Gerontological nurses bringing clarity to dissonance: Sharing our resources

Abstract

Every person, for whom we care as gerontological nurses, is an older person. Indeed, the mental image we hold of our prototypical patient is always of an older person. For us, older is the normative developmental state of being—“those are the people for whom I care,” we think to ourselves. This thinking is synonymous with our gerontological perspective, forming the core of older people nursing. Our colleagues in specialties and practice settings beyond gerontological nursing face a different reality, a dissonant daily experience. The mental image they hold of their prototypical patient—their “every patient”—is generally that of a young or midlife adult. However, given current ageing demographics and non-communicable chronic disease (NCD) epidemiology, their patients are in fact most often older. My clinical specialty of oncology nursing is a good example of such dissonance. In oncology, care for older people persists an optional sub-specialty practice. The sub-specialty designation stands in opposition to the reality of cancer epidemiology and ageing in clinical practice. The global epidemiology of cancer is shifting quickly (Bray et al., 2018). People over 65 years of age constitute the majority of people diagnosed with cancer in most regions of the world (Bray et al., 2018). Moreover, that same age group represent the great majority of cancer survivors in many societies around the globe (Shapiro, 2018). Critically, research with young people who survive childhood cancers shows early expression of clinical frailty, prematurely ageing these young people (Shapiro, 2018). Thus, despite clear evidence that oncology nurses routinely care primarily for older people along with younger people who may be biologically older than their years, the mental model of a prototypical cancer patient remains firmly cast in midlife. As a result, significant efforts to increase gerontological competence across the oncology workforce often garner less return than hoped. Nurses in other specialty practices and settings contend with similar. The epidemiology of other CNDs suggests that nurses in specialties across acute, ambulatory and community settings care for aged populations but do not view themselves as specialists in care of older people. Nurses, like me and countless others around the world, who practice outside of aged care settings, are in effect gerontological nurses. Nonetheless, many of us do not think of ourselves as such or feel a sense of gerontological competence. Our professional identity and skills may be at odds with the needs of our patients and their families. Conversely, gerontological nurses possess much to offer our colleagues in other specialties and settings. Our gerontological science and expertise caring for older people, along with experience in age- and dementia-friendly initiatives, are a treasure trove from which we are able to share generously. Looking forward, I challenge us as an international community of gerontological nurses—clinicians, scientists and educators alike. Let us redouble our outreach to our nursing colleagues to help them become proud and successful gerontological generalists, replete with foundational competencies and a positive vision for the future. Gerontological nurse researchers, educators and clinicians alike possess an incredible range of knowledge and skills as well as essential approaches and models. All are profoundly useful when translated to settings beyond aged care. We easily differentiate person-centred practice from patient-centred care. Similarly, we quickly dismiss myths and mystery surrounding the “3 D's”—delirium, depression and dementia—bringing clarity to care for elders experiencing these conditions. The examples are limitless; we have so much to share. Bringing clarity to dissonance begins with sharing our resources. So much of what we take for granted aids colleagues establishing gerontological competence in practice, education and research. Consider offering seminars, workshops, tools, and assets like favourite websites and publications to colleagues. Extend invitations for observation and consultation to better explore translation of evidence and dissemination of best practices. In taking up this challenge, let us disseminate through social media how and what we are sharing. Tweet about it to the International Journal of Older People Nursing at @IntJnlOPN, using our favourite hashtag #geronurses and adding two new hashtags #gerocompetence and #geroshare. Post your seminars, workshops and other events, tagging our Facebook page (https://www.facebook.com/IJOPN/), using the same hashtags. Suggest to your colleagues in other specialties that they use these hashtags too as well as those designating their cross specialty focus. In oncology, for example, that hashtag is #gerionc. Thank you for your generosity in time, energy and spirit. I look forward to lively dialogue about dispelling dissonance, gaining clarity and building gerontological competence.