GERONTOLOGICAL NURSING

Gerontological nursing has taken several centuries to become acknowledged as a separate nursing specialty. Its rise should be understood within the context of the emergence and development of the nursing profession generally. Additionally, the growth in the number of older adults, and in the cultural care of elderly persons around the world, must be considered. It is important to note that the preparation of gerontological nurses is dictated somewhat by the cultural strictures and interpretations of a particular society's definition of older persons, which will influence the status of this specialty in different countries.

The beginnings of nursing

The development of nursing has followed the development of mankind. In its most early phases, nurses were almost exclusively female family members. Nursing gained ground toward becoming a profession due to the care provided to the poor, the indigent, the infirm, and the insane; to prisoners and orphans; as well as to women during childbirth and to people during war times. Laywomen who initially tried to fill the demand for more nursing care during the expansion to the New World were ineffective, as they were without role models or training. Religious orders played an important part in the development of nursing care facilities through care provided in their convents, abbeys, and almshouses. In the mid-1850s, the Crimean War provided Florence Nightingale with the necessary outpouring of public support to effect changes in nursing. Nightingale initiated such advances as the establishment of an organized training school and a formalized and standardized organization, thus finally turning nursing into a suitable occupation for women. Nursing was well on its way to being a profession, although it would still take more than one hundred years to become fully acknowledged as a separate health care entity. Nurses now make up the largest international work force in health care.

The impact of world population changes

Reduced infant mortality and death rates, the conquering of major diseases, major medical advances, and better overall health care throughout the world have together resulted in increased life expectancy, and thus more elderly persons, especially those of extreme age (eighty-five years and older). In North America, the immigration boom between 1900 and 1920 also added to the number of older persons at the turn of the century. In modern industrialized societies, old age is identified in terms of chronological age. In other societies, onset of old age is more commonly linked with events such as succession to eldership or becoming a grandparent.

The importance of family life to the well-being of the elderly person can be seen in many cultures. In developing countries, the existence of an extended kin network provides regular and frequent contact as an essential part of the traditional welfare (support) system. In developed countries, even with reduced family size, childless marriages, fewer single adult daughters, and increasing numbers of middle-aged women in the work force (all of which have led to decreasing availability and opportunity for children to care directly for aging parents), the first and major resource for elderly persons is still the family: less than 10 percent of older people are ever institutionalized in these countries.

The field of aging

Gerontology as a field of study was notable in Europe prior to North America because of the earlier maturing of Europe's population while initially North America had a younger population. However, in the early 1930's as North America's war against infectious diseases was won, more focus was placed upon degenerative, chronic diseases—most of which were notable in the growing, older population. Gerontology began as an inquiry into the characteristics of long-lived people. It is defined as the science of aging, studying the effects of time on human development, specifically aging. Gerontology is the preferred term for the normal aging process including the biologic, psychosocial and spiritual aspects of the older adult. The term geriatrics is the area of study related to diseases of the elderly and became popular as geriatric medicine evolved.

The specialty of gerontological nursing

The nursing profession has clearly been affected by the increased aging of the world population, the sheer numbers of elderly people, and the different ways the world's elderly persons are treated. As the population has shifted from baby boomers to senior surge, the demand for expertise in this escalating population has also intensified. Nurses have long been interested in the care of older persons, and they seemed to have assumed more responsibility than other professions for this segment of the population. With a shift (change of focus from emphasis in children and adolescents towards the elderly) in societal emphasis giving visibility to elderly persons, the nursing community has focused upon this population in terms of increasing their knowledge base and increased education in this neophyte specialty field.

