- Email: [email protected]
The most rewarding work
"No therapy or drug will substitute for the skilled, thoughtful nursing care that helps restore our elders." mates of millions more in the community who could benefit from appropriate care."(2). Capping those staggering statistics are the estimate that Alzheimer's disease is the fourth or fifth leading cause of death among the elderly in the U.S., and the tremendous nursing care needs of middleaged and elderly persons with Alzheimer's disease (3-5). Because the problem is so vast and the numbers of qualified staff so few, the care provided to the aging is often poor. Yet, in 1979, Gunter and Estes found little evidence that nursing is making any concerted effort to remedy this problem through the basic education of nurses, and these researchers remind us that gerontological nursing still is not included in the nurse licensure examinations (6). There is a need for nurses who have specialized in the care of the
aged at both the master's degree and the doctoral level. A physician searching for nursing faculty recently wrote me that gerontological nurse practitioners "are as scarce as hen's teeth." But that, too, is changing as more nurses enroll in practitioner programs. Interest in children and youth still predominates, even in nursing schools. An encouraging sign, h<;>wever, is the establishment, in the late 1970s, of at least eight master's degree programs to prepare nurses specifically for primary health care of the older adult. Disincentives The reluctance of nurses' to specialize in the care of the older adult is not entirely without reason. The salaries of nurses employed in skilled nursing or intermediate care facilities are often $8.00 per shift less than salaries in acute care hospitals. Where I live, handymen sometimes earn more than nurses in SNFs. Frequently, the workloads in long-term care facilities are better suited to mules than to humans. In 1974, out of 12,600 nursing homes surveyed by the Department of Health, Education, and Welfare, only 3,600 had registered nurses on duty for three shifts (7). This
means that most nursing home RNs must worry not only about their own shifts but also about the shifts that do not have registered personnel in charge. No wonder the burnouts continue in long-term care units across the country. And though burnout spreads like California brush fires, I find little in the literature about the problem in these facilities or how to handle it. The high rate of burnout and the reluctance of nurses to work in extended-care facilities or, I fear, with the increasingly older populations in short-term facilities often mean that positions are not filled. So, why does a nurse in her right mind enter the field of gerontological nursing? What are the incentives? Are there any rewards? Motivations One motivation, odd though it may seem, is the extent of the problems. Nurses tend to be relatively altruistic persons, who find purpose for their own lives by helping people in need. Some find the greatest sense of purpose by helping where the need is greatestand I am not suggesting that a desire for martyrdom is their motivation. Many nurses are "ou't there" working on a one-to-one basis to
The Most Rewarding Work Down the hall 78-year-old Ms. Murcheson is going home. The fractured hip has healed nicely. She gets around quite well with a walker. After months of therapy her right wrist functions properly. She is happy to be going home. Her family is pleased. We rejoice with them. Yesterday, Ms. Dwyer, 96 years old, returned from the hospital. She fell in her room four weeks ago, fracturing the neck of the right femur. A hip replacement was done instead of the usual pinning. During her hospital stay she became disoriented and confused. She puJled out her catheter, and restraints were necessary when intravenous fluids were administered. Often Ms. Dwyer did not recognize her daughter. She would make no effort to feed herself, and turned her face away when the nurses tried to feed her.
