Plant a Seed … and Maybe a Tree Will Grow
Article Outline
Barbara Resnick, PhD, CRNP, FAAN, FAANP
As with anything else, there is nothing like the lived experience. The opportunity to work with older adults across all care settings is critical, and all of us as professors, preceptors, or clinical mentors must work to ensure that these are in fact positive aging experiences and not simply clinical hours. Healthy aging can be taught to students through exposure to older adults in continuing care retirement communities, retirement communities, or active and vibrant senior centers. Exposure to rehabilitation can help students learn that miraculous recoveries are not reserved for the young. Rather resilient, determined older individuals often overcome disabilities from acute or chronic illness. Exposing these students to the pearls of wisdom that are bestowed on each of us who have chosen geriatrics as our area of specialization is our best hope for building a cadre of interested nurses. In addition, however, these nurses must be given the right tools, knowledge, and skills to care for these individuals successfully. Augmenting coursework with references such as those available from the Hartford Institute of Geriatric Nursing (http://www.geronurseonline.org) is likewise critical. The importance of this exposure struck me recently when speaking with an undergraduate nursing student from the University of Maryland. This student, Jennifer, shared her experiences as part of a required interaction in a course dedicated to care of older adults. I share her story as a reminder to us all to consider the importance and potential power of the encounters with older patients that we can share with students as a way to motivate and engage them. Following Jennifer’s story is that of a recently graduated nurse, Yael, who has chosen to specialize in geriatric nursing.
A Student’s Story
Jennifer Jones
Undergraduate Nursing Student
University of Maryland School of Nursing
It is a well-known fact that the fastest-growing portion of the U.S. population is the elderly. Gerontology, the term used for the study of this group of people, is defined by Merriam-Webster’s Medical Dictionary as “The comprehensive study of aging and the problems of the aged” (Dictionary.com, 2006). Because the aged constitute such a large number, it is a requisite that all baccalaureate nursing students at the University of Maryland School of Nursing successfully complete a course in Gerontological Nursing. As a nursing student whose ultimate goal is to become a certified nurse midwife, I had little concept of how problems of the aged could possibly pertain to my focus area. In fact, the only interest I initially had in the course was passing it to obtain my nursing degree. Ironically, I learned a much more valuable lesson than I believe the course was designed to teach.
One of the course assignments was to interview a generally healthy older adult residing in the community and relate his or her lived experiences to the theoretical concepts taught in lecture. My first challenge was finding an older adult to interview. Having no living older relatives of my own, I decided to speak with a friend’s grandmother. The second (and more difficult) challenge I had to overcome was my preconception of older persons. I associated aging with deterioration—both cognitive and physical. After all, even the definition of gerontology associates the process of aging with problems. Given that the woman I chose to interview was a stroke survivor, my assumption that her cognition would be altered was further strengthened. I walked into the interview wondering whether she would even understand the purpose of the discussion. Would she be able to articulate responses to the questions I needed answered? Would she continuously get lost midsentence and forget where the conversation was going? I assumed I would have to repeat questions, sometimes varying terminology, to ensure her comprehension. In general, I perceived the dialogue would be a drawn-out, tedious chore.
As it turns out, my preconceptions were actually misconceptions. Not only did she fully understand the questions I asked and why I was asking them, her answers surpassed the project requirements and gained my personal interest. We sat for hours talking about her life from childhood to the present. I learned through her experiences what it was like to experience life as a black child growing up before the civil rights movement, and then through the Great Depression as a small child. I empathized with what it must have been like to support a family on as little as $2 a day. I felt her pain as she relived the loss of parents, siblings, children, and even grandchildren. I appreciated her strength as she told of hardships she was able to face and overcome with the support of family and her faith in a higher being. I listened to her tell these stories, never skipping a beat. She spoke of the future, too, in anticipation of an elaborate birthday party and her desire to travel to Africa when finances permitted. She didn’t see her challenges as “problems” with aging, only as opportunities for growth. Even in speaking of the stroke, she communicated how it strengthened the bond between her and her daughter, and her faith in the Lord. She was witty, funny, and, from what I could tell, not the slightest bit impaired cognitively. We spoke on her back porch with the background noise from the neighbor’s air-conditioner, and it surprised me that I did not have to repeat questions or speak in an excessively loud voice.
My expectations for her physical status were also not accurate. Her gait was somewhat unsteady from the stroke she had had less than a year before our meeting. She was, however, able to get around quite well and had recently won an exercise contest at physical therapy. Her biggest complaint was that she was unable to keep up with the house cleaning like she used to, although she was determined that with time she would soon be able to again.
