Academic nursing leaders—deans, associate deans, department chairs, and all others with direct input into curricular development and public service options—play a key role in bringing about changes in the way current and future nurses are educated at all levels. In executing their various roles, academic nurse leaders marshal human and fiscal resources, anticipate future needs, and act as project managers of internal culture change. “In academic departments and colleges, chairs and deans can become agents of culture change because they occupy administrative positions closest to where most significant activity—research, teaching and service—occurs in academia” (Bystydzienski, Thomas, Howe, & Desai, 2017, p. 2301).
Nursing education also brings with it the opportunity (and challenge) of public communication. Today, nurses and nurse educators are expected to communicate politically (Woodward, Smart, & Benavides-Vaello, 2016), across disciplines inside and outside of health care (Koh, 2016; Lennen & Miller, 2017), and with the public on a wide range of health-related issues (Kaslow, 2015; Kemshall & Moulden, 2016). As former National Institute of Nursing Research director Patricia Grady (2017) recently noted in talking about the future of nursing science, “We must also be vigilant in communicating the results and impact of nursing science to ensure that the results of our studies reach the broader community and inform practice” (p. 248).
In 2015, Friedman, Shah, and Hall said, “A review of the literature suggests that attention to health or successful aging has failed to keep pace with the focus on frailty” (p. 1459). As a result, the American Geriatrics Society (AGS; 2018) developed a white paper encouraging its members to increase their focus on healthy aging, as opposed to the then-existing emphasis on frailty. In an executive summary published separately, Friedman et al. (2019) said:
As individuals and as a national organization, we can nurture this [interest in health(y) aging] through advocacy as clinicians and leaders, building partnerships with community and public health stakeholders; through public and professional education; through best practices that support health[y] aging, and through research participation and support.
Healthy aging represents an aspect of nursing science where there is accelerating academic interest in a topic that is of great public interest. Thus, an opportunity presents to consider how best to leverage academic resources to assure a forward-looking curriculum, foster relevant research, and communicate results to a public that wants to know what was learned.
Engaging with and Reframing Aging
Although the “how” of aging is still being defined, recent work has elucidated many of the metabolic details and their implications at the cellular and organism level (López-Otín, Galluzzi, Freije, Madeo, & Kroemer, 2016). Inevitably, mitigating strategies have been proposed, from caloric restriction (National Institute on Aging, n.d.; Redman et al., 2018) to specific dietary interventions (Adomaityte, Mullin, & Dobs, 2014). López-Otín et al. (2016) caution, however, that “none of the longevity-extending interventions described... have been demonstrated to delay the onset or progression of age-associated disorders in humans” (p. 815).
Aging is thus inevitable, but how it is viewed and dealt with is malleable. Healthy aging goes by many other designations with varying nuances—optimal aging (Brummel-Smith, 2007), active aging (Bousquet et al., 2015), and successful aging (Cosco, Prina, Perales, Stephan, & Brayne, 2014). In a literature review, Cosco et al. (2014) found 105 “operational definitions,” concluding that “[successful aging] is vastly more complex than mere survival, including a mastery or maintenance of functioning across a number of constructs, such as social, cognitive, and emotional” (p. 378).
Doris Carnevali, Professor Emeritus University of Washington School of Nursing, began a blog, Engaging with Aging (access https://engagingwithagingblog.wordpress.com), that combines elements of a research project, diary, and a casual conversation among good friends. In an early post, Carnevali (2019) acknowledged that, “As a nurse, I was taught to view aging from birth to death from the perspective of health. Normal versus abnormal...now, decades into my ‘old age,’ I find that seeing aging primarily through the lens of health is too confining” (para. 2 and 3).
As a recent Journal of Gerontological Nursing guest editorial noted, “Doris Carnevali, in her mid-90s, is changing the way we think about aging” (Primomo & Belza, 2019, p. 3). From her self-observation, reflection, and experiments with herself as a subject, Carnevali has developed a strategy and attitude for engaging with all multifaceted aspects of aging and age-related changes.