30 Gerialric Nursing May/June 1980
Ms. Dwyer returned by ambulance. Besides an Ace bandage on her right thigh, she was wearing Kling dressings and heel protectors to cover large decubitus ulcers with half-dollar-size necrotic areas on both heels. After adjusting the side rails a'nd placing the calli bell in her hand because of her blindness, I stooped and said into her ear, "Honey, it's nice to have you back." . Her eyes came alive, and for the first time she spoke, ··It's Mrs. . . .? Mrs. . . ?" She couldn't remember my name so I told her. "I'd know that voice anywhere," she said. "It's so good to be back. Lean down here and I'll hug you." The hug was weak but I never had a warmer one. Ms. Cottle's eyes seem to plead, "Please be patient with me." She sits in a wheelchair, laprobeover her
rick, Virginia Stone, Sister Marilyn Schwab, Doris Schwartz, Bernita Stem and many more whose names escape me as I write this quiet Saturday morning. Some nurses find excitement in the challenge of improving the system, in battling with bureaucracies and funding agencies. Others are expert in assessment and planning care for elderly clients; The Elderly Themsehes
"Remember that 'he who laughs, lasts' -it will relieve many tensions,"
improve the health care and the lives of the elderly in their particular corners of the system. The fine nursing papers presented at recent national and international gerontology conferences prove what nurses are accomplishing "out -there": the nurses at Triage, Inc., for example, under Joan Quinn's leadership; and Mary Opal Wolanin's presentation in To-
kyo about translocation trauma. Olivia Cameron, geriatric nurse practitioner from San Antonio, Texas, who appeared on "Over Easy" was a credit to gerontological nursing. And then there are the educators who have been trailblazing and encouraging their students to do the same: Dolores Alford, Dorothy Blake, Sally Buseck, Maxine Pat-
legs. "I went down to that party last night. It wasn't much of a party. They served little bits of food. I didn't know if I was to payor not, but I didn't have any money so I just walked out. I didn't know how I was going to get home. Then I saw Dick pushing Mrs. Smith and I asked him to take me home. They put me to bed but I couldn't go to sleep because I didn't know where I was Dr where my things were. Then I heard someone coughing and I didn't know who it was or why she was in my room. And people were laughing and I wondered why they were laughing at me." Ms. Cottle's hands, gripped in her lap, tremble. "Am I going crazy? It all seems unreal and I can't sort anything out." These are not the ramblings caused by drug overdose, but the toll of chronic brain syndrome. Ms. Cottle's family visits and they are concerned. Their eyes are full of questions, but they only ask, "How is mama?" The staff questions: "Why is she so confused? What can we do? Why doesn't the doctor do something?"
What motivates many nurses who choose gerontological nursing is simply the old people themselves. Initially, students or graduate nurses may be depressed by their early clinical experiences with the aged-there is, after all, no drug or therapy that will "cure" old age, that will substitute for the skilled, thoughtful nursing care that helps restore our elders. The nurses whom I observe conquer depression by growing in selfawareness, by learning to overcome their own fear of aging, and by readjusting their goals and expectations of health care toward helping old people live a fulfilling life. Gradually, nurses adjust as they meet older persons whose courage, or wisdom, or ability to handle grief, or ability to view life with . perspective and humor seems to
The physician says, "Probably a slight stroke; nothing I can do." Day after day we shower her with TLC, reinforcing reality, and trying to keep her active and involved. We are smiling and cheerful, but inwardly we cry. It is true that nursing home work is hard. The hours are long. It is often depressing and usually frustrating. You are lost under mountains of paper work. For every family that is pleased, another is unhappy. But the Ms. Murchesons, the Ms. Dwyers, and even the Ms. Cotties make it all worthwhile. To see total recovery or to see a paralyzed person move a finger or blink an eye in response spurs you on. Each small victory is a cause to rejoice. These and the warm appreciation from families "for the good care you have given mother" are my thanks-and my stimulus. If a new graduate nurse asks what kind of work she should do, I say, "Try a nursing home. It's the most rewarding work you can do."-Edith Cowan, R.N., supervisor, Colonial Acres Nursing Home. Chanute. Kansas.
