it We're not elderly, we're seniors" was the greeting we received one morning as we entered the Senior Center. It was shortly before the opening of the modular unit that now houses our nurse-managed center known as the Wellness Center.* The woman greeting us pointed to the invitation for the grand opening, posted on the bulletin board. Unable to find a response, we listened while she regaled us with her feelings about the word elderly in the title of the federal contract that funded the Wellness Center for three years.
The nursing Wellness Center had begun several years previously in response to a request from the cornmunity in which a large public university is located. From its inception, the emphasis of the center has been to help clients stay well, cope with the developmental tasks of older adulthood, and learn to live with the chronic conditions that are often a part of growing older. At first, the center was open on a part-time basis, staffed by volunteer faculty and students from the school of nursing. The Wellness Center has always been housed in or near the Senior Center which began in a grammar school, then moved to a fire hall, and finally into a permanent home in a new building adjacent to two senior housing complexes. An early client of the Wellness Center was at one time mayor of the town; certainly his support helped our image in the community considerably! TTie ideas for the Wellness Center and its germination and development have always come from the community. Our clients tell us what they want, how they like what we do, and what they don't like. An advisory committee of seniors was formed during the early years of the center to shape the direction of the programs and services. The individuals on this committee have always been candid and forthright with their opinions and advice, supportive and sympathetic as we struggled with problems ranging from funding to the escalating electric bill, and decisive about who should cut the ribbon at the grand opening and what kind of refreshments to serve. They are quick to give us their undivided support before the zoning board and just as quick to let us know when we have erred.
When we were awarded the federal contract under the Division of Nursing of the US Public Health Service to establish our nursing center as a demonstration project for an intradisciplìnary nursing team, our charge was to design, implement, and evaluate the nursing center. The project title reflected that charge: "Intradisciplìnary Nursing Practice in a Wellness Center for the Elderly." The 37-month contract enabled us to rent a modular unit to house the Wellness Center, as well as to support a staff of two full-time nurse practitioners, a part-time nurse researcher, a part-time project director, and a secretary-receptionist.
After the modular unit was opened with the grand ribbon-cutting ceremony, we decided that a critical facet of the project was to ask our clients for their perceptions of what the nurse practitioners could do for them. In designing client record forms, therefore, we included a query about the reasons for visits to the nursing center and expectations about services.
We also sent out an evaluation form to a random sample of clients at the beginning, midpoint, and toward the end of the project. Hie responses from clients reflect their varied perceptions of expectations of the role of nurse practitioners, and of the services provided.
Most of the clients who utilize the services of the nursing Wellness Center have their own physicians. Thus, they see nurse practitioners as offering something unique, different, and/or desirable. Expectations include: "wide advice and positive reinforcement and medical guidance," "a checkup now and then, " "advice and encouragement on losing weight," "competent advice about maintaining physical and mental health," "tell me directions I should go nealthwise."
Evaluations reflect satisfaction with services and astute perceptions of what nurse practitioners offer in wellness care. Clients perceive the nurse practitioners to be caring and concerned about them: "sometimes to talk to someone who is concerned about you as an individual"; "to help me stay healthy, give me peace of mind"; "make me feel happy and secure"; "keep me happy and active."
Over and over, our clients state that the nurse practitioner is able to help by listening, giving advice, offering information, making concrete suggestions for self care such as diet and exercise, acting as a liaison with other healthcare providers, doing health assessments, and by instilling confidence and answering questions.
Adjectives used to describe the nurse practitioner are invariably positive: "friendly, concerned, helpful, pleasant, courteous, capable, kind, intelligent, thoughtful, open, and thorough." One person characterized the nurse practitioner as "more than a GP or specialist MD." The comments of two clients seem to sum up how seniors feel about coming to the Wellness Center: "I felt very good and very happy" and "my expectations were met in every way."
Since the completion of the federal contract, this nurse-managed center continues to provide services to the community. The center is staffed with one full-time nurse practitioner, whose salary is supported by the university. This person also holds a tenured faculty appointment and is responsible for classroom teaching, as well as clinical teaching at the Wellness Center. Seven or eight students each semester are involved with providing care during individual client visits, and participating in group teaching and screening sessions.
Faculty sometimes participate with their students in organizing and conducting screening sessions such as a foot-care clinic or a group- teach ing session on a topic like Alzheimer's disease. Enough money is generated through donations, voluntary fees-forservice, fund-raising events sponsored by seniors, and third party reimbursement to support a half-time nurse practitioner during the summer months when the university is not in session and to provide the supplies needed for operation of the center.
The town purchased the modular unit and provides utilities and maintenance. Through a special federal program for seniors, a member of the community acts as part-time secretary and receptionist. Volunteers from the senior community assist with clerical responsibilities and act as receptionists when the paid individual is not present. Adjusting to one full-time nurse practitioner instead of two has meant careful planning for wise use of that person's time. The number of students at the center has increased, helping to offset the loss of one practitioner. The 37 months of the contract provided time to create forms for client records. develop protocols for care, pilot health screening and group education sessions, and establish manageable ways to integrate research, administration of the center, education of students, and provision of care to clients.
Over the more than three years since the completion of the federal contract, the caseload for the center has continued to increase. From an average of 60 visits a month during the contract, the number of visits has grown first to 70 and, in the fall of 1987, to over 100 a month. Even with the increased student participation in caring for clients, the caseload cannot grow any larger with the present nursing resources. Over the next several months, the full-time nurse practitioner, who is also the director for the center, will be exploring the need for expansion with the town and the university.
In 1988, the Wellness Center celebrates its 1 lth year of serving the town's elders. Our clients continue to provide more than enough reward for the effort that has gone into maintaining the Wellness Center. Perhaps one of the most rewarding aspects of working with older adults is their frankness. The honest and candid reactions of our clients to services and programs are a testimony to their support for the center. A recent example of their perseverance and power within the community was a victory at the polls, after almost a decade of lobbying, for financing of a sidewalk from the Senior Center, Wellness Center, and senior housing complexes to the commercial area of the town. The clients of our Wellness Center are truly examples of all that is good about becoming a senior!