Taking the time to sit down and talk with this woman taught me so much, although the lesson I learned is probably not what you’re thinking. Of course this experience reinforced the common cliché “don’t judge a book by its cover,” but it’s so much more than that. I now believe that the dictionary definition quoted earlier is inappropriately worded because it suggests that only problems, not positives, are experienced by the aged. This insinuation may have played a role in my stereotypical view before conducting the interview. I realize now that the study of aging is relevant to all disciplines of nursing, including midwifery. After all, every experience beginning at the moment of conception influences, in one way or another, the process of aging.
Although the experience was definitely eye opening and helped clear up some misconceptions, my passion nonetheless lies with perinatal care and reproductive and women’s health. This was a wonderful experience to have had before doing my adult health clinical. It helped me to be more open-minded when walking into a room to meet a patient. It helped me treat each person as an individual based on his or her personal level of cognition and physical ability. I recognize that I would likely not have elected to take this course in gerontology if it was not a part of the curriculum. It is only because it was part of the BSN plan of study that I was able to have this worthwhile experience.
A Newly Graduated Nurses Story
Yael Sollins
University of Pennsylvania School of Nursing, 2005
When most teenagers are looking for summer jobs, they tend to end up as lifeguards, cashiers, waiters, camp counselors—something “normal.” I decided to be original and scoured the help-wanted ads of the local newspaper in an attempt to find a summer job that would be noteworthy. To my surprise and interest, the best-looking jobs were for a position known as a “caregiver” in the local assisted living facilities and nursing homes. There were tons of job postings, the hours were flexible, and I thought, how hard can it really be to “care” for someone?
Most old people scared me, particularly the frail ones in the hallway that repeated the same phrases over and over again. Despite this, I was willing to get over my childhood reservations for a job that I knew would prove to be interesting, if nothing else. I did not really think being a caregiver entailed doing much other than preparing a few meals and providing company.
I started a caregiver training class at a local community college in the beginning of summer. I experienced shock number 1 the day we learned how to do perineal care. Shock number 2 came when clinicals began and I had to give a woman with contracted arms and legs a shower in some type of mesh contraption and ended up with soap in both of our eyes. Shock number 3 came when, still on my first day on the job, I saw a frail older woman sitting at a table eating. She was so bent over that her nose hovered only 3 inches from her lap, and I was simply perplexed by how she was cared for on a day-to-day basis.
It’s amazing how fast one can learn; 55 showers, 200 diaper changes, and 307 meals later, I was starting to get the hang of being a caregiver to older adults. The woman with significant enough kyphosis to almost scare me away from my job for good was finally going to be my patient for the evening. She enthralled me that whole evening, and I could not find that part of me that had been afraid of her anywhere inside of me. After I realized how drastically my opinions changed, I was never able to look back.
To make a long story shorter, my experience as a geriatric caregiver provoked me to enter nursing school, where I made geriatric nursing my ultimate focus. Today I am your average medical surgical nurse in a small teaching hospital with an above average passion for geriatric patients. Just the other day, a nurse colleague became frantic trying to care for one of her confused older patients. She came to me, asking for my recommendations to help her deal with what was an impossible situation to her. My response: listen. As I gently held the patient’s hand, she began to sing, “I love you, you’re beautiful, I love you.” She pulled my face in for a large wet kiss.
I have always found it difficult to explain to others, even within the nursing profession, why older adults hold such a special place in my heart. Sometimes it’s easiest to tell stories such as the one I just recalled. Although I still struggle with the unique challenges of hospitalized older patients, I find every one to be a puzzle, often full of different diagnoses and complications but also complete with fascinating life experience.
Conclusion
Jennifer will likely not choose to work with older adults exclusively. Yael has chosen this path, at least for now, as a new nurse. Their experiences have planted seeds of where their nursing careers can and may go in the future. Jennifer may one day change her mind, and Yael may continue to specialize in geriatrics, as well as teach others how to care for older adults and to love doing it. I challenge us all to continue to throw out seeds and see what will grow. As we work together on building a nursing workforce with expertise in care of older adults, feel free to share your stories on how you help motivate and engage our future nurses in geriatrics with Geriatric Nursing.
References
- National Center for Health Statistics. (2004). Home health care patients. Data from the 2000 National Home and Hospice Care Survey. Available at http://www.cdc.gov/nchs/releases/04facts/patients.htm. Cited March.
- The American Nurses Credentialing Center. Available at http://www.nursingworld.org/ancc. Cited March 2006.
PII: S0197-4572(06)00132-7
doi:10.1016/j.gerinurse.2006.03.013
© 2006 Mosby, Inc. All rights reserved.
