daughter came to the United States as a registered nurse and met her husband, a drug company representative. The older couple moved to the United States when their daughter became a U.S. citizen and petitioned them as immigrants. Since the couple was facing retirement, they welcomed the opportunity to come to the United States.

 The Arahans found life in the United States different from that in their home country, but their adjustment was not as difficult because both were healthy and spoke English fluently. Most of their time was spent taking care of their two grandchildren and the house. As the grandchildren grew older, the older couple found that they had more spare time. The daughter and her husband advanced in their careers and spent a great deal more time at their jobs. There were few family dinners during the week. On weekends, the daughter, her husband, and their children socialized with their own friends. The couple began to feel isolated and longed for a more active life. 

Mr. and Mrs. Arahan began to think that perhaps they should return to the home country, where they still had relatives and friends. However, political and economic issues would have made it difficult for them to live there. Besides, they had become accustomed to the way of life in the United States with all the modern conveniences and abundance of goods that were difficult to obtain in their country. However, they also became concerned that they might not be able to tolerate the winter months and that minor health problems might worsen as they aged. They wondered who would take care of them if they became very frail and where they would live, knowing that their daughter had only saved money for their grandchildren’s college education. They expressed their sentiments to their daughter, who became very concerned about how her parents were feeling. 

This older couple had been attending church on a regular basis, but had never been active in other church-related activities. The church bulletin announced the establishment of parish nursing with two retired registered nurses as volunteers. The couple attended the first opening of the parish clinic. Here, they met one of the registered nurses, who had a short discussion with them about the services offered. The registered nurse had spent a great deal of her working years as a community health nurse. She informed Mr. and Mrs. Arahan of her availability to help them resolve any health-related issues. 

Reflective Questions 

1.What strategies could be suggested for this older adult couple to enhance their quality of life? 2.What community resources can they utilize? 3.What can the daughter and her family do to address the feelings of isolation of the older couple? 4.What health promotion activities can ensure a healthy lifestyle for them? 

Write aof 2-3 pages about the proposed interventions for your problem/issue supported by evidence collected by conducting a literature search and review. Integrate the information into your project.

The assignment should include:

1. The extent of evidence-based data for proposed interventions.
2. Comprehensive description of factors that might influence the use of proposed interventions.
3. Identify the barriers related to the proposed interventions.
4. Detailed list of resources that will be needed.
5. Detailed steps, or sequence of events, or specific implementation activities that will be required to implement the intervention.
6. Monitoring, tracking and ongoing review.
7. Performance of tasks required for implementation. Staff responsible in the implementation of the interventions and their qualifications.
8. Strategies that facilitate the implementation of the proposed intervention.
9. Timeline.
10. Expected outcomes to be achieved by your project.

Expectations

• use US sources and project is nurse retention and the role of leadership in this
• Length: 2-3 pages
• Format: APA 7th ed.
• Research: At least one peer reviewed reference within the last 5 years

1) Many vulnerable populations exist in the United States. Which vulnerable population do you think is the most challenging to care for, and how might your nursing care change when caring for this population as opposed to individual clients? 

 Examples of Vulnerable Population

* Pregnant Teenagers
* Migrant Farmworkers
* Homeless persons
* Persons in poverty
* Substance abusers
* Individuals with mental illness
* Persons living with HIV/AIDS
* Victims of abuse/violence
* Gay, Lesbian, Bisexual, Transgender populations

1st 

The Theory of Goal Attainment and Transactional process is a theory that guides nurses to practice nursing based on a personal approach. It is a Grand Theory based on Interactive Process.  The purpose of this theory is to be able to achieve patients’ goals by forming a relationship with the client or patient. To be able to form a relationship with a patient/client there are several factors that have to be consider.  One of the main factors that has to be consider is the fact that the patient is a unique individual and as such nurses must think how to approach this patient to form a therapeutic relationship that will involve the patient in his/her own healthcare goals.

The goal of attainment has impacted research, education, and the nursing. However, it has impacted nursing education in particular. “For example, it served as a frame work for the baccalaureate program at the Ohio State University School of Nursing where it determined the content and process taught at each level of the program” (McEwen & Wills,2023, p. 177).