Geriatric Nursing May/June 198031
demonstrate the best characteristics of being human. The aged are our best teachers about the process of aging, in which all of us arc involved. The poem on this page captures well the rewards of working with the aged. Among the traits of the aged that have made my work fascinating are the intriguing characteristics identified by Robert Butler: the older person's change in the sense of time, sense of the life cycle, tendency toward the life review, reparation and resolution, attachment to the familiar, conservation of continuity, desire to leave a legacy, transmission of power, sense of fulfillment in life, and capacity for growth (8). Their Gratitude Martin Buber wrote that no one can say "thank you" the wayan old person can (9). Perhaps the aged express their gratitude so freely and intensely because so little is done for them. But it is also possible that one learns how to show appreciation only late in life, after the passion and hurly-burly of youth are over. And perhaps the· loss of friends and relatives that all old
people experience makes them eager to seize every opportunity to say thanks. Whatever the reason, these men and women who lived through the terrible depression, eating popcorn for breakfast and going hungry, do find ways to express their gratitude. Barchilon described the profound significance of a hard-boiled egg she received from an elderly woman in a nursing home who had known poverty most of her life (10). Money is often presented by people who have very little of their own. An 86-year-old resident in a nursing home had spent 10 years in a wheelchair, with all of $13 per month to spend for his beloved snuff and gingersnaps. Imagine how I felt as he gave me a wadded up two-dollar bill at Christmas from the wallet he sat on so he would not lose it. Can we learn to receive such "trivial" presents with the thoughtfulness given, and to understand the value of the gift? Their Resourcefulness I have written elsewhere of the problem-solving abilities of the older person (11). Recently, I interviewed an 80-year-old Portuguese
Learning Top From Bottom That wrinkled shell has more than darkness to shout about! More than loneliness to wrap about thin shoulders, More than pain has coursed through those bones! Those lips have drunk long and fully from the cup of life and have known songs and dances and thrills I'll never touch. That wondrous mind has filtered through countless experiences and distilled life's real meaningwhat's worth dancing for, and what isn't; What little can be held tightly in one's hands, and what unbounded treasures can be stored in one's heart! . This incredible person knows what I have not discerned well yet; that life is not determined by what we do, or have-not even by our friends; relatives, and loved ones-and is lit from the heart. Sister Patricia Murphy, O.L.V.M. From Healing with Time and Love; a Guidefor Visiting the Elderly. The Ethel Percy Andrus Gerontology Center. University of Southern California. Los Angeles. 1979. p.46. Reprinted with permission from the author and publisher.
32 Geriatric Nursing May/June 1980
lady for a class. Afterwards a student explained how the woman managed to hang onto her money and not have it pilfered in spite of her severe memory loss and a confusional state caused by malnutrition and dehydration. She kept her money wrapped in small squares of aluminum foil in an Ex-Lax box. No one ever bothered to check whether the foil contained Ex-Lax. A man who had once been in a group of mine was pleased when I stopped by during the holidays to visit him in the nursing home. "Would you like some Christmas cheer, Ms. Burnside?" "Of course." I said, laughing, because I knew that the straightlaced administration ran the home as if prohibition was still here. From a bunch of dirty socks in his bedside stand, he pulled out a small flask of good whiskey. With unsteady hands, he fixed me Irish coffee, using the coffee from his supper tray, and apologized be-· cause there was no whipped cream. Then he smiled, slyly. "My socks smell so bad that no one ever wants to clean out that drawer." Most aged persons are walking history books and eager to share that history once they realize that it's all right to reminisce and not a sign of a failing mind. We find our own Jane Pittmans and George Burnses as we begin to listen to their life stories and descriptions of the era and the places where they have lived. We just need to spend more time listening attentively. The uniqueness of each aged person becomes more impressive the longer one works with them. They tend to respect your individualism, your right to be you. Often they will encourage you as you struggle with your own "becoming." They not only dare to be different, but they have nothing to lose and can thumb their noses at the world. If they have too much flair, of course, we tend to write them off as eccentric. Ordinarily, the famous are allowed more eccentricity than the rest of us. But I am reminded of the tolerant, obliging staff in a nursing home in Riverside, California. One
"Most aged persons are walking history books and eager to share their past."
