Controversy over the issue of entry into practice abounds, clouding the issue and that of another (perhaps more volatile issue) health care of the elderly. The result is not unlike the aftermath of the cloud of volcanic ash that erupted from Mount St. Helens and enveloped thé surrounding area. Thé fallout of ash obstructed vision and impaired mobility, disrupting the lives of many persons. Suddenly, activities wefe arrested by the swirling cloud of ash and the people were immobilized. Unless we come to terms with the issue of entry into practice and get on with the mission of professional nursing, we may experience an explosive reaction and the fallout of ihe ash of burned out intentions. This turn of events would further impede discharge of responsibility to the elderly and to the society that mandates the existence of the nursing profession.
The nursing profession, like other segments of society, has long had access to demographic data highlighting the increasing numbers of those 65 and older in the US. Creation of the Division of Gerontological Nursing Practice and development of the standards of gerontological nursing practice by the American Nurses' Association are tangible evidence of the concern for the health care needs of older adults. Less tangible, however, is evidence of changing attitudes toward aging and commitment needed to ensure appropriate and effective care of the elderly. While the establishment of the new specialty area and standards of practice is commendable, it is insufficient for the task at hand. The increasing number and proportion of the elderly indicates need for more aggressive action if their health care needs are to be effectively met.
Care of the elderly remains the responsibility of a relatively small number of professional nurses. As a profession, we have been slow to act in terms of promoting gerontological nursing and recruiting nurses into the field. While the number of older adults is rapidly increasing, the number of nurses prepared for and working in the field of gerontological nursing is still too few. We must increase the ranks of those nurses who have so valiantly rallied to the cause of the elderly as one way of alleviating the situation.
Individual nurses comprise the nursing profession and are responsible collectively and individually for discharging responsibility for health care to society. In view of the societal need for health care of the elderly, we can no longer afford to dissipate energy on issues that should have long since been resolved to the exclusion of attention to other critical issues. We can no longer afford to let the clouds of controversy cloud our vision and impair our mobility. We must be true to the mission of the nursing profession which includes health care Of the elderly.
We cannot wait until we have all the answers to take action. Experience has validated principles important to care of the elderly and the value of the systematic, deliberative approach of the nursing process. "Failure to thrive" seems to be part of the problem in gerontological nursing today. It is as if there were a case of arrested development at the assessment stage of the nursing process. For all of the assessment of needs, there is lack of consistent and systematic application of knowledge and principles in care of the elderly. This leaves unmet needs and unresolved problems that plague older persons and their families.
This lack of application is apparent in the paucity of nurses participating on advisory boards and policy making committees affecting care of the elderly. It is apparent in the lack of prepared nurses in settings where older persons are found. Many rules and regulations, however well intentioned, create a sterile environment that mitigates against the joys of living and dampens the zest for life. Inattention to need for personal space and privacy in institutional settings decreases self-esteem of elderly residents and is an indicator of inaction at another level of nursing function/ "
Many older persons are unclear about the role of the gerontological nurse and anxious about unmet needs and health care problems. Family members call asking for information of various kinds and for guidance regarding family relationships and dynamics. The question arises, what are you as a professional nurse doing to assist with the interpretation of gerontological nursing in your practice?
Are you so blinded and immobilized by controversy over the issue of entry into practice that you cannot see other critical issues and participate in activities directed toward their resolution? How do you view aging-your own and that of others? Do you see it as a naturally occurring process appreciated by most, or as a pathological condition to be avoided at any cost? Do you perceive the right to health as a right of older as well as younger persons? How do you view your responsibility for health care of aging and aged persons? Is controversy impairing your vision and disrupting your efforts to participate more responsively to the mission of the nursing profession?
Lest this barrage of questions mislead you into thinking once again the greater emphasis is on nursing assessment, let me raise one more question: Will you commit yourself to actively promoting health care of the elderly? Many await your answer.