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Nursing students often seem
to be drawn towards the field of pediatrics or emergency care. Some
nursing students that I have mentored seem to view geronotological nursing as a low-tech, uninteresting, and
even boring profession. Perhaps this view is made all the more attractive
by programs such as “ER”, in which older female patients are minimized
by being called “LOL” for “little old lady”. The prevailing view is
that older persons have lived their lives and it is expected that if
they get sick, they may not survive. The nursing role is that of caretaker
until the inevitable “death” occurs. Gerontological
nursing can be rewarding in so many ways, the least of which is helping
older people to continue leading healthy enriched lives in their senior
years.
The frail elderly have multi-dimensional,
multi-complex health issues. The specialty practice of gerontological
nursing therefore is a demanding field. It requires the practitioner
to have a diverse knowledge base of the social and psychosocial issues,
many disease processes and treatment regimens that focus on elder care.
This challenge makes older persons fascinating to work with because
of the uniqueness and richness of their histories. Many of the clients
I have worked with have lived through the depression, world wars, saw
Elvis, danced on stage and raised families. The diversity of their
stories is endless. Gerontological nursing boring?
Never!
In the hectic cost-cutting
milieu in which we have to function, it is sometimes difficult to see
the fruits of our labours. One sometimes wonders if the care given
today makes a difference. Sometimes doing ten tasks at once leaves little
time to reflect on what our real mission is, to provide quality care.
It is gratifying then, to find
out that your efforts have indeed made a difference. “Mary” a 90-year-old
woman was admitted to the Day Hospital where I work after becoming deconditioned post-pneumonia. She lived with her supportive
family who was concerned that “Mary” had lost interest in former activities
and exhibited symptoms of decreased mood. She was physically weak and
afraid to ambulate independently. She also became incontinent of urine
and therefore was reluctant to go out. Her family worked during the
day and because she no longer went to her Bridge Club or lunch with
her friends, she was now socially isolated.
Our Day Hospital
uses an inter-disciplinary client –centred approach to care. On admission
we interview the client and family to determine the client’s needs and
develop appropriate goals to meet those needs. The interdisciplinary
team includes our manager who has a social work background, a geriatrician,
registered nurse, pharmacist, social worker, physiotherapist, psychometrist,
occupational therapist, three support staff and a secretary. We build
the client’s treatment plan based on the client/family’s concerns about
all aspects of their health care needs. The client is kept informed
of these interventions through a series of letters and teaching materials.
These are given to the client in a red binder that is kept on discharge.
At discharge they receive a summary letter of the care received and
recommendations for staying healthy.
The primary goal for “Mary”
was to be able to work in her garden again. She was able to achieve
this goal on discharge. The intervention at the Day Hospital enabled her to regain continence and
increased mobility thus allowing her to resume some of her former activities.
A few months after discharge, “Mary” suffered a fatal stroke while gardening.
Her son told our team that the Day Hospital
had changed “Mary” from a person who was waiting to die, to a person
Death had to chase! Although the remainder of her life was not long,
Mary died doing what she loved to do, gardening and enjoying life again.
Our care had indeed made a difference!
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