very old resident insisted on having eight wash cloths daily. She used them to pull up sagging chins, cover scrawny elbows, encircle both wrists, and I forget where else: Oh, yes, one was around her forehead as though she might at any minute decide to go jogging! An understanding staff that can find eight wash cloths at bath time speaks well for that nursing home. Capacity for Love We should study our elders' capacity for loving and caring. They reach out to their caregivers, frequently with genuine compassion. Often; aged clients have expressed concern that I did not look well or seemed tired. During a crisis in my life, I was deeply touched when I discovered that the women in my group were praying for me. Spontaneity and Humor The spontaniety of old people is delightful. Even the grossly confused person can be both spontaneous and charming. Recently another instructor" asked me to see a confused man in a nursing home, but warned that he could be really quite 0l!t of it. He was asleep in his wheelchair as I approached. I spoke his name, then squatted in front of the wheelchair so that I might see his face. Slowly he opened his eyes, looked at me-and winked! I winked back
and we both laughed. Then in a very clear, steady voice he said, "That gets them every time." Many a very old soul can teach us what humor is all about and add zest to our work. The jokes are often so ancient that I have never heard them. Or their wit is so dry and. subtle that it almost escapes me. A w.ag said, "He who laughs, lasts." Remember that-it will relieve many of the tensions. I think the complexity of caring for patients with multiple diagnoses and intricate psychosocial problems is the greatest incentive for most of us. Complexity exists both in the direct care-the laying-onof-hands-and the indirect careeducation, research, and administration. Wells points out that "commitment is recognizing that there is little known about ~ffective nursing of the old and searching to find new knowledge"(12). We are, in a sense, pioneers who have a chance to devise new methods to deal with serious problems. This gives us a unique opportunity to' shape our professional careers, as the nurses who have pioneered reality orientation have done. We just must communicate this sense of creative excitement and opportunity to students and to nurses, along with a sense of the great need for them and the rewards of the career.
Perhaps most important, if gerontological nursing is to become truly rewarding, wherever it is practiced, we must view ourselves in a positive way. The positive ways are many: reassuring scared new students, young graduates, or older nurses returning to practice; writing a chapter in an all-doctor contributed book, writing our own books and articles about the state of the art, or doing independent study to expand our knowledge. If we feel good about ourselves and our abilities, we can move a mountain or two. And when we doubt that, well, all we need to do is ask our elders. They will tell us quite frankly how good we are and what we mean to them. References
I. Moran, Joyce. Sex;uality: an ageless quality, a basic need. J. Gerontol.
Nurs. 5:16, Sept.-Oct. 1979. 2. Eisdorfer, Carl, and Cohen, Donna. The ~ognitively impaired elderly: differential diagnosis. In The Clinical Psychology of Aging. ed. by Martha Storandt and others. New York, Plenum Publishing Co., 1978, p. 7. 3. Katzman, Robert. The prevalence and malignancy of Alzheimer disease. A major killer. (editorial) Arch. Neurol. 33:217,218. Apr. 1976. 4. Burnside, I.M. Alzheimer's disease: an overview. J. Gerontol. Nurs. 5:14-20, July-Aug. 1979. 5. Bartol, M.A. Dialogue with dementia: nonverbal communication in patients with Alzheimer's disease. J. Gerontol. Nurs.5:21-31, July-Aug. 1979. 6. Gunter, L.M., and Estes, C.A. Tomorrow's aged: impact of transgenerational trends on nursing education. ANA Publ. G-135: 86-95, 1976. 7. U.S. Health, Education, and Welfare Department. Month. Vital Stat. Rep. Sept. 5, 1974. 8. Butler, R.N. Why Survive? Being Old in America. New York, Harper & Row, 1975, pp. IX, X. 9. Buber, Martin. I and Thou. New York, Charles Scribner's Sons, 1970. Interview with a 10. Barchilon, B.N. Nursing Home Resident. Paper presented for class, Arizona State University, May 1977. II. Burnside, I.M. Listen to the aged. Am. J. Nurs. 75:1801-1803, Oct. 1975. 12. Wells, T.J. Nursing committed to the elderly. In Current Practice in Gerontological Nursing. ed. by A.M. Rein. hardt and M. D. Quinn. St. Louis, C.Y. Mosby Co., 1979, p. 195.
