Readings in Gerontological Nursing, edited by Edna M. Stilwell. Thorofare, New Jersey, Charles B. Slack, Inc., 1980. 254 pages. $16.50.
The Journal of Gerontological Nursing revisited! This compilation is a sampling of articles on many diverse practice situations already published in the journal. The volume comprises 30 chapters and as many authors. The spontaneity and creativity of each author is preserved, and one is refreshed that nurses are not expected to be "expert" in all areas of practice. There is a consistent use of "older adult" throughout the text, thereby avoiding euphemisms coined for this age group.
Although the editor does not specify the rationale for inclusion of content areas, certain divisions that provide a logical flow throughout the book are apparent. These include: (a) issues and trends in gerontological nursing - the realities of the practice, where we are heading, and role changes; myths, the need to change negative attitudes both of professionals and society in general; (b) physiologic assessment - drugs, sensory changes, sexuality - much practical information emanates for the practitioner's use; (c) problem areas - relocation, injury, suicide, death - some of the common areas demanding significant adaptation in the lives of older adults; (d) psychosocial factors - theories, ethnicity, family, mental health or impairment - vital issues discussed concern adjustment throughout the life span; and (e) research - often neglected, but critical to the development of the science of nursing and excellent nursing practice.
The book has many strengths, not the least of which includes outof-print articles still in demand. Excellent chapters include "Positive Aspects of Aging," which outlines 10 points to assist nursing actions based on a complete, realistic, positive viewpoint of what aging is and can be. "Demythologizing the Issues" is written in an excellent, scholarly fashion and reveals stereotypes surrounding roles, retirement, sexuality, widowhood, and death. It encourages one to explore ways to overcome negative viewpoints. Both chapters present positive looks at the potential for change focused for nurses today.
Chapter 4, "Health Assessment," is an excellent guide for the practicing nurse in all settings that will aid in discerning the normal changes of aging. It should increase assessment skills and observational powers, and lead to improved nursing care plans. However, it does repeat some factors affecting communication that have been covered earlier. In Chapter 6, the assessment tool for individualized care is a comprehensive, systematic instrument. Though not presented as a research tool per se, scoring is possible. The paucity of research instruments dictates testing to ascertain validity and reliability. The tool appears practical, if not in toto because of length, then at least in part. It assesses functional status, and physiological status, and psychosocial parameters. The author generates important questions that practitioners should be asking, such as: What are the client's expectations and perceptions? What services are needed by the client and family? What are the coping abilities of clients faced with problems?
No compilation can be considered complete without information on drugs, because their use is fraught with problems for older adults, i.e., polypharmacy and lack of norms in dispensing medications to this group. "Introduction to Drug Therapy" provides useful details, including assessment of behaviors, the resource of a clinical pharmacist, education relating to norms of older adults, and a knowledge base alerting to drug-related problems in older adults. Emphasis is on prevention, and actions are listed to guide in making appropriate clinical judgments when prescribing for the elderly. Chapter 15, "Relocation of the Elderly," affords excellent, concrete suggestions for aiding in relocation of the older adult. Research findings are incorporated. There are two offerings on relocation, both different and informative.
Chapter 23, "Issues of Treatment," provides an excellent background for understanding the present dilemma in the treatment of the psychogeriatric client. "Group Work with the Aged" is written in excellent style, including recent references; there are many practical suggestions for group leaders. Chapter 26 is an excellent overview of Alzheimer's disease. Chapter 27 discusses Alzheimer's in an actual client situation, thereby increasing utilization of principles and the suggested activities for nurses. "Simulation" to create an active understanding of disabled older adults supplies an excellent conclusion to the book. This activity can influence health care providers' attitudes. Heretofore unpublished, it will be utilized widely by professionals to gain empathy with the elderly and to increase understanding of the aging process. It has many implications for those who care for older adults.
Other interesting fare involves content on "Medical model vs. Nursing"; thought provoking, it places the responsibility on the nurse as well as on others to reorient their approaches to long-term care. Chapter 5 is an interesting presentation of the "Geriatric Evaluation Process." Offering practical information on the management of complex problems of the client for practicing nurses, it also utilizes the nursing process. Sensory losses are very important topics; Chapters 8 and 9 on hearing and visual changes are replete with information necessary to accompany good nursing care. These are very important areas when one acknowledges that loss of hearing separates a person from people and blindness separates one from things. "Foot Assessment of the Elderly" contains an instrument for assessment of the lower extremities. This needs further testing as a research instrument, but appears invaluable for assessment of his common complaint and low priority need of the older adult. Chapter 1 1 covers the multifaceted problem of "incontinence." "Sexuality in the Aged" gives an overview of sexuality, including sensuality and the need for intimacy. The author recommends inclusion of this content in professional school curricula. Chapter 19 on Jewish ethnicity, written by a non-nurse, gives one an intimate glimpse into a heritage perhaps little understood previously. A richness of tradition and cultural is shared; perhaps other cultures might have been included. Chapter 20 portrays an intriging view of the affluent elderly, a group considered to have few problems, due to the bias of lower and middle class values.
"Family Group Meetings" proposes material helpful to aid transition into nursing homes. It assists families in forming bonds, deals with issues surrounding institutional care, and problem -solves them. Chapter 22 focuses on some of the psychosocial theories of aging. Chapter 29 encompasses a general literature review of the development of gerontological nursing. A compilation of research to be utilized in nursing practice is shared in order to disseminate findingsand improve nursing practice. The author also gives a historical overview of agencies, both governmental and ANA, for the funding of research.
The main weakness of this text is the lack of an additional, extensive, updated bibliography addendum, especially on contributions published over two to three years ago. The chapters on injuries and suicide contain practical suggestions; however, some conclusions are based on old data and may be misleading. The chapter on dignified death is excellently written and generates solutions worth considering. Once again the sources are dated. Chapter 28 provides some general guidelines for teaching adults, features unique to this age group. The most recent reference is 1972. The topics of relocation and Alzheimer's disease are duplicated. Perhaps some collaboration was necessary so that advocacy, hypo-hyperthermia, nutrition, or ethical issues might have been included instead. In Chapter 12 on "Constipation" the enthusiasm of the author is transmitted to the reader, but a rigorous research design seems lacking.
Overall the offerings are written for the practitioner. Creative implementations are given, aiding problem-solving. Although of practical value, the benefit to undergraduate and even gradua te students is not precluded, particularly in introductory courses. While not exhaustive on any topic, the way is pointed to further study and provides continuity for scholars between the realities of clinical practice and academia.
Among the many other strengths are the portable size of the book, the quality of writing styles, the practical interventions to be incorporated into practice, and the succinctness of each chapter, which respects the time spent by a busy practitioner in an effort to keep informed. Amidst the plethora of publications today, it is delightful to be able to find under one cover the best of offerings for the last five years. Written mainly by nurses for nurses, it urges us to share our experiences, strengths, and hopes for the improvement of the care of the older adult. As stated perfectly, in the beginning pages anonymously, "What do you see, nurse?"