Reframing Aging is an initiative of eight major national aging-focused organizations that have committed to an effort that seeks a change in the public's perceptions of aging (FrameWorks Institute, 2017). The Engaging With Aging blog is one among many resources that are consistent with this larger effort to reframe aging and that dovetail well with the AGS call to broaden the view of aging and place new emphasis on a prospective approach that focuses on healthy aging as being about more than physical health.
If healthy aging and concepts such as engaging with aging (EWA) are to emerge as a new paradigm, it brings to the fore the larger issue of how academic nurse leaders can best fulfill the role of being agents of culture change internally and externally. While nurse leaders seek to foster research and encourage educational efforts that shift the focus to healthy aging, they must also fulfill an obligation to communicate this to the public. The executive director and CEO of the Gerontological Society of America recently observed that “the public's perception of aging differs markedly from what we as experts and advocates in the field know to be true” (Appleby, 2018, para. 2). He goes on to say that, “Changing cultural attitudes is not a small endeavor, but we have to start, playing our appropriate stewardship role as researchers, practitioners, and educators in the aging field” (Appleby, 2018, para. 4).
Nurse Leader Roles in Engaging with and Reframing Aging
Educators have many resources and roles as academic leaders to advance transformational ideas such as healthy aging. They bring knowledge of the need for evidence-based research to guide policy and decision making as it relates to aging, as well as the ability to convey to a non-professional audience what that research informs. Among the roles played are incubator and resource; hub and bridge; educational futurist; and public advocate.
Incubator and Resource
According to Phillips (2017), “The difficult truth that most innovators face is that what's currently accepted, and mostly acceptable, isn't innovation but continuation or extensions of existing solutions” (para. 2). That's true, he says, for several reasons: people are familiar with the solutions, so building on them or extending them does not create a lack of familiarity; the risk of an existing solution is lower than the risk of a new, untested solution; and existing solutions or extensions do not require learning or new efforts from the user.
Nursing education leaders are uniquely situated to play a pivotal role as innovation incubators. As visible leaders, what deans and other leaders say and do has a large potential impact on making ideas acceptable for discussion and validation by colleagues and students locally and beyond one's own campus. They are, in modern social media parlance, “influencers.”
They are also influencers because of the faculty they recruit and hire; the examples they set; curriculum changes they initiate; and the connections they have to funding sources, commercial entities, and colleagues around the world. They are also influencers when they act as mentors for faculty and students, and by virtue of the initiatives they put forward that inspire research, or provide financial support and research opportunities for nursing students across their entire educational journey.
It is incumbent upon nurse leaders to create safe spaces for unfamiliar ideas. Nurse leaders should be the welcoming recipients of non-conforming, non-conventional formulations so that these ideas have an opportunity to be expanded, communicated, and fully explored.
An example of the role of incubator is the development of Carnevali's blog. When encouraged by a nurse leader to consider writing a blog as a way to share both her thinking and also garner feedback, Carnevali was hesitant at first. She eventually embraced the opportunity, making the concept of EWA publicly visible.
Hub and Bridge
One of the most valuable roles nurse leaders can play is to be a hub that connects people and their innovative ideas, such as EWA, across disciplinary, community, and other boundaries.
By virtue of their positions, nurse leaders usually have extensive knowledge of institutional, professional, and societal resources—human, financial, and political. They know of resources not only within but also outside of their immediate discipline. They have the knowledge and ability to create connections, stimulate collaboration, and expand the ecosystem within which an “outside the box” idea exists.
In adopting the hub role, nurse leaders are called on to reintegrate nurses and their innovative ideas with the complementary disciplines from which they may have become isolated and insulated. The hub function is a two-way street. At the same time that the innovator is introduced to outside resources, the new idea is made visible to others, giving them the opportunity to adopt, rework, expand, and propagate the concept.
The hub function is also a bridge that spans the chasm between academia and individuals, institutions, disciplines, and many other binary relationships. The hub function can involve bridging the gap between nurses of different ages, career stages, or institutional locations to facilitate collaboration, or translating nursing concepts for potentially interested lay people including foundations and the public.
