geriatric nursing essay

Geriatric Nurses’ Role for Elderly Patients

Identification of the problem, significance of the problem to nursing, purpose of the research, research question.

The efforts of geriatric nurses are concentrated on the health of elderly patients. Understandably, this patient group faces an increased risk of various traumas and diseases (e.g., Alzheimer’s). Therefore, the main objective of geriatric care is the development of effective preventive measures (Arai et al., 2011). On a larger scale, nurses are responsible for helping patients and their families deal with their illnesses/diseases as well as their consequences. Geriatric nurses can usually be found working in nursing homes, taking care of patients who are bedridden or who suffer from mental disabilities (Arai et al., 2011). In other words, the role of geriatric nurses in elderly care is constantly changing, but it is in no way losing its significance.

Geriatric nurses are in charge of developing interventions and counseling, and they have to organize resource utilization plans and understand and promote the essential needs of their elderly patients (Moore, Boscardin, Steinman, & Schwartz, 2012). In the majority of cases, these nurses are in control of educating the patients, the patients’ families, and other healthcare specialists who may be involved in the processes of geriatric care. Currently, all the major innovations that have been introduced in the field of geriatric nursing care based on the initiatives of geriatric nurses and their collaborative practice. Their intentions are aimed at improving the health condition of elderly people (Inouye, Westendorp, & Saczynski, 2014). The full potential of geriatric nurses has yet to be reached, and the current research problem should be identified to help the researcher understand the core aspects of geriatric nursing and its implications.

Regardless of the significant progress that has been made in the area of geriatric care, problems within the framework of the geriatric care setting still exist. First of all, there is the critical issue of finding a balance between the services of healthcare consultants and the basic palliative skills that should be possessed by geriatric nurses (Stewart, Chipperfield, Perry, & Weiner, 2012). Currently, not all nurses can work with critically ill individuals and effectively interact with their families. Of course, this problem of equilibrium varies from one healthcare facility to another, but the basic premises of the issue are evident across the profession and have a momentous impact on geriatric care in general (Stewart et al., 2012).

The re-evaluated principles of geriatric health care should be unifying and thus put into practice across all health care facilities. Secondly, to design and employ interventions aimed to trigger the development of the key aspects of geriatric care—including effective communication, the identification of health care objectives, the decision-making process, and professional provision of support for patients and their families—geriatric nurses should be able to adjust their interventions to the local environment and relevant policies (Stewart et al., 2012). A more specific problem relates to the inefficiency of interventions designed to simplify the lives of Alzheimer’s patients. The majority of geriatric nurses are well-versed in terms of general interventions intended to help patients with Alzheimer’s, but a limited number of individually adjusted and flexible approaches are available at the moment (Stewart et al., 2012).

The problem that Alzheimer’s poses for the framework of geriatric nursing can be explained by the preventive nature of geriatric care. Indeed, precautionary measures intended to help the nurse treat the patient may prove ineffective when applied to different patients (Curtis, 2015). The problem is significant because while the incidences of Alzheimer’s disease have increased in a linear progression, the number of available interventions has not varied substantially. Geriatric nurses should be keen on detecting the disease early because it would ultimately allow them to choose from an extensive array of interventions (Dall et al., 2013). In perspective, the nurse would also be able to combine these interventions and let the patient discover individualized treatment options. Alzheimer’s and its connection to geriatric care should be researched to support the important decisions made by nurses and patients regarding the financial and lawful aspects of their care (Moore et al., 2012). In the long term, early detection of the disease and better design of personalized interventions can minimize anxiety in elderly patients.

The purpose of the current research is to enable geriatric nurses to identify the key components that go beyond the local nursing setting and provide high-quality geriatric care for patients with Alzheimer’s. The researcher is interested in studying the outcomes and developing several flexible interventions. To this end, the outcome measures will be identified, and the most efficient measures will be highlighted. The researcher’s key concern is the development of high-quality approaches that can be diversified based on the individual features of each geriatric patient.

How can nurses mitigate the adverse outcomes of Alzheimer’s disease by a personalized approach and intervention and an individual care plan in a geriatric setting?

Arai, H., Ouchi, Y., Yokode, M., Ito, H., Uematsu, H., Eto, F.,… Kita, T. (2011). Toward the realization of a better aged society: Messages from gerontology and geriatrics. Geriatrics & Gerontology International, 12 (1), 16-22.

Curtis, J. (2015). Palliative care in critical illness: Challenges for research and practice. Palliative Medicine, 29 (4), 291-292.

Dall, T. M., Gallo, P. D., Chakrabarti, R., West, T., Semilla, A. P., & Storm, M. V. (2013). An aging population and growing disease burden will require a large and specialized health care workforce by 2025. Health Affairs, 32 (11), 2013-2020.

Inouye, S. K., Westendorp, R., & Saczynski, J. (2014). Delirium in elderly people. The Lancet, 383 (9920), 911-922.

Moore, K. L., Boscardin, W. J., Steinman, M. A., & Schwartz, J. B. (2012). Age and sex variation in prevalence of chronic medical conditions in older residents of U.S. nursing homes. Journal of the American Geriatrics Society, 60 (4), 756-764.

Stewart, T. L., Chipperfield, J. G., Perry, R. P., & Weiner, B. (2012). Attributing illness to ‘old age:’ Consequences of a self-directed stereotype for health and mortality. Psychology & Health, 27 (8), 881-897.

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• v.8(5); 2021 Sep

Nursing students' willingness to work in geriatric care: An integrative review

Fengling dai.

1 Faculty of Nursing, Southwest Medical University, Luzhou China

2 Department of Emergency Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou China

Yufeng Yang

3 Sichuan Tianyi College, Chengdu China

Associated Data

The data sets generated for this review are available on reasonable request to the corresponding author.

This integrative review aims to explore the willingness of nursing students to work in geriatric care over the past 10 years and to explore the factors influencing nursing students to work in geriatric care.

An integrative review.

Studies investigating nursing students’ willingness in gerontological nursing work and related influencing factors published in English in Cochrane Library, MEDLINE, Embase, PsycINFO and CINAHL between 2010–2020 were included. Data collected in April 2020.

Twenty‐four studies were analysed. Most studies presented a contradictory or negative attitude about the willingness of nursing students to engage in gerontological nursing work. In most studies that rank the intention to work in nursing fields, gerontological care received the lowest or a relatively low ranking. The main factors affecting work related to gerontological nursing include prior experience caring for older adults, attitudes towards geriatrics, anxiety about ageing, clinical practice environment and living experience with older family members.

1. INTRODUCTION

Due to the increase in ageing, meeting the needs of the increasing older population for medical and health services is challenging. According to a WHO survey, by 2050, the proportion of people over 60 years old will increase to 22% (World Health Organization,  2018 ). There is a large demand for gerontological nurses due to the growth of the ageing population; additionally, the prevalence of chronic and degenerative diseases is high, thus resulting in an unprecedented demand for health care (King et al.,  2013 ), particularly for staff in nursing homes, registered nurses specializing in gerontological care and home care personnel (Carlson & Idvall,  2015 ).

Although the global ageing population has reached a serious level, encouraging nurses to work in geriatric nursing is challenging in many countries (Neville et al.,  2013 ). Nursing students' expectations regarding gerontological caring employment reflect a low level of aspiration and most students are not intent on entering the long‐term nursing workforce to care for older people (Brown et al.,  2008 ; Happell,  2002 ; McCann et al.,  2010 ; Neville et al.,  2013 ; Stevens,  2011 ); this lack of intent of nursing students to work in long‐term nursing is a concern.

Liu et al. ( 2013 ) conducted a review of nurses' attitudes towards older people. Neville et al. ( 2013 ) explored the reasons why undergraduate nursing students are not choosing gerontology as graduate specialty. Abudu‐Birresborn et al. ( 2019 ) examined nurses’ and nursing students’ preparedness to care for older people in lower and middle‐income countries through a scoping review. Algoso et al. ( 2016 ) discussed undergraduate nursing students’ attitudes, perceptions and experiences in aged care setting. However, as searched in databases including Cochrane Library, PubMed, Embase, PsycINFO and CINAHL, the evidence about comprehensive review of nursing students' willingness to work in gerontological care and of the influencing factors is limited. In particular, as the ageing population increases, an understanding of nursing students’ desire to work in gerontological nursing and the factors influencing nursing students’ consideration of gerontological nursing work is urgently needed. This understanding can provide guidance for educational and clinical decision‐making and help formulate corresponding measures to encourage more students to engage in geriatric nursing care.

Therefore, this integrative review aims to analyse and criticize the current literature on nursing students' intention towards gerontological nursing work and on factors that influence the willingness of nursing students to pursue careers as gerontological nursing practitioners and to provide relevant evidence regarding this phenomenon.

An integrative review of the literature was conducted using the framework provided by Whittemore and Knafl ( 2005 ); this approach allows for the inclusion of diverse methodologies (i.e., experimental and non‐experimental research) and contains five stages, including problem identification, literature search, data evaluation and analysis and presentation. This method can use diverse data sources, thereby developing a holistic understanding of the topic of interest (Hopia et al.,  2016 ).

2.1. Literature search

The following databases were searched for articles published between 2010–2020: the Cochrane Library, Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica dataBASE (Embase), PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The following three groups of search terms (text words and Medical Subject Headings (MeSH) terms, if available) were used in combination: (a) geriatric nursing, aged care, gerontology nursing, old people, elderly, old age, older adults, older population or elder care; (b) willingness to work, job intention, work, employment intention, employment intent or preference of employment; and (c) nursing students, student nurses or undergraduate student nurses. The reference lists of all included studies were hand‐searched to identify any potentially relevant studies, and the authors were contacted to access additional relevant publications.

2.2. Eligibility criteria

All studies investigating nursing students’ attitudes towards gerontological nursing work and related influencing factors and that were published in English were included. To analyse up‐to‐date results on this research topic, only articles published in recent ten years were included. In addition, both qualitative studies and quantitative surveys were included.

2.3. Study selection and data extraction

Two reviewers independently assessed the studies for eligibility. After eliminating the duplicates, the studies were first selected based on the title and abstract; then, the full‐text publications were examined. Disagreements were resolved by discussion or referral to a third review author. Any differences were discussed, and agreement among the researchers was achieved. A Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) diagram was presented to outline the screening process used in the literature search.

The data extracted included the author, year, the country where the study was conducted, purpose, data collection and analysis methods, sampling and main results. One researcher extracted all the data from the included studies.

2.4. Quality appraisal

The quantitative studies were assessed using the Center for Evidence‐Based Management (CEBM) appraisal of a survey checklist (CEBM,  2014 ), and the mixed‐methods studies were assessed using the Mixed Methods Appraisal Tool (MMAT; Hong et al.,  2018 ). Two reviewers were independently involved in the appraisal process; disagreements were resolved by discussion or referral to a third review author.

