The following question was asked of the readers of the Journal of Gerontological Nursing:
As professional nurses, the relationships we have with our clients are giving ones. But we also receive gifts. What nonmaterial gifts have you received as a gerontological nurse?
Mary (not her real name) wheels herself around in the wheelchair all day, rarely having interactions with other residents or staff except when she runs into them. She has severe hearing loss and this discourages others from attempting verbal exchange with her. When we attempt to have her participate in activities, she usually wheels herself out of the activity area. In fact, she has a sad expression on her face most of the time. At Christmastime, I was coordinating a student group caroling in Mary's day room. I had wheeled Mary in with others to see and hear the group. As I was scanning the residents present I saw Mary smiling, keeping time to the music with her feet and her lips were saying the words of the familiar songs. I burst into tears of joy to see Mary in this rare state. I still crywhen I think about it. I explained to the students what a Christmas miracle they had created that night.
Alma Anne Miles, PhD, RNCS
St Luke's School of Nursing
Some of my greatest satisfaction comes from supporting family members in crisis over placement issues of their elders. Assisting with care decisions and supporting them in those decisions takes effort and patience. When they are happy and feel safe in their decision, and the elder resident is happy and wellcared for, then I know we have done a good job. Satisfaction of all persons involved is my benchmark.
Jeanne Doll-Seiko, BSN, RNC
Director of Nursing Service
Bonell Good Samaritan Center
I am the Director of five Adult Day Programs located in the Bronx, Manhattan, and Yonkers. I am continually amazed at the courage, strength, and conviction of those family caregivers who strive to keep their family members at home despite Alzheimer's disease or severe physical illness. It could be easy to give up and let another take over the 24-hour care of their loved one. However despite their own personal struggles and losses, these caregivers persevere "one day at a time."
These family caregivers are my role models for today and the future. I will most likely care for my parents as they age and face the likelihood of being diagnosed with dementia or physical illness in their later years. The caregivers in the adult day programs have shown me the strength to care for a relative who may not know you anymore; the patience to answer the same question over and over; the compassion to care for the person who is not the person who once was; and the love to do this daily and without anger. These are timeless lessons today and for tomorrow.
Ann Marie Levine
Director, ElderServe Adult Day Service
Hebrew Home for the Aged at Riverdale
Riverdale, New York
The greatest gift I have received as a gerontological nurse is being able to have my own homebased business. This, in turn, has allowed me flexibility in parent time, the ability to earn a six-figure income (if I can dare admit a good salary as a nurse) and doing work I truly love!
For the past 6 years, I have operated an assisted living home. I have four elderly residents that live with myself and two sons. The residents have rooms on the upper level, and we have rooms in the basement. Although the house is not large, its design allows for privacy for my family and for my providing the needed care the residents require. Assisted living is definitely an emerging industry with more and more homes opening. I have two staff (certified nursing assistants) that work for me, to come and go as needed.
The best part is that the residents get wonderful care. They sleep in and get breakfast when they wake up. They get frequent snacks and foods they will eat, plenty of fluids, and lots of attention. Most of the residents are in the mid to acute stages of Alzheimer's disease. One of the things most enjoyed as expressed by the residents is bath time. We make this a special time with a bubble bath, curling hair (for the ladies, which they love), lotion massages, and back rubs. We do activities, go for walks, listen to music, and bake a lot of cakes (again, something the residents love to do).
Giving good care is something so basic and simple that it puzzles and saddens me to realize how it becomes so complicated in the longterm care industry. In fact, your question regarding strategies used by state and federal governments to promote quality in American nursing homes is a sad reflection on the industry (Your Turn Question published in the January 1999 issue [Vol. 25, No. 1] of the Journal of Gerontological Nursing). Why haven't nursing homes been more proactive in initiating methods to promote quality care?
I do not know about other parts of the country, but in Colorado, many assisted living homes (like mine), which serve 4 to 15 residents, have opened in the past 2 years. This has resulted in more competition in the long-term care industry. Residents enter assisted living facilities, and now there is a trend for "aging in place" which brings in additional services to support additional care needs residents may have as they decline with age. While there are some problems that arise with assisted living, the one thing it has brought to long-term care is competition. In my area, many nursing homes are becoming concerned with increasing numbers of empty beds.
I am in the process of having a larger home built that will serve 15 to 20 residents. As a gerontological nurse, there is no better gift than being able to create an environment that gives good care at the residents' pace.
Lois Huffman, RN, BA
My gifts are plentiful and boundless from my patients. There are the gifts of hope, time, courage, and acceptance.
As a gerontological nurse on a very busy rehabilitation unit at the Johns Hopkins Geriatric Center for the past 6 years, I use these gifts every day - not only at work, but in my personal life with my husband Tony and family. Through the eyes of my patients, I have visited their past, present, and future. This is the gift of hope.
