Kathleen C. Buckwalter
Only nursing research takes a comprehensive approach to human health and illness that addresses the needs of all ages, genders, and conditions.
-Dr. Donna Shalala, 1998
Addressing the National Institute of Nursing Research (NINR) at a September 16, 1998 reception marking its fifth anniversary, Health and Human Services Secretary Dr. Donna Shalala reaffirmed the administration's commitment to nursing research. In her speech, Dr. Shalala highlighted the NINR's contributions toward the creation of a seamless health care system and how much the Institute has added to the health care system. Her remarks were timely for geriatric nurses and are presented for our readers' use and reflection:
Over the past 5 years, we've seen just how much the research funded by the National Institute of Nursing Research has contributed to the creation of a seamless health care system - how much it has added to our health care tapestry. People should know that nursing research proved, for the very first time, that gender affects the effectiveness of pain relievers. Nursing research also developed a successful elementary school program that lowers cardiovascular risks in children. And nursing research produced a model of how to reduce high blood pressure in young, urban African American men.
The first challenge for nursing research is to help improve the quality of life for Americans as they age. Thanks to advances in medicine and public health over the past century, Americans are now blessed with the gift of longevity. Nearly 46 million Americans are [age] 60 or over, and the fastest growing segment of the population is the 100 plus age group. But a longer life is not necessarily a better life. As our population ages, we must do much more to ensure that Americans not only have more years in their lives - but more life in their years. We need nursing research to help find innovative ways for older persons to preserve cognition, the ability to function, and the overall quality of their lives.
And that brings me to my second challenge. If we want to improve the quality of American life, we must help people of ail ages to better manage chronic illness. For too long [chronic] illness has remained hidden in the shadows while medicine and research focused the spotlight on acute illness. But chronic illness is the leading cause of death and disability. It affects 100 million people. And with the eider boom, we can anticipate a steady increase. When it comes to chronic illness, we need nursing research to continue to point the way in three areas. It must show us: 1) how to help patients manage their symptoms and control their pain; 2) how to prevent complications of disease and disability; and 3) how to help family caregivers best meet their relative's needs - and their own needs - so that everyone can enjoy the best quality of life.
And that brings me to my third and final challenge - 'the challenge of quality. Patients today know that our health care system - although the best in the world - isn't "as good as it gets" for everyone. And they are demanding the highest quality care. They want to see a specialist when needed. They want to know all medical options. They want adequate recourse if denied care. And they want to hold research to the highest standards.
President Clinton has exhorted Congress to pass a "Patients' Bill of Rights" that will guarantee access, choice, privacy, and recourse for shoddy care. (This Bill was not passed by Congress before they retired for the season). Guaranteeing the rights of consumers is an important first step in ensuring the quality of our health care. But to paraphrase the poet, we still have miles to go. We must seize the opportunity to not only ensure quality - but also to improve it. And nursing research has a vital role to play. By always focusing on the patient, nursing research can shed light on how to reduce the risk of illness, to speed recovery, to ease symptoms, and to reduce hospital stays - all without sacrificing quality. And nursing research can help introduce evidence-based reforms in health care - and so guarantee that efforts to improve quality will be supported by proven science.
Meeting the challenge of quality, like the challenges of age and illness, will not be easy. But I've no doubt that nursing research can and will do it.
-Dr. Donna Shalala
These words have given us many research and clinical topics to ponder. To cite a few:
* Pain and elderly individuals.
* Quality of care and its dimensions for older people at varied stages of aging.
* Caregiving and the multiple implications for families.
* Chronic illness and disability: its prevention and management.
* Discharge planning and how to use to shortened hospital stays to a nursing advantage.
There are implications for all nurses interacting with older adults in multiple settings. I would like to add a fourth challenge and that is one of recommitment. These words of Dr. Shalala provide both a reflection and a reminder that the time is now, as we prepare to enter a new century, to reinvest our energies in caring for older adults through clinical practice, education, and research.
For additional information, contact Friends of NINR at 1111 14th Street, Suite 900, Washington, DC 20025, by phone at (202) 638-2352, or by fax at (202) 638-2590.
Virginia Burggraf, RN, C, DNS
Grants Development Coordinator
American Nurses Association
The Journal of Gerontological Nursing is grateful to Virginia Burggraf for bringing Secretary Shalala's timely remarks on meeting the challenges of quality, chronicity, and aging to the attention of our readership. As we celebrate nursing research, I echo Dr. Burggraf 's sentiment regarding recommitment and encourage gerontological nurses to reflect both on how far we have come in recent years as well as on Secretary Shalala's remark about "miles to go." Indeed, the past defines the present, and the present shapes the future.
Fifty-six years ago in that nursing classic, Cherry Ames: Student Nurse, author Helen Wells (1943) wrote:
"Your own first steps toward a nurse's skill - and toward the coveted nurse's cap," Miss Reamer said, "will be classes. But not for long" [italics added] (p. 31).
This suggests that the basis of nursing practice was training not education. Currently, science is changing at such a revolutionary pace that we must invest in new technologies, infrastructures, and people with the appropriate skills to meet the challenges of the new scientific era. As we approach the 21st century, gerontological nurses must be poised to open new frontiers of knowledge, to cross disciplinary boundaries, and to broaden their field of vision (Achenbaum, 1995). Nurses must question the scientific basis and validity of every procedure; test standards of care; investigate nursing interventions; and develop new products, innovations, and inventions. Gerontological nurse researchers must devise specific, age-associated, objective criteria for evaluating changes in outcomes, and develop sensitive measures of well-being and affective changes, as well as comprehensive and diverse methods of assessing treatments. This is because, as stated by former National Institute on Aging Director T. Franklin Williams (1988), research and care, "require each other; they interact with each other; they benefit from each other" (p. 579).
Gerontological nurses also must target their research agendas to address health care problems and issues of the highest priority to the nation and the profession, including improving the health of at-risk populations and advancing information technologies that are revolutionizing care, education, and research. Finally, I would argue that while current nurse scientists certainly need high-level and diverse methodological skills, they also need a proper mindset and attitudes toward research that include creativity, caring, and commitment. Nursing science is anything but cut-and-dried - the memorization of complex formulas and the statistical manipulation of numbers. Rather, the hallmarks of a scientist, as suggested by Albert Einstein, include
* Intellectual skepticism.
* Divine inquisitiveness.
* Constructive imagination.
* Activity and reflection.
* The ability to appreciate the humanity of technology.
So let us go forth into the new millennium carrying the banner of "managed passion" (Harris, 1998, p. 2) - whereby gerontological nurses will continue a tradition of excellence and provide the leadership to advance clinical knowledge and build nursing science that takes risks, is creative, and is sensitive to the needs of those for whom they care.
Achenbaum, W. A. (1995). Crossing frontiers: Gerontology emerges as a science. Cambridge, England: Cambridge University Press.
Harris, D.L. (1998). We need to open doors to women leaders [Editorial]. Academic Physician & Scientist. Association of American Medical Colleges, January/February, 2-3.
Wells, H. (1943). Cherry Ames: Student nurse. New York: Grosset & Dunlap.
Williams, T.F. (1988). Research and care: Essential partners in aging. The Gerontologist, 28(5), 579-585.
Kathleen C Buckwaker, PhD, RN,
University of Iowa
Iowa City, Iowa