Gerontological nursing

Gerontology nursing is a unique field in nursing which requires nurses to focus their care on older population. This population tend to have more comorbidities such as high blood pressure, diabetes, heart conditions, etc. This field requires complex care to fulfill their needs. Nurses are to be mindful of their long history for individualized care. Nurses use evidence based practice in their care to educate and promote well-being in gerontological population. Professional nursing involves the use of culturally competent care combined with scientific research to deliver clinical expertise. Geriatric nurses are expected to be skilled in patient care, treatment planning, education, mental health, and rehabilitation. They also take on many roles in the workplace. The main responsibility is as a caregiver. They can also be advocates, counselors, and educators for their patients. Gerontological nursing draws on knowledge about complex factors that affect the health of older adults. As well, drug metabolism changes with aging, adding to the complexity of health needs. There are many issues that arise as people age, which includes but are not limited to vision loss, hearing loss, dental issues, incontinence, and increased risk for falls. Gerontological nursing is complex and requires extensive interventions to keep the elderly safe. Nurses must be able to accommodate their patients for the vision loss, hearing loss, and dental issues. Elderly people with poor vision can be given reading materials with larger font, be provided with magnifying glasses, and brighter lighting. Incontinence care is crucial to preventing skin breakdown and skin infections such as candida albicans. Population aging and the complexity of health care needs of some older adults means that older adults are more likely than younger people to use health care services. Including, GAPNA (formerly NCGNP) which was founded in 1981, by a group of Gerontological Nurse Practitioners with the intention of offering the first continuing education conferences designed specifically to meet the needs of advanced practice nurses providing care for older adults. Currently, GAPNA represents the interests of all advanced practice nurses who work with older adults. These advance practice nurses are active in a variety of settings across the continuum including primary, acute, post-acute and long-term care. GAPNA an organization for advanced practice nurses seeking continuing education in gerontological care as well as networking and peer support from experienced clinicians. What Attracts Nurses to Gerontological Care In the United States, caring for the elderly is predicted to be the quickest developing employment area in health care. The demand for nurses is high in geriatrics, however the nurses who are interested in geriatrics are low. Studies have found that less than 1% of nurses are certified in geriatrics and less than 3% of advanced practice nurses are certified in geriatrics. A qualitative, descriptive study was conducted by Negad (2017), it was found that to attract more nurse's higher compensation and health insurance should be offered. Nurses should have safe working conditions, onsite training and education, support from administration, flexible scheduling and sign on bonuses. The last few decades have brought in more interest in older people as their numbers in society grow. More people than ever before are surviving to their senior years which substantially makes the demand for more working nurses in gerontology. Viewing aging as a natural process also develops more positive attitudes towards working with older adults. Gerontology study is becoming an important field in nursing and this is due to the increasing population of older adults. This increase requires an educated nursing staff who equipped to provide care to the needs of this growing aging population. There is a negative attitude towards old age and this bias can invoke negative feelings leading to great anxiety in many. Due to this prejudice, many fail to see the benefits and the opportunities that old age brings, focusing only on the challenges of old age. Gerontology educates people about old age and other issues that affect older adults. This field of study is important as it educates the public about the beauty of old age and it also encourages those advancing in age to embrace this change. Knowledge about the aging process not only helps people to understand the aging process but it also assists in helping older adults to achieve a better quality of life. Geriatric training for nurses and nursing assistants can increase quality of patient care and improve employee retention rates in the nursing home environment. Gerontology vs Geriatrics The terms Gerontology and Geriatrics are often used interchangeably, but there are differences between the two. Gerontology is the study of the social, cultural, psychological, cognitive, and biological aspects of ageing. Geriatrics, or geriatric medicine, is a specialty that focuses on health care of elderly people. Gerontological Nurses need to know how to care for illnesses that affect the aging, the other factors affect aging, and how these impact people. ==History==