2.5. Data analysis

Data analysis was initially undertaken by the primary author and later scrutinized by other authors to ensure accurate interpretation and credibility. As suggested by Whittemore and Knafl ( 2005 ), four phases were constituted in this stage: (a) Data reduction. In this phase, the primary sources are divided into subgroups according to the logical system to facilitate analysis; (b) Data display. In this phase, data display matrices and graphs are developed to enhance the visualization of patterns and relationships with and across primary data sources; (c) Data comparison. In this phase, data are iteratively compared with examine data displays to identify patterns, themes or relationships. Specifically, in comparing data, the authors searched for common and unusual patterns, contrasted and compared the patterns and themes, clustered similar themes together and subsumed these themes into more general themes and alternated between the literature and the conclusions drawn to verify the findings and test for plausibility and (d) Drawing conclusions and verification. In this phase, the important elements and conclusions of each subgroup are synthesized into an integrated summation of the phenomenon.

3.1. Search results

The electronic database search yielded 427 titles and abstracts. After the duplicates were removed, 246 titles and abstracts were screened according to the inclusion and exclusion criteria. This process yielded 35 manuscripts for full‐text review. Fourteen manuscripts were unavailable and were, therefore, excluded. In some studies, the themes focused on students with employment intentions in various departments rather than specifically gerontological care, but these studies also investigated the students’ attitude towards becoming gerontological care practitioners; thus, we included these studies. Overall, 24 publications were included as follows: 19 quantitative publications reporting surveys and five mixed‐method studies; no qualitative study was searched (Figure  1 ).

Study selection flow chart

3.2. Study characteristics

Twenty‐four studies were included in the final review, and the main characteristics of the included studies were extracted (Table  1 ). Most of the studies were conducted in Australia ( N  = 3), Hongkong ( N  = 1), Israel ( N  = 3), Korea ( N  = 1), Malaysia ( N  = 1), Mainland China ( N  = 3), Sri Lanka ( N  = 1), Sweden ( N  = 1), Taiwan ( N  = 1), Turkey ( N  = 1) and the United States ( N  = 6); additionally, one of the studies was conducted in Australia and China and another one was conducted in both Korea and the United States. Regarding the participant characteristics, overall, 8,892 participants were involved in the study and the average sample size was 370 (range: 50–1,462).

Characteristics of the studies

3.3. Study quality

No qualitative research was included according to the criteria after literature searching. No studies were excluded due to poor quality. See Tables  2 and ​ and3 3 for a summary of the quality assessment.

Methodological quality of quantitative studies

Cited from: Center for Evidence‐Based Management (July 2014), Critical Appraisal Checklist for Cross‐sectional Study. Retrieved (9 June 2019) from https://www.cebma.org .

Methodological quality of mixed‐methods studies

Cited from : Hong QN, Pluye P, Fàbregues S, Bartlett G, Boardman F, Cargo M, Dagenais P, Gagnon M‐P, Griffiths F, Nicolau B, O’Cathain A, Rousseau M‐C, Vedel I. Mixed Methods Appraisal Tool (MMAT), version 2018. Registration of Copyright (#1148552), Canadian Intellectual Property Office, Industry Canada.

3.4. Nursing students' willingness to work in gerontological care

In two studies, the willingness of nursing students to engage in gerontological care was positive (Chi et al.,  2016 ; Zhang et al.,  2016 ). In two other studies, the nursing students' choice of gerontological care as a career and the nursing students’ motivation was at a moderate level (Che et al.,  2018 ; Cheng et al.,  2015 ). However, in two studies, the nursing students had a contradictory attitude. On the one hand, they had a moderate or positive attitude towards older people; on the other hand, the nursing students had no interest in working in gerontological care (Neville,  2016 ; Rathnayake et al.,  2016 ). In addition, one study showed that the nursing students’ attitudes towards working in geriatrics were negative (Natan et al.,  2015 ). King et al. ( 2013 ) found that the negative attitude was related to working in nursing homes rather than to working with older people. In five studies ranking the intention to work in many nursing fields, gerontological care received the lowest or a relative low ranking (King et al.,  2013 ; McCann et al.,  2010 ; Shen & Xiao,  2012 ; Swanlund & Kujath,  2012 ; Yildirim et al.,  2011 ). Stevens ( 2011 ) indicates that due to the accumulation of the process and experience of nursing education, the willingness to work in gerontological care gradually decreases.

3.5. Factors influencing nursing students' willingness to work in geriatric nursing

Twenty‐seven variables were identified from the 24 papers. The relationship between these variables and nursing students' willingness to work in geriatric nursing is summarized in Table  4 . The variables were grouped into one of six categories and listed in the order of the most investigated to the least investigated.

Variables related to positive attitudes towards work with older people

3.5.1. Demographics

Five demographic variables that affect nursing students’ willingness to work in geriatric nursing are mentioned. Three studies showed that younger students were more active in gerontological nursing work (Shen & Xiao,  2012 ; Xiao et al.,  2013 ). However, Neville ( 2016 ) showed that young participants were less active than those in the older age group. Carlson and Idvall ( 2015 ) and Che et al. ( 2018 ) found the willingness to care for older people did not significantly differ among students of various ages.

There is also a difference in the impact of the gender of nursing students. While two studies showed that males were more likely to work in gerontological care (Che et al.,  2018 ; Natan et al.,  2015 ), another study showed that females were more active than males (Neville,  2016 ). Moreover, two studies showed no significant correlation between the different sexes (Carlson & Idvall,  2015 ; Mattos et al.,  2015 ).

Neville ( 2016 ) indicated that third‐year participants have more positive perceptions about working with older people. However, Che et al. ( 2018 ) and Zisberg et al. ( 2015 ) showed the opposite results. Swanlund and Kujath ( 2012 ) showed that the willingness to work with elders was not significantly related to the year of study.

Further, religious students were more inclined than secular students to intend to work in geriatrics (Natan et al.,  2015 ). Zisberg et al. ( 2015 ) showed that ethnicity was a predictor of intentions to work in geriatric care, and the Arab students demonstrated higher intention to work with older people than Jewish students.

3.5.2. Education

In three studies, an enriched clinical practice environment more positively affected students' selection of gerontological care (Carlson & Idvall,  2015 ; Cheng et al.,  2015 ; Stevens,  2011 ).

Haron et al. ( 2013 ) showed that the type and place of training made a difference; approximately half the diploma students were prepared to consider working in geriatrics, but only a third of the college students and less than a quarter of the university students were prepared to do so. However, Che et al. ( 2018 ) and Mattos et al., ( 2015 ) showed that the willingness to work with older people did not differ significantly by the type of training programme.

Mattos et al., ( 2015 ) showed that, compared with a gerontological nursing course that was integrated into other nursing courses, a stand‐alone gerontological nursing course yielded students with higher intention levels. Che et al. ( 2018 ) showed that the approach used by the gerontological nursing course did not significantly affect the intention to care for older people. In Akpinar Soylemez et al. ( 2018 ), no statistical differences were found regarding students’ willingness to work with older people before and after the students’ taking an elective geriatric nursing course and an elective emergency and surgery nursing course. Cheng et al. ( 2020 ) evaluated the efficacies of a Senior Simulation Suit Programme; compared with the control group, the programme showed no significant difference.

Moreover, compared with nursing students from public nursing institutions, nursing students from private nursing institutions exhibited slightly lower levels of intention to work with older people. Additionally, the background of nursing educators has no statistical significance (Che et al.,  2018 ). The care willingness towards geriatrics positively correlated with knowledge about ageing (Zhang et al.,  2016 ).

3.5.3. Experience

In our synthesis, nine studies determined that prior experience in caring for older people was positively related to nursing students’ desire to pursue a career in geriatric care after graduation (Cheng et al.,  2015 ; Chi et al.,  2016 ; Haron et al.,  2013 ; Mattos et al.,  2015 ; Neville,  2016 ; Swanlund & Kujath,  2012 ; Xiao et al.,  2013 ; Zhang et al.,  2016 ; Zisberg et al.,  2015 ). Nevertheless, Carlson and Idvall ( 2015 ) and Che et al. ( 2018 ) determined that prior experience in caring for older people did not statistically significantly affect working preference. In Jang et al. ( 2019 ), the quality of contact with older people was a positive influencing factor in the willingness of Korean nursing students to care for older people.

3.5.4. Family

Cheng et al. ( 2015 ) and Rathnavake et al. ( 2016 ) revealed that having a living experience with older family members was a positive factor in geriatric career intention, while Che et al. ( 2018 ) showed that there was no significance. Cheng et al. ( 2015 ) also indicated that having parents that have good attitudes towards older people and having a close relationship with elder relatives positively affected students’ intention to work with older people.

3.5.5. Attitudes

In our synthesis, nine studies suggested that having a positive attitude towards older people is a positive factor promoting geriatric nursing work among nursing students after graduation (Che et al.,  2018 ; Cheng et al.,  2015 ; Chi et al.,  2016 ; Haron et al.,  2013 ; Jang, Oh, et al.,  2019 ; Natan et al.,  2015 ; Rathnayake et al.,  2016 ; Zhang et al.,  2016 ; Zigberg et al.,  2015 ), while Brabham ( 2018 ) and Swanlund and Kujath ( 2012 ) found no statistically significant relationship between employment preference to work with older people and students’ attitudes.

Similarly, Shen and Xiao ( 2012 ) and Xiao et al. ( 2013 ) determined that discriminatory attitudes towards older people were a negatively influencing factor in work related to gerontological nursing. Cheng et al. ( 2015 ), Jang et al. ( 2019 ) and Jang, Oh, et al. ( 2019 ) revealed that anxiety about ageing negatively affects the expectancy and value aspects to choose geriatric nursing as a career and the willingness to care for older people.

In addition, nursing students who had empathy for older people had a high willingness to care for them (Jang, Kim, et al.,  2019 ; Jang, Oh, et al.,  2019 ). Zhang et al. ( 2016 ) discovered that gratitude was a mediator between knowledge about gerontological adults and the willingness to care for them.

3.5.6. Others

In our study, we included several influencing factors that are only mentioned in individual studies and cannot be grouped in the above categories.

Cheng et al. ( 2015 ) showed that investigators believe that personal interest is an important factor affecting work in gerontological care. The results from Haron et al. ( 2013 ) revealed that significantly most of the participants who had planned to consider working in gerontological nursing cited the expansion of the management powers and the creation of the clinical nurse specialist role. Natan et al. ( 2015 ) found that normative and control beliefs were predictors of nursing students’ intention to work in geriatrics on graduation.

4. DISCUSSION

This study reviewed the willingness of nursing students to work in geriatric nursing care over the past ten years. The results indicated that although some studies showed the willingness of nursing students engaged in gerontological was at a positive or moderate level, more studies presented a contradictory and negative attitude. Furthermore, in most studies where nursing fields were ranked according to the intention to work in these fields, gerontological care was ranked the lowest or ranked relatively low.

A few decades ago, students did not prefer geriatric care. Heller and Walsh ( 1976 ) showed that nursing students tend to treat older people with a negative attitude and that negative emotions render these students reluctant to engage in geriatric nursing work; Feldbaum and Feldbaum ( 1981 ), Kayser and Minnigerode ( 1975 ) demonstrated, in comparing students’ willingness to work in other areas, that most students were unwilling to work in a “nursing home”; Happell’ ( 1999 ) also showed that, among students who wanted to work in psychiatry, gerontology was the lowest ranked in terms of willingness to work.

