"I am constantly distressed by our denial of geriatric nursing as if it had bad connotations."1 "The majority of nursing graduates in the 80s will continue to be better equipped to care for expectant mothers and children than for the majority of their clients-the aged."2
Each of the above statements was written by a nurse knowledgeable about the practice of, and education for, nursing care of the aged. Both of these statements can soon be obsolete with changes in the curriculum of all undergraduate programs in nursing. The changes would include revision of the curriculum to allow nursing students to be educated-both theoretically and experientially-in nursing care of the aged. The significant questions are: How will this be done? Will geriatric/gerontologic theory and clinical experience be integrated into the present course of study for undergraduate nursing students or will it be provided as a separate entity? There are arguments for and against each method. These arguments will be reviewed here to help the reader decide which way to go.
The integration method will be discussed first. By integration is meant the inclusion of geriatric/gerontologic content into the present course of study over the entire nursing program including all areas except maternal and child nursing. Superficially it appears that the integration method would be the easiest and the most efficient way. It can be argued with some degree of persuasion that this is being done at the present time. When queried, individual faculty say it is. The medical-surgical sites for nursing student rotations include large numbers of aged patients to whom the students are assigned on a regular basis. However, what theory preparation do the students have for this experience? Probably none-or very little-or the student simply applies concepts from adult nursing to that of nursing care of the aged.
Other drawbacks associated with the integration method can be readily identified. One is the inadequate control over the theory content as to what will be taught and who will teach it. It also lacks sufficient emphasis on nursing care of the aged, as instructors (who might be biased against the aged) are free to decide which patients will be selected for students. There will not be a way to clearly record the course work and experience on aged and aging that each student has acquired. In fact, by use of the integration method, it is quite likely that some nursing students would be able to complete their undergraduate program with no exposure to the theory or the practice of gerontological nursing.
If geriatric/gerontologic content is not integrated throughout the undergraduate nursing program, it can be done by another method-that of separation. Separation means the provision of a block of time in the basic nursing program exclusively for the teaching of theory and for providing experience to the students in the area of gerontological nursing. By placing it. on a par with pediatric, medical-surgical, psychiatric nursing, and others, gerontological nursing will be given an appropriate emphasis. Each student would be required to take the theory course and rotate through clinical sites for elderly only. By so doing, students who enter graduate programs on nursing care of the aged will have a baseline of geriatric/gerontologic content which they do not presently possess. Graduate education in this field will not have to start at the beginning as though students were never exposed to its theory and participated in the experiential aspects.
On the negative side, the opponents of separation can state that there is no time in the undergraduate program to introduce another theoretical course and clinical rotation. And furthermore, these same opponents will claim that gerontological nursing is not a specialty and does not need to be taught as though it is. Historical evidence will readily refute the first argument. At one time, psychiatric nursing was not a part of all basic programs; presently, it is a requirement. Communicable disease and operating room nursing rotations have been dropped from most programs. There is a precedent for extensive change in undergraduate education. The second argument has not been thoroughly disproven as there is still the struggle to identify the body of knowledge germane to gerontological nursing. However, at the national level, the American Nurses' Association, through the action of its House of Delegates, declared nursing care of the aged a specialty area some 14 years ago. Standards of care were developed and a certification program * initiated for this practice division. Standards of care are part of the nursing process in gerontological nursing and certified geriatric nurses are increasing in number each year.
With both methods-integration and separation-presented and the pros and cons established, which method is preferred? I place my vote with separation as I identify gerontological nursing as a specialty, on a peer relationship to the other four nationally designated specialties of community health, maternal and child, medical-surgical, and psychiatric/mental health nursing. A separation would encourage state boards of nursing to include items on geriatric/gérontologie content in their tests. Nursing accreditation bodies would be able to mandate the inclusion of this theory and experience for those schools desiring accreditation. Nurses who never had gerontological nursing in their undergraduate programs, could return to pick up that area in a concentrated five-week course or more leisurely in 10 to 12 weeks. This would be especially valuable as preparation for graduate work.
How would separation be implemented? It would require reallocation and readjustment of such traditional courses and rotations as maternal and child nursing and medical-surgical nursing. With the present dropping of the birth rate and the increasing numbers of aged receiving medical and surgical care, it seems reasonable and logical to realign these specialties. In addition, the present core courses in physiology, nutrition, pharmacology, and psychology would need to be reviewed to include appropriate content on the aged and the aging process.
To conclude: the debate of should geriatric/gerontologic nursing be included in undergraduate nursing programs has come to an end. The question to be addressed now, as proposed by this editorial is: How should nursing students be taught about gerontological nursing? What is your answer? Do we integrate, or do we separate?
- 1. Wolanin MO: Letter to the Editor. Geriatr Nurs 1(1 ):19, May/June 1980.
- 2. Brower HT: Letter to the Editor. Am Nurs 12(5):5, May 1980.