Aid for the aide and the aged

EDITORIAL Aid for the Aide and the Aged "Being an aide is kind of tough," says Jan Rick in her poem accompanying an article in this issue, " A New Perspective on Nurse's Aide Training," by Jane Barney. In light of that article and poem, one session in the 1982 Gerontological Society meeting seems especially pertinent for all who work with nursing home residents. At that session the staff of a project sponsored by T h o m a s Jefferson University in Philadelphia, Pennsylvania, described a remarkably successful inservice program conducted in four skilled nursing facilities that employ 155 aides and have a large population of former psychiatric patients. Three clinical nurse specialists taught the 12-week course, basing it entirely on the learning needs those aides identified. More than 40 percent perceived a need for training in basic nursing skills and for information about physical illness. Initially, fewer than 10 percent of the aides saw a need for information on mental illness. As their learning increased, however, more aides expressed a desire for mental health content. Attendance was voluntary and it increased over the three months. At the final session, over 60 percent of the aides rated the program as very beneficial. Even more impressive, 87 percent rated it that way 12 weeks after the program had ended. T h e greatest benefit to the aides, however, according to the project evaluator, was the strong supportive relationships that the aides developed with the three clinical nurses specialists. Inservice education for aides has, of course, been provided by nursing departments in medical center and community hospitals since the 1950s. Now it is offered in long-term care facilities. But it is sporadic. The amount and quality vary w i d e l y - often providing just enough hours to satisfy Federal and state regulations, and content with little relevance to aides' needs or interests. Aides deserve better. T o d a y it is usually the aide who is present with the resident seven days a week, around the clock, the aide who assists the resident with bathing, eating, dressing, toileting, and getting to and from scheduled activities. Those actions do not encompass all of nursing, but they certainly are a critical part of it. Aides help nurses, physicians, and therapists with the day-by-day care of the 1,126,000 elders who reside in skilled, intermediate, or health-related facilities. Some of those residents, and many of their families, complain that their care is substandard. Too m a n y administrators and nursing directors reply that qualified aides are scarce and inservice costs too much. Is it not high time for all disciplines, particularly nursing, to help aides become qualified for their very demanding work and derive satisfaction from it? T h r e e choices seem possible. One is to continue talking about the nurse's 24-hour presence with the resident, largely ignoring the aide's contribution, (the head-in-the-sand option). The second is for droves of R N s to seek employment in nursing homes (best'option but apt to be resisted on budgetary grounds). The third choice for nurses is to (1) work individually and collectively, through the American Nurses' Association and the network of age-related groups, for the establishment of sound preservice and inservice programs for aides; (2) lobby state legislators to mandate aide certification (as California nurses have done successfully); and (3) promote the inclusion of content on nurse-nurse's aide relationships in all schools of nursing.. To advocate for our elders, we had best aid their and our invaluable aides.

Geriatric Nursing January/February 1983 21