Unfortunately, despite decades of effort, students' willingness to work in gerontological care has not significantly changed or improved. Swanlund and Kujath ( 2012 ) suggested that students prefer to work in a fast‐paced working environment, such as acute care departments, rather than gerontological care settings. Compared with paediatric care, intensive care, etc., geriatric nursing is considered to be physically laborious and to have low status and remuneration (Abbey et al.,  2006 ; Neville,  2016 ; Neville et al.,  2008 ). In an Israeli study, university students' willingness to work in gerontological care was lower than that of college‐ and diploma‐qualified students (Haron et al.,  2013 ) and this finding is similar to the willingness of Chinese nursing students to work in the gerontological care setting. In China, highly educated nursing students are more reluctant to work in a gerontological ward or other institutions care for older people. Hence many institutions care for older people can provide only basic life care, the professional nursing services such as chronic disease management, rehabilitation nursing and palliative care are inadequate. In particular, older people often have multiple chronic diseases, self‐function degradation and decreased self‐care ability; therefore, gerontological care is more complex than simple daily life care and the support and guidance of a more professional and personalized caregiver are needed. Like paediatric and intensive care nursing, the gerontological care specialty requires professional high‐quality nursing personnel.

Regarding the demographic characteristics of the subjects, studies show contradictory results. In terms of age, younger students were more positively engaged than older students in gerontological care work (Shen & Xiao,  2012 ; Xiao et al.,  2013 ) and senior students hold a negative attitude on geriatric working intention (Che et al.,  2018 ; Zisberg et al.,  2015 ). These findings are inconsistent with the rules of education; it is generally presumed that as the level of students’ education increases, the students’ knowledge of gerontological nursing and willingness towards gerontological nursing work will both improve. The level of engagement should demonstrate an increasing trend.

Concerning gender, female students working in geriatric nursing are more positive (Neville,  2016 ); however, Che et al. ( 2018 ) and Natan et al. ( 2015 ) showed the opposite result. Neville ( 2016 ) provided an analysis showing that women are more likely to be set up as “role caregivers” in the traditional sense. In an analysis conducted by Natan et al. ( 2015 ), the male nurses indicated that they could assist older people with meeting their fitness goals, such as rotation and activities; therefore, gerontological care provided by male nurses is in high demand. In addition, the role of male nurses in traditional women's work is a feature of certain departments, such as maternity wards and finding a related job can be challenging. We believe that the contradictory results obtained by studies conducted in different geographical areas can be explained by cultural differences or may have originated from scientific sources, such as sample size or sample bias due to fewer male nurses.

Concerning educational level, although some researchers have explored various courses and training programmes in recent years, many studies (Akpinar Soylemez et al.,  2018 ; Che et al.,  2018 ; Cheng et al.,  2020 ; Lamet et al.,  2011 ) have failed to find significant differences compared with the control groups or show significant improvements in students’ willingness to work with older people, thus indicating that more efficient educational strategies should be explored.

Geriatric nursing education includes academic and practical clinical training. In some nursing faculties and schools, geriatric nursing courses are available for one semester, mostly at the senior level, and are mainly centred on disease‐centred medical modes (Shen & Xiao,  2012 ). The distinction between nursing courses on gerontological care and those on general medical care is unclear; the specific characteristics of gerontological nursing are not sufficiently prominent, particularly regarding specialized gerontological nursing skills, such as communication skills, multiple medication nursing and gerontological rehabilitation nursing. Therefore, students who enter clinical practice have difficulty in addressing complex situations in older patients; this difficulty further leads to the negative attitudes held by students towards gerontological care. Besides, Garbrah et al. ( 2017 ) presented that nursing curriculums as featuring too much emphasis on acute and critical left nursing students feeling unprepared to work in gerontological nursing, which suggested that adequate gerontology‐related courses should be included in the curriculum for every student irrespective of their specialization option. Concerning curriculum design, nursing educators should incorporate methods to increase interest and promote the attractiveness of lectures so that students will more readily accept geriatric nursing courses. Furthermore, as were evidenced to be the effective learning approaches to improve students’ theoretical knowledge and skills, more education methodologies such as flipped classroom pedagogy, and simulation‐based learning (Hu et al.,  2018 ; Torkshavaned et al.,  2020 ) are encouraged to be explored in designing gerontological nursing programmes.

In clinical training, nursing education regarding gerontological care promotes a positive clinical learning experience that can improve attitudes towards older people and motivate nursing students to prioritize their intentions to engage in gerontological nursing work (Abbey et al.,  2006 ; Brown et al.,  2008 ; Chenoweth et al.,  2010 ; King et al.,  2013 ; Liu et al.,  2013 ; Robinson et al.,  2008 ). Clinical practice includes the clinical ward environment, staff, patients, nurses, teachers and interactions with student tutors (Papp et al.,  2002 ). Schools and hospitals should carefully screen for knowledgeable and caring teachers, train teachers, provide adequate medical supplies and equipment in the internship section and develop a comprehensive internship programme for students (Chi et al.,  2016 ). In particular, regarding the role of teachers during internship, it is important for high‐quality nursing centres to create a harmonious relationship between nurses and patients, provide a good environment and establish a high‐quality nursing service consciousness. As stated by Che et al. ( 2018 ), the clinical learning setting is critical for cultivating students’ interest in geriatric care; therefore, nursing programmes should ensure that both the training environment and assigned mentors work to promote positive attitudes towards caring for older people.

In addition, in the past, the treatment and care of the older people were mainly distributed in other disease‐centred specialties departments, not enough attention was paid to the holistic care model regarding older people, thus lead to the development of the geriatrics department of hospitals in many countries was slowly, many people including nursing students often consider gerontology nursing as only working in a nursing home type situation. This reminds educators should give a comprehensive introduction to nursing students about the geriatric care related facilities especially when they are planning their career in geriatric nursing.

Moreover, as prior experience caring for older people positively affects intention to work with them, more activities involving caring for older people are encouraged. Examples of such activities include encouraging older people to participate in community activities; regularly visiting and performing volunteer work for older people in nursing homes; and assisting older people with housekeeping, reading, communicating, etc. Increasing opportunities to interact with older people cultivates patience and responsibility, generally improves knowledge about geriatric nursing and generally develops more experience in working with older people.

Concerning family education and its impact on working intention, the experience of living and interacting with older people in daily life includes both the experience of caring for and the experience of understanding older people. Living with the older members in a family can promote nursing students' understanding of the lifestyle involved with interacting with older people. Compared with students without relevant experience, experienced students have more confidence and skills in caring for older people (Zhang et al.,  2016 ). Students' concern and sympathy for older people can be easily simulated (Pan et al.,  2009 ) and interactions with older people can reduce the anxiety of nursing students regarding ageing (Yan et al.,  2011 ). Furthermore, young persons who live with older people are more likely to be enthusiastic about people who need help because such young persons are more likely to take care of older people (Zhang et al.,  2016 ). The role of parents is vital; parents should be filial to their parents and set a good example for their children to encourage respect for older people.

4.1. Limitations

Because of the limitation of language, we included only articles published in English; this restriction may have led to language bias, and some significant findings published in other languages might have been overlooked. Second, although the search strategy was extensive and inclusive, we did not search the unpublished literature, and hence, the related data might be missed. Moreover, the inclusion criteria did not clearly distinguish among gerontological care workplaces, such as geriatrics departments, nursing homes, rehabilitation centres, or general wards at gerontological care pension institutions; the nursing students’ work tendency in different workplaces of geriatric nursing may have differed. Further studies are needed to clarify these issues.

5. CONCLUSION

This paper reviewed 24 studies reporting on the willingness of nursing students to work in geriatric nursing over the past ten years and the relevant influencing factors. The results showed that although in recent years, governments, educational systems and professional nursing associations have initiated efforts to promote gerontological care services, nursing students’ willingness to work in gerontological care services is still not promising. And the main factors affecting work related to gerontological nursing include prior experience caring for older adults, attitudes towards geriatrics, anxiety about ageing, clinical practice environment and living experience with older family members.

This finding suggests that continued and dedicated work towards improvements can be achieved by government policies, public opinion, school programmes, clinical practice education, family atmosphere and many other efforts. Given the global ageing population has reached a serious level and the demand for geriatric nurses is expected to increase dramatically, further research on the subject is desirable and timely.

CONFLICT OF INTEREST

No conflict of interest has been declared by the author(s).

AUTHOR CONTRIBUTIONS

DF, LY, JM: Study design. DF, YY: Data collection. DF, LY, JM: Data analysis. DF: Manuscript writing. DF, LY: Critical revisions for important intellectual content.

ACKNOWLEDGEMENTS

We would like to thank The National Social Science Fund of China for their support.

Dai F, Liu Y, Ju M, Yang Y. Nursing students' willingness to work in geriatric care: An integrative review . Nurs Open .2021; 8 :2061–2077. 10.1002/nop2.726 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

Funding information Research reported in this publication was supported by The National Social Science Fund of China under Award Number 16XSH017.

DATA AVAILABILITY STATEMENT

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Geriatric Nursing Case Study (Essay Example)

Ben Albrecht

In the field of nursing, geriatric care plays a crucial role in addressing the unique healthcare needs of elderly patients. This case study focuses on Mrs. Smith, an 80-year-old woman admitted to the hospital with a hip fracture following a fall at home. As a geriatric nurse, providing specialized care for Mrs. Smith involves a comprehensive assessment of her physical, emotional, and social well-being to ensure a holistic approach to her treatment and recovery. Upon admission, Mrs. Smith's geriatric nurse conducts a thorough assessment to identify her specific needs and develop an individualized care plan. This includes assessing her mobility, cognitive function, nutritional status, and medication management. Understanding the complexities of aging, the nurse takes into account factors such as polypharmacy, decreased physiological reserves, and increased susceptibility to delirium in older adults. In caring for Mrs. Smith, the geriatric nurse emphasizes the importance of promoting independence and maintaining her quality of life. This involves implementing interventions to prevent complications such as pressure ulcers, falls, and delirium. The nurse collaborates with a multidisciplinary team, including physical therapists, occupational therapists, and social workers, to provide comprehensive care that addresses Mrs. Smith's physical, emotional, and social needs. As Mrs. Smith progresses in her recovery, the geriatric nurse continues to monitor her closely, adjusting the care plan as needed to promote optimal outcomes. Through ongoing assessment, communication, and advocacy, the nurse plays a key role in supporting Mrs. Smith through her rehabilitation journey. By providing compassionate, evidence-based care, the geriatric nurse helps enhance the quality of life for older adults like Mrs. Smith, promoting dignity, autonomy, and well-being in the aging population.

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Geriatric Nurse Career Overview

Are you ready to earn your online nursing degree?

how long to become

Job outlook, average earning potential, geriatric nurse career in brief.

Geriatric nurses work with doctors and other healthcare professionals to care for the physical, mental, and emotional well-being of elderly patients, helping them maintain independence and quality of life. These registered nurses (RNs) possess specialized knowledge and skills to treat common health issues affecting the elderly population. Some key responsibilities include the following:

Primary Responsibilities

• Develop treatment plans and administer medications
• Educate patients and caretakers on coping skills to handle age-related conditions
• Provide treatment for chronic conditions most likely to affect the elderly (e.g., heart disease, arthritis, diabetes, osteoporosis, Alzheimer’s disease)
• Monitor for signs of elder abuse
• Assist with and train patients on daily living activities, such as hygiene, toileting, and medication management

Career Traits

• Knowledge of the aging process and disease progression
• Ability to recognize verbal and nonverbal communication cues

Where Do Geriatric Nurses Work?

