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Consider the consequences
FROM
THE
EDITOR
Consider the Consequences T h i s effort began with a clear in- and Aging, was our Bible. Let Marianne know of any J. tention of developing a treatise texts you believe should be reviewed. Second, Dr. Virginia Brooke and the reviewers have on the fundamental importance of basic care to geriatric nursing--the functioned unofficially to keep us on target regarding the most essential aspects of real nurs- strength and validity of research backing the articles we ing: caring, comfort, continuity, publish. We believe that, although this is not an official collaboration, all the elements that research-oriented journal, we should critique the strength support client coping and healing. of research that underlies the clinical decisions that are But then I spent a day with Mary being made by those in the field. With that in mind, we Opal Wolanin, my fount of wis- have asked Virginia to provide critiques of research that dom, in San Antonio, Texas. She has significant clinical applicability. The consequences of said the most important thing we must do right now, in this new feature may enhance clinical practice and stimnursing and in life, is "consider the consequences" of ulate some nurses in the field to replicate and reinforce, every action. She is talking about long-range conse- or countermand, through research findings, some of the quences. It is not her own future that is of greatest con- decisions we now make so routinely. This effort is indeed oriented to outcomes. cern, but our future in Third, Robyn Rice, an aunursing and the future of elder care. Her thoughts The most important thing we must thor, teacher, and consultant with extensive are deep and her range of experience in the direct concern vast. Since that do right now, in nursing and in life, provision of home care brief exchange we have will provide a home care given a lot of thought to page for us in each issue. consequences and projecting the possible outcomes is "consider the consequences" of This w i l l bring us greater understanding of the rapidof our actions as much as ly advancing field of geripossible. every action. atric nursing in the home. We expect to accomplish several new things in The consequences could this new year. First, we are extend in many directions, going to begin including book reviews, topically orga- but we believe the main result will be to reinforce collabnized to give a comparative view from an expert in that oration all along the continuum of care. Our sights have specific field of focus. Dr. Marianne Matzo has agreed to been trained on sites of care for so long, that we tend to guide and oversee this process. What are the conse- think of where care is given more frequently than to quences of such action? We hope to give recognition to whom it is given. Rather than visualizing different shapes our colleagues as they publish and to assist others in se- of buildings, let us imagine the position of the patient on lecting texts that emphasize aspects of a topic that will the continuum of care. We will enjoy and be enlightened meet their needs. Because needs vary, we believe the by Robyn's contributions. comparisons and identification of strengths will be useWe also expect to focus an article in each issue on an ful. On the other hand, we will necessarily and inadver- individual nurse who has made significant contributions tently ignore some excellent work. Literally hundreds of to geriatric nursing. Although we already have numerous texts are now available that deal with some aspect of geri- ideas of people whose stories we would like to share with atrics and gerontology. Thirty years ago, they were in- you, we welcome your suggestions as well. In this issue, deed scarce. Neugarten's edited collection, Middle Age we have chosen to focus on Sister Rose Therese Bahr, the organizer of the first NGNA conference in 1985, which was held in Washington, D.C. Knowing about our roots in the past may help us direct our future. And, last, but significant to GERIATRICNURSING, Leslie Geriatr Nurs 1996;18:1-2. Flatt will bring her vast experience in journal editing to Copyright © 1996 by Mosby-Year Book, Inc. 0197-4572/96/$5.00 + 0 34/1/78851 us and will act as managing editor. Consequently, we will - --
GERIATRIC NURSING Volume 18, Number 1
Ebersole
1
have many increased capabilities. We welcome Leslie's assistance and journal management expertise. Beyond the changes we anticipate in the journal, there are other changes we do not welcome. The emphasis on "family" practice is a concern. I don't believe one nurse or one doctor or any other professional is capable of sufficient expertise to deal with the entire family in more than a superficial manner. I believe this is one trend that has not been carefully considered but happens to fit the political emphasis at present. My major concern is that the special knowledge about and special needs of the older person are in danger of being ignored before they are fully recognized. It is not acceptable for a family nurse practitioner with no other specialized credentials to be the first line, primary care provider for a frail old person with complex problems. Interdisciplinary collaboration, life-span approaches to curriculum, assistive personnel; all are important ideas that have a shaky foundation unless carefully thought through and judiciously used. What will be the outcome of these shifts in emphasis? They can be effective if a common destination has been agreed on. Where are we going?
