Guest Editorial: Response to “Preserving today with an eye on our future”

Abstract

A society must ultimately be morally judged by how it treats its weakest members—Mahatma GandhiFirst, we would like to thank Dr. Broome for graciously agreeing to publish our response to her editorial entitled Preserving today with an eye on our future.1Broome M.E. Preserving today with an eye to our future.Nurs Outlook. 2008; 56: 45-46Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar As gerontological nurses, we value the opinions expressed by Dr. Broome and acknowledge the importance of pediatric nurses. However, we are concerned about the underlying assumption that a recent emphasis on justice in care for elders has come at the expense of justice in care for children.The need for nurses prepared to care for elders is clearly documented in the 2008 report from the Institute of Medicine, Retooling for an Aging America.2Institute of Medicine (2008, April)Retooling for an Aging America: Building the Health Care Workforce. National Academies Press, Washington DC2008http://www.iom.edu/CMS/3809/40113/5342.aspxGoogle Scholar Efforts to expand the cadre of experts in gerontological nursing were catalyzed by nursing's recognition of a dearth of expertise in gerontological nursing at a time when the number of elders is increasing rapidly, and by the generous investment in gerontological nursing by the John A. Hartford Foundation.Rather than mirroring political strategies that pit one generation against another, we challenge pediatric and gerontological nurses to adopt a framework that builds on intergenerational interdependence, solidarity and non-competition across the ages and generations, emphasizing the provision of care that responds to the unique needs of each age group.All vulnerable groups need special attention. Nursing's social contract addresses our role in relation to the health of the population. Within the population, it is essential for us to focus on health disparities, minority health, and vulnerable and underserved groups. Both the very young and frail elders are vulnerable groups. We fully endorse increasing the number of pediatric nurses in the country—to assure a good supply of advanced practice nurses to care for children, researchers to generate scholarship about the care of children and faculty who will teach care of children in schools of nursing.Likewise, there is a critical need for more nurses skilled in care of elders. Now representing 13% of the US population, 50% of hospital days, 70% of home health services, and 90% of residents in nursing facilities, elders are nurses' predominant patient population. Despite significant efforts to strengthen gerontological nursing, < 1% of practicing nurses are certified in this area. Most hospitals, home health care agencies and nursing homes serving elders do not have a single nurse certified in geriatric nursing on staff.While nearly every baccalaureate-nursing program in the country has a required course(s) in pediatrics and maternal child health, only one-third of these programs have a required course in gerontological nursing. It is likely that this situation results, in part, from severe nationwide shortage of gerontological nursing faculty and in part from the ongoing lack of appreciation within some schools of nursing regarding the special/unique needs of elders. The enhanced efforts in gerontological nursing over the past decade address a longstanding and continuing void.Healthy children become healthy adults and elders. Our second point is to underscore Dr. Broome's request that we not lose sight of the longer-range implications of our decisions. Children who are helped to adopt healthy habits related to diet, exercise and smoking avoidance become healthy adults and elders in the future. Strengthening healthy aging behaviors should begin at an early age and continue throughout the life span; a curriculum and faculty focused on children and elders together can promote this.Gerontological and pediatric nurses have much to learn from each other. There are areas where nurses caring for children and those caring for elders share responsibilities. For example, > 4.4 million children < 18 years of age live in grandparent-headed households; over one-third of these children have no parent present in the home. That is > 6% of our nation's children, and the number is growing rapidly.3Lugalla T. Overturf J. Children and the Households they Live in: 2000.http://www.census.gov/prod/2004pubs/censr-14.pdfGoogle Scholar Clearly, health care for these families requires nurses who are competent in the care of children and elders as well as care for intergenerational families.In conclusion, our challenge is to assure that nurses are competent to execute our social contract. An “eye on the future” requires that nursing embrace the care of elders, including care of people at the end of life. Nursing needs to counter prevailing cultural norms and guard against devaluing care of elders in nursing education and in nursing practice.Nursing also has a commitment to the whole and must balance the populations/content areas to assure that the appropriate preparation is in place. The health of elders and of children depends on our actions. We must ask ourselves: Do we want to raise our children in a society that neglects them? Do we want to raise our children in a society that neglects their grandparents? A society must ultimately be morally judged by how it treats its weakest members—Mahatma Gandhi First, we would like to thank Dr. Broome for graciously agreeing to publish our response to her editorial entitled Preserving today with an eye on our future.1Broome M.E. Preserving today with an eye to our future.Nurs Outlook. 