CANADA: Nursing the Elderly

MONTREAL (The Gazette), May 17, 2008: Stephanie Whittaker, Freelance Judy Bianco admits that it can be a tough sell. "We have a hard time attracting nurses into gerontological nursing," said Bianco, the head nurse in the Jewish General Hospital's geriatric unit. Then again, she added, many of the student nurses who do internships on her ward end up loving this specialized slice of the nursing profession that cares for the senior population. "It's so challenging," Bianco said. "Unfortunately, no one makes TV shows about gerontologic nursing. It's too bad, because this is a specialized part of nursing that spans the gamut." The "gamut" to which Bianco refers is the physical, psychological and social. "When you're nursing older adults, particularly those who are in failing health, the family is very involved in the care. In gerontologic nursing, we're looking at bio-psycho-social care and the entire patient in the context of the family and the community." That's why the first question a geriatric nurse asks when assessing an out-patient, for instance, is not: Tell me about your health, Bianco said. "The No. 1 question is: What is a normal day in your life like? We want to know the nitty-gritty of how the person functions. We want to know everything, including how they're going to get in and out of a bathtub. It's a bit like detective work. Patients are often surprised at how much time we spend on these questions. Older people may have multiple health problems that require time to understand." Dealing with a vulnerable population, she said, means geriatric nurses must be advocates for their patients. "We collaborate with CLSCs and other community services. Our role is to help people to stay as autonomous for as long as possible." Bianco works on a ward that is dedicated to acute care. Often, patients are admitted suffering the adverse effects of drug interactions. "We take care of the acute medical problem and get them on their feet again," she said. About 35 per cent of the patients admitted to the unit are unable to return to their lives in the community and require chronic care, Bianco said. Others might require palliative care. Gerontologic nurses work with the families of their patients. "We do a lot of anticipatory guidance with families," Bianco said. "When someone is diagnosed with dementia, for instance, we help the families understand it." Not all geriatric nursing takes place in hospitals. At Health Access, a Beaconsfield company that provides nursing and home care to help keep people autonomous at home, owner Donna Byrne says about 85 per cent of her clientele are seniors. "Our nurses co-ordinate the care," Byrne said. "They oversee the plan, which is carried out by our home-care attendants." In addition to evaluating the needs of the elderly clients, she said, Health Access nurses meet with the senior's family members to "decide on the kind of care that's needed." Byrne says the need for geriatric nursing will expand in the next couple of decades as baby boomers move into their senior years. "There'll be huge growth in this area. In the past, nurses weren't that interested in geriatric nursing but there is such a need." It's also becoming high tech, she said. Health Access is participating in a pilot project with McGill University's school of nursing to deliver services to seniors via the Internet. "Three of our seniors have Web cameras and can have conferences with our nurses," Byrne said. "They're equipped with a blood-pressure cuff, which they can put on, and our nurses can read them from the office." Home-care geriatric nurses also tend to be educators, she said. "If one of our clients needs to learn how to administer his own insulin, our nurses can go to the home to teach them. They're helping people learn to help themselves." Lucie Ladouceur, a nurse at the Lakeshore General Hospital who is called a care counsellor in geriatrics, agrees that the need for gerontologic nurses will increase as the population ages. "It's a big concern," she said. "Most geriatric patients have multiple illnesses rather than just one." Like Bianco, Ladouceur says geriatric nurses are holistic. "We look at the psycho-social elements of our patients' lives and not just the physical." Moreover, she said, geriatric nurses work in various departments in hospitals. "We have nurses with a geriatric specialization in the emergency ward as well as in the geriatric unit," she said. "We work on a multi-disciplinary team because the nurses put together the care plan for patients. The medical component is one part of that plan, but you have to look at the overall picture. "For instance, if you're treating an elderly patient having cataract surgery, you need to know whether that person will be able to function both prior to the surgery and afterward. "Perhaps, the person may not be able to cope at home. When you're dealing with the convalescence of a younger adult, you may be looking at a shorter period of time." "A person may be coming in with a heart problem but also has diabetes," said Ladouceur. "It's a challenge dealing with this, but it's also a passion for us. The nurse has to be a central advocate for that patient, as well as the liaison with the patient's family." Ladouceur said "there's a false impression that geriatric nursing is just about doing maintenance. It's not. If you do a good evaluation, you can see the potential to optimize someone's care." Bianco agrees and adds that one of her most important functions is to protect the dignity of her patients. She's also seen nursing students fall in love with gerontology. "When they do their rotations, they say it's nothing like they thought it would be. They didn't think it would be quite this challenging. People have the impression that geriatrics is where people go to end their nursing careers. I say: 'Look at me. Do I look like I'm here to end my career?' " In fact, Bianco returned to the Jewish General two weeks ago after taking an eight-month leave of absence to complete her master's degree. She's in the profession she loves for the long haul. © The Gazette (Montreal) 2008