NSG4067 Gerontological Nursing
Patient Questionnaire
INTERVIEW OF CHOSEN ELDER ADULT
Name: ________________________________ Age: ________________
Brief Introduction (Background information):
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
1. Philosophy on living a long life
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. Thoughts about when a person is considered “too old”
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3. Opinion on the status and treatment of older adults
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4. Beliefs about health and illness
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
5. Health promotion activities he or she participates in
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
6. Something special that helped the person live so long
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
7. Life span of other family members
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
8. Special dietary traditions in patient’s culture attributed with aiding long life
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
9. Any remedies/medications that have been handed down in family/group. If yes, describe. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
10. Patient’s description of current and past health status
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
11. The values that guided life so far
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Additional Questions
1. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Summary
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Contrast of client’s responses with findings in current literature
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Page 1 of 4
© 2015 South University
The post NSG4067 Gerontological Nursing Patient Questionnaire INTERVIEW OF CHOSEN ELDER ADULT Name: ________________________________ appeared first on PapersSpot.