RNs specializing in geriatric care typically find employment at hospitals and medical clinics. In addition, work settings such as nursing homes, long-term care facilities, and home healthcare also rely on the services of geriatric nurses.

Geriatric nurses implement treatment plans, administer medications, and educate patients and families about care options.

Nursing Homes

Nursing home RNs provide full-time healthcare, assist with personal needs and rehabilitation, and monitor patients for bedsores, infections, or other conditions.

Home Healthcare

Home healthcare geriatric nurses help patients recover from surgery and care for those with chronic conditions such as dementia or paralysis. They may also assist with personal hygiene and nutritional needs while working with families to maintain the best level of care.

Why Become a Geriatric Nurse?

Although geriatric nurses often work in physically demanding and stressful settings, this career offers personal and professional fulfillment by providing crucial healthcare services and improving the quality of life for the aging population.

Advantages to Becoming a Geriatric Nurse

Disadvantages to becoming a geriatric nurse, how to become a geriatric nurse, earn an associate degree in nursing (adn) or a bachelor of science in nursing (bsn), pass the nclex-rn to receive rn licensure, gain bedside nursing experience, consider earning a gerontological nursing certification, geriatric nurse vs. adult-gerontology nurse practitioner.

While geriatric nurses may enter the field with an RN license, adult-gerontology nurse practitioners (NPs), as advanced practice registered nurses, must hold a master’s and specialized certification.

Geriatric Registered Nurse

Adult-gerontology nurse practitioner, how much do geriatric nurses make.

The population over the age of 65 will grow to over 82 million by 2030 . This demographic surge will positively impact the demand for geriatric nurses, as the expanding elderly population seeks an array of primary and preventive healthcare services.

Although the U.S. Bureau of Labor Statistics (BLS) does not differentiate between RN specialties, RNs can expect a 7% overall job growth between 2019 and 2029, with more opportunities available to those with certifications. Based on salary information provided by PayScale’s employee reports, RNs with geriatrics skills earn an average income of $67,530, below the overall median salary of $75,330 for all RNs as reported by the BLS. Certifications can significantly boost geriatric nurse salary levels and job prospects.

Questions About a Career as a Geriatric Nurse

What does a geriatric nurse do.

Geriatric nurses provide healthcare services to the elderly, helping them maintain their quality of life. Although responsibilities vary by employment setting, these RNs may assess vital signs, administer medications, and collaborate with other healthcare professionals to implement treatment plans. They may assist with basic functions and personal hygiene and offer patients information and resources about their conditions.

How long does it take to become a geriatric nurse?

A geriatric nurse can enter the field after earning a two-year associate degree or a four-year BSN followed by receiving an RN license. Employment opportunities increase by earning gerontological nursing certification which requires two years of RN experience with 2,000 hours of practice in gerontological nursing.

What qualifications do you need to be a geriatric nurse?

Geriatric nursing requires a valid RN license and undergraduate coursework that provides the essential knowledge and skills necessary to engage in evidence-based practice. In addition to gaining experience in clinical placements, nursing students receive training in acute and chronic disease management, advanced pharmacology and pathophysiology, palliative care, and healthcare promotion.

What kind of nurse takes care of the elderly?

Licensed practical/vocational nurses (LPNs/LVNs) and certified nursing assistants often work with older patients in nursing homes and home care settings. However, hospitals and other facilities serving elderly populations prefer to hire RNs who hold BSN degrees, and, in some cases, voluntary gerontological nursing certification. MSN-trained advanced practice nurses may obtain national certification as adult-gerontology acute care NPs and adult-gerontology primary care NPs.

Resources for Geriatric Nurses

Gerontological advanced practice nurses association, american geriatrics society, eldercare workforce alliance, american assisted living nurses association, related pages.

Adult-Gerontology Nurse Practitioner Career Overview

This guide answers the question “What is an adult-gerontology nurse practitioner?” for those interested in pursuing this fulfilling healthcare career.

Advanced Practice Registered Nurse Career Overview

Learn about advanced practice registered nurse jobs, roles, salaries, and requirements.

Hospice Nurse Career Overview

Read below to learn about hospice nurse jobs, how to become a hospice nurse, and typical hospice nurse salaries.

Home Health Nurse Career Overview

Read on to discover home health nurse jobs, what home healthcare nurses do, and home health nurse salary expectations.

Reviewed by:

Nicole Galan, RN, MSN

Nicole Galan is a registered nurse who earned a master’s degree in nursing education from Capella University and currently works as a full-time freelance writer. Throughout her nursing career, Galan worked in a general medical/surgical care unit and then in infertility care. She has also worked for over 13 years as a freelance writer specializing in consumer health sites and educational materials for nursing students.

Galan is a paid member of our Healthcare Review Partner Network. Learn more about our review partners .

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Geriatric Nursing Topics, Ideas, and Research Paper Examples

James colson dnp, rn.

• May 15, 2024
• Nursing Topics and Ideas

Geriatric nursing, a specialized field within the realm of healthcare, plays a crucial role in promoting the well-being and quality of life of elderly individuals. As the world’s population continues to age, the demand for skilled geriatric nurses is on the rise.

Geriatric Nursing Topics

In this article, we discuss Geriatric Nursing Topics, ideas, and give 5 Research Paper Examples on Geriatric nursing.

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PICOT Questions Examples about Geriatric Nursing

• In geriatric patients residing in long-term care facilities (P), how does the implementation of a personalized exercise program (I) compared to routine care (C) affect the incidence of falls (O) within a six-month period (T)?
• In older adults with Alzheimer’s disease (P), what is the effect of music therapy (I) on reducing agitation and improving cognitive function (O) compared to standard care (C) over a three-month period (T)?
• In elderly individuals living independently (P), how does regular social engagement (I) compared to social isolation (C) influence the risk of depression (O) within a one-year timeframe (T)?
• In older patients with chronic pain (P), what is the impact of opioid analgesics (I) versus non-pharmacological pain management techniques (C) on overall pain relief and functional status (O) during a three-month intervention (T)?
• Among geriatric patients undergoing hip replacement surgery (P), how does preoperative physical therapy (I) compared to no preoperative physical therapy (C) affect postoperative mobility and recovery (O) within a two-month period (T)?
• In older adults with type 2 diabetes (P), what is the efficacy of self-monitoring of blood glucose levels (I) versus standard glucose management (C) in achieving glycemic control (O) over a six-month period (T)?
• Among older adults receiving palliative care (P), how does the provision of art therapy (I) compared to standard palliative care (C) influence overall comfort and quality of life (O) in their final weeks (T)?
• In elderly individuals with heart failure (P), what is the impact of telehealth monitoring (I) compared to traditional in-person follow-up (C) on hospital readmission rates (O) within a three-month period (T)?
• Among geriatric patients with pressure ulcers (P), how does the use of advanced wound dressings (I) compared to conventional wound care (C) affect wound healing rates (O) over an eight-week period (T)?
• In older adults with chronic obstructive pulmonary disease (P), what is the effect of pulmonary rehabilitation (I) on improving exercise capacity and reducing dyspnea (O) compared to standard care (C) within a three-month intervention (T)?

You can also check out PICOT Questions Examples about Integration of Palliative Care in Cancer Treatment

Geriatric Nursing Evidence-Based Practice (EBP) Project Ideas

• Developing a falls prevention program tailored to geriatric patients in a specific healthcare setting.
• Assessing the effectiveness of reminiscence therapy in improving memory and reducing agitation in individuals with dementia.
• Implementing pain management strategies that prioritize non-pharmacological interventions for geriatric patients.
• Evaluating the impact of mindfulness meditation on reducing anxiety and improving overall well-being in older adults.
• Investigating the role of nutrition in preventing malnutrition and promoting healthy aging.
• Creating a geriatric care plan that addresses the unique needs of LGBTQ+ elderly individuals.
• Exploring the effectiveness of telehealth services for delivering mental health support to older adults.
• Designing a protocol for the early detection and intervention of delirium in hospitalized geriatric patients.
• Assessing the benefits of pet therapy in reducing depression and loneliness among elderly residents in long-term care facilities.
• Investigating the impact of technology-assisted home monitoring on medication adherence and health outcomes in older adults.
• Developing a comprehensive wound care protocol for managing pressure ulcers in the elderly.
• Implementing a structured exercise program for improving mobility and strength in older adults.
• Evaluating the use of alternative therapies, such as acupuncture or aromatherapy, in managing chronic pain in geriatric patients.
• Investigating the effectiveness of different communication strategies in enhancing the doctor-patient relationship for elderly individuals.
• Developing a culturally sensitive geriatric care plan for diverse populations.
• Exploring the role of family caregivers in providing support to older adults with chronic illnesses.
• Assessing the impact of environmental modifications in reducing the risk of falls in home-based geriatric patients.
• Investigating the barriers to accessing healthcare services faced by elderly individuals in rural communities.
• Evaluating the use of assistive technologies, such as smart home devices, to enhance the independence of older adults.
• Developing a medication management program to reduce polypharmacy and medication-related adverse events in geriatric patients.

Geriatric Nursing Capstone Project Ideas

• Enhancing End-of-Life Care: Implementing a Palliative Care Program in a Nursing Home.
• Geriatric Medication Management: A Comprehensive Review and Improvement Plan.
• Exploring the Role of Telehealth in Geriatric Mental Health Services.
• The Impact of Fall Prevention Strategies on Reducing Hospital Readmissions in Geriatric Patients.
• Addressing Malnutrition in Elderly Patients: Developing a Nutritional Screening Protocol.
• A Multidisciplinary Approach to Delirium Prevention and Management in the Hospital Setting.
• Evaluating the Effectiveness of a Dementia-Friendly Environment in Long-Term Care Facilities.
• Improving Care Transitions for Geriatric Patients: A Hospital-to-Home Continuity Program.
• Assessing the Benefits of Pet Therapy in Long-Term Care Facilities: A Comparative Study.
• Optimizing Geriatric Pain Management: A Holistic Approach.
• Enhancing Medication Adherence in Older Adults through Technology-Assisted Interventions.
• Cultural Competency in Geriatric Nursing: Developing a Training Program for Healthcare Providers.
• Promoting Independence in Aging: An Assistive Technology Implementation Project.
• Evaluating the Impact of a Comprehensive Wound Care Program in Geriatric Settings.
• Addressing Polypharmacy in Geriatric Patients: An Interprofessional Medication Review.
• A Community-Based Approach to Geriatric Healthcare in Underserved Areas.
• Exploring the Benefits of Mindfulness Meditation in Geriatric Mental Health.
• Telemonitoring for Heart Failure Management in Older Adults: A Feasibility Study.
• Reducing the Risk of Falls in Home-Based Geriatric Patients: An Environmental Modification Project.
• Improving Healthcare Access for Elderly Residents in Rural Communities: A Needs Assessment.

