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
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