Aged care divide wrong

Some nurses consider working with the elderly is not 'real' nursing but nothing could be further from the truth, writes Peter Kieseker.

The implicit - and often explicit - message received during my study was: "Aged care - it's not real nursing." This care was apparently for those who themselves were only one step from moving from nurse to resident.

It wasn't real nursing; just baby-sitting with copious hygiene regimes. Real nursing was gung-ho procedures and fast critical thinking.

Well that might be so on television, but in the real world it seems to this writer that aged care comes closer to real nursing than one finds on the average ward in an urban hospital.

Jazwiec says it really well. Paraphrased she writes: "Healthcare, and especially nursing, was created to make people feel better. Even in its most basic, original form, it made people less anxious and more comfortable. It made a difference.

"Many say: 'No, healthcare was started to heal and cure'. But this is wrong.

"When healthcare first began, we didn't know how to heal and cure. All those first caretakers could do is make people more comfortable, help them feel better, and do a lot of praying that they hoped would make a difference." (Liz Jazwiec, Eat that Cookie, 2009).

In aged care often all that can be done is to give care and comfort, but this is the original and hopefully still the essence of nursing. When compared to ward nursing it is, arguably, aged care that is real nursing.

Consider the facts. Ward nursing in many instances resembles a conveyor belt of endless medications, observations, hygiene and ordered procedures. There is usually simply not enough time amidst all the tasks, and especially amidst all the paperwork, to truly see the individuality of each patient.

There is little time for the healing touches of meaningful conversation, reminiscence therapy, or even the moisturising of dry skin; and time to share a cup of tea with a patient is a fantasy. There is little time for the basic human connection that was once the soul of nursing.

Yet in age care the opportunity for such gentleness is often not only possible but it in fact forms a therapeutic cornerstone of the person-centred care that aged care nurses strive to deliver.

Oh yes, says the haughty ward nurse, but there is little scope for critical thinking in aged care. Again, the facts. Ward nurses may do all the critical thinking they like, but the only autonomy they really have is to consult the doctor.

Most ward nurses, even with years of experience, can not initiate as much as a paracetamol table without written permission.

In contrast, it is the aged care nurse who most often makes the routine, and the critical decisions, in a nursing home. Nurse initiated medication and procedures are second nature to the aged care nurse. For these nurses there is no safety net of a ward doctor to call upon when in doubt.

It is the aged care nurse who most needs critical thinking to assess deterioration in a patient and to make and enact intervention decisions; decisions usually made alone or with only fellow nurses to consult with.

This is only an opinion but perhaps it is time that many in the profession ceased their condescending and often degrading comments of aged care nursing because it is in fact, very much real nursing.

Peter Kieseker is in the second half of a graduate transition year (mature age graduate). He is currently working on a medical ward at Caloundra Hospital and before that worked at an aged care/aged psychiatric facility.

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