Other readers also checked out  Nursing Capstone Project Ideas on Patient-Centered Care

Nursing Research Paper Topics on Geriatric Nursing

• The Impact of Geriatric Nursing on Healthcare Outcomes: A Systematic Review.
• Geriatric Depression and Social Isolation: Strategies for Prevention and Intervention.
• Aging with Dignity: LGBTQ+ Elderly Healthcare Disparities and Solutions.
• Frailty Assessment in Geriatric Patients: Tools, Trends, and Clinical Implications.
• The Role of Family Caregivers in Supporting Older Adults with Chronic Illness.
• Polypharmacy in Geriatric Patients: A Critical Analysis of Medication Management.
• Exploring the Benefits of Complementary and Alternative Therapies in Geriatric Care.
• The Influence of Nutrition on Healthy Aging: A Comprehensive Review.
• Cognitive Decline in Aging: Early Detection and Intervention Strategies.
• End-of-Life Decision-Making in Elderly Patients: Ethical Dilemmas and Best Practices.
• The Impact of Environmental Factors on Falls Among Geriatric Patients.
• Telehealth in Geriatric Nursing: Advancements, Challenges, and Opportunities.
• Technology-Assisted Interventions for Managing Chronic Pain in Older Adults.
• Cultural Competence in Geriatric Nursing: Addressing the Needs of Diverse Populations.
• Aging in Rural America: Access to Healthcare and Health Disparities.
• Innovations in Geriatric Rehabilitation: From Physical Therapy to Cognitive Training.
• The Influence of Social Determinants of Health on Geriatric Healthcare Outcomes.”
• Telemonitoring for Chronic Disease Management in Geriatric Populations.
• The Role of Music Therapy in Enhancing the Quality of Life for Alzheimer’s Patients.
• Geriatric Palliative Care: Providing Comfort and Support in the Final Stages of Life.

Geriatric Nursing Research Questions Examples

• How does the utilization of geriatric-specific nursing interventions impact the overall health outcomes of elderly patients in long-term care facilities compared to traditional care practices?
• What are the factors contributing to the high prevalence of depression among geriatric patients, and how can nursing interventions effectively address this issue?
• How can geriatric nursing care plans be tailored to meet the unique healthcare needs and preferences of LGBTQ+ elderly individuals?
• What are the most reliable tools and methods for assessing frailty in geriatric patients, and how can early detection impact healthcare outcomes?
• How can geriatric nursing contribute to optimizing medication management and reducing polypharmacy-related issues in elderly patients?
• What are the most effective complementary and alternative therapies in geriatric care, and how can they be integrated into traditional healthcare practices?
• How do social determinants of health, such as income and housing, influence the health outcomes of elderly individuals, and how can geriatric nursing address these disparities?
• What innovative telehealth interventions can enhance the delivery of healthcare services to geriatric populations, particularly in remote or underserved areas?
• What strategies can be employed to effectively manage chronic pain in older adults, considering the potential risks associated with opioid medications?
• How can geriatric nursing training programs incorporate cultural competence to provide equitable care for diverse populations of elderly individuals?

You can also check out Nursing Research Paper Topics on Community Health Nursing

Nursing Essay Topic Ideas on Geriatric Nursing

• The Role of Geriatric Nursing in Addressing the Silver Tsunami.
• Geriatric Nursing: Challenges and Opportunities in the 21st Century.
• Dementia Care in the Elderly: A Comprehensive Nursing Perspective.
• End-of-Life Decision-Making: Ethical Dilemmas in Geriatric Nursing.
• The Impact of Family Caregivers on the Well-Being of Elderly Patients.
• Geriatric Nursing and the LGBTQ+ Elderly Community.
• Palliative Care in Geriatric Nursing: Providing Comfort and Dignity.
• Geriatric Depression: Identifying Risk Factors and Effective Interventions.
• Polypharmacy in Geriatric Patients: Balancing Benefits and Risks.
• Music Therapy in Alzheimer’s Care: A Nursing Approach.
• The Importance of Nutrition in Healthy Aging: A Nursing Perspective.
• Telehealth and the Future of Geriatric Nursing.
• Cultural Competence in Geriatric Nursing: Bridging the Gap.
• Frailty Assessment in Elderly Patients: A Nursing Perspective.
• Complementary and Alternative Therapies in Geriatric Care: Evidence and Practice.
• Fall Prevention Strategies for Geriatric Patients: A Nursing Approach.
• Geriatric Nursing in Rural Communities: Challenges and Solutions.
• Technology-Assisted Interventions for Chronic Pain Management in the Elderly.
• The Role of Social Determinants of Health in Geriatric Nursing.
• Geriatric Nursing Research: Advancements and Implications.
• Cognitive Decline in Aging: Nursing Interventions and Strategies.
• Geriatric Medication Management: Nursing Protocols and Best Practices.
• Telemonitoring for Heart Failure Management in Older Adults: A Nursing Perspective.
• Art Therapy in Geriatric Care: Promoting Emotional Well-Being.
• Telehealth and Mental Health Support for Geriatric Patients: A Nursing Exploration.
• Environmental Modifications for Fall Prevention in Home-Based Geriatric Patients.
• The Benefits of Pet Therapy in Long-Term Care Facilities: A Nursing Approach.
• Geriatric Nursing and Patient-Centered Care: Building Stronger Doctor-Patient Relationships.
• Nutrition Assessment and Intervention in Elderly Patients: A Nursing Priority.
• Geriatric Nursing and the Importance of Interdisciplinary Collaboration.

Geriatric Nursing Research Paper Example

• Geriatric Windshield Survey

Geriatric nursing is a dynamic field that demands both specialized knowledge and a commitment to continuous learning and research. The PICOT questions, EBP projects, capstone project ideas, research paper topics, and essay examples provided in this article serve as a valuable resource for students and practitioners seeking to explore the diverse facets of geriatric nursing. As the elderly population continues to grow, so too does the importance of geriatric nursing in ensuring that our older adults receive the highest quality care and support in their later years.

1. What are the core principles of geriatric assessment?

Geriatric assessment extends beyond the traditional disease-oriented medical evaluation of older persons’ health to include assessment of cognitive, affective, social, economic, environmental, spiritual, functional, and frailty status, as well as a discussion of patient preferences regarding advance directives.

2. What are the principles to be followed during geriatric prescribing?

Prescribing Cascade – “Any symptom in an older adult should be considered a drug side effect until proved otherwise.”

3. What are the 4 M’s of geriatric care?

Matters, Medication, Mentation, and Mobility

• “Gerontological Nursing” by Charlotte Eliopoulos
• “Evidence-Based Geriatric Nursing Protocols for Best Practice” by Marie Boltz, Elizabeth Capezuti, and Terry T. Fulmer
• “Geriatric Nursing Review Syllabus: A Core Curriculum in Advanced Practice Geriatric Nursing” by American Geriatrics Society
• “Nursing Care of the Older Adult: In the Hospital, Nursing Home and Community” by Marquis D. Foreman and Doris Smith Sisk
• “Essentials of Gerontological Nursing: Adaptation to the Aging Process” by Meredith Wallace Kazer
• “Geriatric Nursing: Growth of a Specialty” by Eileen R. Crusse and Audrey S. Barber
• “Gerontology Nursing Case Studies: 100 Narratives for Learning” by Donna J. Bowles
• “Gerontological Nursing Competencies for Care” by Kristen L. Mauk
• “Gerontological Nursing: A Health Promotion, Protection, and Care Approach” by Priscilla Ebersole and Patricia Hess
• “Gerontological Nursing: An Advanced Practice Approach” by Kristen L. Mauk

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Nursing-Geriatric/Adult Nurse Practitioner, Essay Example

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Ethical issues in healthcare for elderly patients affect practitioners and the way in which healthcare delivery is handled. The morals and ethics used in geriatric care regarding end-of-life and the patient’s wishes and instructions are very important. A current moral and ethical issue concerning society today is the principal of justice which is the notion of an allocation system of healthcare resources and a patient’s autonomy. Ethical issues in healthcare particularly affect the elderly; older people are sick more often than younger people and suffer more in the end stages of various chronic progressive diseases (Knowlton, 2002). Additionally, there is the dilemma of elderly patients not being able to make critical decisions in most cases. If the patient has not signed over a power of attorney to a family member, any decision making can become a legal and family member struggle.

The principle of justice and allocation of healthcare resources deals with the cost-benefit ratio and determining when healthcare should be given or withheld. The utilitarian ethical viewpoint dictates healthcare should be allocated to do the most good for the largest number of people (Knowlton, 2002). While this concept on the surface appears to be positive, the components associated with this create ethical and moral issues. It will impact negatively the elderly as well as women over men. Successful intervention in healthcare for the elderly is less than for younger individuals. Statistically above the age of 65 there are 68 men and 100 women and over the age of 85, there are 48 males for every 100 females (Kowlton, 2002).

The idealistic approach to the concept of healthcare rationing states that resources should be allocated purely determined on where it is needed the most.  This means that help should be given to the individuals who are the sickest and need it more than someone not as sick; regardless of age. This also means the geriatric population is going to benefit from this concept since the elderly generally need more healthcare delivery. So the healthcare dollars would be spent on the elderly.

These two differing approaches to the same concept create problems for practitioners and society in general. The problem of limited healthcare creates a debate over how to handle the situation. If a patient over the age of 80 needs surgery with an unfavorable prognosis, it is still up to the patient and family whether to proceed with the needed intervention. If healthcare rationing were legalized the decision would be taken out of the patient’s hands and the physician and most certainly committee approval for his/her recommendation would be the deciding factors.  The physician would be placed in an ethical and moral dilemma with state and government interference.

Professional Career Goals

I am applying to the field of geriatric medicine due to the experiences I have had in my work with the elderly. I have worked for approximately two years in a critical care unit in a hospital setting prior to my decision to return to graduate school. As I work on my Master’s degree I am currently working as a personal nurse aid inside a hospital. The type of care is multifold but most of the patients are elderly. After working with the geriatric population I began to see that my career path should focus on furthering my education to better serve this age group.

The dynamics of nursing care regarding the geriatric population is diverse and specific in the needs for care. As individuals get older, not only does the body change but there are psychological changes also. It requires specific skills with knowledge that cannot be learned in the classroom but rather by working hands on with patients. I began to realize this as I have worked with this age population. The treatments and response to treatments are different in the geriatric population. Many of the past approaches to care used in gerontology are no longer appropriate and research has shown that evidence-based practices should be routinely employed to provide the safest and highest quality care possible (Kany, 2009).

The healthcare status is often a product of the patient’s income level. This determines the living arrangements. For the most part the elderly have a specific need for physical support; but the need for psycho/social support is also an important component (Williams & Mezey, 2000). The geriatric nursing population is relatively small as this specialty is often not attractive to the majority of nurses. The reason for this is multifold and includes the complexity of the problems, the high maintenance requirements of the needs of this group and for the most part the patients die and this creates a loss for the nurses. Also nurses tend to cluster in urban areas and few advanced practice geriatric nurses are available to care for older persons living in rural areas (Williams & Mezey, 2000).

I am pursing my graduate degree at this time in order to further my current knowledge and abilities to be able to care for the geriatric population in a proficient and efficient manner.  Furthering my education will help me grow in knowledge, skills and understanding of the dynamics of caring for the elderly. It will help me in analyzing the effectiveness of community resources. I hope to grow in communication effectiveness with older adults and families and learn how to be more sensitive in my perception of this population and the physical, cognitive and psychological challenges they face in dealing with health issues.