2008; 56: 45-46Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar As gerontological nurses, we value the opinions expressed by Dr. Broome and acknowledge the importance of pediatric nurses. However, we are concerned about the underlying assumption that a recent emphasis on justice in care for elders has come at the expense of justice in care for children. The need for nurses prepared to care for elders is clearly documented in the 2008 report from the Institute of Medicine, Retooling for an Aging America.2Institute of Medicine (2008, April)Retooling for an Aging America: Building the Health Care Workforce. National Academies Press, Washington DC2008http://www.iom.edu/CMS/3809/40113/5342.aspxGoogle Scholar Efforts to expand the cadre of experts in gerontological nursing were catalyzed by nursing's recognition of a dearth of expertise in gerontological nursing at a time when the number of elders is increasing rapidly, and by the generous investment in gerontological nursing by the John A. Hartford Foundation. Rather than mirroring political strategies that pit one generation against another, we challenge pediatric and gerontological nurses to adopt a framework that builds on intergenerational interdependence, solidarity and non-competition across the ages and generations, emphasizing the provision of care that responds to the unique needs of each age group. All vulnerable groups need special attention. Nursing's social contract addresses our role in relation to the health of the population. Within the population, it is essential for us to focus on health disparities, minority health, and vulnerable and underserved groups. Both the very young and frail elders are vulnerable groups. We fully endorse increasing the number of pediatric nurses in the country—to assure a good supply of advanced practice nurses to care for children, researchers to generate scholarship about the care of children and faculty who will teach care of children in schools of nursing. Likewise, there is a critical need for more nurses skilled in care of elders. Now representing 13% of the US population, 50% of hospital days, 70% of home health services, and 90% of residents in nursing facilities, elders are nurses' predominant patient population. Despite significant efforts to strengthen gerontological nursing, < 1% of practicing nurses are certified in this area. Most hospitals, home health care agencies and nursing homes serving elders do not have a single nurse certified in geriatric nursing on staff. While nearly every baccalaureate-nursing program in the country has a required course(s) in pediatrics and maternal child health, only one-third of these programs have a required course in gerontological nursing. It is likely that this situation results, in part, from severe nationwide shortage of gerontological nursing faculty and in part from the ongoing lack of appreciation within some schools of nursing regarding the special/unique needs of elders. The enhanced efforts in gerontological nursing over the past decade address a longstanding and continuing void. Healthy children become healthy adults and elders. Our second point is to underscore Dr. Broome's request that we not lose sight of the longer-range implications of our decisions. Children who are helped to adopt healthy habits related to diet, exercise and smoking avoidance become healthy adults and elders in the future. Strengthening healthy aging behaviors should begin at an early age and continue throughout the life span; a curriculum and faculty focused on children and elders together can promote this. Gerontological and pediatric nurses have much to learn from each other. There are areas where nurses caring for children and those caring for elders share responsibilities. For example, > 4.4 million children < 18 years of age live in grandparent-headed households; over one-third of these children have no parent present in the home. That is > 6% of our nation's children, and the number is growing rapidly.3Lugalla T. Overturf J. Children and the Households they Live in: 2000.http://www.census.gov/prod/2004pubs/censr-14.pdfGoogle Scholar Clearly, health care for these families requires nurses who are competent in the care of children and elders as well as care for intergenerational families. In conclusion, our challenge is to assure that nurses are competent to execute our social contract. An “eye on the future” requires that nursing embrace the care of elders, including care of people at the end of life. Nursing needs to counter prevailing cultural norms and guard against devaluing care of elders in nursing education and in nursing practice. Nursing also has a commitment to the whole and must balance the populations/content areas to assure that the appropriate preparation is in place. The health of elders and of children depends on our actions. We must ask ourselves: Do we want to raise our children in a society that neglects them? Do we want to raise our children in a society that neglects their grandparents?