It is difficult to overestimate the role of a nurse in treatment of patients, particularly in hospitals. Making doctor's appointments, taking care of seriously ill patients, carrying out many complex manipulations - all these things are the direct responsibility of the nursing staff. The nurse is also involved in the examination of the patient, preparing him for various surgical interventions, working in the operating room as a surgical nurse or anesthesiologist and monitoring patients in resuscitation and intensive care.
Importance of the development and improvement of geriatrics is determined by the rise of the absolute number and proportion of older persons. According to forecasts, the trend of demographic aging will persist until the end of the century. The incidence rate of these people is approximately 2 times higher than the incidence rate of people who are younger than forty. For the elderly, the combination of different diseases is also inherent, which is closely associated with the development of age-related processes in an aging body (Alligood & Marriner, 2010).
Such a tendency places high demands not only to the knowledge and practical skills of the nurse, but also challenges the nurse’s moral standing, ability to behave in a group and communicate with patients and their relatives. Only with the full sympathy of the patient, with the understanding of his position, real contact between him and the medical staff can be possible. It is so necessary for successful treatment. Patient needs sensitivity, emotional support, and warmth even more than drugs (Alligood & Marriner, 2010).
Description of the Role of Nurse in Geriatrics
Communication of nurse with the elderly patients has a number of characteristics. Transmission of information is done by verbal and nonverbal means. Communicating with an elderly patient, the nurse should provide training and pass information considering the involutional changes in his body.
a) As a result of age-related changes of the eye, visual acuity, and adaptation to light/ darkness, the color vision can decrease. This may be accompanied by an increase of sensitivity to bright light. To reduce the impact of these changes, it is recommended to be closer to the person to create the possibility to see whom he or she is talking to; it is also recommended to increase the light while reading (Archbold, 2013).
b) Changes in organs of hearing can lead to age-related hearing loss (presbyacusis) and decrease in the ability of perception of all sounds because of the atrophy of cells responsible for the perception of high-pitched sounds (Bickley & Szilagyi, 2009).
c) The ototopika (the ability to locate the source of audible sounds in space to determine their direction) can deteriorate in the elderly, which increases the risk of injury. So, the nurse should follow the performance criteria of the verbal message more carefully.
d) The sense of smell can be an asset to people of the old age, but with age, smell acuity can gradually decrease, which leads to an inability to detect the smell of smoke, gas, and spoiled food.
e) Decrease in the perception of taste may lead to the decrease in appetite and weight loss, as well as use of poor-quality food (Arnold & Boggs, 2007).
f) With age, skin changes, too. There are such disorders of skin sensitivity in the practice of nurses as touch abnormalities, feeling of pressure, temperature, and pain. This increases the risk of damage due to deprivation of security mechanisms provided by cutaneous receptors (especially, on the tips of the patient’s fingers, palms, and feet). Retardation of reaction to hot and cold leads to burns (while taking bath or using heaters).
In the process of communication, the nurse builds perception and understanding of a partner. The degree of perception and understanding largely determines the communication process, the level of relations between the nurse and patient, and how to implement their joint activities (Arnold & Boggs, 2007).
It is necessary that the nurse had a full and proper understanding of each patient. This is the basis which allows individual approach and better understanding of the patient’s personality and create the most favorable conditions for reaching the optimal level of functioning (Bickley & Szilagyi, 2009).
Education Requirements and Experience Required Role of Nurse in Geriatrics
Speaking about education, we should mention that the nurse has to study from 2 to 6 years. RN (Registered Nurse) needs 2 years of studying to get the Associate Degree. If anyone wants to be BSN (Bachelors of Science in Nursing) and to get Bachelors Degree, he should study during 4 years. MSN (Masters of Science in Nursing) and Masters Degree need two years after the BSN.
Many people receive RN firstly and then complete their education trying to get the BSN while working at the same time. MSN is necessary in two cases: if a person wants in the future to be a nurse-manager or plans to teach at the university. But some hospitals do not recruit nurses only with 2 years of studying. For example, one of the largest and most famous hospitals in Boston - MGH (Massachusetts General Hospital) writes in its advertisements that a nurse with the degree of Bachelors of Science in Nursing is required. The degree is necessary (Bickley & Szilagyi, 2009).
After finishing studying, a person has to pass NCLEX (national examination for accreditation of nurse). Only after that, one becomes a nurse.
