Journal of Gerontological Nursing

Guest Editorial 

What If We Could Start Over?

Debra L Schutte, PhD, RN

Abstract

In a recent series of articles in The Journal of Nursing Administration, Rovin and Formella (2004) implore the nursing profession to embark upon a process of idealized redesign to create a fundamentally new system of nursing practice that can truly impact health. The process of idealized redesign involves setting aside the existing system and any perceived constraints to changing the system, thus freeing the imagination to start fresh.

Although Rovin and Formella (2004) propose this approach as a means to address the qualitative problems within the nursing profession as a whole, what if this approach was taken to address the fundamental and qualitative problems in the current system of elder care? Certainly innovations in care for older adults exist. Concepts such as aging in place, naturalistic environmental modifications in long-term care facilities, the emergence of assisted living facilities, care management models, and dementia-specific elder care are all attempts to improve the delivery of care and quality of life for the growing population of elderly adults. Nonetheless, policy and funding constraints, persistent medical models of care, institutional environments, and insufficient numbers of professional nurses to lead the planning, implementation, and evaluation of care plague the current system of care and prevent widespread diffusion of these innovations. What if we, as gerontological nurses, could start over?

The approach recommended by Formella and Rovin (2004a, 2004b), applied to gerontological nursing and elder care, might look something like this:

* Gerontological nurses convene small working groups. These groups could be within a setting (e.g., long-term care facility, academic setting) or across settings. Working groups might begin with only nurses, but will eventually need to invite participation of key stakeholders including consumers.

* The working group considers this scenario: "The current system of elder care, as we know it, was destroyed last night. It no longer exists" (Formella & Rovin, 2004b).

* The working group then answers three questions: "If you were to build health care for elderly adults from scratch, what would it look like? What would it do? How would it function?" (Formella & Rovin, 2004b).

* A system for sharing, reflecting upon, and refining these new visions for elder care, generated by the working groups, would be developed, perhaps by a gerontological nursing organization or academic institution.

* Only when a preferred vision of elder care is articulated would a process for identifying and addressing constraints begin. Strategies for planning, implementing, and evaluating systems-level changes would be developed. A preferred system of care would emerge.

On one hand, the process of idealized redesign seems cumbersome and the product unrealistic. On the other hand, the same can be said of the status quo. In fact, the elder care status quo is no longer tolerable. What type of system would provide the care our parents and grandparents need? What type of system would provide the care the next generation of older adults will need? What type of system would provide a safe, fulfilling, and stimulating environment for professional gerontological nursing practice? Gerontological nurses can lead the effort to redesign a preferred future for elder care. What if we, as gerontological nurses, could start over?…

In a recent series of articles in The Journal of Nursing Administration, Rovin and Formella (2004) implore the nursing profession to embark upon a process of idealized redesign to create a fundamentally new system of nursing practice that can truly impact health. The process of idealized redesign involves setting aside the existing system and any perceived constraints to changing the system, thus freeing the imagination to start fresh.

Although Rovin and Formella (2004) propose this approach as a means to address the qualitative problems within the nursing profession as a whole, what if this approach was taken to address the fundamental and qualitative problems in the current system of elder care? Certainly innovations in care for older adults exist. Concepts such as aging in place, naturalistic environmental modifications in long-term care facilities, the emergence of assisted living facilities, care management models, and dementia-specific elder care are all attempts to improve the delivery of care and quality of life for the growing population of elderly adults. Nonetheless, policy and funding constraints, persistent medical models of care, institutional environments, and insufficient numbers of professional nurses to lead the planning, implementation, and evaluation of care plague the current system of care and prevent widespread diffusion of these innovations. What if we, as gerontological nurses, could start over?

The approach recommended by Formella and Rovin (2004a, 2004b), applied to gerontological nursing and elder care, might look something like this:

* Gerontological nurses convene small working groups. These groups could be within a setting (e.g., long-term care facility, academic setting) or across settings. Working groups might begin with only nurses, but will eventually need to invite participation of key stakeholders including consumers.

* The working group considers this scenario: "The current system of elder care, as we know it, was destroyed last night. It no longer exists" (Formella & Rovin, 2004b).

* The working group then answers three questions: "If you were to build health care for elderly adults from scratch, what would it look like? What would it do? How would it function?" (Formella & Rovin, 2004b).

* A system for sharing, reflecting upon, and refining these new visions for elder care, generated by the working groups, would be developed, perhaps by a gerontological nursing organization or academic institution.

* Only when a preferred vision of elder care is articulated would a process for identifying and addressing constraints begin. Strategies for planning, implementing, and evaluating systems-level changes would be developed. A preferred system of care would emerge.

On one hand, the process of idealized redesign seems cumbersome and the product unrealistic. On the other hand, the same can be said of the status quo. In fact, the elder care status quo is no longer tolerable. What type of system would provide the care our parents and grandparents need? What type of system would provide the care the next generation of older adults will need? What type of system would provide a safe, fulfilling, and stimulating environment for professional gerontological nursing practice? Gerontological nurses can lead the effort to redesign a preferred future for elder care. What if we, as gerontological nurses, could start over?

REFERENCES

  • Formella, N., & Rovin, S. (2004a). Creating a desirable future for nursing, part 2: The issues. Journal of Nursing Administration, 34(6), 264-267.
  • Formella, N., & Rovin, S. (2004b). Creating a desirable future for nursing, part 3: Moving forward. Journal of Nursing Administration, 34(7/8), 313-317.
  • Rovin, S., & Formella, N. (2004). Creating a desirable future for nursing, part 1: The nursing shortage is a lack of creative and systemic thinking. Jou mal of Nursing and Administration, 34(4), 163-166.

10.3928/0098-9134-20041101-05

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