During the past year, I had the good fortune to spend 6 months in Oxford, England. Although not formally affiliated with any health-care organization, I did have two experiences that profoundly and positively affected my perspective on gerontological nursing.
I volunteered 2 days a week at St. Luke's Rehabilitation Center, a 54-bed nursing home in Oxford. This afforded me the opportunity to observe care in another cultural setting and to "practice what I've been preaching" to my students over the years; that is, to work both one-on-one and in groups with emotionally disturbed elders. Not only was this gratifying work from both a personal and professional perspective, but also it reinforced the notion that I clearly made the right choice (although somewhat by fiat at the time) when I decided to become a geriatric mental health nurse.
Getting back to the "roots" of caring for the elderly, by spending time working in a long-term care setting, is something I would hope every geriatric nurse-educator and researcher would be able to do. It puts you in touch with what are the truly "significant" issues facing practitioners today in a way that can never be gleaned from simply reading journals or attending conferences. In addition, it has provided me with wonderful case stories and clinical vignettes to enhance my teaching and professional presentations.
For example, because I was a volunteer, I had the luxury of time to plan and participate in many special activities and outings for the residents. One such day trip consisted of a bus ride and picnic for 20 wheelchair-bound residents at the nearby Cotswolds Wildlife Park. Mustering all the off-duty staff, adult children, and other volunteers we could find (as everyone had to be pushed around the extensive grounds as well as loaded and unloaded from the bus), we arrived at the wildlife park by late morning. The bus pulled to a stop in a parking lot next to the ticket booth and park entrance near a lovely gift shop, as well as the public restrooms.
One of the female residents whom I was assisting to disembark from the bus grabbed my sleeve in a somewhat agitated manner and whispered, "I have to spend a penny!" I put her off, indicating I had to help the others disembark first, but that I would get back to her in a bit. Not long after she was at my side again, this time more insistent: "I have to spend a penny!" So, although a little annoyed with her, I dutifully pushed her wheelchair into the gift shop. Little did I realize that the phrase "spend a penny" in England means "go to the toilet," and my lack of understanding almost created an unfortunate incontinent episode for this poor woman on what should have been a delightful outing.
I have used this and many other examples from my work at St. Luke's to illustrate principles of communication with the elderly and the fact that even though we may speak the same language, we may not always understand the intent - with potentially disastrous consequences.
The second experience was equally instructive. As part of my journey of "rediscovery," I wanted to explore alternative nursing strategies, known as "complementary therapies," which are much more common in the United Kingdom than here. I informed members of the Oxford nursing community that I was particularly interested in innovative or unique approaches to care of the elderly employed by English nurses. Virtually everyone I talked to responded, "Then you must go see Sister Passant." So I called Helen Passant, ward sister for Ward 8, the "geriatric ward" at the Churchill Hospital in Oxford.
What a joy it was to observe this gentle, caring nurse in action. She gave new meaning to the term "holistic care" in that even though all the patients on her ward were terminal, she and her staff were able to restore harmony, to bring body and mind together, and to "allow the spirit to shine through" (Passant, 1 990). Patients are treated allopathically, but also increasingly with complementary therapies, with a goal toward meeting the needs of patients more sensitively.
For example, on Ward 8, food is used as medicine. Complex slowrelease carbohydrates, such as fruits, nuts, molasses, and honey, are used to promote natural relaxation and bowel hygiene. Massage with herbal oils (especially lavender and rose geranium for patients with dementia, cedarwood for mood swings and chest problems, cardamom for memory, and lavender for headache and muscular pain) is another essential component of the care routine (Passant, 1990). It was almost a miracle to observe gnarled, twisted, and contracted limbs of a stroke patient "open up and unfold" under the gentle touch of this loving nurse and her staff Patients also opened up emotionally, and the touching promoted a closer relationship between staff and patients.
Furthermore, the oils seem to strengthen the skin of elderly patients, helping to prevent bruising and tissue damage. Essential oils are also dropped in the bath water, placed on the pillow, and infused throughout the ward for inhalation. Sister Passant notes that aromatherapy benefits both patients and staff, in that caregiver and care recipient both become calmer and less anxious, and patients sleep better, requiring fewer laxatives and sedative drugs (Passant, 1990).
A variety of natural healing remedies (instead of steroid creams) are used on Ward 8. Garlic, in ointment form, is a particular favorite, and is used for the treatment of a variety of maladies, such as fungal infections. Comfrey is used for bruises, abrasions, and sores; chickweed for dry, itchy skin; eyebright for the treatment of minor eye infections; and rosemary for problems of the scalp (Passant, 1990).
Music and the healing sounds of nature, as well as visualization, are also used extensively to promote peace and harmony and in the treatment of chronic pain (Passant, 1990). The combination of these complementary therapies produces a unique result. When you step into Ward 8, you are immediately struck by the soothing pleasantness of the area, so different from the smells and chaos of many terminal geriatric wards.
Although not yet systematically tested in the sense of geriatric nursing research in this country, Sister Passant and her colleagues have formed a research group and have begun to set standards, quality assurance outcomes, and guidelines for the application of essential oils in nursing practice. Now that I am back in the land of academic nursing, I have not abandoned quasiexperimental designs and "competitive grantsmanship," for these, too, have their place and their own rewards.
But I can assure you that the next time I am called on to deal with an agitated resident, I am going to try massaging his feet with comfrey oil mixed with a few drops of lavender before I suggest IM haloperidol!
- Passant, H. A holistic approach in the ward. Nursing Times 1990; 26(4):26-28.