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Examining Risks and Benefits to Enhance Quality of Life

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Teaching strategies serve two purposes. First they are designed to help students feel comfortable initiating conversations with older adults about risks they may be willing to take to achieve benefits that may improve quality of life. They are also meant to raise awareness of decisions older adults make which may be unconventional within the context of a best practices model, yet are consistent with the older person’s wishes, expectations, resources, cultural traditions, and strengths. These strategies can be used both in the classroom and clinical settings and are designed for all levels of students.

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Examining Risks and Benefits to Enhance Quality of Life

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Learning Objectives
Students will:
- Develop a collaborative relationship with patients to discuss perceived risks in relation to benefits that enhance quality of life.
- Initiate conversations with the health care team to advocate for risks patients and/or families are willing to take to achieve an improved quality of life.
- Explore salient issues to consider when discussing risks and benefits with older adults.
- Identify standardized assessment tools which provide a foundation for the older adult’s decision making.
- Increase their own self-awareness of judgments and pre-conceived notions that may affect their advocacy for older adults.
Learner Pre-Work
These teaching strategies focus on assessment and making situational decisions to enhance the student’s spirit of inquiry and development of professional judgment.

Ask the students to consider the following questions in order to more fully understand the experience of weighing risks and benefits. Students can write their answers in a log or in an on-line discussion group.

1. Which of these two statements is most important to you?
- I want to live as long as possible regardless of the quality of life that I experience.
- I want to preserve a good quality of life even if this means that I may not live too long.
2. Do you feel you have full autonomy for decision making?

3. How do you feel when people make decisions for you?

4. What do you see as important in your life?

5. What risks have been identified to you that you agree or disagree with?

6. What risks have you taken in the past and how has this affected you?

7. What is your understanding of the risks you want to take now?

8. What risks are you not willing to take?

9. How would you explain to the people who love you why you want to take this risk?

10. What frightens you about taking this risk?
Suggested Learning Activities
1. Journaling: Have students keep a journal of risks they take every day and how they may think about these risks in terms of the benefits they reap. Encourage them to also examine their own feelings and motivations when others may have opinions on the risks they take and what considerations they think about before taking the risks. Examples of risks that students take may include driving, flying, smoking, diet, exercise, and travel. This exercise can also be done in a large group with risks written on a board and discussed as above. Have students look at older adults in the course of clinical in a week, and identify risks that were or were not taken and the discussions that were or were not held around the topic.
2. Concept Map: In a group discussion, use a concept map to describe risks which may occur in an identified older adult and how to assess these risks using the How to Try This Series. This could lead into a discussion on how intervening with only the goal of safety can affect quality of life. Students should be able to look at improvising interventions, collaborating with clients and families, and develop talking points with both clients and members of the health care team in regard to risks and benefits of situational decision making. Have students write down two considerations they had not thought of before when looking at risks and benefits in caring for older adults.
  
  Use the Examining Risks and Benefits to Enhance Quality of Life case studies for this activity or use a case study of a patient taken care of by a student during her/his clinical day.
3. Interview: Have students interview an older adult asking questions about how quality of life is perceived and about what risks the person is willing to take or has taken to preserve that quality of life. The interview might also include questions about how they felt when they were not permitted to make certain decisions. Students should consider assessment tools from the How to Try This Series to fully assess risk, benefits, and safety.
Assessment Tools

ConsultGeri.org, the website of the Hartford Institute for Geriatric Nursing at New York University's College of Nursing, contains many evidence-based assessment tools. Those listed below from the Try This:^® and How to Try This Series are particularly recommended for the content on geriatric syndromes. The tool, an article about using the tool, and a video illustrating the use of the tool, are all available for your use. The SPICES tool is listed first, since it is an overall assessment tool.
Author Information

Laureen Tavolaro-Ryley, MSN, RN
Community College of Philadelphia
Philadelphia, PA

Patricia Brown O'Hara, MSN, RN
Gwynedd Mercy College
Gwynedd Valley, PA