Final Paper

Introduction

Mrs. Al Bahrani is my seventy-five years old grandmother who has born and brought up in Muscat, Sultanate of Oman. She freely agreed to by my interviewee in this life review interview. This is a rare opportunity offered to me to reflect and know her legacy. I have always had much respect for her, discerning the details of her life will help me become a better person, be more compassionate and conscientious nurse. After spending like a long time with Mrs. Al Bahrani, I got the chance to know her better. She lives in her own house that is located near my house. With the knowledge I have acquired throughout this semester, we were able to have engaging communication. The semi-structured interview took place in my grandmother’s room. We started by having a cup of coffee and our conversation lasted for about two hours, with such a soul near you, time can really fly! I can confidently say that talking to the old and wise is very rewarding, it increases the connection between the parties and helps understand one another. The life review interview illuminates different concept of legacy. For my grandmother, her legacy has been her family and big love she shares with other people.

Summary of the interview

As a teen, I lived with both parents and they loved me so much. During my childhood, I involved myself in manual jobs and walked four miles on a scaring path to school every day. She had intense passion in learning and her favorite subject in school was drawing. I was almost likely to have a younger brother, unfortunately my mother has a still birth during her second pregnancy. My parents never got any other child and this made her life revolved around her parents and the few neighbors. The family did not have much wealth at their disposal and this meant that toys were uncommon. Despite this, I loved to play hide-and-seek and make-it believe games. During her elementary schools, my parents decided to relocate to rural land to practice agriculture. I had to join a new school and at this new place, I had hard time trying to adjust and this affected her studies.

After completing my high school, I had hope of becoming a nurse. I wanted to help her community fight killer diseases, she owned it to her people because they were seemingly nice to her. In my teenage year, I met a young and promising man who swept me off her feet. We as lovebirds had passion in dancing and this made us have many dates. Sometimes thereafter, we got engaged and invested more time together. My fiancé’ taught her how to drive, unfortunately, he had narcolepsy and this made it unsafe for him to be on the road.

My alarm for back pain went off after giving birth to my daughter. One night I woke up and realized I was in agony. It was my back, I tried to move, I tried lying still, I also tried to sit, every posture hurt. I remember one day I closed the door on my crying baby and left her in her crib, stretching out for me. This experience made me walk away in tears. My child was sick, and as a loving mother I wanted to calm her. But I could not raise and rock her to help her sleep. Seemingly my broken back was fast wasting away!

At one point I visited physiotherapist recommended by a family friend, however, I do not remember her explanations. Over the next months, the pain intensified just above the right hip, but it had infused my whole body, drained my energy, and taken my pleasure of parenting. It was exhausting being in pain and worrying about the pain. I started exercise but shortly after, I went from exercising five time each week to doing zero exercise. I had the urge to get better instantly, so that I could slide back to my old ways of doing things. There is something about my back pain that makes me desperate to find instant solution. Bearing the pain and waiting for it to come to an end is unthinkable.

I have had the back pain for the better part of my life caused by scoliosis, a curvature of the spine. One day, I thought my back would snap if I cuddled by growing daughter. I had to give up on some parenting practices. Because of the back pain, I cause my daughter suffering. I realized that the pain make kids whose caregivers have the chronic pain at higher risk for behavioral issues, adjustment challenges, and the children are expected to have the pain. The entire family suffers. In my case, my two children felt I was uninvolved emotionally and physically, and more likely to be unpredictable and ill-tempered. Because of this, may be my child hid her true needs from me, lived in anxiety of stressing me or bringing more pain. Unfortunately, young adults and children who deal with this type of parents become perfectionists and retreat in silence.

My back pain advanced steadily. From age of 6 to 18, I had a brace under my clothes to strengthen my S-shaped spine. At the start, the brace kept the spine straight but the curving, like unruly adult, could not be controlled. At the age of 45years, the spine persisted with its wayward path and this means that the pain was constant in my body (Stensland & Sanders, 2018). After the strenuous pregnancy, the pain intensified and took another dimension. I went through my parenting taking anti-inflammatory medication. A scoliosis expert suggested corrective spinal fusion surgery, however, I observed that the risks of the operation are not significant compared to the possible benefits. The operation would involve “slitting the back, inserting steel rods, taking bone graft by the hip, and fusing the vertebrae together to stabilize the spine” (Wong, Karppinen, & Samartzis, 2017). I had worried of the operation. What if the surgery brings complications in other areas? What if the surgery cause paralysis and damage of nerves? The pain is more at my age but at least I am managing.