Geriatric Nursing May/June 198033
aged at both the master's degree and the doctoral level. A physician searching for nursing faculty recently wrote me that gerontological nurse practitioners "are as scarce as hen's teeth." But that, too, is changing as more nurses enroll in practitioner programs. Interest in children and youth still predominates, even in nursing schools. An encouraging sign, h<;>wever, is the establishment, in the late 1970s, of at least eight master's degree programs to prepare nurses specifically for primary health care of the older adult. Disincentives The reluctance of nurses' to specialize in the care of the older adult is not entirely without reason. The salaries of nurses employed in skilled nursing or intermediate care facilities are often $8.00 per shift less than salaries in acute care hospitals. Where I live, handymen sometimes earn more than nurses in SNFs. Frequently, the workloads in long-term care facilities are better suited to mules than to humans. In 1974, out of 12,600 nursing homes surveyed by the Department of Health, Education, and Welfare, only 3,600 had registered nurses on duty for three shifts (7). This
means that most nursing home RNs must worry not only about their own shifts but also about the shifts that do not have registered personnel in charge. No wonder the burnouts continue in long-term care units across the country. And though burnout spreads like California brush fires, I find little in the literature about the problem in these facilities or how to handle it. The high rate of burnout and the reluctance of nurses to work in extended-care facilities or, I fear, with the increasingly older populations in short-term facilities often mean that positions are not filled. So, why does a nurse in her right mind enter the field of gerontological nursing? What are the incentives? Are there any rewards? Motivations One motivation, odd though it may seem, is the extent of the problems. Nurses tend to be relatively altruistic persons, who find purpose for their own lives by helping people in need. Some find the greatest sense of purpose by helping where the need is greatestand I am not suggesting that a desire for martyrdom is their motivation. Many nurses are "ou't there" working on a one-to-one basis to
The Most Rewarding Work Down the hall 78-year-old Ms. Murcheson is going home. The fractured hip has healed nicely. She gets around quite well with a walker. After months of therapy her right wrist functions properly. She is happy to be going home. Her family is pleased. We rejoice with them. Yesterday, Ms. Dwyer, 96 years old, returned from the hospital. She fell in her room four weeks ago, fracturing the neck of the right femur. A hip replacement was done instead of the usual pinning. During her hospital stay she became disoriented and confused. She puJled out her catheter, and restraints were necessary when intravenous fluids were administered. Often Ms. Dwyer did not recognize her daughter. She would make no effort to feed herself, and turned her face away when the nurses tried to feed her.
