Sue E. Meiner, EdD, APRN, BC, GNP On completion of this chapter, the reader will be able to: 1. Trace the historic development of gerontologic nursing as a specialty. 2. Distinguish the educational preparation, practice roles, and certification requirements of the gerontologic nurse generalist, nurse practitioner, and clinical nurse specialist. 3. Discuss the major demographic trends in the United States in relation to the older adult population. 4. Describe the effects of each of the following demographic factors on the health, well-being, and life expectancy of older adults: 5. Explain why old age is considered a woman’s problem. 6. Describe the effect of functional ability on the overall health status of older adults. 7. Discuss how the “aging of the aged” will affect health care delivery. 8. Explore future trends in gerontologic nursing care along the continuum of care. 9. Explore the concept of ageism as related to the care of older adults in various settings. 10. Identify the issues influencing gerontologic nursing education. 11. Analyze the issues affecting the development and future of gerontologic nursing research. The years 1960 to 1970 were characterized by many “firsts,” as the specialty devoted to the care of older adults began its exciting development (Table 1–1). Journals, textbooks, workshops and seminars, formal education programs, professional certification, and research with a focus on gerontologic nursing have since evolved. However, the singular event that truly legitimized the specialty occurred in 1969, when a committee appointed by the ANA Division of Geriatric Nursing Practice completed the first Standards of Practice for Geriatric Nursing (ANA, 1991). These standards were widely circulated during the next several years; in 1976 they were revised, and the title was changed to Standards of Gerontological Nursing Practice. In 1981 A Statement on the Scope of Gerontological Nursing Practice was published. The revised Standards and Scope of Gerontological Nursing Practice were published in 1987, 1995, and the current 2010 edition is in press. The changes to this document reflect the comprehensive concepts and dimensions of practice for the nurse working with older adults. In 1995 the revised Scope and Standards of Gerontological Nursing Practice reflected the nature and scope of current gerontologic nursing practice but also incorporated the concepts of health promotion, health maintenance, disease prevention, and self-care. In 2004 all scope and standards of practice were combined into a set of three books known as the Nursing Scope & Standards of Practice, Nursing’s Social Policy Statement (ANA, 2003), and the Code of Ethics for Nurses with Interpretive Statements (ANA, 2001). “These three resources provide a complete and definitive description for better understanding by specialty nursing organizations, policy makers, and the public of nursing practice and nursing’s accountability to the public in the United States” (ANA, 2004, p. vi). This merging of the standards of practice of all the specialties was an effort to outline the expectations of the professional role within which all registered nurses must practice nursing. However, with the tremendous increase in care of the older adult, the ANA has again published Scope and Standards of Gerontological Nursing Practice with input from nurses across the United States before the final publishing in 2010. This document can be obtained from the ANA website: www.nursingworld.org/. TABLE 1–1 DEVELOPMENT OF GERONTOLOGIC NURSING: 1960–1970 Modified from Burnside IM: Nursing and the aged: a self care approach, ed 3, New York, 1988, McGraw-Hill. Another hallmark in the continued growth of the gerontologic nursing specialty occurred in 1973, when the first gerontologic nurses were certified through the ANA. Certification is an additional credential granted by the ANA, providing a means for recognizing excellence in a clinical or functional area (ANA, 1995). Certification is usually voluntary, enabling the nurse to demonstrate to peers and others that a distinct degree of knowledge and expertise has been achieved. In some cases, certification can mean eligibility for third-party reimbursement for nursing services rendered. From the initial certification offering as a generalist in gerontologic nursing, to the first gerontologic nurse practitioner (GNP) examination offering in 1979, to the most recent gerontologic clinical nurse specialist (GCNS) examination (first administered in 1989), this specialty has continued to grow and attract a high level of interest. Eligibility criteria for the application process to take any one of the three certification examinations can be found in Box 1–1. • Geriatrics—from the Greek geras, meaning “old age,” geriatrics is