Another incentive for pursuing my degree at this level is to further my skills and ability to apply evidence-based standards to how patients are treated, screened and immunized against illnesses. The complexity of acute and chronic co-morbid conditions in the elderly takes more than just theory and I feel my current work environment with this degree will able me the abilities to recognize the needs of geriatric patients. Complementary health care practices and management of symptoms for the elderly requires high quality of care. I feel this is the perfect time for my endeavors in working on a high level of degree to promote and involve myself in becoming a high performing and care-giving geriatric nurse.

Motivation is goal-oriented behavior undertaken to achieve a goal or mission. Pursing a university graduate degree requires motivation, dedication and perseverance. Having a desire is not enough to create the motivation needed to undertake the pursuit of a higher educational degree.  Personal causation is comprised of cognition, skills, and motivations or intents (McClellend, 1987). Each person has within him or herself certain desires and aspirations. Motivation can be formed by materialistic endeavors or status acquisition. However, to me true motivation comes from the heart.

Sigmund Freud said “I had become a physician quite reluctantly, but was at that time impelled by a strong motive to help nervous patients, or at least to learn to understand something of their conditions” (McClelland, 1987, quoted p. 5). Often our motivation comes from so deep within ourselves that we may not recognize the reasons or causes.  This to me summarizes how I feel about obtaining my degree; there is always financial and time commitment risks involved but the rewards are numerous.

Another motivational factor in attending a university graduate program is the increase in knowledge which can be obtained in my field of interest. Although money should not be a motivating factor, it nevertheless plays a small role in the possibility of greater financial earning opportunities. Overall, attending university graduate programs will foster creativity and tangible thinking processes to better define avenues for quality patient care and the specific needs of a geriatric population.

With the ever changing and undetermined health care reimbursement processes of today, most may not be motivated to enter this field. However, I believe motivation itself is the key to changing how health care reimbursement is handled. The bottom line is always the care of the patient and reimbursement often takes away from the quality of care. Attending a program to learn the skills and techniques needed for an effective nurse practitioner role allows me the opportunity to be involved in how health care delivery is conducted in my area. This is a motivating factor for my career goals.

Working with physicians have also motivated me as I have watched and learned how to order, perform and interpret diagnostic tests to include lab work and x-rays. To be able to work along-side physicians in more independent role with diagnosing, prescribing medication and managing overall care allows me to help patients learn how their lifestyle behavior affects their health and well-being. This is also a high motivation factor. Although I am pursing geriatric nursing, the elderly also need to understand how past actions and further actions affect their health.

More patients are choosing Nurse Practitioners since they have a reputation for taking more time with patients and provide personalized health education and counseling. My desire is to be able to help patients accurately and dependably. It is motivating to me to be able to accurately and dependably provide this service through the practical working knowledge I have coupled with a formal education through attending a university program.

Career Progress

My career progress and goals to date have been consistent with my motivation and desires for the end result.  I have been working as a Registered Nurse and have been productive and steady in my contribution to health care delivery. My early career in the hospital began my foundation for working with all ages and types of individuals. I learned a tremendous amount through these formative years.

My current work in affords me the opportunity to work directly with elderly patients as this is the highest portion of my patient population. While my work is rewarding and I feel my contributions are helpful and meaningful to my patients, further progression through my education will allow me to continue to grow in my knowledge and career goals. Entering this university program will allow me to enhance my talents and skills to better serve my patient population. Once I have completed my studies my desire is to focus on the geriatric population and work to help these individuals with their complex and threatening ailments.

Although work experience through the years would allow me to learn hands-on, attending a formalized program will better equipment me to better deal with the nature of geriatric care. A well rounded program which encompasses all the dynamics of learning to include classroom, textbook and practical experience will develop what I have learned to date in my undergraduate program and working experience.

Nurse practitioners have a reputation for distinguishing their profession from the various other health care professions by attention to the patient as a whole person and understanding how the systems of the human body affect each other. I believe by providing this type of care to patients it helps in the overall health care cost, reducing physician charges and fewer emergency room visits. As nurse practitioners have become more commonplace in the health care industry, they are learning to lower these costs, resulting in lower prescription and medicine costs along with shortening hospital stays.

Moral and ethical health care is vital to the community and to health care delivery. Understanding the dynamics of how health care is delivered to maintain high morals and ethics is a goal and desire I feel strongly is needed by all health care personnel. Attending a university program to become a nurse practitioner will be a rewarding and challenging endeavor for which my motivation remains at high levels. I believe my work experience and current career progression supports my aspiration to attend and graduate from a program; earning my graduate degree as a nurse practitioner in the field of geriatric nursing.

Karyn, Katherine. “Nursing Care of Older Adults.” Lippincott’s Nursing Center.com. 2009. Retrieved March 8, 2010 from http://www.nursingcenter.com/library/static.asp?pageid=730388

Knowlton, Leslie. “Ethical Issues in the Care of the Elderly.” Geriatric Times .  March/April, 2002, 111(2). Retrieved March 9, 2010 from http://www.cmellc.com/geriatrictimes/g020301.html

McClelland, David C.  Human Emotion . Press Syndicate of the University of Cambridge: New York, 1987.  Retrieved March 12, 2010 from http://books.google.com/books?id=vic4AAAAIAAJ&printsec=frontcover&dq=motivation&source=bll&ots=Ap0Y4JZ-e2&sig=I8ebXlTyY4beW_zdMkIWs8qEGEE&hl=en&ei=4KeaS9z6IcKB8gac54WNDg&sa=X&oi=book_result&ct=result&resnum=11&ved=0CDcQ6AEwCg#v=onepage&q=&f=false

Williams, Carolyn, and Mezey, Mathy. “Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care.”  2000. Retrieved March 12, 2010 from http://www.aacn.nche.edu/Education/pdf/Gercomp.pdf

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• Research article
• Open access
• Published: 29 June 2020

Elderly patients with complex health problems in the care trajectory: a qualitative case study

• Marianne Kumlin   ORCID: orcid.org/0000-0002-5639-4120 1 , 2 , 3 ,
• Geir Vegar Berg 2 , 4 ,
• Kari Kvigne 1 &
• Ragnhild Hellesø 3  

BMC Health Services Research volume  20 , Article number:  595 ( 2020 ) Cite this article

11k Accesses

Metrics details

Elderly patients with multiple health problems often experience disease complications and functional failure, resulting in a need for health care across different health care systems during care trajectory. The patients’ perspective of the care trajectory has been insufficiently described, and thus there is a need for new insights and understanding. The study aims to explore how elderly patients with complex health problems engage in and interact with their care trajectory across different health care systems where several health care personnel are involved.

The study had an explorative design with a qualitative multi-case approach. Eleven patients ( n  = 11) aged 65–91 years participated. Patients were recruited from two hospitals in Norway. Observations and repeated interviews were conducted during patients’ hospital stays, discharge and after they returned to their homes. A thematic analysis method was undertaken.

Patients engaged and positioned themselves in the care trajectory according to three identified themes: 1) the patients constantly considered opportunities and alternatives for handling the different challenges and situations they faced; 2) patients searched for appropriate alliance partners to support them and 3) patients sometimes circumvented the health care initiation of planned steps and took different directions in their care trajectory.

Conclusions

The patients’ considerations of their health care needs and adjustments to living arrangements are constant throughout care trajectories. These considerations are often long term, and the patient engagement in and management of their care trajectory is not associated with particular times or situations. Achieving consistency between the health care system and the patient’s pace in the decision-making process may lead to a more appropriate level of health care in line with the patient’s preferences and goals.

Peer Review reports

The World Health Organization [ 1 ] highlighted the need to implement an integrated people-centred health service, particularly for people with chronic or complex health conditions in need of care and support. Elderly persons with multiple health problems often experience disease complications and functional failure, resulting in a need for health care across different levels of care and social services. It has been shown that such care trajectories can be complex when many health and social personnel are involved [ 2 , 3 ].

Several terms have been used to describe patients’ needs that span levels of health care system, including care pathways, clinical pathways, critical pathways, care trajectories, standardised patient pathways and care bundles. The term care pathway can be defined as the management of care and chronological activities of a health care process for a well-defined group of patients during a well-defined period of time [ 4 ]. Standardised care pathways have been suggested as a solution for ensuring patient safety, improving risk-adjusted patient outcomes, increasing patient satisfaction and optimizing the use of resources [ 5 ]. Nevertheless, studies have shown that standardised care pathways are more effective in contexts with predictable care trajectories and low uncertainty and complexity [ 4 , 6 , 7 ]. At present, health care authorities have an increased demand for patient treatment standardisation and patient treatment individualisation. Standardised care pathways promote procedures and standardised activities. However, questions have been asked if these pathways are a risk to patient preferences and if individual needs will receive less attention [ 8 , 9 ].

In this study, we chose the term care trajectory that is commonly used to describe a patient’s journey through the health care system. According to Allen et al. [ 10 ], the term refers to ‘the unfolding of patients health and social care needs, the total organisation of work associated with meeting those needs, plus the impact on those involved with that work and its organisation’ [ 10 ]. They provide a framework for the understanding of the linkages between individual trajectories of care and broader health and social care systems.

Many elderly patients with multiple health problems perceive health services as complex and challenging to comprehend, and therefore need support from health care professionals to ensure continuity of services. The transition from hospital to home can be an uncertain and challenging experience [ 11 , 12 , 13 ]. Information and participation in planning and decision-making during hospital stays and discharge may be inadequate; therefore, elderly patients should be encouraged to participate. Studies have shown that patients’ health needs must be considered and the hospital environment should be organised and prepared to encourage patients’ participation in their discharge planning [ 14 , 15 , 16 , 17 ].

International as well as Norway health authorities have deployed standardised care pathways for specific patient groups. However, in Norway, no care pathways have been fully established and understood for elderly patients with multiple health problems [ 18 ]. Local tailoring combined with standardisation can be important in developing pathways that enable different purposes and contexts [ 19 , 20 , 21 ].

Research has emphasised the need to expand our understanding of complex care trajectories and why integrated health and social service care can be challenging. The importance of investigating how individual activities and decisions take place in an organisational context and how involved persons interact has also been emphasised [ 22 ].

The perspectives of elderly patients with complex health problems of care trajectories have been insufficiently described in previous studies [ 8 , 19 , 23 , 24 ]. New insights are required to achieve an integrated care pathway. Therefore, this study aims to explore how elderly patients with complex health problems engage in and interact with their care trajectories across different health care systems where several health personnel are involved.

The study used an explorative design. We adopted a qualitative multi-case approach to obtain an in-depth understanding of patients’ perspectives of care trajectories and how patients participate during their hospital stay, discharge and return to home process. This case approach was considered appropriate for examining patients’ real care trajectories because it was possible to account for the diversity of context [ 25 ]. The multi-case method enabled the exploration of inequalities and similarities across care trajectories, aiming to identify common patterns [ 26 ]. We recruited 11 patients representing diversity across contexts for our data collection. For each case, observations and multiple interviews were carried out to elucidate the divergent aspects of care trajectories. The cases provided us with rich and comprehensive information relevant to the aim of this study [ 25 ].