30 Gerialric Nursing May/June 1980
Ms. Dwyer returned by ambulance. Besides an Ace bandage on her right thigh, she was wearing Kling dressings and heel protectors to cover large decubitus ulcers with half-dollar-size necrotic areas on both heels. After adjusting the side rails a'nd placing the calli bell in her hand because of her blindness, I stooped and said into her ear, "Honey, it's nice to have you back." . Her eyes came alive, and for the first time she spoke, ··It's Mrs. . . .? Mrs. . . ?" She couldn't remember my name so I told her. "I'd know that voice anywhere," she said. "It's so good to be back. Lean down here and I'll hug you." The hug was weak but I never had a warmer one. Ms. Cottle's eyes seem to plead, "Please be patient with me." She sits in a wheelchair, laprobeover her
rick, Virginia Stone, Sister Marilyn Schwab, Doris Schwartz, Bernita Stem and many more whose names escape me as I write this quiet Saturday morning. Some nurses find excitement in the challenge of improving the system, in battling with bureaucracies and funding agencies. Others are expert in assessment and planning care for elderly clients; The Elderly Themsehes
"Remember that 'he who laughs, lasts' -it will relieve many tensions,"
improve the health care and the lives of the elderly in their particular corners of the system. The fine nursing papers presented at recent national and international gerontology conferences prove what nurses are accomplishing "out -there": the nurses at Triage, Inc., for example, under Joan Quinn's leadership; and Mary Opal Wolanin's presentation in To-
kyo about translocation trauma. Olivia Cameron, geriatric nurse practitioner from San Antonio, Texas, who appeared on "Over Easy" was a credit to gerontological nursing. And then there are the educators who have been trailblazing and encouraging their students to do the same: Dolores Alford, Dorothy Blake, Sally Buseck, Maxine Pat-
legs. "I went down to that party last night. It wasn't much of a party. They served little bits of food. I didn't know if I was to payor not, but I didn't have any money so I just walked out. I didn't know how I was going to get home. Then I saw Dick pushing Mrs. Smith and I asked him to take me home. They put me to bed but I couldn't go to sleep because I didn't know where I was Dr where my things were. Then I heard someone coughing and I didn't know who it was or why she was in my room. And people were laughing and I wondered why they were laughing at me." Ms. Cottle's hands, gripped in her lap, tremble. "Am I going crazy? It all seems unreal and I can't sort anything out." These are not the ramblings caused by drug overdose, but the toll of chronic brain syndrome. Ms. Cottle's family visits and they are concerned. Their eyes are full of questions, but they only ask, "How is mama?" The staff questions: "Why is she so confused? What can we do? Why doesn't the doctor do something?"
What motivates many nurses who choose gerontological nursing is simply the old people themselves. Initially, students or graduate nurses may be depressed by their early clinical experiences with the aged-there is, after all, no drug or therapy that will "cure" old age, that will substitute for the skilled, thoughtful nursing care that helps restore our elders. The nurses whom I observe conquer depression by growing in selfawareness, by learning to overcome their own fear of aging, and by readjusting their goals and expectations of health care toward helping old people live a fulfilling life. Gradually, nurses adjust as they meet older persons whose courage, or wisdom, or ability to handle grief, or ability to view life with . perspective and humor seems to
The physician says, "Probably a slight stroke; nothing I can do." Day after day we shower her with TLC, reinforcing reality, and trying to keep her active and involved. We are smiling and cheerful, but inwardly we cry. It is true that nursing home work is hard. The hours are long. It is often depressing and usually frustrating. You are lost under mountains of paper work. For every family that is pleased, another is unhappy. But the Ms. Murchesons, the Ms. Dwyers, and even the Ms. Cotties make it all worthwhile. To see total recovery or to see a paralyzed person move a finger or blink an eye in response spurs you on. Each small victory is a cause to rejoice. These and the warm appreciation from families "for the good care you have given mother" are my thanks-and my stimulus. If a new graduate nurse asks what kind of work she should do, I say, "Try a nursing home. It's the most rewarding work you can do."-Edith Cowan, R.N., supervisor, Colonial Acres Nursing Home. Chanute. Kansas.
