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Original Question
Read the following Problem Statement: Early stage dementia is a highly personal experience for individuals with this chronic illness. There is growing recognition that the diagnosis results in a wide range of feelings related to the disease, such as loss and uncertainty, placing major demands on patients’ coping strategies. Individuals living with early stage dementia also retain important strengths and have positive experiences. They acknowledge and actively seek to understand and adjust to current and future loss of memory, independence, previous roles and lifestyle, as well as feelings of depression and frustration. They cope by holding on and “compensating,” in keeping with Lazarus and Folkman’s theoretical framework; however, they also experience a continuum of reactions and emotional responses ranging from self-adjusting, in which self-concept is flexibly adapted to the new circumstances, to self-maintaining, in which the prior self-concept is emphasized. Evidence suggests that the ability to experience a coherent sense of self or self-concept remains stable in the early stages of dementia and is a predictor of quality of life. While self-concept is a stable understanding of self, self-esteem is an evaluative component and a resource that a person can draw on to avoid or to cope with the negative effects of stressors on one’s health. Self-esteem is a global perception of an individual’s evaluation of themselves as a person. Low self-esteem is a risk factor for depressive symptoms across the lifespan. Since clinically significant depressive symptoms are common, self-esteem has an important role in developing positive coping strategies in early stage dementia. In early stage dementia, hope is an active process that is integral to living and important to maintaining well-being and quality of life. Hope is central to the adjustment process when trying to maintain a sense of normalcy and developing cognitive, social, and behavioral strategies to improve confidence. People in early stage dementia utilize intrapersonal strategies to enable them to continue to live in the present and find new ways of being in the world. Despite the scarcity of studies regarding hope in early stages of dementia, high levels of hope have been associated with lower psychological distress and adaptation in other chronic illnesses, such as cancer. Hope may be a protective factor that allows a person with dementia in the early stages to function effectively despite the disabling effects of dementia. Hopelessness is a strong predictor of adverse health outcomes in heart disease and cancer, independent of depression and other risk factors. Numerous studies have demonstrated a significant association between social support and protection from depression in older adults. Social support group interventions for people in the early stages of dementia increase self-esteem, reduce depression, and improve quality of life. Social support has been closely linked with hope in cancer and depression. Yet it remains unclear how factors such as hope or social support might influence self-esteem in persons with early stage dementia. The purpose of this study was to examine the relationships of hope and social support to self-esteem in individuals with early stage dementia. Our specific hypotheses were as follows: (1) There will be a positive relationship between hope and self-esteem, (2) There will be a positive relationship between social support and self-esteem, and (3) There will be an interaction effect of hope and social support on self-esteem. Source: Cotter VT, Gonzalez EW, Fisher K, Richards KC. Influence of hope, social support, and self-esteem in early stage dementia. Dementia. 2018;17(2):214-224. 1. Rank the problem statement on a scale of 1 to 5 (5 = Excellent, 4 = Good, 3 = Adequate, 2 = Fair, 1 = Poor) as to its Clarity Importance to nursing Comprehensiveness Logical presentation
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