the branch of medicine that deals with the diseases and problems of old age. Viewed by many nurses as having limited application to nursing because of its medical and disease orientation, the term geriatrics is generally not used when describing the nursing of older adults. • Gerontology—from the Greek geron, meaning “old man,” gerontology is the scientific study of the process of aging and the problems of aged persons; it includes biologic, sociologic, psychologic, and economic aspects. • Gerontologic nursing—this specialty of nursing involves assessing the health and functional status of older adults, planning and implementing health care and services to meet the identified needs, and evaluating the effectiveness of such care. Gerontologic nursing is the term most often used by nurses specializing in this field. • Gerontic nursing—this term was developed by Gunter and Estes in 1979 and is meant to be more inclusive than geriatric or gerontologic nursing because it is not limited to diseases or scientific principles. Gerontic nursing connotes the nursing of older persons—the art and practice of nurturing, caring, and comforting. This term has not gained wide acceptance, but it is viewed by some as a more appropriate description of the specialty. For several decades, the American Association of Retired Persons (AARP) maintained a yearly update of the profile of older adults in America. This organization is a nonprofit, nonpartisan membership organization for people age 50 or older. The AARP is dedicated to enhancing the quality of life for all Americans as they age. The association acknowledges that its members receive a wide range of unique benefits, special products, and services. Additional information can be found at their website: www.aarp.org. In 1997 the organization stopped compiling profile demographics and began to collect more specific data on a narrower scope. The federal government maintains aging statistics that are available to the public. These publications include an annual chart book with the name of the year. Information can be found at www.agingstats.gov/agingstatsdotnet/Main_Site/Data/2008_Documents/OA_2008.pdf. Use the exact year (e.g., 2010) at the end of the web address for a specific year. This is now a part of public census and reporting efforts. Not only are large numbers of persons living to age 65 but they are also living to older ages. When the current figures are validated, the population aged 85 or older is expected to be 5.7 million in 2010 and increase to 6.6 million by 2020. Data obtained in 2007 found that adults 65 or older numbered 3.8 million, which is an increase of 11.2% since 1997. The number of Americans aged 45 to 64, who will reach 65 over the next 20 years, increased by 38% during this past decade. One person in every eight is an older American. That accounts for 12.6% of the United States population (AOA, 2008). See Fig. 1–1 for population trends of persons 65 years or older through 2030.
Overview of Gerontologic Nursing
Foundations of the Specialty of Gerontologic Nursing
Standards of Practice
YEAR
EVENT
1961
Formation of a specialty group for geriatric nurses is recommended by the American Nurses Association (ANA).
1962
First national meeting of the ANA Conference on Geriatric Nursing Practice is held in Detroit, Mich.
American Nurses’ Foundation receives a grant for a workshop on the aged.
First research in geriatric nursing is published in England (Norton D et al: An investigation of geriatric nursing problems in hospital, London 1962, National Corporation for the Care of Old People).
1966
First gerontologic clinical specialist nursing program is developed at Duke University by Virginia Stone.
Geriatric Nursing Division of the ANA is formed; a monograph is published, entitled Exploring Progress in Geriatric Nursing Practice.
1968
Laurie Gunter is the first nurse to present a paper at the International Congress of Gerontology in Washington, DC. First gerontologic nursing interest group, Geriatric Nursing, is formed.
Barbara Davis is the first nurse to speak before the American Geriatric Society.
First article on nursing curriculum regarding gerontologic nursing is published (Delora JR, Moses DV: Specialty preferences and characteristics of nursing students in baccalaureate programs, Nurs Res March/April, 1969).
The nine standards for geriatric nursing practice are developed.
1970
Standards of Geriatric Nursing Practice is first published.
First gerontologic clinical nurse specialists graduate from Duke University.
Terminology
Demographic Profile of the Older Population
The Older Population
Highlights of the Profile of Older Americans
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Overview of Gerontologic Nursing
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