The most pressing and challenging imperative facing society as we prepare for the next century is the need for a shift in the traditional view of aging. The health care system must move beyond the limited view offered by the medical model, which focuses on illness and disease, to incorporate the expectation of wellness, even in the presence of chronic illness and substantive impairment. Emphasis must be placed on more natural treatments, such as environmental manipulation, nutritional interventions, and activity - with reduced reliance on pharmaceuticals. For the good of society, all human beings must be valued, with special attention to at-risk and underserved groups including women, minorities, the homeless, children, and the elderly.
This editorial captures the visions of nine leaders in nursing and gerontology who were asked by the Southern Council on Collegiate Education for Nursing to chart their vision for the direction of gerontological nursing education in the next century. Specifically, nine of the authors were convened as an expert panel and asked to engage in dialogue about the challenges facing those charged with the education of gerontological health care professionals for the coming century, with particular attention to curriculum issues and the generation of a research agenda. The 4-hour dialogue that ensued was recorded on audiotape and flip charts by staff members of the Southern Regional Education Board (SREB), and later analyzed by Dr. Sarah Hall Gueldner, who served as chair of the group, to provide the content for this discussion. Specific comments about curriculum topics and research concerns were extracted from the transcript and categorized to generate the lists presented in Tables 1 and 2. Background statistical data related to gerontological education were provided by the report of the 1992 White House Conference on Aging Planning Cornmittee, prepared by Dr. Celeste A. Dye, who joined the group as a co-author. A summary of the futuristic thinking that emerged from that dialogue follows.
The implications of this proposed new world view are vast. Less emphasis will be placed on illness and disease, with more energy directed toward achieving maximum health and independence for persons of all ages. Our elderly must stay healthy and live independently longer. Above all else, emphasis must be placed on quality of life, to the end; thus, health promotion must be incorporated as a critical feature of longterm care. People, rather than the health care system, will retain ownership of their own health and assume responsibility for promoting good health. Lifestyle counseling will become a major thrust of health care practice.
The proposed new world view of aging will recognize and value the attributes of age, for example, wisdom as a legacy that comes only from longevity. Likewise, gerontology must be viewed not as a separate entity, but as a natural culmination of human development over a lifetime. Health promotion and autonomy will have greater societal relevance for all ages.
This philosophical stance will provide the opportunity to redefine nursing practice. Collégial relationships must be nurtured, with health care workers from all disciplines coming together to design health care. We acknowledge a clear imperative for increasing gerontological content at all levels of nursing education. Nursing has responsibility for providing services to the elderly in a wide range of settings, including hospitals, long-term care institutions, ambulatory care and home care programs.
The report of the White House Conference on Aging Planning Committee (Dye, 1992) revealed that the number of gerontological nurses having formal academic credit for gerontology courses still falls far short of the documented need. Of the nation's 1,400 basic nursing education programs, only 14% percent have specific required courses in gerontological nursing, and only 4% offer gerontological électives. Of 247 graduate programs, only 64 offer advanced preparation in gerontological nursing. Most of the graduate programs offering a specialty in gerontological nursing are new, and have been developed through federal grants.
Curriculum Topics to Meet future Demands
Since graduate study in gerontological nursing has only recently been available, the need for qualified faculty to instruct and supervise students in gerontological programs remains a major priority. Davis (1991) lamented, "... until a change is seen in job opportunities and appropriate compensation for master's prepared gerontological nurses, the numbers recruited into the field will remain small." (p. 36).
The report of the Planning Committee for the White House Conference on Aging Dye, 1992) revealed that an alarming 40% of the nursing faculty now teaching in graduate level gerontological nursing programs have had no formal gerontological preparation. Three-fourths (77%) of all clinical preceptors and instructors in all programs in nursing have no formal preparation in working with the elderly. The impact of these deficiencies within the educational system is sobering in view of the rapidly increasing need for health care to meet the unique needs of gerontological populations. Long-term care facilities experience more acute RN shortages than any other segment of the health care industry; nearly one in five nursing positions in longterm care settings was unfilled in 1990. Moreover, it is estimated that for every person in a nursing home, there are two to three older people living in the community who require equal levels of personal care. In fact, 90% of the case load of home health care agencies is for people 65 years and over (Dye, 1992).
The greatest challenge confronting those charged with the education of gerontological health care professionals of all disciplines is recruitment of both students and faculty. We suggest the initiation of cost-effective measures, such as the relaxation of out-of-state tuition, to facilitate the matriculation of students into existing programs. This strategy would also help to overcome the documented shortage of formally prepared faculty. We also recommend consideration of strategies to increase flexibility within the curricula. Particular attention must be directed to the need for creative clinical teaching that generates positive feelings toward eîders, increases community awareness of the needs of older adults, and builds demand for practitioners. Increased use of instructional technology will allow educators to reach potential students in remote or outlying geographical areas.
We recognize that gerontological programs must be driven by society's needs, and that this awareness must be reflected within both the curriculum design and content areas. The curriculum should be organized around major concepts relevant to the needs of elders. An emerging area of need is for graduate level nurses to have a strong administrative background with specific content related to fiscal responsibilities. Content related to formulation of social policy and the conduct of gerontological research are also important.
Realizing that the necessary formal programs of gerontological education cannot be put into place quickly, we endorse intensive continuing education programs as an important stop gap measure and have identified in Table 1 topics that warrant consideration in future educational programs.
Advancing the knowledge base for practice of gerontological nursing is a major imperative if the rapidly increasing aging society is to have adequate health care. An alarming barrier is the serious shortage of doctorally prepared gerontological nurses with the ability to design and conduct scientific inquiry. Kayser-Jones (1986) and Dye (1983) both addressed this pressing need as a problem of the last decade, noting that a critical mass of research scientists is necessary for the development of strong gerontological nursing research programs. As poignantly expressed by Thelma Wells (1979), "Nursing education and practice rest upon research; gerontological nursing will be encumbered until doctoral preparation in the field is given priority." Priority research concerns for the next century are delineated in Table 2.
The preceding comments provide direction for nurse clinicians, nurse educators, and nurse scientists as we position our profession to meet the demands of the next century. Too long unattended, the nursing profession must now address, and quickly, gerontological nursing's place in the future of health care. In view of the projections of dramatically increasing elders in the next century, gerontological nursing will hold a critical position in the health of the nation and the world. It is essential that we prepare for that role. Accordingly, nurses must become more involved in the development of innovative approaches to health care delivery and obtain greater visibility as a client advocate. We must sit among society's rulemakers, shaping health care policy through legislation and policy development that addresses the needs of elders.
- Davis, D.C. (1991). Including gerontological nursing in graduate nursing curriculum. Journal of Gerontological Nursing, 17, 28-36.
- Dye, C-A. (1983). Research in gerontology and implications of nursing education. In The Aging Society: PSA Challenge for Nursing Education. Atlanta: Southern Council on Collegiate Education for Nursing.
- Dye, C.A. (1992). Education and Training. Report of the White House Conference on Aging Planning Committee.
- Kayser-Jones, J. (1986). Doctoral preparation for gerontological nurses. Journal of Gerontological Nursing, 12, 19-23.
- Wells, TJ. (1979). Nursing committed to the elderly. In Reinhardt, A., & Quiim, M. (Eds.), Current Practice in Gerontolagical Nursing. St. Louis: C.V. Mosby Co.
Curriculum Topics to Meet future Demands