Nursing

AS A NURSING INSTRUCTOR who has taught geriatric content inside nursing homes and other long-term care facilities for many years, I hear these same questions time and again from students: "Why do we have to do what nurses' aides do? Are we not going to do the things 'real' nurses do?"

Students are aspiring professionals, and to be the best they can be, they need to recognize that giving the best care to all clients should be their ultimate goal.

As nurses, we should keep in mind that we strengthen and give meaning to the client-nurse relationship in everything we do, whether by feeding a client who is unable to pick up a utensil or by performing range-of-motion exercises for an elderly client. The rewards are many. If we hear the silence and see the faces of those we care for, we will know that there is much to be learned in long-term care. The toothless smile, the gnarled hands, the dry skin, the "thank you" for the special attention given to them while bathing—all these nursing moments are priceless.

One day during her rotation, Emily saw Jim eating breakfast in his bed. He had very limited mobility and was in declining health. "Nurse! Where's my Diet Coke? Can't you do anything around here?" Jim yelled at her.

Unaccustomed to being addressed in this manner, Emily was at first repulsed. But then she thought about her grandmother, who was very dear to her, and resolved in her heart to treat Jim as she would her own family member. She saw that as the only way she could get through a whole semester of Jim's brusqueness. "Yes, Jim, just a moment," she said.

"Well, it doesn't take a whole day to eat, you know! Isn't anyone competent here?"

Emily handed Jim his Diet Coke. "Thank you," he said irritably as he popped open the can.

A few weeks went by, and Jim gradually slid into increasingly ill health and neared death. As Emily continued to care for Jim, she noticed he never had any visitors, even when it became clear that he wouldn't survive much longer.

Jim weakened to the point where he was not able to communicate verbally, but whenever Emily gave him water or food, or adjusted his position on the bed, there was a hint of a smile in his eyes, a silent "thank you."

Emily felt that experience, her first of its kind, had opened her eyes to the inevitability of death. She told me the rotation taught her that elders are much more than how they are portrayed. Despite the stereotypes that are applied to them, these are wonderful beings who have personalities, smiles, and feelings that many people overlook. Emily was thankful to have experienced this rotation, and although not all the situations had been pleasant, the assignment was worth every step.

Another gentleman recently in our care had been in a motor vehicle accident that left him a paraplegic. He was able to follow our gaze at first, but only mumbled incoherently when we would attempt to converse with him. I thought to myself how young he was—only 63. I asked the students, "Do you think Tom knows what we are saying?" They replied, "At times he mumbles 'yeah' when answering a yes-or-no question." I observed how attentive Tom's family was to him. His wife even left a journal in the top drawer of his dresser so that anyone who took care of him could write a note inside.

One day, about three months into the semester, Tom suddenly answered two or three of the students' questions in a coherent sentence. He still had a faraway look in his eyes, but he was able to understand parts of their conversations. We were ecstatic! We left a note in the journal for his family that day.

Not all residents in the nursing home are elderly. Often, young people are placed there due to a tragic accident or a chronic, debilitative disease. We have learned that all residents deserve the best care and understanding we can offer—and always that unconditional acceptance.

Geriatric nursing may not be as glamorous as other types of nursing, and its future depends on those nurses who aspire day after day to making these elders comfortable. We palliate, encourage, and lift the spirits of all those in our care. These are the things that real nurses do.

RITA C. BERGEVIN is a clinical assistant professor at Binghamton University, Decker School of Nursing, in Binghamton, NY.

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