Hiemstra (2001) defines a futurist as one who either forecasts the future using quantitative and qualitative means; imagines the future, using primarily intuition and writing skills; or creates the future, using techniques of planning and consulting.
Nurse leaders are called on to be educational futurists. They must forecast the future of nursing to prepare today's students for tomorrow's nursing ecosystem. They must imagine the future to put necessary curricular elements in place. And they must ultimately create the future through a combination of research focus and curricular implementation. Although responsible for the day-to-day functioning of schools of nursing, they are also charged by society and the profession with envisioning what the future will require of those being educated.
In their role as educational futurists, nurse leaders must maintain a high index of awareness about the need to be internal and external advocates for a transformational idea such as Reframing Aging. There are a number of options and opportunities to leverage academic leadership in a way that advances the reframing of aging, including component parts such as EWA. Among the possibilities are:
- Fostering research focused on aging research by offering fellowships, internships, or creating dedicated centers such as the University of Washington's de Tornyay Center for Healthy Aging or the Johns Hopkins Center for Innovative Care in Aging.
- Offering speaking opportunities, cross-disciplinary workshops, and other information dissemination options within and outside the academic environment.
- Recruiting and providing financial seed support to those performing aging research.
- Facilitating webinars and other technology-based means of disseminating Reframing Aging concepts.
- Sponsoring local/regional/national conferences focusing on Reframing Aging.
- Identifying and rewarding research mentors and faculty who provide services to older adults.
- Assuring technical support for blogs, such as Engaging with Aging, webinars, and other technology-based communication distribution for information on matters related to healthy aging.
The urgency of looking ahead cannot be overemphasized. As nursing takes on an ever-increasing role in providing primary care, those being educated today will be the primary care providers for many—and perhaps a majority—of those who are aging. As a profession, nursing is well-positioned to bring to such care the EWA attitude that age-related changes, per Carnevali, are different than pathologies and need to be understood and engaged with rather than “treated.” Achieving this perspective will require academic leadership that invites, empowers, and nurtures innovative thought and makes it an integral part of the educational experience.
The role of public advocate is important for the nursing profession and for attaining and maintaining its educational goals.
Most university schools of nursing depend to a greater or lesser extent on public funds and public support. Public funds include research funding from federal and state agencies as well as direct state or local support of the school. Public support of the nursing education mission, in turn, is what sustains financial support from public as well as private philanthropic sources.
Reframing Aging and EWA represent a unique opportunity for public advocacy on behalf of research as well as attitudinal shifts. Reframing Aging and EWA address a process that ultimately touches every person, speaks to issues that anyone and everyone can understand, and requires common sense rather than medical background to grasp. EWA's strategies for responding to age-related changes are practical, immediately applicable, and predominantly cost-free.
Nurse leaders have a chance to be powerful public advocates, both directly and indirectly, for Reframing Aging and EWA. They can advocate directly, by speaking to community groups, public health departments, legislators, and others whose interests, policy making, and budgetary authority intersect with the needs of older adults. Nurse leaders can be indirect public advocates by seeing that faculty who conduct aging research think about not only professional publication, but also about how they can translate and communicate their findings to practice.
Public communication is part of the job description for all nurses, and aging research offers an opportunity to engage with the non-academic world on a topic of interest, importance, and relevance to everyone.
Nurse leaders have enormous non-monetary capital that can be invested and leveraged to have a significant impact on health care, the experience of aging, and the profession of nursing. They have the position, reputation, interconnections institutionally and cross-institutionally, visibility, commitment, and interdisciplinary relationships that can bring visibility to an initiative, such as Reframing Aging, and take an innovative idea, such as EWA, and give it broad public exposure while simultaneously testing its utility and validity through research.
Nurse leaders are charged with envisioning and creating the educational structure that will imbue the next generation of nurses with the knowledge and judgment they need to transform health care. To accomplish that mission, nurse leaders need to do more than simply manage existing intellectual and educational resources. They must be more than caretakers; they must be risk takers by identifying, investing in, and responding to ideas such as EWA that have the potential to be truly transformative.
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