Not only are
we
being restricted in
our use of specialists, we don't even have sufficient personnel that understand the basic needs of elders. Not only are we being restricted in our use of specialists, we don't even have sufficient personnel that understand the basic needs of elders. As an example, the functions that are fundamental to independent living and form the grounds of assessment of an elder's independence are the abilities to move about, eat, and toilet oneself. Yet the requirement that we pay attention to the dentition of an elder in our care is not emphasized in any of the textbooks or minimum data set tools. In nursing school is any serious evaluation of elders' dentition taught? Are you thinking, "Well, of course not. That is the
2
Ebersole
reahn of dentistry"? When I called the University of California Dental School seeking a geriatric dentistry consultant, they had no idea where I could find one. They do not train any nor have any emphasis on such, but they all have "lots of experience taking care of older people." I was outraged and began thinking of taking this up as a task. Why, when there is so much else to be done? Because we are slipping backward when we have barely begun to gain a foothold on the slippery slope of ageism. But there is a more personal reason. Theories are simply words until they happen to you. Then they become something quite different. Whom do you know who is 70 years or older who has all of their own teeth? Have you ever asked? Who of your older acquaintances has dentures that fit well and have been refitted recently? Where do individuals chew? Which side? Do they munch, rabbitlike, because of a lack of molars that meet? Do they have stray molars that do no good but are being preserved on principle? Is eating a pleasure or a trial? Are soft or pureed foods being eaten by the elder because they can't chew or have impaired swallowing? What are the reasons? In my era many children had some permanent teeth extracted, few had orthodontics, and none had fluoride treatments. I now have an upper and a lower major molar on the "chewing side" that do not meet but continually bump edges when I attempt to chew. One is becoming loose, and the misalignment of my jaw causes trigeminal nerve irritation and pain. Eating is no longer as enjoyable as it was, and I am beginning to lose weight. Worse, there is a tendency to blame the victim. "Well, h a v e you been flossing regularly? Do you brush after every meal? Have you had your teeth cleaned every 3 months?" Even if these actions have assumed the status of ritual in your life, it is assumed that you have somehow failed if the condition of your dentition is simply not improving. "Stop smoking! Oh! You don't smoke. Well then, perhaps more vitamin C?" I am trying to find a dentist that understands Wolanin's wariness rule, that is, what are the likely outcomes in the future of decisions we are making now. If the outcomes are unknown, one must be very wary of taking irreversible action. And thus my search for a geriatric dentist to help me make good decisions that will still feel good in the future. There is already contention among gerontologists regarding the need for geriatric certification and accreditation. We have barely touched the edge of the special needs of the aged. And yet we seem to be letting go of the idea that any special knowledge is needed. The consequences of basic care without sufficient knowledge may be grim. •
January/February 1997 GERIATRICNURSING
THE
EDITOR
Consider the Consequences T h i s effort began with a clear in- and Aging, was our Bible. Let Marianne know of any J. tention of developing a treatise texts you believe should be reviewed. Second, Dr. Virginia Brooke and the reviewers have on the fundamental importance of basic care to geriatric nursing--the functioned unofficially to keep us on target regarding the most essential aspects of real nurs- strength and validity of research backing the articles we ing: caring, comfort, continuity, publish. We believe that, although this is not an official collaboration, all the elements that research-oriented journal, we should critique the strength support client coping and healing. of research that underlies the clinical decisions that are But then I spent a day with Mary being made by those in the field. With that in mind, we Opal Wolanin, my fount of wis- have asked Virginia to provide critiques of research that dom, in San Antonio, Texas. She has significant clinical applicability. The consequences of said the most important thing we must do right now, in this new feature may enhance clinical practice and stimnursing and in life, is "consider the consequences" of ulate some nurses in the field to replicate and reinforce, every action. She is talking about long-range conse- or countermand, through research findings, some of the quences. It is not her own future that is of greatest con- decisions we now make so routinely. This effort is indeed oriented to outcomes. cern, but our future in Third, Robyn Rice, an aunursing and the future of elder care. Her thoughts The most important thing we must thor, teacher, and consultant with extensive are deep and her range of experience in the direct concern vast. Since that do right now, in nursing and in life, provision of home care brief exchange we have will provide a home care given a lot of thought to page for us in each issue. consequences and projecting the possible outcomes is "consider the consequences" of This w i l l bring us greater understanding of the rapidof our actions as much as ly advancing field of geripossible. every action. atric nursing in the home. We expect to accomplish several new things in The consequences could this new year. First, we are extend in many directions, going to begin including book reviews, topically orga- but we believe the main result will be to reinforce collabnized to give a comparative view from an expert in that oration all along the continuum of care. Our sights have specific field of focus. Dr. Marianne Matzo has agreed to been trained on sites of care for so long, that we tend to guide and oversee this process. What are the conse- think of where care is given more frequently than to quences of such action? We