Nursing Research Fosters Independence
words by barbara hurley /
photograph by pete byron
efore joining the faculty at UMDNJ’s School of Nursing, Kathleen Patusky, PhD, assistant professor, worked as a psychiatric and medical home health nurse for more than 15 years. During that time, she became attuned to the emotional experiences of her elderly clients and developed a keen respect for their need for independence. While pursing a doctorate at the University of Michigan, she became involved in the development of a “theory of human relatedness,” which explains how nurses develop effective therapeutic relationships with psychiatric patients and the impact on independence. It led to an understanding that when a patient is given too much or too little by others, independence may become either dependence or a sense of alienation. This in turn led her to the creation of a model for older adults called “event-generated dependence” and clinical research to test portions of the model.
“Nursing research is generally not about testing medications,” Patusky explains. “We are concerned with other types of patient care, in my case supportive and behavioral interventions.” Accordingly, she prefers the term “clinical research” to “clinical trials.”
Event-generated dependence reframes dependence as a function of the social environment rather than an attribute of the older adult. Elders in nursing homes, for example, with or without neurodegenerative diseases, are treated as being less able to do for themselves. Others — nurses or aides — do more and more for the patient rather than encouraging the older adult to do as much as possible for himself. According to Patusky’s model, the older adult feels that they have become helpless and may lapse into depression. Alternatively, a social environment that respects the patient’s inherent autonomy will maintain the sense of connection necessary for sound mental health.
Patusky conducted a longitudinal study comparing older adults in the community receiving home healthcare with those who did not. The study found that those receiving home care were more likely to adopt an increasingly dependent frame of mind and become more prone to depression. Consequently, she has become very interested in older adults with medical disorders who become depressed and believes that, although there might be a link to her model of event-generated dependence, past history, neurotransmitter activity, and interactions with medication are likely involved.
“I enjoy solving puzzles,” she says, “especially those that have the potential to improve the care that nurses provide patients.” And once she meets study participants, she takes great pleasure in knowing that, at some point, their participation and her findings may enhance the quality of life for older adults.