As educators we respond to two basic questions: "What is to be taught?" and "How it is to be taught?" These pedagogical pieces continually are revised and updated. Ideally, the revision advances both the subject matter in question and the profession in evolution. The subject matter of gerontology most obviously is expanding at a velocity that mirrors the expansion in population trends. Gerontological research, offering information and insight to us on a daily basis, demands that education keep up with that pace.
The profession of nursing, and specifically gerontological nursing, is excitingly dynamic. Few other professions are moving forward with such rapidity. Nursing educators, defining gerontological nursing roles, are exploring broader avenues of practice. Nursing roles of the past are being reworked, redefined, and researched.
Seton Hall University College of Nursing offers a 42-credit Master of Science degree program. The "Clinical Specialist in Primary Health Care of the Aged" program is a discrete tract preparing gerontological nurse practitioners. Within our philosophy of nursing and education, we believe the concept of advocacy to be integral. We believe that gerontological nurses need to see themselves within a role of client advocate. Additionally we believe that learning takes place through active behavior on the part of the learner. Nurses are reasonably, and are ultimately, best suited for the complex task of advocacy due to their broad theoretical, scientific, and practice bases.
Within this context, we define advocacy as an action deliberately taken, resulting in a positive outcome for older adults. Positive outcome is defined by older adults themselves. Action involves bringing about change within a system.
The conceptual framework of the College of Nursing is that of selfcare. The gerontological nurse practitioner program has as one purpose the development of nurse as advocate; a specific terminal objective states that graduates will function as advocates. We measure the meeting of the objective through the "Advocacy Project" assignment.
The "Advocacy Project" within the curriculum is a process experience. The process begins with the conceptualization of the term and with emersion into the clientrole. Specifically, the "Advocacy Project" is designed to be carried out over the length of the program, which is three semesters plus one summer or a total of 18 months. In Semester One students a question, assessing a problem need regarding older adults. The need for advocacy is documentated by a search of the literature and by validation from the population involved. Older adults verify to the students that they do in fact see a need for advocacy in a particular area. Short-term and long-term then are outlined. Specific are developed for the next 12 months of advocacy activity.
In Semester Two, students focus on short-term goals. Specific objectives are carried out. Projects actively are instituted. Implementation is completed in the final semester. Both short- and long-term goals are evaluated. Students prepare a written summary that describes their advocacy projects, specific strategies utilized, outcomes, obstacles encountered, and an evaluation of the advocacy process. Students orally present the process of change, highlighting learning that occurred.
To date, 18 Seton Hall students have designed advocacy projects. For descriptive purposes, the projects are divided into categories dealing with social systems of varying complexity. They include projects that focus on the individual older adult and family; those that focus on the community or environment of the older adult; and those projects focusing on society itself.
Within the individual/family category, students have assessed the following examples for advocacy and developed action strategies that are presently being carried out.
The need for professional legal advice was verbalized by older adults as a specific need in a day care center. The action taken by the student was the development of a free legal counseling network. The student, acting as liaison, negotiated with a law school for law students to volunteer their services to the center on a weekly basis. The older adult members now have assumed the liaison-role of this legal network.
A group of older persons in a community acknowledged the need for an understanding of insurance plans and policies available to them. The student collected data from a broad range of private insurers and developed a printed brochure that compared and contrasted the policies. This brochure is available in senior citizens centers and on marketplace bulletin boards. Older adults have the opportunity to make insurance decisions based on comparisons.
Clients in an inner city setting identified the lack of informational material regarding who, what, where, and when to contact in cases of various emergencies. The student advocate developed and distributed flyers and posters explaning "What To Do In Cases Of Emergency" throughout the area in an organized, understandable fashion. The aged have an opportunity to make decisions for themselves in times of emergency.
Another student assessed the fear of fire as one problem verbalized by the residents of a domiciliary facility. The student organized and conducted fire drills along with an educational program. A group of residents have assumed her role and are now organizing and conducting their own fire drills.
These project examples have directly affected individual older adults and the students have had an impact on communities.
The establishment of a "Senior Citizen Council" is one such example. The student assessed the expressed lack of a communication system in one suburban community whereby older citizens would feel informed and involved in affairs that effect them. She contacted representatives from various senior citizen clubs, day care centers, local groups, and the community at large who would come together in the form of a council to share information and solve problems for themselves. Once the project is well established, the student plans to terminate her involvement. The citizens will continue the council to meet their own needs.