Through the smiles of a patient with Alzheimer's disease masked with tears and ongoing forgetfulness, I learn to appreciate each day more realizing one never knows what lies ahead. This is the gift of time.
I may cut a piece of food and help someone eat or simply listen to them. This is the gift of courage.
Many patients have suffered multiple losses in their lives, including losing a limb or losing their independence. This is the gift of acceptance.
Hope, time, courage, and acceptance are the gifts I have received from my patients. Although I face challenges every day - and some are not always pleasant - somehow I reach out to my precious gifts and, surprisingly, I get by.
Deborah A. Luciano, RNC, BSN
Johns Hopkins Geriatric Center - Tenace
I have worked with the elderly for more than 30 years, beginning back when there were no certifications for caregivers, no formal care plans, and very little individualizing of care routine or diet. Still, there was very much individualization of the relationships. At that time there was no strict separation of duties either. I gave medications, did baths, made beds, did laundry, cleaned rooms, scrubbed floors, and did curtains and windows at times if that was needed.
Often I could talk with residents while doing these tasks, and they made very special friends. I learned these now frail and dependent people had once led successful, exciting, and stressful lives and, for the most part, survived with a smile for me. Over the years, the care tasks have changed as technology and paper requirements crept in, but the value of the relationships and the learning has only deepened with almost every elderly person I have cared for.
Over the years, I have met many successful business men or businessmen's wives who had traveled the world at a time when that was not the relatively easy task it is today. I have heard great stories and wisdom from a gold rush saloon girl/model, one of the first woman long-distance truck drivers, home-front war heroes, and those who lived without electricity and water most of their lives and depended on animals for transportation and food.
For the most part, the energy and care and patience I give to them is greatly given back to me in genuine appreciation and thankfulness, in humor and smiles in uncomfortable or unpleasant situations, in patience to adjust to my work, and in constantly somehow making me feel I have made a positive difference in their lives - if even for one moment.
Eunice Officer. RN
There is one thing I receive from many of the residents that, even after many years, still touches my heart like nothing else. As I walk on the units each day to look in on the residents, there are some with severe cognitive loss who cannot verbalize their needs. When I approach them, their faces light up, and they give me their best smiles. We have "communication from the heart." They could not give me anything more precious than how I feel at that moment. Sometimes they try to verbalize what they want to say, and although the words do not say anything, their expression says it all.
Gerry Hull, RN, C
Director of Nursing Services
Renaissance Manor of Westfield
I have been a nurse for 30 years. Most of my experience is in obstetrics and nursing education. I recently have assumed the role of staff development coordinator at a nursing home. Many people questioned my decision. Working within the delivery room provides such joy. Being part of the most important part of a family's experience - the birth of their child. How could I give that up to go to a depressing and sad facility? Well, listen up all my nursing friends: I have joy everyday, and all I do to get it is show up. At least once a day a resident tells me how beautiful I am, what a pretty dress I am wearing, or thanks me for remembering their name. A simple hello, a warm touch, or even a joke or a quick tease brings such happiness to a sometimes long and lonely day. I am the winner. I have given and received such joy. I have learned once again from my residents about the simple things of life and how important they are - and best of all they are iree.
Judith lngrasin, MS, RN
Staff Development Coordinator
Schrurmacher Nursing Home
White Plains, New York
The gifts I have received as a gerontological nurse are too numerous to recall. Examples include the feeling of joy and satisfaction when a client tells me, "You are a real nurse" or the good feeling I receive when I discover a covert reason for a client's pain and discomfort and know that my intervention promoted their well-being. Sometimes it is the look in their eyes, a smile, a hug, a pat on my hand as a sign of their appreciation. These gifts are priceless - they are the paycheck that feeds my heart and soul.
Denise Lloyd, RN
Bennington Health and Rehabilitation
The greatest gifts I have received from residents in the nursing home where I work are general "lessons for living." It is obvious that one's social or financial status are of little importance, but what is of value is a sense of wholeness within. Another lesson comes from watching a mildly confused 89-year-old woman confined to a wheelchair as she delights in trying and learning to do a new game or activity.
The importance of a sense of spontaneity and fun was made clear one day when a resident noticed a staff member reaching up high for something and the resident said, "Oh I just feel like I should tickle her." That same woman was very caring also, and made a point to remember all the other residents with a birthday card and would frequently sing "Happy Birthday" to them in the dining room.
To me, these are just some of the glimpses into what is really important in life. These things, to me, are gifts.
