She's a nurse!

This past August, Asia, if not the world, was seized by the news of the Hong Kong tourists held hostage by a dishonorably discharged policeman in the Philippines. Now, we all know that it ended up as a tragedy, with eight Hong Kong citizens being killed. As I write this, we are still not sure whether they were killed by the gunman or by the rescuers, the Philippines police force having been shown to be disappointingly deficient in resolving a hostage crisis.

Well, all this is in the past, but there was one particular event I would like to mention here. Before the gunman lost control of himself, some hostages—seniors and children—were released.

About 90 minutes into the crisis, a woman called Tsang Yee-lai was told to leave the tour bus with her two children, ages 10 and 4. Tsang told the gunman that another boy on board the bus, 12-year-old Jason, was her relative; she asked to take Jason, too. The gunman agreed and so Jason was freed. Jason, of course, was not her relative.

The people of Hong Kong praised Tsang for her calmness and sharpness in saving a life. Her heroic deed saved Jason, but she lost her husband, and her children lost a father. Jason’s older sister, age 15, was saved, but both of their parents were killed. The incident has been emotionally draining for the people of Hong Kong.

Tsang is a geriatric community nurse working at the Kowloon Hospital in Hong Kong.

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

Seniors and fast food

As a Hong Kong Chinese, I did not associate seniors with fast food until about 10 years ago, when I moved into an apartment from which, if I needed to get to the train station fast, I had to take a short cut through a McDonald’s.

Every morning I made that trip, the scene never failed to amaze me—lots of seniors having breakfast at McDonald’s. Maybe it is a myth, after all, that Chinese people are particular about food. My—or our, if I can claim that I represent a certain segment of our society—belief used to be that Chinese seniors would not like fast food. They preferred congee to burgers, jasmine tea to coffee. But, obviously, I learnt something new when I moved into that apartment.

When I was taking a course for my doctoral program, my professor told me that she had been to Hong Kong and that both she and her husband were totally surprised to see that McDonald’s was such a favorite spot for children in an Asian city. She predicted that this generation of Hong Kong youngsters would have the same kind of cardiovascular problems as those in her country, the United States.

When I saw the large number of seniors having breakfast at McDonald’s, I remembered what she had said and thought, not only will we have a generation of young people with cardiovascular problems, we will also have a generation of seniors with those problems, as in Western countries.

I remarked about this to a friend, and she suggested it could be the free coffee refill that attracts seniors. This may be one of the reasons, but probably only one. To this day, although not so amazed as before, I am still puzzled. Maybe one day, I will do a survey on this, trying to find out seniors’ perceptions of fast food, and why they patronize these restaurants.

My speculation is that fast-food restaurants treat everybody the same. Our seniors enjoy the same kind of “freedom” as anyone else. They can sit for as long as they like, in spite of buying little, and not be driven away or given strange looks by waiters and waitresses. They don’t have to abide by the rules of a regular restaurant. This, then, is a good aspect of fast-food chain restaurants. They are a place for any age group; there is no age discrimination.

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

Life and death in education

I am still into experiential learning. My definition of experiential learning is that someone has actually gone through an experience; not a simulated experience, such as just pretending you are blind by putting on a blindfold.

One thing that bugs me is the tendency of the social and health service sectors in Hong Kong to be crazy about getting into the latest trends. First, it was reality orientation (RO) that became really popular. Every agency was trying to conduct RO. Then it was reminiscence, life-story work, music therapy and so on and so forth. The latest is horticultural therapy. Once a craze begins, everybody tries to get a head start.

As a researcher and educator, I am appalled at the lack of planning for all of these activities. Because the trend in question is not well understood and has not been studied, it leaves little room for researchers to examine whether there are therapeutic effects from these interventions. And if there are, what are they? In what ways do they have an impact? These questions often remain unanswered, because there are no baseline data. Also, it is hard to “unteach” myths and misconceptions about what certain therapeutic interventions can or cannot deliver. People have gone too far to embrace the ideas.

But I digress. Another trend of the city’s health and social service sector is life-and-death education. I recall a news item about schools cooperating with non-governmental organizations (NGOs) to organize experiential learning on life and death for elementary school children. They go into a psychedelic (my description) space (room or passage) and play games that ask spiritual questions about life and death. Supposedly, it is thought provoking for the youngster, so that he or she will not shy away from matters of life and death, and accept them as a part of life.

How odd and unnatural for school children to learn about life and death in this manner! How artificial our society has become. Everything has to be structured for our learning. Do we really believe that our children will better grasp matters of life and death after going through this kind of exhibit?

I believe our youngsters would learn a lot more if they had more opportunity to grow up with their grandparents and their grand-aunts and -uncles. Wouldn’t it be nicer to have carnivals to bring generations together? Life-and-death education is something I have learnt about experientially. My friends’ and relatives’ deaths have taught me about life. I believe in learning in a more naturally occurring context. Of course, core family units in today’s highly mobile society are scattered far and wide, with some family members miles apart from others. But the Internet, Facebook, Skype and other technology applications can keep us together. Learning about life and death cannot be left to exhibitions and teachers alone. It has to come from those who really “live” with us, and have a place in our hearts.

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

You only know it when you've gone through it

We learn about sandwich generations from books and by talking with friends and patients, but unless you have become one of those being “sandwiched,” you don’t really know what it means. Being sandwiched means not only that you have to look after your older and younger blood relations; it also means constant worrying about your parents and your younger ones, be they nephews, nieces or your own children.

