An article by Mayte Vázquez Resino,
General Health Psychologist
Training Member of the Spanish Association of Psychogerontology ()
Member of the group for Good Treatment of the Elderly of the
Expert in cognitive development and interventions in Emotional Intelligence, Mindfulness and Positive Psychology in the elderly
Geriatric nursing is a profession very marked by contextual factors, in this paper we want to emphasize these factors throughout its history and evolution, and specifically at present where a stage of marked changederived from the health and social crisis that it suffers and where older people play a fundamental role and therefore the health profession, in general and geriatric nursing, in particular.
Towards a concept of Geriatric Nursing
Let’s start by doing a little history about the concept of geriatric nursing, from its beginnings to its current contextualization. In fact, the definition of geriatric nursing is linked to the evolution of nursing throughout history. Professional nursing begins with Nightingale (1853-1874) who places the vision of nursing not only in administering medicines, but in carrying out tasks based on knowledge of the person and their environment, that is, in developing care for and by the patient. It is 100 years later, when Peplau H. (1952), defines nursing as a interpersonal therapeutic process that acts in coordination with other human processes that make possible the health of individuals in communities. When the health teams offer services, nurses participate in the organization of the conditions that facilitate the natural march of the tendencies of the human organism.
On the other hand Wiedenbach E. (1952-1965) emphasizes the importance of feelings and thoughts in nursing when carrying out an action, going so far as to postulate that nursing, in general, must administer the necessary help and verify that the need for help has been satisfied. Also, in 1966, the World Health Organization (WHO) defined nursing as the promotion of health and also the responsibility for the prevention of disease and the provision of care to the sick.
At the end of the 20th century, Barker P. (1995-1996), expanded the definition of Peplau H., turning it into a more global concept where the social construction in the role of nursing It is very important, since it not only develops a care process, but also personal and environmental growth. It is already in the 21st century, when heNursing is framed within an ethical modeldeveloping the actions, at all times, as agent of the patient, What would you do for yourself if you could?”, adding later Mercer R. (2014), “if I had the strength and the will”.
Geriatric nursing in the current residential environment also encompasses the performance of activities of daily living and the development of vital projects
The training and research have developed in parallel, hence the advances in medicine and health sciences, produce an increase in longevity, placing nursing in new areas of interest: that of the elderly or geriatric area. The term geriatrics It is published for the first time in 1909, by Nascher L.., at that time it was about caring for people with chronic or disabled diseases, later it is when the World Health Organization (WHO) defines health not only as “the absence of disease”but to be able to guide the health sciences towards promotion, prevention and rehabilitation.
In 1947-1948, a group of internal medicine specialists became aware that traditional medicine was not enough to protect and care for people over 60 years of age, and thus the concept of geriatrics, as a comprehensive medical specialty, It is also in 1947 when the Spanish Society of Gerontology was created, initially made up of doctors, and later by other professionals caring for the elderly, such as nurses and psychologists.
Evolution of geriatric nursing in the Residential Care Model in Spain
In line with the above, around the 70s-80s in Spain, a social and cultural change began where it is relevant that women begin to work outside the home and beginning the demographic agingwhich makes it necessary to create residential centers that help to alleviate the needs, in our elders, created at that time.
The international trend calls for person-centered residential models, although in Spain they still focus on services. For many years, Spain has traditionally started from a care model based on family caremoving to a model oriented towards organizational efficiency influenced by political decisions where the challenges of aging are faced through programs aimed at meeting the health needs of the elderly.
Progressively, it is at the end of the 20th century and the beginning of the 21st when geriatric nursing becomes very important and in this way this profession not only covers the prevention and maintenance of health, but also begins to promote self-care in the elderlyas well as the promotion of dignity and respect in the face of death, without moving away from the focus of the feeling of ethics, which nourishes this maintenance of autonomy, capacities and independence in the elderly person, is the beginning of the promotion of active aging and with success.
Currently and based on this range of values: dignity of the person, ethics, accompaniment, autonomy and independence and, above all, favoring the well-being and safety of the elderly, promoting decision-making, the residential model of personal carewith a professional team for comprehensive care, where professionals, including geriatric nursing, will be trained in skills related to teamwork, such as interpersonal communication, healthcare ethics and relational skills, providing permanent training.
In conclusion, geriatric nursing currently, in the residential environment, not only perform the usual care tasks, but also those related to the support to carry out the activities of daily living and the development of vital projectsTherefore, its role is fundamental in communication, accompaniment and decision-making. Society must also support and promote the work of these professionals, in order to present a comprehensive view of the elderly and active aging In order to delay dependency and enhance functional capacity and autonomy, let’s go through this point in more detail.
Geriatric Nursing in the Covid-19 Pandemic
At present and due to the emerging crisis caused by COVID-19, a turning point for this reality of gerontological and geriatric nursing, Have the objectives and functions of the same, seen previously, been modified? It is evident that the impact of the COVID-19 crisis on the elderly and more so in residences and centers for the elderly have been the most affected, but this crisis has also come to highlight several underlying aspects within this environment, on the one hand there is no other place where the pandemic is doing more damagewith a fatality rate that in some cases has reached 20% of those infected, on the other, the insensitivity that prevails in society in the care of our eldersand on the other the decimation that occurs in many professionals who work on the front line, forcing the Government to deal with the hiring of non-specialized professionals. And that is where the first question arises that will last beyond the pandemic, are residences social centers, not health centers? and therefore they were poorly prepared for a pandemic of this type.
Observing this photograph, in a global way, we highlight the professionalism of geriatric nursing and since it has been affected in those aspects that we indicate, we will highlight the professional demand, where day by day care, regardless of the age of the people, of chronic or acute pathologies and their intrinsic vulnerability, has reached the extremes of exhaustion, both physically and mentally.
The Spanish Society of Geriatric and Gerontological Nursing has endorsed this commendable work, and the respect with which their work has been carried out from the residential world and by extension to the care of the elderly regardless of where they are. This recognition of these nursing professionals underlines the intense work days and the high emotional loadseeking at all times the well-being and dignified and quality care for the elderly in all its actions.
The Madrid Association of Geriatric Nursing (AMEG) has also highlighted the high training of qualified professionalsthe role of nursing specialized in geriatrics being more important than ever in this crisis.
Towards a model of change, adapted to current needs
and from this “storm of emotions, both personal and social”is it necessary a change of performance within the geriatric nursing scenario? There is no doubt that the answer is yes, let’s look at some of the needs that have become evident and how to alleviate them in the future.
From the Official College of Psychology of Madrid, on a personal level and when these needs are revealed, a device of Psychological Supportto help alleviate the end of estress and above all to manage that belief of helplessness and incomprehension before society, the objective, in addition to emotional accompaniment, is to avoid “cognitive distortions” based on catastrophic or interested criticism, in order to help save lives and minimize the negative impacts that have occurred.
Three months after the start of this device, a very interesting study was published in the area of this psychological need of these professionals, where the need for help was established, given the symptoms of anxiety, stress and depression and above all prevent PTSD, which can develop due to the chronicity of these symptoms. (Hair, IR et al. 2020).
At a social level, AMEG proposes a change where enable centers that combine various and complex health needssuch as the possibility of the appearance of a pandemic, with the warmth of being the resident’s home and thus it is highlighted that “Health is about providing specialized coverage that covers the care spectrum of all types of users who are cared for in residences; cognitive impairment, residents with clinical complexity, palliative care, post-acute care, day center users, convalescence, etc. This kind of services requires highly trained professionals, and that the health system supplies resources to the residential social system; and…