Gerontological nurses walk a tight rope stretching across the centuries from the past to the present that introduced the notion that those who entered could survive and recover. The modern hospital is an 18th century innovation and those who entered were youths with acute injuries rather than chronic illnesses heavily seen in modern society. Beginning in the 1980s, nurse researchers have pursued answers on older adults about their well-being, and those suffering from serious chronic conditions.Bowers2020/> The NIH played a powerful role in the advancement of geriatric nursing science in the 1980s and 1990s, since then the NIH has funding nurse investigators who are transforming understanding of gerontological nursing. Although nurses published articles about care of older adults as early as 1904, the specialty of gerontological nursing emerged beginning in the 1950s, with the publication of the first gerontological nursing textbook. Pioneers in the field of gerontological nursing include Vera McIver, Doris Schwartz, Mary Opal Wolanin. A geriatric nursing specialty group was formed by the American Nurses Association in 1966, with the name changed to the Gerontological Nursing Division in 1976. Standards of practice for gerontological nursing were published by the American Nurses Association in 1971. Between 2007 and 2009 the Geriatric Nursing Education Consortium created teaching tools and trained educators in the US to improve gerontological content in nursing education. A few initiatives that were taken to improve gerontological care is "The Nurse Competence in Aging" project which focused on providing grants and assistance to over 50 specialty nursing organizations and provided nurses with a free online gerontological nursing resource center. This resource center can be assessed using the computer, an iPAD, or iPhone applications. The resource center provides nurses with the opportunity to review evidenced based articles to learn about how to care for the older adult. Another resource that was developed in 2009 was the Sigma Theta Tau's center for Nursing Excellence in Long-Term Care. The Geriatric Nursing Leadership Academy was sponsored by Sigma Theta and it provided products and services to support nurse's ability to grow professionally and become great leaders. A writer in 1956 requested that nurses refocus their research to include major health issues of the time and how to support the frail elderly. the average life expectancy is 78.93 years which is a 0.16% increase since 2018. With the elderly population becoming more popular, there is a crucial need for gerontological nursing research. The older patient has more comorbidities and different mental health issues that affect their daily living activities. American Senior Communities (2020) ==Training and education==

Gerontological nursing includes generalist and specialist practice. A generalist is a registered nurse or Licensed Practical Nurse. A gerontological nurse specialist is an advanced practice nurse or nurse practitioner who has graduate education in gerontological nursing. Specific education in gerontological care is important for all nurses, even those who work outside of long-term care, because older adults make up a significant portion of patients across specialties. However, additional certification in Gerontological care is uncommon for registered nurses, with less than 1% being certified. Fewer than 3% of advance practice nurses in the United States have this certification. Registered nurses have the option of becoming certified in gerontological nursing. National nursing organizations such as the American Nurses Credentialing Center and the Canadian Nurses Association offer certification in gerontological nursing. Requirements for maintaining certification vary. The American Nurses Credentialing Center lists requirements as including 2 years experience as an RN, 2,000 hours of clinical experience and 30 hours of continuing education, both within the specialty of gerontological nursing. Post graduate certificates in gerontological nursing are also available by completing continuing education courses through colleges and universities. Gerontological nursing is often ignored within baccalaureate educational programs, with only 1/3rd of all schools requiring a specific course in geriatrics. 1/4th of all nursing programs in the United States do not have a gerontological staff member. To better identify those who are most qualified and experienced in managing patient care, there is an APRN Specialty Certification in Gerontology. This APRN Gerontological Specialist Certification (GS-c) distinguishes APRNs who possess expert knowledge, experience, and skill in managing the complex health needs of older adults. Due to the knowledge gap from nursing school to the work force, it is advised that nurse educators modify current curriculum to the fast growing elderly population by incorporating content specific to the care of the elderly from pre-licensure through the doctorate's level. Researcher Cline was able to create a framework centering around the complexity of care among the elderly, that schools could use to educate students with the intention to improve quality of care. == Issues in Gerontological Nursing ==