In North America, gerontological nursing began its rise with the acknowledgment of this new nursing specialty by the American Nurses Association in 1962 and the formation of the National Gerontological Nursing Association in 1984. In Canada, the Canadian Nurses Association recognized the Canadian Gerontological Nursing Association as a specialty in 1985. Other nursing specialty organizations developed in Australia and Great Britain. In contrast to the continued use of the term geriatric, the term gerontological nursing was in use by the early 1980s to reflect the provision of care and the treatment of the whole person, not only care of disease in a medical setting. The assessment of the health needs of older adults, the planning and implementing of health care to meet those needs, and the evaluation of the effectiveness of such care are critical activities in assisting older adults to optimize their functional abilities and thereby maximize independence and promote well-being—a prime directive for gerontological nurses. A more recent term, gerontic nursing, refines the sphere of responsibility of gerontological nurses who care for the elderly by encompassing the art and intuition of caring and maintaining the "well elderly" as well as emphasizing illness and scientific principles of care.

During the last half of the twentieth century, there was profound growth in the literature of gerontological nursing. A North American gerontological nursing text was published in 1950, and a monthly journal devoted to gerontological nursing began publication in 1975. The birth of gerontological nursing research to provide a strong, independent knowledge base to link research with the increasing complexity of practice expertise began in the late 1970s.

As the skill and knowledge base of gerontological nurses has continued to accelerate, there has been a corresponding growth in education, with the development of undergraduate baccalaureate, graduate masters, and postgraduate Ph.D. programs in gerontological nursing designed to prepare the necessary clinicians, researchers, educators, and administrators. Specific university-prepared clinical practice streams now include nurse practitioners as clinical nurse specialists and expanded role nurses, among others, providing advanced practice knowledge to older populations. Gerontological nurses must have the knowledge and skill to manage care focused upon normal and abnormal age-related physical changes (e.g., musculoskeletal, sensory, neurological) and age-related psychosocial and spiritual changes (e.g., developmental, intellectual capacity, learning and memory, losses). Gerontological nurses must be educated concerning care strategies about wide-ranging basic and complex physiological and behavioral issues such as pain, pressure ulcers, cognitive impairment, self-esteem disturbance, bereavement, fluid and electrolyte imbalance, and caregiver stress, among other issues. Gerontological nurses must also have expertise in navigating the health care system to act as advocates for their clients.

Standards of nursing practice have been developed in various countries to define the uniqueness and scope of gerontic nursing practice and to provide a foundation for evaluation of nursing practice in all settings where the focus of care is on the older person. Gerontological nurses may also be certified through a written examination available in certain countries, as a recognition of expert professional competency.

The future is secure for gerontological nursing as an acknowledged and well-respected specialty within nursing, as well as a discipline among its interdisciplinary colleagues in efforts to improve care for older persons throughout the world.

Deborah A. Vandewater

See also Geriatric Medicine; Long-Term Care; Nurse Practitioner.

BIBLIOGRAPHY

Andersen, H. C. Geriatric Nursing. St. Louis: Mosby, 1950.

Barash, D. P. Aging: An Exploration. Seattle: University of Washington Press, 1983.

Burnside, I. M. Nursing and the Aged: A Self-Care Approach, 3d ed. New York: McGraw-Hill, 1988.

Ebersole, P., and Hess, P. Toward Healthy Aging: Human Needs and Nursing Response, 4th ed. St. Louis: C.V. Mosby, 1994.

Hogstel, M., ed. Nursing Care of the Older Adult: In the Hospital, Nursing Home and Community. New York: John Wiley & Sons, 1981.

Journal of Gerontological Nursing 1, no. 1 (1975): 6.

Kane, R. L.; Evans, J. G.; and MacFadyen, D., eds. Improving the Health Care of Older People: A World View. Oxford, U.K.: Oxford University Press, 1990.

Novak, M. Aging & Society: A Canadian Perspective, 3d ed. Toronto: ITP Nelson, 1997.

Steffl, B. M., ed. Handbook of Gerontological Nursing. New York: Van Nostrand Reinhold, 1984.

Woodruff, D. S., and Birren, J. E., eds. Aging Scientific Perspectives and Social Issues, 2d ed. Monterey, Calif.: Brooks/Cole, 1975.