Another student assessed the elderly's fear of crime as prevalent in her neighborhood. She became a consultant to the County Prosecuter 's office and an active member of the "Criminal- Witness Assistant Unit". Through speaking engagements and printed material, this student educated the community on how to prevent crime and what assistance is available to elderly victims.
Placement on a local board of mental health actively was pursued by another student. Through letter writing and insistence, she has become a member. She is in the process of placing on their agenda the needs of the frail elderly in her community. She hopes to sensitize board members to the unique needs of older adults and potentially meet the needs of citizens in her communty.
A bulletin comprised of the available community support services for the elderly was developed. The student included such services as transportation, food stores, and pharmacies. Each service was comparatively assessed for cost. This bulletin will be available at strategic points throughout the community.
Advocacy projects also have been designed to impact society. A "Senior Citizen Awareness Program" was established in a primary school. The student chose to work with fourth, fifth, and sixth graders after a search of the literature informed her that children's attitudes are still being shaped during these years. Children were given an opportunity to. share their already stereotyped views about the elderly. The nursing student arranged for older adults to come to the school and share attitudes, feelings, and facts with the elementary school's classes. Over the year, the teachers and even the principal of the school became mvolved in the awareness project. Attitudes have changed toward the elderly.
In a similar vein, a student in consortium with a community talent bank developed educational programs in county high, middle, and elementary schools. The programs, conducted by elderly members of the talent bank, centered around personal, historical Accounts of a variety of careers. The goal of the program was for the youth to view older adults as productive members of society. Among the talent represented was an elderly scientist who had worked with Thomas Edison. A member of the Grey Panthers presented "Youth and Age in Action." Response from the schools has been overwhelmingly positive.
Two students are writing columns on the topic of aging that appear monthly in county newspapers that circulate to over 50,000 residents. Topics have been covered ranging from "Types of Surgery for Cataracts" and "Sexuality and Aging" to "How to Pick a Nursing Home." Responses in the form of letters to the editor have been quite positive.
These projects have been designed to reach a wide variety of people and have the potential of influencing individual, group, and societal attitudes about the aged and aging. In addition to the obvious positive outcomes for the elderly, the gerontological nurse practitioner students, who consciously assume the role of advocate, have a changed view of themselves and their profession. Advocacy widens their perspective on the meaning of holistic care of the elderly client. Nurses are capable of promoting change in a broad variety of areas that ultimately affect the health status of the elderly. Alternates to the plan of care expand. A multiplicity of resources are viewed as approachable. Nursing itself becomes a part of the holistic plan.
The concept of advocacy is intimately linked with the nursing framework of self-care. Nurses design and implement action that enhances older adults' ability to act for themselves and to increase their own level of independence. Advocacy becomes one possible nursing approach when utilizing a theoretical framework of self-care.
Nurse advocates practice assertiveness. To be a successful advocate, the nurse skillfully asserts influence. This assertiveness potentially can be transferred into spheres of the advocate's practice.
The gerontological nurse practitioner students have learned to work within various systems. They have become organizationally astute. They have affirmed their roles within systems previously considered not within the realm of nursing.
Advocacy as a deliberate, straightforward action increases the visibility of the profession of nursing. Nurses participate with other professions, community groups, institutions other than health care service providers, and people in general. This increased visibility enhances the perception that nursing is a valued profession. It is valuable because of the positive changes it evokes. Change is visibly a result of nursing action.
Advocacy is an attitude. Nurses who assume this posture think well of themselves. They are secure in their knowledge base. They focus on goals and achieve them. They are proud of their individual ability and have an aura of self-confidence. These nurses feel good about nursing.
The time for gerontological nurses to enter the arena and provoke change is now. Educators have a responsibility to the future of the nursing profession and gerontological nursing. Behaviors must be adopted that make a difference in the lives of older adults. The role of advocate is one such behavior. The concept of advocacy can be interwoven throughout a curriculum plan. A specific advocacy project gives students the opportunity to experiment with increasingly complex systems in which they can effect change. Older adults need nurses as "members of the board." Nurses and nurse educators are a potential power source within themelves.