Fast forward, I know odds are against me now because of my age. I do not know what the medical future hold, lifetime of pain, therapies, or surgery. Parenthood may have damaged my body more, but as per doctor’s orders, I checked my curve. Currently I am push my back beyond its limits with little consideration of curve and the frequent pain.

Wear-and-Tear Theory

The low back pain (LBP) is a major incapacitating health conditions affecting people aged above 60 years. However, while most causes of the back pain are self-limiting and non-specific, older persons are more prone to develop low back pain pathologies because of their age-related psychosocial and physical changes. Existing literature shows that chronic and sever back pains increase with age. Compared to working-age adults, older people are likely to have certain back pain pathologies such as spinal infections, tumors, osteoporotic vertebral fractures, and lumbar spinal stenosis (Wong, Karppinen, & Samartzis, 2017). Moreover, different age-related mental, physical, and psychological change such as dementia, spinal degeneration, and physical inactivity as well as other risk factors such as genetic and gender may affect the prognosis and management of low back pain.

According to age-clock theory, the back pain can be explained based on different factors. As people age, their muscle lose the elasticity, the bone also lose their strength, and the spine lose cushioning, all these lead to back pain (Docking, Fleming, Brayne, Zhao, & Macfarlane, 2015). Moreover, Injuries cause back pain. In case of an accident, through lifting heavy object, you can strain the spine and cause the disc to rupture or even bulge outwards. This puts more pressure on the back and nerves within it, and pain results. Other risk factors increase the chances of back pain. These include poor sleeping habits, overweight, inactivity, and smoking. Behind the high incidence of nonspecific (LBP) of young people lies the fact that these people should have high degree of activity of daily life at the point when age-related change in tissues and lumbar spine start to occur (Wong, Karppinen, & Samartzis, 2017). Therefore, as people try to fight symptoms and signs of aging, some foes greater compared to other. This is the case with back pain. Majority of the people will experience back pain at some point in life. However, back pain does not have to be inevitable part of aging process.

Reflection

The interview has brought me closer with the interviewee. Before I conducted the interview, she did not have much influence on me, but I have learned more about back pain from her life and the connection was resourceful. I had great learning time about the prognosis and management of back pain. This was possible because of the communication skills which I exercised. I would mention something and she would go into details about herself. I did not use the question-answer approach because it is limiting in terms of details. My interviewee enjoyed a continual conversation and it was a great time.

This was my first clinical experience in my nursing profession and it was a great learning process. Her conditions and fear makes me want to give evidence-based care and managed her fears on possible effects of spine surgery. Her worries push me to be a nurse who can be approached and offer solutions to different groups based on their culture, experience, and expectations. Unfortunately her source of back pain has genetic influences and this is a non-modifiable cause. Studies (Wong, Karppinen, & Samartzis, 2017; Docking, Fleming, Brayne, Zhao, & Macfarlane, 2015) shows that genetic play a significant role in vulnerability to chronic pain development, it plays a role in modulating pain sensitivity, and responses to analgesics. My grandma genetic factors predispose her to spinal disorder (scoliosis) and also altered her brain structures which modify central pain processing and perception. I believe the way out is to avoid occupational exposures to lifting heavy object or bodies, reduce twisting and bending, and stooping as a way of avoiding risks for the back pain in when. To this end it is true that higher education helps to prevent the back pains. More educated person are likely to be compliant to treatment and are willing to adopt a healthy lifestyle.

References Docking, R., Fleming, J., Brayne, C., Zhao, J., & Macfarlane, G. (2015). Epidemiology of back pain in older adults: prevalence and risk factors for back pain onset. Rheumatology (Oxford), 1645–53. Stensland, M., & Sanders, S. (2018). Living a Life Full of Pain: Older Pain Clinic Patients’ Experience of Living With Chronic Low Back Pain. Qualitative Health Research, 28(9), 1434-1448. doi:https://doi.org/10.1177/1049732318765712 Wong, A. Y., Karppinen, J., & Samartzis, D. (2017). Low back pain in older adults: risk factors, management options and future directions. Scoliosis Spinal Disorder, 12(14). doi:10.1186/s13013-017-0121-3