The development of this theory was created by Imogene King in the 1960’s.  “During this time nursing practice was not so much based on theory.  Nursing practice was generally prescribed by others and highlighted by traditional, ritualistic tasks with little regard to rational” (McEwen & Wills, 2023, p.25).

It is interesting to know that this theory has been used not only for the purpose of education, research and nursing practice but it has also help to develop other theories.   “In addition to application in practice and research described previously, King’s work has been the basis for development of several middle-range nursing theories.  For example, was used by Rooda (1992)  to develop a model for multicultural nursing practice” (McEwen & Wills, 2023, p. 117)> 

2nd 

Virginia Henderson was born in Missouri and raised in Virginia. She grew up to receive her diploma in nursing from the Amy School of Nursing located at Walter Reed Hospital. Within two years of working as a bedside nurse her passion for the profession grew immensely.  She applied to and was offered a nurse educator position at a hospital in Virginia. From that day Henderson embarked on a lifelong mission to educate nurses on her concept of the nursing profession. Over a decade she had  went on to obtain her Bachelors of Nursing degree in 1932 and her Master’s degree in 1934. Her concept and theories evolved and was imitative of her passion, practice and education. 

The philosophical and structural components of her theory was focused on educating nurses and providing patient care in an encouraging environment. Henderson was introduced to physiologic principles during her graduate education. The study of these principles was the fundamental basis of her framework for patient care (Henderson, 1965, 1991). The physiologic principle implies that the patient’s biology, psychology and sociology (biopsychosocial) all had to be taken into consideration when providing care. As her studies and work experience progressed, she was also introduced to “Thorndike’s fundamental needs of a man” (McEwen, Grand Nursing Theories Based on Human Needs 2022), in which she gave credit to as having a direct influence on her beliefs. Another major concept of her theory is that nurses should assist patients with otherwise daily activities of life in times of illness until the patient is back to their optimistic level of health. Overall, helping the patient to regain independence by providing a supportive environment. Her concept of nursing included the nurse assisting the patient with 14 activities.

Henderson’s theory of nursing has immensely affected nursing education, nursing research and nursing practice.  Lucier (2018), for example, described how Henderson’s model could be used to enhance the nurse−patient relationship to provide holistic care at the end of life. Similarly, Waller-Wise (2013) found that Henderson’s theory assisted nurses in attaining excellence in childbirth education, and Miranda et al. (2018) used Henderson’s assumptions and model in their analysis of the concept of “nursing care of overweight children.” (McEwen, Grand Nursing Theories Based on Human Needs 2022). Her contribution to nursing textbooks extended from 1930-1990’s. Her contributions to nursing had a global impact by strengthening the focus on nursing practice and confirming the value of tested interventions in assisting individuals to regain health (McEwen, Grand Nursing Theories Based on Human Needs 2022). Researchers internationally continue to be influenced by Henderson’s model as a framework.

Rubric

Criteria for Grading Discussion Participation
Interactions should be thorough, thoughtful and facilitate the learning community’s growth.
Behaviors will be reviewed on a weekly basis. Contribution toward the course grade total
will be based on the pattern of demonstrating these characteristics.
Please remember, initial posts should be submitted by midnight by deadline. Your
responses to two of your peers’ initial posts should be made by deadlines, and then
responses to questions or comments made to you on your posts or discussion responses
should be made by deadlines also, per syllabus above.
Rubric for evaluating Discussion Participation
Characteristic of the Response Point Value
 No response 0
 Responses are noncontributory (e.g., “I agree with the comment;”
“I was thinking the same thing:” “I had a similar experience.”
2
 On-time response to all points
 Response is not relevant to other statements or the discussion
thesis
 Response shows minimal understanding of the topic
4
 On-time response to all discussion points
 Response reflects the point being discussed; builds on ideas of
other participants
 Facts and examples are appropriate to each thesis and are
accurate
 Rules of communication, language, etc. are utilized so as not to
distract the flow of discussion
6
 All elements in the 6-point division (above) and
 Responses reflect complete understanding of topic and assigned
readings
 Uses greater detail, examples and other sources to support
discussion
 Initiates another question (which may/may not be discussed by
group0
8
 All elements in the 8-point division (above) and
 Analyses, discussions and conclusions explicitly linked to the
10