Shaping the Quality of Health Care for the Elderly: Are Nursing Students Prepared?
Mezey, Mathy, Fulmer, Terry, Nursing and Health Care Perspectives
Today, with few exceptions, a nurse's typical patient is an older adult. People 65 and over represent 12.8 percent of the American population. Older adults account for over 60 percent of ambulatory adult primary care visits, 80 percent of home care visits, 48 percent of in-hospital patients, and 85 percent of residents in nursing homes.
The elderly are among the frailest of the patients for whom nurses care. Elderly patients often cannot manage their basic health care needs, and many no longer have family members who can assist with their needs or speak on their behalf. Older peoples' nursing and medical problems are often complex. They respond differently to medications, anesthesia, dehydration, infections, and sleep deprivation.
There is strong evidence that care that incorporates best geriatric nursing practice improves outcomes for elderly patients. Whether elderly patients regain function, maintain independence, recover from an illness, and achieve a peaceful death is dependent to a large measure on the nursing care they receive.
Setting a national agenda and shaping the quality of health care for elderly Americans by promoting the highest level of competency in the nurses who deliver that care is the vision of the Hartford Institute for Geriatric Nursing. Funded by a generous grant to the New York University Division of Nursing from the John A. Hartford Foundation, Inc. of New York, the Institute seeks to raise the standards of nursing care, therefore ensuring that people age with optimal function, comfort, and dignity.
The primary mission of the Hartford Institute is to identify and develop best practices in nursing care for the elderly and to disseminate these practices into the knowledge base and work environment of every practicing professional nurse and every nursing student. The Institute seeks to inform the public to expect best practice as the standard for geriatric nursing care and to foster the role that the nursing profession plays in the integrated delivery system of care for the elderly. (The term geriatric nursing is used in this article to represent geriatric/gerontological nursing.)
To accomplish these goals, Institute initiatives cluster in four areas: practice, education, research and policy, and consumer education. In the area of education, the Institute seeks to ensure that all nursing graduates are competent in care of the elderly through curriculum and faculty development.
Just as recognized standards of nursing practice underpin pediatric and psychiatric mental health nursing, the care of older adults has recognized standards of care. National consensus conferences and national organizations, such as the Association for Geriatrics in Higher Education and the National Geriatrics Nursing Association, have developed standards for curriculum content and competencies in the care of the elderly for undergraduate and graduate nursing education. Clear standards of care now exist for functional and mental status assessment of the elderly, the use of physical restraints, the management of urinary incontinence, the prevention and treatment of pressure ulcers, and the prevention and assessment of geriatric syndromes such as falls.
However, despite gains in promulgating geriatric standards of care, concern exists within the nursing profession about whether nursing students are adequately prepared to care for older adults. Two central questions remain: Do professional nurses have the requisite knowledge and skills to adequately deliver care to elderly patients? Are there sufficient advanced practice nurses, geriatric nurse practitioners, geriatric clinical nurse specialists, and gero-psychiatric nurses prepared to deliver care to the elderly?
In the area of basic professional nursing preparation, one apparent strategy to ensure a workforce adequately prepared to care for the elderly is to give every nursing student adequate knowledge and skills in geriatric nursing. …