Geriatric Nursing May/June 198031
demonstrate the best characteristics of being human. The aged are our best teachers about the process of aging, in which all of us arc involved. The poem on this page captures well the rewards of working with the aged. Among the traits of the aged that have made my work fascinating are the intriguing characteristics identified by Robert Butler: the older person's change in the sense of time, sense of the life cycle, tendency toward the life review, reparation and resolution, attachment to the familiar, conservation of continuity, desire to leave a legacy, transmission of power, sense of fulfillment in life, and capacity for growth (8). Their Gratitude Martin Buber wrote that no one can say "thank you" the wayan old person can (9). Perhaps the aged express their gratitude so freely and intensely because so little is done for them. But it is also possible that one learns how to show appreciation only late in life, after the passion and hurly-burly of youth are over. And perhaps the· loss of friends and relatives that all old
people experience makes them eager to seize every opportunity to say thanks. Whatever the reason, these men and women who lived through the terrible depression, eating popcorn for breakfast and going hungry, do find ways to express their gratitude. Barchilon described the profound significance of a hard-boiled egg she received from an elderly woman in a nursing home who had known poverty most of her life (10). Money is often presented by people who have very little of their own. An 86-year-old resident in a nursing home had spent 10 years in a wheelchair, with all of $13 per month to spend for his beloved snuff and gingersnaps. Imagine how I felt as he gave me a wadded up two-dollar bill at Christmas from the wallet he sat on so he would not lose it. Can we learn to receive such "trivial" presents with the thoughtfulness given, and to understand the value of the gift? Their Resourcefulness I have written elsewhere of the problem-solving abilities of the older person (11). Recently, I interviewed an 80-year-old Portuguese
Learning Top From Bottom That wrinkled shell has more than darkness to shout about! More than loneliness to wrap about thin shoulders, More than pain has coursed through those bones! Those lips have drunk long and fully from the cup of life and have known songs and dances and thrills I'll never touch. That wondrous mind has filtered through countless experiences and distilled life's real meaningwhat's worth dancing for, and what isn't; What little can be held tightly in one's hands, and what unbounded treasures can be stored in one's heart! . This incredible person knows what I have not discerned well yet; that life is not determined by what we do, or have-not even by our friends; relatives, and loved ones-and is lit from the heart. Sister Patricia Murphy, O.L.V.M. From Healing with Time and Love; a Guidefor Visiting the Elderly. The Ethel Percy Andrus Gerontology Center. University of Southern California. Los Angeles. 1979. p.46. Reprinted with permission from the author and publisher.
32 Geriatric Nursing May/June 1980
lady for a class. Afterwards a student explained how the woman managed to hang onto her money and not have it pilfered in spite of her severe memory loss and a confusional state caused by malnutrition and dehydration. She kept her money wrapped in small squares of aluminum foil in an Ex-Lax box. No one ever bothered to check whether the foil contained Ex-Lax. A man who had once been in a group of mine was pleased when I stopped by during the holidays to visit him in the nursing home. "Would you like some Christmas cheer, Ms. Burnside?" "Of course." I said, laughing, because I knew that the straightlaced administration ran the home as if prohibition was still here. From a bunch of dirty socks in his bedside stand, he pulled out a small flask of good whiskey. With unsteady hands, he fixed me Irish coffee, using the coffee from his supper tray, and apologized be-· cause there was no whipped cream. Then he smiled, slyly. "My socks smell so bad that no one ever wants to clean out that drawer." Most aged persons are walking history books and eager to share that history once they realize that it's all right to reminisce and not a sign of a failing mind. We find our own Jane Pittmans and George Burnses as we begin to listen to their life stories and descriptions of the era and the places where they have lived. We just need to spend more time listening attentively. The uniqueness of each aged person becomes more impressive the longer one works with them. They tend to respect your individualism, your right to be you. Often they will encourage you as you struggle with your own "becoming." They not only dare to be different, but they have nothing to lose and can thumb their noses at the world. If they have too much flair, of course, we tend to write them off as eccentric. Ordinarily, the famous are allowed more eccentricity than the rest of us. But I am reminded of the tolerant, obliging staff in a nursing home in Riverside, California. One
"Most aged persons are walking history books and eager to share their past."
