During last summer's American Nurses Association (ANA) convention, I had the good fortune of hearing Mathy Mezey, Director of the Hartford Institute for Geriatric Nursing at New York University, talk about the recent work conducted ^n «tUXJUl UIC ICVClU WUIÄ CUI behalf of older adults, the most precare in dominant recipients of nursing care ? America. As a gerontology advocate myself, I was pleased to hear her remind the authence that older adults constitute half of all days of care in hospitals, 46% of intensive care unit patients, 80% of home care, and 90% of nursing home residents. She also reminded us that older adults make up 63% of cancer patients, 60% of visits to cardiologists, 53% of visits to urologists, and 52% of visits to ophthalmologists. Despite all this, only 1 % of nurses are certified in gerontology.
ENCOURAGING HEIGHTENED SENSITIVITY AND COMPETENCY
We must accept reality: Many nurses are not interested in being specialists in gerontology. Instead of trying to convince non-gero nurses to come over to "our side," it seems more do-able to go over to "their side," that is, to encourage, not necessarily in-depth specialty geriatric training, but rather, heightened sensitivities and competencies in its basic and practical concepts. Armed with knowledge of what is normal and what is abnormal, these non-gero nurses would then know when to bring in their geriatric colleague nursing experts to help them understand and develop a meaningful care plan.
Until a recent specialty practice meeting hosted by the Nurse Competence in Aging, a formal and credible group of varied specialty associations had never been brought together to specifically discuss "burning issues." Nurse Competence in Aging (www.geronurseonline.com) is a 5-year initiative funded by the Atlantic Philanthropy (USA), Inc., awarded to the ANA representing a strategic alliance between ANA, American Nurses Credentialing Center, and the John A. Hartford Foundation Institute of Geriatric Nursing, New York University. What was revealing was that a common thread exists - all nurses come in contact with older adults in their daily practice.
LEADERS IN GERONTOLOGICAL NURSING COMPETENCY
More attention is being paid to geriatric nursing, and more organizations are providing leadership in this area. Nursing: Scope and Standards of Practice was recendy revised to include providing age- appropriate and culturally sensitive care to include care of older adults (ANA, 2003). Scope and Standards of Gerontological Nursing Practice (Congdon, 2001) can be incorporated as necessary into the scope and standards for specialty organizations caring for older adults, and integrated into nursing curriculum content. For example, the Texas Board of Nurse Examiners requires undergraduate competencies for all schools of nursing to address care of the older adult And, regulatory bodies (e.g., Joint Commission on Accreditation of Healthcare Organizations), some legislators (Texas Nurses Association works closely with key legislators), and lawyers are using these standards.
Geriatric nursing protocols are available to busy nurses. A second edition of Geriatric Nursing Protocohfor Best Practice was released in 2003 (Mezey, Fulmer, Abraham, & Zwicker). I have used this book in my hospital practice to help staff nurses incorporate pertinent practice concepts into their units' policies and procedures. The American Journal of Nursing (Lippincott, Williams, and Wilkins, Philadelphia, PA) and the Gerontological Society of America have joined forces to produce additional evidence-based articles and columns to promote changes within institutions and to encourage more nurses to become certified in geriatrics.
The Journal of Gerontological Nursing has definitely set the leadership and clinical tone for competencies in gerontological nursing for a long time to come. I am honored to be the guest editor for this issue. I wrote the article titled, "Therapeutic and Healing Foot Care: A Healthy Feet Clinic for Older Adults" (pp. 25-32) because I am concerned about falls and also wanted to design a more innovative and practical way to teach older adults about fall prevention than a poster or lecture. This issue is full of models for helping older adults - problems identified by nurses and solved with nurse ingenuity and scholarship.
Many important initiatives reveal the hard work and dedication of nurse leaders and clinicians who advocate on behalf of older adults, their caregiver families, and the nursing staff who care for them. 2004 has been a good year. We look forward to 2005.
- American Nurses Association. (2003). Nursing: Scope and Standards of Practice. Washington, DC: Author.
- Congdon, JG. (2001) Scope and Standards of Gerontological Nursing Practice (2nd ed.). Washington, DC: American Nurses Publishing.
- Mezey, M., Fulmer, X, Abraham, L, & Zwicker, DJl (2003). Geriatric Nursing Protocols for Best Practice (2nd ed.). New York; Springer.