Problems in Geriatric Nursing Care: A Study of Nurses' Problems in Care of Old People in Hospital by Thelma J. Wells. New York, Churchill Livingstone, 1980. 135 pp. $13.50.
The author states that there are two objectives for this book: (I) to share her study opportunity; and (2) to submit findings so that nurse researchers may test them in a variety of settings. The book explores several problems in geriatric nursing over a period of three years in one teaching hospital in a residential area near a large city in Northern England.
Chapter I is an overall introduction to the total nursing research project, detailing the development of the problem, the definition of the problem, the design, the setting, the sample, and the philosophy of the author in choosing nursing care of the elderly as a topic for description and exploration. Subsequent chapters each contain one substudy of completed research that is a part of the design of the total research project. The author describes the logic of the design as "... exploring the problem from the obvious external factors to the subtle internal ones." I'he substudies include the environmental exploration of space, equipment, and furniture; nurse descriptions of patients, nurses' knowledge and attitudstaboiit the care of old people; the outcome of an unplanned imposed change in geriatric nursing care; an activity study of geriatric nurses' work; and subtle nurse patient verbal communication in a geriatric ward.
The author discusses the methodology in each substudy chapter, as well as the findings, a summary, and implications for nursing. Tables and illustrations are well documented for easy reading, and the narrative is simple and direct. Limitations of the study, such as small sample size, lack of nurse agreement on patient confusion, and the difficulties in communication data collection and analysis, are acknowledged.
A chapter on the system of health care and the training of health personnel in England at the time the study was undertaken (1972) would have clarified the information. Comparison between geriatric nursing in England and in the U.S.A. is limited by the omission of clearly defined terms. The author uses subjects described as trained nurses, untrained staff, auxiliary nurses, sister/charge nurses, etc. The American equivalency or education of these job titles is not stated.
Although the problems discussed in the book are not new to many nurses working in geriatrics, the author's presentation is provocative for several reasons. A strong point is made that current nursing education and nursing research are not entirely relevant to geriatric nursing practice or, in fact, to general nursing practice. The author identifies nurses who are giving geriatric care as overworked but doing the best they can, receiving no direction and having no role models, having no administrative input in planning care, task-oriented rather than patient-oriented, and lacking in communicative skills. Each of these findings is highly significant for quality nursing care. The book is useful for investigators and educators in geriatrics or for nurses engaged in nursing care to expand the ideas presented and to seek solutions to the problems identified.