Setting and participants

The Norwegian health care system consists of two organisational structures. The local municipalities are responsible for providing primary care services, including general practitioners (GPs), intercommunal emerging primary care centres, home care services, nursing homes and preventive services. The Ministry of Health and Care Services is responsible for specialist care, which involves all hospitals. In 2012, the government implemented the Norwegian Coordination Reform [ 27 ] to strengthen the interaction between different levels of health services and to secure coordinated health care. Development of integrated care pathways, especially for patients with long-lasting complex health needs, has increased the focus on developing pathways. This reform, combined with the Patients Right Act, emphasises the importance of patient participation in improving the continuity and quality of care.

To identify patients who met our inclusion criteria, the study’s starting point was conducted at two different hospitals located in the same health region: one rural and one urban hospital. We intended to follow patients during their hospital stays and trajectories across different health care levels. We considered it inappropriate to recruit patient participants prior to possible hospital admissions. The recruiting process was, therefore, conducted at the hospital departments.

Patients were selected from the surgery and internal medicine departments of the hospitals. The inclusion criteria for the patient participants were as follows: older than 65 years, having 2 or more chronic diseases and living at home before hospital admission. The exclusion criteria were if the patient was not capable of giving consent or in the terminal phase. A contact nurse in the eligible departments informed the patients verbally and in writing about the study. Eighteen patients were requested for participation. Eleven patients consented to participate whereas seven patients declined due to worsening health conditions. The patients varied in age and the distance between their homes and the hospitals. Patients from nine different municipalities were involved. The population ranged from 2000 to 27.000 inhabitants. Characteristics of the patients who agreed to participate and the observation period for each patient are shown in Table  1 . No participants dropped out of the study.

Data collection

We applied an observationally driven approach to this case study [ 28 ]. The starting point for the data collection was to meet the patient in the department where he or she was hospitalized. The first author (MK), a PhD candidate and an experienced geriatric nurse, conducted field notes and conversations with the patients and repeated more structured interviews with the patients during the observation period. The professional background of the researcher was known to the participants. Moderate participant observation was used; the researcher was identifiable, interacted with the participants and engaged in activities, but did not participate in the setting [ 29 ].

The focus of the observations was to identify situations and activities during the care trajectory in connection with the health services and patient’s interactions with the involved persons. Typically, observation points at the hospitals involved sitting with the patient and observing activities and dialogue between the patient and health personnel, observing morning meetings with the staff group, noting pre-visits and doctors’ attendance at the patients’ rooms and following patients during discharge and their transfer home. In the municipalities, the observations commenced at the professional base of the homecare nursing or the multidisciplinary team and following the staff on their visits to the patients’ homes. On some days, when the first author visited patients at their homes or rehabilitation units, the next of kin was also present. The length of the structured interview varied from 5 to 45 min, according to the patient’s health status and day-to-day condition. The main theme of the interview was on the patient’s past, current, and future perspective on the care trajectory (See additional file  1 ). Overall, the first author conducted 24 structured interviews and 86 h of observations. The data were collected from November 2017 to June 2018.

Analysis process

The first author transcribed all the recorded interviews verbatim. Field notes were written down as short sentences during the observation. Immediately after the observations, the field notes were expanded into full sentences. All the data was de-personalised before analysis. A thematic analysis approach using Braun and Clarke’s [ 30 ] was applied . Initially, the first author read the field notes and the interviews thoroughly and chronologically for each case to identify essential characteristics and patterns. Notes were taken to describe the descriptive and analytical attributes of the data. Thereafter, the data were read and coded systematically and the codes were organised into possible sub-themes for the entire cases as illustrated in Table  2 . The back-and-forth process between the codes and possible themes involved reviewing relevant research and theoretical perspectives to help understand the data. This process revealed three main themes.

Ethical considerations

The study has been notified by the Norwegian Centre for Research Data (ID: 54551) and assessed and approved by the hospital data controller of the two hospitals.

Participation in this research was based on informed, voluntary consent. Ethical issues related to consent were considered during the recruitment process. During the observation period, the first author had a special awareness of maintaining voluntary and consent-based participation. Information about the possibilities to withdraw any time from the study was given both verbally and in writing. The first author had no contact with the patients before they were informed of this study by the nurse. The patients’ consent to participate was given both verbally and in writing. To ensure that patient anonymity is protected, some of the demographic data were rewritten. Hospitals and municipalities involved in the studies were anonymised.

The overall findings of this study suggest that patients’ engagement in managing their care during the care trajectory is not a linear process regarding time and space or situations and events that need action. They chose a variety of strategies to participate in their care management, driving the care trajectory forward and handling barriers. The patients were engaged and positioned themselves according to three identified themes: continuous consideration of opportunities and alternatives, consideration for appropriate alliances and circumvention of the health care initiation of planned steps.

The analyses revealed that the care trajectory is characterised as a landscape of complex and interconnected events and situations—sometimes planned, chaotic or ad hoc. In some settings during the care trajectory, patients need to deal with many activities simultaneously. The observations revealed that, in some situations, patients had to manage information on the follow-up treatment, medication changes, decisions regarding further health care and readiness to return home or nursing homes, which was given at the same time.

Another simultaneous event that occurred during hospital stays was when health personnel decided to move a patient to another ward or unit at the hospital because of limited space while they were prepared for discharge. Such a situation could be sudden and unexpected to the patient. On the day of discharge from the hospital, several activities, such as ongoing treatment and various controls, were conducted. In the municipality, the patient could receive health care services from several units with different health personnel involved, including homecare nursing and home care assistance, multidisciplinary team, physiotherapists and GPs. Parallel to primary care health services, patients also received outpatient treatment at the hospital.

To provide an in-depth understanding of the themes, cases that are typically for each theme are chosen.

Continuous consideration of options and alternatives

A strategy some patients used was to continuously consider options and possibilities on how they managed different actions and challenges during their care trajectory. The patients expressed their views on their current health situations. Furthermore, they also questioned how they could manage their situations and use their strength and energy appropriately and weighed different possibilities. They consider what was most important, what could wait and what was not possible.

Sometimes patients felt they were not ready to make decisions concerning changes in their housing situation or plan for further health care. They chose to see ‘what happens’ and prolong the decision. In situations involving several individuals and rapid changes in care environments, patients deliberated about their strength and capacity and assumed a distant or observant position.

Below, we chose to present two typical cases that describe the patients’ considerations of their opportunities and alternatives to housing conditions and further health care. The patients needed long-term decision-making beyond the period of hospitalisation and discharge planning. They held off on deciding until they were ready for it.

Anna was admitted to an internal unit at the local hospital due to chronic breathing difficulty that worsened. Anna lived in her apartment in a community near the hospital. A homecare nurse visited her once a day; and during the rest of the day, Anna managed by on her own. In the early phase of her stay at the hospital, she expressed that she was afraid she could no longer manage by herself at home; her health condition was too poor. However, she was still looking for possible options for going home and thinking about what she might need in terms of health care and facilitation, such as night visits by homecare nurses. This option was important for her, as it made her feel safe about being alone at home.

A few days after hospitalization, Anna was discharged to a rehabilitation unit in her home community. During her stay at the hospital and the rehabilitation unit, there was a conversation between her and the health personnel about either being discharged to her apartment or being moved to a nursing home. Anna was reluctant to be active in these decisions . Several times during these weeks, she expressed that she had to be in better shape and wait for further development before making a decision as illustrated in this quote:

‘When I feel that I can’t manage myself at home, there is no point in trying. Then, I just have to get help from someone by applying for a permanent place in a nursing home or a sheltered house. However, I have to say I am not ready for that yet. If I do not get any better, then I will have no choice, but I have to decide on that later. I will take it one day at a time and see what happens .’

After 3 weeks at the rehabilitation unit, Anna expressed that she needed to take it 1 day at a time but could already take a more active position:

‘I still have problems with my breath, but I am so satisfied and feel I am in better shape. I know my body. Next week, I will go home with help from homecare nurses. Tomorrow, we are going to have a meeting here. Then, we will decide on the number of visits I will need from the homecare nurse. Then, I will know. We are going to have the meeting together with the leader at the unit. ’

Anna’s case shows how several patients constantly considered their capacity and strength and continuously searched for possibilities and options. Anna chose to wait and hold off on deciding whether she should return home or to a nursing home.

May considered changing the house conditions to achieve the appropriate level of care for herself and her husband. She lived with her husband, who received assistance every day from homecare nurses due to illness and functional decline. They lived in a single house with bedrooms on the second floor. May took care of housekeeping, organised health care, and kept in touch with their GP and homecare nurses, among others. I (first author) met May when she was admitted to a hospital because of vertigo and declining general conditions, and followed her during her hospital stay and some months after her return home. After her discharge, she and her husband started receiving additional homecare nursing assistance, and a personal emergency response system was installed in their home. She worried that she and her husband could fall down their stairs. She mentioned several times that she and her husband were discussing applying for sheltered housing. According to May, the health personnel in community care told them many times that they could move to a sheltered house. She expressed:

‘We intend to apply for it, but we have not chosen to do so yet. Now, life goes on as before. It's stable, and I’ve got a personal emergency response system. The neighbour picks up the mail for us. Basically, we do not want to move out of the house as long as we can manage to lock the door!’

The cases show the constant considerations of what options would be the best for them.

Consideration of appropriate alliance partners

One strategy that patients used to handle unclear situations and considerations of health care was to search for health personnel they found trustworthy who could help them organise their health care needs. The patients described the people that supported them in their daily living and the trustworthiness of the health personal. These trusted persons and health personnel were strong alliances for patients during their care trajectories.

The following case describes how a patient actively searched for health care personnel who could help or take responsibility in his situation, which involved persistent health problems.

Eric was a patient with a complicated and persistent illness. After spending several weeks in a hospital for diagnosis and treatment, he was discharged and sent home. He lived with his wife in an apartment. Eric followed-up with two different wards at the hospital and received homecare nursing and physical therapy from the municipal health service. In daily life, he expressed that he and his wife had many unanswered questions about his health problems and symptoms. Eric mentioned several times how challenging it was to find health care personnel at the hospital who could give accurate information and somebody who could be responsible for his ongoing medical treatment. He was told that he needed to contact his GP, but he felt his GP was not particularly involved. Due to his limited interaction with his GP, Eric felt his symptoms were initially not taken seriously, and he lost trust in his GP. At one point, Eric felt he needed advice related to specific symptoms involving his leg and ongoing treatment but felt that he was not likely to receive proper health care. Thus, he approached a homecare nurse he trusted to contact the doctor at the hospital on his behalf about his concern with the leg. He told he did it this way:

‘The call becomes a priority when the nurse calls to ask about the symptoms. I talked to the nurse about this physiotherapist too, he needs a case summary and referral from the doctor. Now it’s okay, I got this by the doctor when I was at the hospital for treatment this week.’

This case illustrates how a patient actively searched for alliance partners to obtain access to proper health care in a setting where he needed to interact with many actors at different levels.

Circumventing the health care initiation of planned steps

We also identified cases where patients circumvented the hospitals’ formal planning systems because the situations were not well-facilitated or appropriate for their ability to participate. In some cases, patients design their care trajectory. The following case is an example of how a patient circumvented the hospital’s planning process.

