FROM

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The Evolution of Critical Care and Geriatric Nursing I

write this as an eyewitness to the past 64 years of nursing, from 1928 to the present. In the early part of that era, I believe, no geriatric nursing existed; however, nurses cared for critically ill patients. In fact, there has always been critical care nursing, but the way in which "critical" is defined in terms of nursing depends on the context and the historical time in which the term is used. The elite nurse before the discovery of sulfanilamide in the late 1930s was the pneumonia nurse, one whose pneumonia patients had a high rate of recovery. No remedy for pneumonia had been found before antibiotics came into widespread use during the 1940s. The recovery of the patient with pneumonia or typhoid fever depended on exquisite nursing care. At that time lobar pneumonia had a long clinical course, with crisis or lysis phases occurring after a week or two. During crisis the high fever characteristic of pneumonia fell suddenly, and patients survived only if they were carefully nursed through this crisis period. Such was the nature of critical care nursing before 1940. The essence of nursing, then and now, was the care of the sick and the relief of suffering. Levine I stated that the fundamental moral responsibility of nursing care is the limitation and relief of suffering. Levine's statement serves as a goal for all of nursing and will ground my remarks about the evolution of specialty nursing practice in the United States during the past 64 years. Before World War II the sick elderly were not seen as a different population needing specialized care. They were treated as sick adults who happened to be old. As the percentage of the population over the age of 64 rose from 4% to 10%, however, there was no denying that older people existed and had special care requirements.

The elemental differences between critical care and geriatric nursing are the frameworks of time and the skills required to render care. Critical care nurses see patients during periods of profound illness and only for the time necessary to stabilize conditions and support individual resources during life-threatening events. The health history may not be known in that compressed time period. The future is not delineated except that the patient be stabilized. The hours and days in critical care are a fraction of the patient's total life experience and may not be remembered. Geriatric nurses, on the other hand, have a much broader care imperative, which is often a cooperative venture with the older person--a contractual agreement, in some instances, that preserves the elder's own control and identity. Geriatric and gerontologic nurses have the luxury of long-range subgoals, in contrast to critical care nurses, whose goals are restricted to the here and now. There seemed to be a tacit agreement that geriatric nurses do not care for acutely ill elderly. Critical care nurses are not only hospital-based at this juncture; they are visiting patients in homes. Thus critical care nursing is emerging from a unit-based, episodic nursing phenomenon into a hybrid critical care/geriatric domain of nursing practice. By changing the setting of practice, we have changed the standard of practice for critical care nursing from the goal of relieving physical suffering to the broader goal of relieving mental and physical suffering and prevention of possible sequelae and consequences caused by aging. Will this, then, be the specific knowledge and skills needed by critical care/ geriatric nurses? Conversely, will the gerontoiogic/ geriatric literature of the immediate future contain research and practice in the care of the critically ill elder? Mary Opal Wolanin

Excerpted from "Evolution of Critical Care and Geriatric Nursing," by Mary Opal Wolanin. (From Fulmer T, Walker K. Critical Care Nursing of the Elderly. Springer Publishing Company, Inc., New York 10012, 1992. Used with permission.) 34/1/36716

62 Geriatric Nursing March/April 1992

REFERENCE I. Levine M. Ethics of nursing rhetoric. Image 1989;21(I):4-6.

The evolution of critical care and geriatric nursing.

FROM THE GUEST Ill EDITOR I , In 7 The Evolution of Critical Care and Geriatric Nursing I write this as an eyewitness to the past 64 years o...
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