very old resident insisted on having eight wash cloths daily. She used them to pull up sagging chins, cover scrawny elbows, encircle both wrists, and I forget where else: Oh, yes, one was around her forehead as though she might at any minute decide to go jogging! An understanding staff that can find eight wash cloths at bath time speaks well for that nursing home. Capacity for Love We should study our elders' capacity for loving and caring. They reach out to their caregivers, frequently with genuine compassion. Often; aged clients have expressed concern that I did not look well or seemed tired. During a crisis in my life, I was deeply touched when I discovered that the women in my group were praying for me. Spontaneity and Humor The spontaniety of old people is delightful. Even the grossly confused person can be both spontaneous and charming. Recently another instructor" asked me to see a confused man in a nursing home, but warned that he could be really quite 0l!t of it. He was asleep in his wheelchair as I approached. I spoke his name, then squatted in front of the wheelchair so that I might see his face. Slowly he opened his eyes, looked at me-and winked! I winked back
and we both laughed. Then in a very clear, steady voice he said, "That gets them every time." Many a very old soul can teach us what humor is all about and add zest to our work. The jokes are often so ancient that I have never heard them. Or their wit is so dry and. subtle that it almost escapes me. A w.ag said, "He who laughs, lasts." Remember that-it will relieve many of the tensions. I think the complexity of caring for patients with multiple diagnoses and intricate psychosocial problems is the greatest incentive for most of us. Complexity exists both in the direct care-the laying-onof-hands-and the indirect careeducation, research, and administration. Wells points out that "commitment is recognizing that there is little known about ~ffective nursing of the old and searching to find new knowledge"(12). We are, in a sense, pioneers who have a chance to devise new methods to deal with serious problems. This gives us a unique opportunity to' shape our professional careers, as the nurses who have pioneered reality orientation have done. We just must communicate this sense of creative excitement and opportunity to students and to nurses, along with a sense of the great need for them and the rewards of the career.
Perhaps most important, if gerontological nursing is to become truly rewarding, wherever it is practiced, we must view ourselves in a positive way. The positive ways are many: reassuring scared new students, young graduates, or older nurses returning to practice; writing a chapter in an all-doctor contributed book, writing our own books and articles about the state of the art, or doing independent study to expand our knowledge. If we feel good about ourselves and our abilities, we can move a mountain or two. And when we doubt that, well, all we need to do is ask our elders. They will tell us quite frankly how good we are and what we mean to them. References
I. Moran, Joyce. Sex;uality: an ageless quality, a basic need. J. Gerontol.
Nurs. 5:16, Sept.-Oct. 1979. 2. Eisdorfer, Carl, and Cohen, Donna. The ~ognitively impaired elderly: differential diagnosis. In The Clinical Psychology of Aging. ed. by Martha Storandt and others. New York, Plenum Publishing Co., 1978, p. 7. 3. Katzman, Robert. The prevalence and malignancy of Alzheimer disease. A major killer. (editorial) Arch. Neurol. 33:217,218. Apr. 1976. 4. Burnside, I.M. Alzheimer's disease: an overview. J. Gerontol. Nurs. 5:14-20, July-Aug. 1979. 5. Bartol, M.A. Dialogue with dementia: nonverbal communication in patients with Alzheimer's disease. J. Gerontol. Nurs.5:21-31, July-Aug. 1979. 6. Gunter, L.M., and Estes, C.A. Tomorrow's aged: impact of transgenerational trends on nursing education. ANA Publ. G-135: 86-95, 1976. 7. U.S. Health, Education, and Welfare Department. Month. Vital Stat. Rep. Sept. 5, 1974. 8. Butler, R.N. Why Survive? Being Old in America. New York, Harper & Row, 1975, pp. IX, X. 9. Buber, Martin. I and Thou. New York, Charles Scribner's Sons, 1970. Interview with a 10. Barchilon, B.N. Nursing Home Resident. Paper presented for class, Arizona State University, May 1977. II. Burnside, I.M. Listen to the aged. Am. J. Nurs. 75:1801-1803, Oct. 1975. 12. Wells, T.J. Nursing committed to the elderly. In Current Practice in Gerontological Nursing. ed. by A.M. Rein. hardt and M. D. Quinn. St. Louis, C.Y. Mosby Co., 1979, p. 195.
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