Geropsychiatric Nursing. Hogstel MO (eoi St. Louis, Mo, CV Mosby Co, 1990, 380 pages, $22.95, softcover.
Geropsychiatric nursing is beginning to be recognized as a specialty area in nursing. No longer are the mental problems of older adults attributed to old age and left untreated. Whether at home, in a nursing home, or in an acute setting, the older adult experiencing mental illness or emotional problems requires nursing care that demands an extensive knowledge base. This book does a good job of covering that knowledge in a readable, practical manner. The authors are recognized experts in the field, and the book has been edited in such a way as to avoid overlapping content.
The book begins with a chapter by Mary Harper, of the National Institute of Mental Health, that deals with the scope of the problem, statistics, and research needs. The statistics are impressive. Harper quotes estimates that 18% to 25% of older adults have significant mental health symptomatology that increases with age, and nearly 66% of nursing home residents have some type of behavioral problem. Suicide is listed as a major challenge, with 6,000 to 10,000 suicides per year in the over-60 population, with the rate being higher than for any other age group. These numbers take on added significance when it is realized that suicide is probably an underreported cause of death, meaning that the numbers are probably much higher.
Harper discusses the major mental health problems of older persons and makes the important point that the admission to a hospital or moving into a nursing home often brings these problems to the forefront. Special populations discussed by Harper include the homeless, minorities, mentally retarded, rural elderly, and those with AIDS.
This first chapter also discusses the ethical, moral, and legal aspects of geropsychiatric nursing, including the issues of patient rights, physical restraints, life- sustaining technology, abuse, and quality of life. Chemical restraints are notdiscussed, but Chapter 5 is dedicated to the topic of psychotropic drugs. All the major psychotropic classifications are discussed in a readable, meaningful way.
Other chapters cover topics such as assessment, depression, organic mental disorders, schizophrenia, paranoid disorders, anxiety disorders, somataform disorders, and substance abuse. There are also chapters devoted to mental illness in the nursing home, care of the mentally ill in the home, and community programs.
Each chapter has an extensive bibliography, and most have one or more case studies and care plans. The American Nurse's Association Standards of Practice for gerontological and psychiatric and mental health nursing are included in the chapter on assessment. Tables effectively summarize information and add to the readability of the text. Included in the index are several assessment instruments, a listing of psychiatric diagnoses often found in older adults, NANDA-approved nursing diagnoses, a classification of human responses of concern for psychiatric mental health nursing practice, and lists of resources and journals.
This book is a welcome addition to the growing body of publications aimed toward those working with the mentally impaired older adult. Geropsychiatric nursing is challenging. Hogstel says, "geropsychiatric nurses are unique because they need special preparation and expertise in several areas of nursing: gerontological nursing, psychiatric and mental health nursing, medical and surgical nursing, and community health nursing. General knowledge and skills in all these areas are important in assessing the problems and meeting the needs of geropsychiatric clients."