At the moment, my mother is frequently on my mind. She has fallen four times since June. This is worrisome, indeed, but there is nothing much I can do. She lives with my brother in Toronto. My brother has been taking good care of her, but she is getting older and frailer each year.

I didn’t realize there is a comparative advantage of living in a smaller apartment. (Again, like I said earlier, learning has to be experiential.) When my mother visited me in Hong Kong just a few months back, she remarked that it was good that my apartment is small. She could quickly find something nearby to hold onto when she felt dizzy or when her knees gave way.

I didn’t think much about growing old when I was younger. I didn’t worry about saving money for the future when I was decades away from retirement age. In fact, retirement, secured old age, and so on, were not words and phrases found in my vocabulary when I was young.

There is a growing trend for people to say that we need to teach young people about growing old and getting prepared when they are still young; we need to plan for a secure old age decades ahead of time. As a gero nurse, I am not so sure about this. People grow into their own age. Learning has to be experiential. And where is the fun when, say at age 20, you have to be mindful of what you will become at 65?

Would continually thinking about old age take away our drive to move forward, to explore the world, to dream big dreams? Would teaching our young and making them think of old age prematurely rid them of the innocence of a full and “invincible” life ahead? What joy will it bring if we have to calculate risks when we are still young? We need to be responsible for our lives but not to that extent. At least not for me.

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

When I was young, I was naive.

I believed it was enough to teach nurses to meet basic requirements in providing care. I believed it was unreasonable for us to ask our students to love everyone. (That is still not a realistic expectation.) I used to believe in standards, quality audits and core competencies. (I still believe in some of these things, but in a different frame of reference.) To my mind, as long as everybody did his or her job properly, that would do.

I was wrong. It is not enough to teach our students to meet standards, have their competencies verified by tests or check, through peer- or self-appraisals, whether they have mastered the required skills.

There are so many different systems of accreditation being developed nowadays. Under modern accreditation systems, piles of documents explain protocols, guidelines and procedures about how things are done in a particular context or setting. They have a limited connection with the quality of care. Having documents in place doesn’t mean that the things said in the documents are or will be observed. It only means that specific instructions exist about how something should be done (and is believed to be done), and when and why it is done in certain ways.

As I grow older and, I hope, slightly wiser, I have come to realize that standards and competencies are not enough on their own. As I lecture, work with students on projects and supervise them in field practice, I am gradually coming to see how flawed my thinking was.

The most important thing about nursing is caring—caring about, not just for. It is only when we care about something that we strive to do well, to do better. When we care enough, we show it in our work and how we carry ourselves in practice. It is only when we care about those we serve and our profession that we strive to become better nurses and people.

But the global trend embraces the science of nursing more than the art of it. Something is amiss, but are we aware of what we are missing?

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.

Development of people-friendly cities: Observations of a gero nurse

Hong Kong is probably not on the list of the top 10 most habitable cities in the world. Although my view is coloured by having been born and brought up here, my bias is not unfounded when I say that it is a reasonably good city to live in—apart probably from the air, sound and light pollution problems we have. (We can do something about the air pollution, but won’t be able to solve the problem entirely because of all the factory smoke that is blown from across the border.)

There are certain prerequisites required to survive in Hong Kong. One, of course, is having strong nerves to tolerate sharing 1,095 square kilometers (423 square miles) with seven million others. This means that one should have the ability to withstand crowdedness, noise, a very fast pace of life and a sense of urgency in everything we do.

Although a “developed” city, Hong Kong is not as “civilized” as cities in Japan. But civility comes with a price—a very high cost of living—because its habitants are paying a lot for the basic infrastructure. As a developed city, we share many ills and strange phenomena with others. Our city may be advanced, but it is not quite a senior-friendly city. With the present trend toward cool structures and minimalism in design, there are just too many glassy reflective surfaces, mirrors and glistening facades of massive buildings and shopping malls around us.

These are not good for aging eyes when glare becomes a problem. The many mirrors and glass structures are traps for seniors who have less-efficient depth perception to differentiate subtle changes in tone between surfaces; without such perception you cannot know whether it is a passage or a mirrored wall. Marble floors, a symbol of luxury, pave most new and recently renovated shopping malls. Even though designers claim that these floors are non-slippery, try walking on them on a rainy day. They are essentially traps for seniors in a modern city.

I have not yet mentioned the problem of finding your way. These modern, massive structures are not simple. You need to learn the language and have a different set of orientation skills than what you learnt a couple of decades ago. First of all, you need to learn how to perform a methodical 3D scan of a large space—I mean 360 degrees front to back, and from the tall ceiling to the ground you are walking on. Often, the signage is hanging high up in the air. (Try to recall a large airport you have visited).

What is more, special signs and utilities are designed to be artistic and blend into the physical space surrounding us. The philosophy of modern design is to make transition of space inconspicuous, blending man’s architecture with natural scenes. Thus, you will need to learn to decode the signs or symbols, making sure you are heading toward your destination.

And finally, you need the energy and ability to cover that long distance to find the bathroom or information counter. It is not always a breeze getting into a building and quickly identifying how to get where you want to go. It is a whole new language that the older generation needs to embrace and understand.

There is still a long way to go before Hong Kong can become a people-friendly city.

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