hope to give recognition to whom it is given. Rather than visualizing different shapes our colleagues as they publish and to assist others in se- of buildings, let us imagine the position of the patient on lecting texts that emphasize aspects of a topic that will the continuum of care. We will enjoy and be enlightened meet their needs. Because needs vary, we believe the by Robyn's contributions. comparisons and identification of strengths will be useWe also expect to focus an article in each issue on an ful. On the other hand, we will necessarily and inadver- individual nurse who has made significant contributions tently ignore some excellent work. Literally hundreds of to geriatric nursing. Although we already have numerous texts are now available that deal with some aspect of geri- ideas of people whose stories we would like to share with atrics and gerontology. Thirty years ago, they were in- you, we welcome your suggestions as well. In this issue, deed scarce. Neugarten's edited collection, Middle Age we have chosen to focus on Sister Rose Therese Bahr, the organizer of the first NGNA conference in 1985, which was held in Washington, D.C. Knowing about our roots in the past may help us direct our future. And, last, but significant to GERIATRICNURSING, Leslie Geriatr Nurs 1996;18:1-2. Flatt will bring her vast experience in journal editing to Copyright © 1996 by Mosby-Year Book, Inc. 0197-4572/96/$5.00 + 0 34/1/78851 us and will act as managing editor. Consequently, we will - --
GERIATRIC NURSING Volume 18, Number 1
Ebersole
1
have many increased capabilities. We welcome Leslie's assistance and journal management expertise. Beyond the changes we anticipate in the journal, there are other changes we do not welcome. The emphasis on "family" practice is a concern. I don't believe one nurse or one doctor or any other professional is capable of sufficient expertise to deal with the entire family in more than a superficial manner. I believe this is one trend that has not been carefully considered but happens to fit the political emphasis at present. My major concern is that the special knowledge about and special needs of the older person are in danger of being ignored before they are fully recognized. It is not acceptable for a family nurse practitioner with no other specialized credentials to be the first line, primary care provider for a frail old person with complex problems. Interdisciplinary collaboration, life-span approaches to curriculum, assistive personnel; all are important ideas that have a shaky foundation unless carefully thought through and judiciously used. What will be the outcome of these shifts in emphasis? They can be effective if a common destination has been agreed on. Where are we going?
Not only are
we
being restricted in
our use of specialists, we don't even have sufficient personnel that understand the basic needs of elders. Not only are we being restricted in our use of specialists, we don't even have sufficient personnel that understand the basic needs of elders. As an example, the functions that are fundamental to independent living and form the grounds of assessment of an elder's independence are the abilities to move about, eat, and toilet oneself. Yet the requirement that we pay attention to the dentition of an elder in our care is not emphasized in any of the textbooks or minimum data set tools. In nursing school is any serious evaluation of elders' dentition taught? Are you thinking, "Well, of course not. That is the
2
Ebersole
reahn of dentistry"? When I called the University of California Dental School seeking a geriatric dentistry consultant, they had no idea where I could find one. They do not train any nor have any emphasis on such, but they all have "lots of experience taking care of older people." I was outraged and began thinking of taking this up as a task. Why, when there is so much else to be done? Because we are slipping backward when we have barely begun to gain a foothold on the slippery slope of ageism. But there is a more personal reason. Theories are simply words until they happen to you. Then they become something quite different. Whom do you know who is 70 years or older who has all of their own teeth? Have you ever asked? Who of your older acquaintances has dentures that fit well and have been refitted recently? Where do individuals chew? Which side? Do they munch, rabbitlike, because of a lack of molars that meet? Do they have stray molars that do no good but are being preserved on principle? Is eating a pleasure or a trial? Are soft or pureed foods being eaten by the elder because they can't chew or have impaired swallowing? What are the reasons? In my era many children had some permanent teeth extracted, few had orthodontics, and none had fluoride treatments. I now have an upper and a lower major molar on the "chewing side" that do not meet but continually bump edges when I attempt to chew. One is becoming loose, and the misalignment of my jaw causes trigeminal nerve irritation and pain. Eating is no longer as enjoyable as it was, and I am beginning to lose weight. Worse, there is a tendency to blame the victim. "Well, h a v e you been flossing regularly? Do you brush after every meal? Have you had your teeth cleaned every 3 months?" Even if these actions have assumed the status of ritual in your life, it is assumed that you have somehow failed if the condition of your dentition is simply not improving. "Stop smoking! Oh! You don't smoke. Well then, perhaps more vitamin C?" I am trying to find a dentist that understands Wolanin's wariness rule, that is, what are the likely outcomes in the future of decisions we are making now. If the outcomes are unknown, one must be very wary of taking irreversible action. And thus my search for a geriatric dentist to help me make good decisions that will still feel good in the future. There is already contention among gerontologists regarding the need for geriatric certification and accreditation. We have barely touched the edge of the special needs of the aged. And yet we seem to be letting go of the idea that any special knowledge is needed. The consequences of basic care without sufficient knowledge may be grim. •
January/February 1997 GERIATRICNURSING