The nursing shortage continues to affect all aspects of nursing, and gerontological nursing is no exception. It is estimated that 50-150% more nurses will be needed in this speciality in the next decade. Often nursing students do not express a desire to work in gerontological nursing as their specialty. This can be due to negative stereotypes, misconceptions, and attitudes toward the aging that are common among nursing students. A study conducted by Garbrah et al. (2017) found that nursing students were less to work in gerontological nursing due to lack of experiences, negative experiences during clinicals, negative perceptions of aging, stereotypical attitudes, and prejudice. In order for nursing students to have an interest in gerontological nursing, students should first be introduced to healthy older adults. In addition, nurse educators should be enthusiastic, passionate, and knowledgeable about geriatrics. Nursing facilities should also implement age friendly curriculum to nursing students and current nursing staff. In order to fulfill the open positions of the nursing shortage, many students are choosing to obtain their associate degree in nursing. Nurses who are experts in gerontologic nursing are what is needed, though associate degree nursing programs are not readily preparing their students in this specialty area. According to Boutin et al. (2019), newly licensed associate degree registered nurses have not yet acquired the knowledge, skills, or attitudes to effectively care for this aging population. Therefore, this lack of education is limiting the number of nurses available to fulfill open positions in this area. It is imperative that associate degree nursing programs integrate evidence based gerontological nursing content into their programs as this is the primary population that needs to be taken care of upon graduation. The knowledge and attitudes of the faculty teaching this information is also imperative to persuading nurses to want to specialize in this area of nursing. Another study conducted by Negad (2017) found a challenge nurse's experience are having poor relationships with families and residents. Nurses in the study reported having difficulty caring for patients with unstable conditions such as dementia. Families will often have high expectations of the nurses, however due to the work load nurses were unable to perform some of the interventions that the residents needed. The American Healthcare Association found a turnover rate of 65% for registered nurses working in nursing homes. Burnout among nurses in geriatric care is common. Physical stressors, such as frequent heavy lifting, and emotional stressors, such as regularly encountering death, all contribute. Due to advances in medicine, adults are receiving the opportunity to live longer, healthier lives. In response to this, there have been concerns associate with the concept of ageism. This is the negative practice of discrimination of individuals solely on their age. This act can ultimately hinder an adults experience in receiving adequate health care leading to an overall risk of impaired health. In response to this, Levy (2018) proposed the implementation of the PEACE (positive education about aging and contact experiences) model with the intent to provide education on aging as well as to promoting positive experiences with older adults. The overall goal is to reduce prejudice and stereotypical attitudes towards older adults in all settings. ==Global Challenges in Gerontological Nursing==

In 2017 global population aged 60 years and older reached more than 962 million; more than twice the number of 1980, when the worldwide population of older persons was 382 million. By 2050 the projected number of older persons is expected to double again, reaching 2.1 billion. There are many global challenges to gerontological nursing including, the rapid increase in the older population, the need for different ways of working, transnational migration, changing core competencies, international collaboration, facilitating choice, and the global nurse shortages. To support the unprecedented global growth of the elderly population, nurses will be required to modify core competencies and skills to reflect the unique healthcare needs of the older population. New roles must be defined, and research, education, and clinical practice must support those caring for the geriatric population. Older people are the primary users of health services worldwide; therefore, the healthcare system must proactively develop strategies to maximize services to effectively deliver quality care to the increasing number of older people in both developed and developing countries. Knowledge and understanding of various cultures and their beliefs, values, and practices is vital in caring for older adults worldwide. Because of the shift globally in the aging population, more gerontological education in nursing curriculums and clinical experiences must be incorporated. Nurses must prepare to deliver safe, effective, quality care to this population, including learning to recognize the unique differences in cultural needs across the world. Booker (2015) suggests an International service-learning curriculum aimed at teaching principles on cross-cultural gerontology, including voluntary services in other countries as a student to gain insight into the social determinants and healthcare practices, outcomes, and policy issues in diverse populations. Nursing students and nurses will need strategic education on how to care for an aging society. One barrier to the advancement of gerontological nursing is a global shortage of nurses. The sharp and steady increase in the aging population coupled with a lack of nurses to care for them, highlights the same issues such as nurse burn-out and retention rates seen in other countries around the world. National and international policies are currently being developed in response to the shortage of nurses worldwide and the needed transformation of nursing education, practice, and collaboration standards. ==References==