Symptoms plague older adults. Physical, psychological, emotional, social, and spiritual—all domains of life suffer the impact of uncontrolled symptoms. Daily living is limited, circumscribed by symptoms that discomfort, bother, and get in the way of necessary and desired activities. Each interaction with our patients, clients, and even older relatives and friends reminds us that symptoms that go unmanaged diminish their lives. Most often, older adults who have lived with chronic diseases and comorbid conditions look to nurses to help them control and manage their symptoms so they can get back to their daily activities and time with their family, friends, and community. As gerontological nurses, we are lucky to practice in a time when research in symptom management and specific symptoms is growing, providing us with increasingly useful evidence to improve care. We have the opportunity to help older adults with the many different symptoms they experience, using varied strategies and interventions. Our management and guidance for their self-management is at the heart of gerontological nursing practice.
The group of articles on symptom management published in this issue of the Journal of Gerontological Nursing represent the current generation of thought in symptom management. These three articles all take different perspectives on the broad topic of symptoms in cardiovascular disease. Further, they are specific to diseases, conditions, and symptoms. This specificity builds on general knowledge and directs integration into practice. It strengthens the core of our care.
The first article takes the broadest approach, informing readers with theory made practical for patient care. Jurgens, Shurpin, and Gumersell offer a framework for understanding self-management of symptoms and symptom clusters in heart failure. The second article synthesizes a vast literature to guide nurses in specialty postoperative practice. Clarke, Styra, McRae, and Del Signore address themselves to the particular presentation, mechanisms, and best practice management of delirium in older adults undergoing cardiac surgery. Finally, the third article focuses on complementary and alternative medicine (CAM)—a realm of practice too often neglected in gerontological care—to improve symptom management for older adults. Tobón reviews the available evidence on use of CAM to manage pain in older adults with venous leg ulcers. She puts the evidence into practice with an individual example that demonstrates how this evidence can work for older adults. Taken together, these articles tell us as nurses about what we need in practice today. We need practical models and frameworks that actually work. We need available evidence synthesized in useful formats with clear recommendations for care. We also need evidence and strategies to include CAM in our care of older adults.
Older adults live with many symptoms. As nurses, we possess the means to relieve any suffering they may experience. Symptoms are many, and the evidence needed to control and manage them is vast. Taken together, the articles in this special issue are an example of ways in which we can use frameworks, available evidence, and best practices to improve symptom management. Here our focus is on cardiovascular disease. We could as easily consider neurological, renal, or pulmonary diseases and conditions common to older adults. The challenge is to frame symptom management in relation to these diseases and conditions, evaluate the available evidence, and integrate it into practice while identifying gaps to direct future research.
Sarah H. Kagan, PhD, RN
Lucy Walker Honorary Term Professor of
School of Nursing and
Clinical Nurse Specialist
Abramson Cancer Center
University of Pennsylvania
Carrie T. Stricker, PhD, RN
Abramson Cancer Center and
Clinical Assistant Professor
School of Nursing
University of Pennsylvania