Teaching care of older people: Puzzles of a teacher

How does one teach a nursing student how to care for older people, when that student has very little experience interacting with older adults? When I ask my students if their grandparents are still living, many say they are not. Or, if they are, they don’t see them much.

So most of them are getting their notions about people of advanced years from popular culture—television, news, YouTube, etc.—or through their experiences with older people admitted into hospitals where the students are assigned for clinical learning. Younger people nowadays do not know older people the way people of my generation did, and they have limited opportunities to interact with them.

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If a deeper kind of learning is achieved only through experience, how do we help young people learn how to care for the old, when they don’t really “mingle” with them in their daily lives? How do I, as a teacher, help students appreciate the heterogeneity of seniors as individuals when students have perceptions, coming from popular culture, that more often than not are caricatures of certain behaviors seen in elderly people?

Of course, I try. I try to convince them that older people are not necessarily weak, needy, and cranky. I invite seniors to come to my classes and share their stories. My students are in awe of what they learn from these stories. They learn about people over age 80 who volunteer to help others in need. They never thought seniors could be like that. Another story—an individual close to age 90 who still hikes regularly and for long hours, a person who is much stronger than those much younger. My students listen in disbelief. Some even tell me they are inspired.

To foster intergenerational relationships, we need to begin with the basics—getting to know each other in our daily lives. A regular semester in Hong Kong is 14 weeks. How do we teach students who do not really know older people to develop the right kind of attitude and accumulate the knowledge they need in just three-and-a-half months? Is that “mission impossible” for teachers of gerontology?

I don’t think studying hard facts about age-related physiological changes in the aging body will help younger people better appreciate the needs of those who are growing old. Neither do I think that teaching students about common plights faced by older people—concepts such as cascade iatrogenesis, functional incontinence, and atypical presentation of illness—will make them better nurses in caring for the aged.

Well, I try. I try to cultivate awareness in my students of issues related to aging and older people by asking them to write journals throughout the semester. I ask them to write a brief note each week about news reports or incidents they have seen or heard about elderly people that intrigue or fascinate them. By asking students to actively look for such reports on a regular basis, I hope to sharpen their awareness about age and aging in the world around us.

Only when one starts to look will one begin to see. And only when we start “seeing” matters related to age and aging will we begin to ask questions. Questions lead to deeper reflections about ourselves and others. It is the first step that may lead to changes in us and, I hope, to changes in the environment that emanates from us.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

“All older people are vulnerable.”

The above statement is from the lecture notes of an established global nurse leader at a conference on institutional care of older people, which I attended recently. The statement caught me by surprise. No offense intended, but I could not disagree more.

First, it’s patronizing. I don’t think all older people hold similar beliefs about themselves. I think health professionals should be caring and empathic, but certainly not patronizing. We do not always know what is best for others. We would like to think we do, but we don’t, at least not always.

Second, the message seems to imply that people can be categorized purely on the basis of age, according to whether they are fully capable of looking after their own affairs or not. In our society, we generally agree that children and disabled people are vulnerable and require protection, but if we follow the conference speaker’s logic, it would mean that only those in the well adult population are fully capable beings. So where does that leave us? Should we allow only well adults to lead the world?

Vulnerability should be perceived as a multi-dimensional concept when applied to humanity and should be not used as a descriptive label. A disabled person can be physically handicapped and, therefore, vulnerable to environmental barriers they come across in their daily life. A physically frail person can be vulnerable, in that he or she easily falls ill. A terminally ill person may be vulnerable to “assaults” on his or her humanity when the need for analgesics is ignored. A cognitively impaired older person may be vulnerablebecause his or her power of discretion is compromised.

But not all older people are vulnerable. They should not be. An elder with no loss of mental faculties, even though physically frail, can adequately manage his or her own affairs. Whenever we refer to the vulnerability of older adults, qualifying statements are required so that we are not disempowering our older clients.

The first baby boomers reached 65 in 2006. Let us not forget that future cohorts of older people are better educated and economically more secure than their predecessors. They certainly are in a much better position to manage their own affairs, and we should respect that.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. 

Reflections on student learning

This semester I am teaching a course, “Nursing older people.” One of the assignments I have for my students is to write a reflective journal about any issue pertaining to elderly people and elder care, to be submitted at the end of the semester.

I thought it was an easy enough assignment but, to my surprise, my students do not think so. They tell me it is a burden to them. Quite a number of them say that they don’t know what to write about or how to write it. Again, this is a surprise, because these are third-year students, and reflective journals should not be new to them.

In response, I have modified the assignment with regard to it being a requirement, but have not removed it as part of the course assessment. To me, it is important when studying gerontology to cultivate sensitivity toward elder care issues. The best way to do that is not to write a paper or take a test, but to reflect, over time, on issues pertaining to elder care. Gradual sensitization to elder care issues through the writing of journals will help students develop awareness and insight about care of older people and, I hope, enable them to develop their own perspectives about the study of aging.

But this is not an age that encourages reflection. We humans like to fill our world with sounds. We are so uncomfortable with quiet moments that we try all means to drown our senses.
We need to be entertained every single moment. As soon as we arrive home or check into a hotel room, we turn on the radio or TV. We are defined by the latest electronic gadgets and games, by the PSP, iPhone, iPad and so on. We must have music constantly, whether it comes from an iPod or any other means. We can’t be bored.

We also can’t bear not being connected, even for brief moments. We have the Blackberry, 3G phones, WiFi, etc. Everywhere we go, we want immediate access to the Internet.

Because we are so busy entertaining ourselves, engaging in dialogue with people we know or don’t know, being reached and reaching out to othersand accessing information for all realms of our lives, the time that remains for reflection and recollection is very limited. Although Schön’s seminal article on reflective practice was published in 1987, more than two decades ago, fostering reflective practice nowadays runs counter to modern techno currents—not a very promising battle.

Personally, I need a lot of time to myself. I like people, but I also like solitude. Getting together is good to foster relationships, but getting close to myself and knowing how I feel and think is crucial to living a life that is meaningful to me.

I hope my students become, through repeated learning opportunities, better reflective practitioners.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Do you respect older people?

Do you respect older people? Why? Do you respect older people because of their age? Or for other reasons? If it is because of their age, why so?

Chinese societies are very much into respecting elderly people, with few explanations as to why this should be. I used to wonder why such “wisdom” is passed through generations without being challenged. I have to say that I don’t respect seniors just because of their age. Respect has to be earned.

Just as I don’t disrespect children because of their age, I don’t respect seniors because of their age. Age per se is not a good argument for me. To me, we should respect life, respect people as individuals, having a rightful place on this planet. Seniors don’t get extra respect for the mere reason of being older. There are some young people who put me in awe, and many more who deserve my admiration and respect. And there are a lot of older people whom I don’t respect.
But, of course, there are other qualities that come with age that I appreciate–the ability to withstand adversity, worldly wisdom gained out of a lifetime of experience, and so on. But age is never a good enough argument for me.

As a gero nurse, I advocate for the well-being and health of seniors, not because they are a respectable group because of their advanced age, not because of their growing numbers and looming “grey power.” As a gero nurse, I am cognizant of the right of every member of our society to receive the same respect, irrespective of power, wealth and class. Only when groups live in harmony and recognize each other as having equal rights can we start to build a better world.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.