Myrna Mettler, RNC
Hillsboro Medical Center-Nursing Home
I gain satisfaction when nursing interventions not only improve a patient's physical and cognitive condition but also improve the patient's quality of Ufe through education, * assistance in positive life practices, and coping with end-of-life issues and decisions. Nursing is not only a profession, it is a way of life. Making a difference no matter what the situation is a gift in disguise. Help, educate, and encourage those around you daily, young and old alike.
Sharon Anderson, RN, BS, MSN
James H. Quillen VAMC
Johnson City, Tennessee
A hug and being told Jesus loves me are gifts.
Kathleen Decker, MS, RNCS
Assistant Director Geriatric Training
Center for Family Medicine
Sioux Falls, South Dakota
Working for a state agency, the staff is not allowed to take gifts from residents. However, family members often bring a box of candy for all the staff or send flowers that are placed at the nurses stations for everyone to enjoy.
Beatrice (Sue) Getz, RN
Colorado State Veteran's Center
Nonmaterial gifts I have received:
* Respect for elderly people and respect for all life.
* A vast list of past life histories and stories.
* Laughter - lots of laughter.
* New perspective on death and dying.
* Importance of touch and personai contact.
* Ability to "just listen."
* The art of visiting just to visit.
* Ability to "let go and let God" when the time comes.
* Deeper faith in my religion.
James Hohn, RN
Health Care Facility Surveyor
Department of Public Health
State of Montana
Jefferson City, Montana
As a gerontological nurse, I have seen smiles on the residents' faces when they see me in the morning. They discuss their feelings and concerns with me in a timely manner. They show an interest in my health. When I stay late at work, residents will call me and ask me to go home to my children.
Titilayo Unegbu, RN, BSN
Carroll Manor Nursing Home
Nonmaterial gifts - Read on and you will understand:
* "I'm glad you were on duty when Mom passed away"
* "Thanks for feeding Dad, I don't worry as much about his eating."
* "You really helped my husband. Thank you so much."
* "Thanks for calling my aunt, I feel better now."
* "Thanks for listening, I needed to talk to someone."
* A thank you card from a family to the staff for a job well done.
* A thank you, in the local newspaper, from a bereaved family.
* Simple appreciative remarks from family and friends
* Monetary gain: $0.00 - but worth millions.
* Personal satisfaction - the sky is the limit - immeasurable. After all, isn't that what it is all about?
Mrs. X was a recent open heart surgical resident who was content to stay in bed and do the least possible. She'd say, "I can't, I'm sick." Her doctor said that the resident needed to be "pushed," and I did. Evening after evening, Mrs. X and I would have our "go rounds," which included feisty remarks to me, along with strong expletives. With firm cueing and encouragement from me, we both persisted. At times, I am sure we both wanted to give up. I commented to her, "I would like to go home with you and be your nurse." Her reply, "By darn, I would never hire you." Yes, Mrs. X did go home and under her own power.
My greatest nonmaterial gift came to me 6 weeks later. Mrs. X and her niece came to search me out at the facility to thank me for helping her so much. Mrs. X added another great gift when she said, with tears in her eyes, "It's because of you that I'm on my own at home. God bless you."
Mrs. X has since passed away, but my greatest gifts remain in my mind today.
Rose Maldet RNC
Good Samaritan Nursing Care Center
This question was submitted by Christine Kovach, PhD, RN, Associate Professor, Marquette University College of Nursing, Milwaukee, Wisconsin. Her commentary follows:
The responses to this month's question are a testament to the rewards of a career in gerontological nursing. Guidance counselors and nursing professors should share this column with people contemplating a career in nursing. As friends of mine in other professions each reach middle age and begin to question the meaningfulness of their work, I am thankful that I am not confronted with similar disquieting thoughts.
Our patients, by virtue of their experience, illness, and closeness to death, provide us with a window through which to view qualities of a rich life. I have learned from my patients:
* Humor is a great gift.
* Courage has many faces.
* We are all connected by the frailty and resilience of the human condition.
* To live more often in the present.
* The largeness and smallness of myself.
* Family, compassion, and presence are great medicine.
* Dying is generally not too scary or unpleasant.
* There is no great epiphany at the end of life.
I am constantly amazed at the resilience of the human spirit amidst so much physical pathology. While feeding a man with severe dysphagia and other neuromuscular abnormalities for the first time, I was taken aback by the scope of his limitations. I was focusing so stringently on the sequence of his swallowing that I initially missed his need to have this meal be a time of camaraderie, joking, and irreverence. Once he showed me the scope of who he was, we shared a pleasurable and memorable time.
As our readers point out, working with older adults with chronic and serious illness is a very lifeaffirming endeavor. We don't need to look to sports personalities for our heroes. We daily witness courage, humor, tenacity, and grace. We learn that our degrees, promotions, and material possessions are ultimately unimportant. The older adults we work with give us an array of life maps that we can use to guide our own journey.