During the work of nurse, not everything depends on the drugs which were prescribed by a doctor, as well as not on different medical procedures. These are not all a patient needs for a full recovery. The most important thing is the right attitude, which depends on the mental and emotional state of the patient. In this case, background experience of nurse is important and useful. It can provide:
- good psychological atmosphere of relationships between the nurse and patient (the nurse has already got the experience of building relationships and can be more polite and confident at the same time);
- competencies. The nurse can follow directly everything prescribed by a doctor, the possibility to make a rude mistake become less. He can improve practical skills within his background experience which will increase his competencies.
Setting is also important in the work of a nurse. A complex environment influences on the health of a patient in the same measure as on the work of nurse. It can give psychological, physical, and mental direction for full recovery.
Individuals, working in the field of geriatric nursing, should be educated, have a thorough understanding of working with older people, and be able to perform all nurse manipulation with the appropriate quality (Wendt, 2003).
The geriatric nurse should know the processes of aging, as well as risk factors of premature aging and disease in old age. He or she should also know clinical manifestation and prevention of injury and illness in the elderly, features of gerontological dietetics and pharmacotherapy, and finally, responsibilities of a geriatric nurse in the performance of medical diagnostic procedures. He should be able to:
- communicate effectively and according to the ethical dimension with geriatric patients;
- conduct the nursing process with an initial assessment to identify patient's problems;
- conduct the nursing care plan, do current and complete evaluation of the provided care;
- prepare the patient for treatment and diagnostic procedures;
- provide infectious safety of patients and staff;
- perform nurse manipulations;
- administer medication prescribed by a doctor;
- maintain a safe environment for the patient;
- provide the first aid (Wendt, 2003).
Geriatric nurse should use training exercises, allowing the patient to feel the age-related changes in the main channels of perception of information. Some medical researchers gave the following pieces of advice: to talk and listen with cotton balls in the ears, wear the bandage on eyes and try to read some text, wear rubber gloves, sew buttons, as well as wrap a hand and then do something (Wendt, 2003).
On average, the nurse can identify at least five diseases per one old man. Atherosclerosis of heart and brain, arterial hypertension, chronic bronchitis, tumors, prostatic hyperplasia, diabetes, mental depression, cataracts, and hearing loss often can be combined.
Geriatric patients may suffer from diseases since their youth. But infectious diseases can also occur sharply. Age-related peculiarities of the organism impact these diseases. They will be characterized by such features as atypicality, as well as absence of bright symptoms of the disease. Clinical manifestations of the disease, especially those related to the psyche of an older person, require identification of certain features in examination of the patient. Age-related changes affect the psychology of an old man, as well as his orientation in the environment. Examination of this patient with disorders of several systems requires considerably more time than the examination of a young man. We must take into account the fact that old men are likely to have declined hearing, vision, and they generally demonstrate slower response. If a patient consistently wears glasses or a hearing aid, this means we force him to use these devices during the survey (Archbold, 2013).
Pronunciation should be clear. The face of the person who takes part in the survey should be illuminated so that the movement of the lips helps the patient understand the words uttered. Sometimes, hearing loss can be caused by the presence of sulfur plugs in patients’ ears. If relatives of this patient are present at the examination, the nurse should talk with them first. This allows the researcher to identify the characteristics of any individual patient, his relationships within a family, as well as enables the researcher to identify the characteristics of any individual patient. In case of changes in his/her psyche, patient must be examined in the presence of relatives (Alligood & Marriner, 2010)..
As an example of a patient who benefited from geriatric nursing, we can describe the case of a lady from Alberta (Canada) who was 89 years old. Her relatives were worried because of her getting up in the middle of the night during the week. She walked around the house, looked for something, and prepared food. During the day, she was quite intelligent and did not have somatic diseases except for bilateral cataracts. Every morning, she added the next piece to her knitting, but every day that knitting got more grubby. The nurse suspected that at night, the lady was in a state of disorientation, which could be related to taking any medication. Indeed, examining her nightstand next to the bed, the nurse found digoxin tablets. After three days, she was much quieter at night, and her knitting became neat again.
In conclusion, we should emphasize that geriatric nursing is important for organizing the care of the elderly. The role of a nurse in geriatric care should be given more prominence in the current scholarly literature and everyday practice.