Editorial: Gerontological nursing in a time of change.

Abstract

We practice nursing in a time of great change. Healthcare and health systems are evolving rapidly. Acute care – long the epicenter of most health systems – is now recognized as a high-risk, high-cost endeavor to be used only in case of clear need. The future of healthcare for our aging world lies in highly coordinated care, centered in our communities. The move from acute to community-based care is a major paradigm shift, requiring incredible effort to overcome inertia and effectively redesign systems (Coiera, 2011). As change unfolds, nurses must continue to care for older people amidst the upheaval. Community-based systems, emphasizing ambulatory and home-based care delivery, rely on exquisite care coordination to smooth transitions across settings and specialties. We gerontological nurses inherently understand the value of community-based care, having focused much of our science there. Our emphasis on improving care for elders living in our communities and within residential facilities stood in contrast to the emphasis found in much of nursing and healthcare broadly. Where many viewed hospital nursing practice as the leading edge, we critically evaluated the needs of older people with the overarching aim to maintaining and restoring function and well-being. Acute and transitional care provided to older people requires widespread improvement. Evidence documenting limited safety and effectiveness in acute care for elders is reinforced by the many calls and emails all of us receive from people who are concerned about their loved ones’ hospital experiences. Older people are at significantly more risk of sentinel events, uncomfortable experiences, and poor outcomes than younger counterparts. Whether in an isolated visit to an emergency department or a long hospital stay, elders quickly sustain functional decline, face needs for continuing care, and find their quality of life threatened. The disruption created by just a single acute care encounter is too often long lasting and, for some, even deadly. Increasingly, gerontological nurses are establishing themselves in the realm of acute and transitional care. In practice, initiatives like Nurses Improving Care for Health System Elders (Capezuti et al., 2012) offer significant promise in achieving a gero-competent nursing workforce, even among those acute and ambulatory care nurses who might not yet recognize themselves as gerontological generalists. As we make strides in continuing education for the existing nursing workforce, redesigning entry level education remains more challenging. Overcoming myths of aging and misperceptions of elders, even ageist stereotypes within our own profession, often supersedes content and pedagogy. Incorporating current evidence regarding ageing and care of older people is essential to any curriculum aiming to prepare nursing students to practice in our aging societies. All too often, thoughts, attitudes and beliefs stand between a future or current nurse and the knowledge needed to realize gero-competence mandatory for 21st century practice. Gerontological nursing research offers incredible possibility in this time of health system change. Our science – both in investigations into phenomena typically viewed as gerontological as well as those beyond our traditional domain – represent power to influence that change. Single studies are obviously valuable for what they reveal about the phenomenon under study. However, a maturing body of science represents something more. From our international gerontological nursing science come perspective, values, and priorities, offering the possibilities of making sense of complexity and of surmounting inertia so common in healthcare (Coiera, 2011). These larger products of our research help us to transform a time of change into the preferred future for care of older people.