Henry was admitted to a hospital because of heart failure. Some complications in his health situation unexpectedly prolonged his hospital stay. Because Henry suffered from hearing loss and slowed speech, it was challenging for him to understand and follow the information that was given to him at the hospital. During the pre-visit, the nurse and doctor discussed Henry’s return home. The nurse announced that Henry would need to establish some home care services, if nothing else, to help with his medication. During his doctor’s patient rounds, Henry did not have sufficient time to ask questions or give feedback. Henry tries to tell the doctor he has some questions, but it takes time because of his trouble with the speech. After a few seconds, the doctor says he can contact a nurse when he remembers.

After the visit, Henry told me (first author) that he was unsure about what the doctor meant when he told Henry that he should stay for at least one more day, that is, whether it meant that he might return home the next day or not.

Henry lived with his wife in a single house located in a rural area far from the hospital. His next of kin and health personnel from the community could not visit him during his hospital stay. He described his lasting relationship with the leader of the local homecare nursing facility and his GP. He expressed trust in the local health service like this.

‘I regularly visit my GP to take blood samples. I think my doctor is very capable. The leader in the homecare facility is a decent person. He knows about everything. He has helped us several times.’

During his hospital stay, Henry spoke of having phone contact with the leader of the homecare nursing facility. Together, they organised his need for health care and the assistance that he would require after discharge. He also contacted a neighbour to take care of snow shovelling at his home. The leader of the homecare nursing facility stated that he had known Henry and his wife for a long time. He added that Henry had been clear about coming home instead of being transferred to a nursing home. According to the leader, phone contact served as a way to stay in contact with the patient during the latter’s hospital stay.

This case is an example of how a patient actively chose another approach to handle the further direction of his care trajectory. The hospital’s environment and discharge planning did not functionally allow Henry to interact with health personnel. The next of kin could not be near the hospital for support. Therefore, he sought a new option for handling his situation and circumvented the hospital personnel’s plans and processes for discharge.

How the patients were engaged with and interacted in their care trajectories varied and was influenced by their health conditions and how their situation afterward could be managed. We found that the patients, who are often described as vulnerable, carried out considerable ‘homework’ to navigate their health condition as well as the system they accounted [ 31 ]. The patients constantly considered opportunities and alternatives in interaction, negotiations and relationships between many actors, or ‘players’ [ 22 ] for handling the different challenges and situations that occurred during their care trajectory. To understand why and how they searched for appropriate alliance partners to support them, and in some situations, how they circumvented the planned steps and took different directions in the care trajectory will be discussed against the conceptualisation of care trajectory game (CTG) [ 22 ]. The CTG framework merges Strauss et al.’s [ 32 ] descriptions on illness trajectories and Elias’s [ 33 ] game model and provide a framework to understand and address the dynamics and complexity in the system and thus, move away of thinking trajectories in mono-causal explanations which appear to be the characteristics of current policy [ 3 , 8 ].

The complexity in the patients’ care trajectory became visible throughout the patient’s multiple considerations about options and multiple alternatives they needed to take into account. They were dealing with balancing their strength and capacity and the complexity of the health care system in how they could be involved in decision-making. Their considerations seemed to be a continuous process. We identified that patient participation in their care trajectory was not linked to specific times or situations. Issues regarding the need for necessary health care and life modifications or changes in living arrangements were deliberated for patients throughout their entire hospital stays and continued after discharge. It was often an ongoing negotiation between patients, health personnel and next of kin. Patients wanted to have options, but time for recovery was often essential in preparing them for participation in decision-making. The patients’ also seemed to keep a watchful waiting whereby they try to maintain the status quo to desired preferences for as long as possible. The patients in this study used different strategies in situations with a disagreement between their preferences, health care need and initiation of planned steps. For example, they waited to be ready for decisions, circumvented planned steps and found a new direction in their trajectory. Allen et al. [ 22 ] point on that ‘disagreement’ over plan for further direction in the care trajectory not necessarily needs to be negative for the patient. The negotiations and different input from the involved can bring new opportunities and options, which are more in line with the patients’ preferences. It is not appropriate to try to simplify the complex care trajectories, but rather organize the services so that several opportunities and alternatives can be included [ 22 ]. Today’s health care system is characterised by overall expectations to the health personnel to working quickly and efficiently in bed administration, and hospital period is shortening [ 34 , 35 ]. With reference to CTG, health professionals can form an alliance to achieve an effective transfer of care. As an example to press for a nursing home placement rather than a home discharge, that can be easier to organize. From a health personnel perspective can this solution simplify the complexity in the organization of the patient care trajectories, but on the other side lock and hinder the patient’s ability to see different opportunities and alternatives, which are in preference to the patient’s wishes [ 22 ].

Our findings describe situations with interactions between patients and many health personnel at different health services levels. These situations increased the patients’ perceived considerations regarding which personnel could take responsibility for their treatment and organisation of their care. Existing literature has described patients’ and next of kin’ experiences of fragmentation regarding obtaining control and access to the health care system during discharge and follow-up care, which are in line with our findings [ 36 , 37 , 38 ]. We found that to handle fragmentation and uncertainty about health care, the patients sought alliance partners who could help in their interaction with and access to health care. When complexity increases in the care trajectory, fragmentation increases between the involved actors, leading to a re-grouping of those involved [ 22 ]. Unanswered questions about health problems and symptoms were uncertainty patients in our study experience and a lack of available and appropriate information. Kneck et al. [ 39 ] have pointed out that the patient is expected to be an active partner, but that the patients at home can have insufficient information to manage their illness. They may be unsure of ‘which symptoms might occur and who to contact for different needs’ [ 39 ]. Mattingly et al. [ 31 ] use the term ‘chronic homework, about tasks the patients and family caregivers are expected to carry out when moving health care from hospital to home. Their supporting network was essential to handle this ‘homework’, and to strengthen the patient’s possibility to take responsibility for their care. In our study, the patients described how they used their alliance partner strategically as an important support to achieve access to health care and to drive the plan further in the trajectory.

When the patients experienced that they were not involved in decisions concerning themselves, they used their strategies to circumvent the system. Insufficient facilitation of patient participation in the care environment is another barrier described in our study. Time and space for patients to participate in discussions about their health and the need for health care were not always arranged properly. Despite these situations, the patients considered their possibilities and alternatives and circumvented barriers and make their further plans . According to CTG, the resources available can both shape the complexity and cause those involved to make various moves to circumvent barriers.

Findings in our study describe inadequate facilitation of participation and necessary access to health care, norms and the view of the elderly person may contribute to it. Health professionals’ views of the elderly and younger are highlighted as a possible challenge in access to treatment and follow-up [ 40 , 41 ]. Hamran et al. [ 40 ] found that only based on a norm understanding that ‘they are just old’ access to health care could be less, and the time for treatment and improvement was expected to be resolved in the same way as young people who do not have the same complexity. Norms and values are interviewing with the actions and decisions in the care trajectory and increases complexity [ 22 ].

Implication for practice

For an elderly patient with complex health problems, there is expedient to develop a care trajectory that is developed to meet the need for flexibility. In practice, it can mean accepting that the patient is about participating in managing and making decisions, often a continuous and long-term process. Facilitating for this in organizing the health system service, and time and space for the patients’ considerations to managing necessary modifications in everyday life such as re-housing or move to a nursing home.

Methodological strengths and limitations

Triangulation of data sources, observations and individual interviews were used to investigate the care trajectory from different perspectives and settings, which was appropriate given then intention of the current study to gain a richer and deeper insight of patients’ care trajectories.

The first author who conducted the observations and interviews was an experienced geriatric nurse. The researcher’s assumption, skills and knowledge will influence the focus in observations and shape the interpretation [ 42 ]. Background as a nurse gave the advantage to understand the field. To strengthen the trustworthiness, additional reflection notes were performed describing choices, questions or thoughts that arose during the observations and were for review by the research group.

The first author followed each patient over a long period, which contributed to a broad understanding of each patient’s case. We experienced some challenges in recruiting participants due to patients’ health conditions and vulnerable situations. Despite that the participants’ age, living situation and home setting varied. Since the findings are based on a small sample, they should be considered with caution in the light of generalizability. Nevertheless, we believe these findings provide new insight and understanding of the complexity of elderly patients’ care trajectories.

The patients’ considerations of their health care needs and adjustments to living arrangements are constant throughout the care trajectory. These considerations are often long term, and the patients engagement in and management of their care trajectory is not associated with particular times or situations. It may be important for elderly patients’ time for recovery in order to consider different possibilities and options before managing necessary modifications in everyday life.

Disagreements between preferences, the need for health care and the initiation of planned steps, leads to different strategies from the patients. They wait to be ready for decisions, circumvent planned steps and find a new direction in their trajectory.

Achieving consistency between the health care system and the patient’s pace in the decision-making process during the care trajectory, may lead to a more appropriate level of health care in line with the patient’s preferences.

Abbreviations

General practitioner

Care trajectory game

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Acknowledgments

We would like to give our sincere thanks to the patient who participated in this study. Furthermore, we will thank all the staff in the hospitals and the municipalities who helped recruiting and facilitating the study.

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The data materials generated during the current study are not publicly available due to the sensitive and identifiable nature of the data. Despite names and other identifiers being removed, the in-depth nature of the interviews and field notes themselves may mean that participants can be identified from the full transcripts.

This project is founded by a grant from the Inland Norway University of Applied Sciences and a grant from the Innlandet Hospital trust Norway. The funding body has had no role in the design of the study, the data collection, the analysis and the interpretation of data or the writing of the manuscript.

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Marianne Kumlin & Kari Kvigne

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Marianne Kumlin & Geir Vegar Berg

Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway

Marianne Kumlin & Ragnhild Hellesø

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Contributions

MK, KK, GVB, RH contributed to the conception and design the study. MK performed the data collection and the analysis, and developed the manuscript. KK, GVB, RH contributed to the interpretation of analysis. MK and RH critical revised the manuscript. All authors read an approved the final manuscript.

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The project was notified by the Norwegian Centre for Research Data (NSD), ID: 54551. NSD assessed that the processing of personal data was regulated in The Personal Data Regulations [Forskrift om behandling av. personopplysninger]. NSD considered that the project did not raise any ethical issues, which was in need of ethical approval. The project was also assessed and approved by data protection officer at the hospital.

Participation in this research was based on informed and voluntary consent. All patients that filled the inclusion criteria received verbal and written information about the study. A senor nurse in the department assessed and assured the patient’s consent competence. No participants included in this study had a cognitive decline. All participants consented to participate on their own behalf and signed an informed consent. They were free to withdraw from the study at any time.

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Interview guide. Patient interview schedule

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Kumlin, M., Berg, G.V., Kvigne, K. et al. Elderly patients with complex health problems in the care trajectory: a qualitative case study. BMC Health Serv Res 20 , 595 (2020). https://doi.org/10.1186/s12913-020-05437-6

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Received : 02 January 2020

Accepted : 17 June 2020

Published : 29 June 2020

DOI : https://doi.org/10.1186/s12913-020-05437-6

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Geriatric care for nursing students: a comprehensive guide, carla johnson.

• August 21, 2023

As the global population ages, the demand for geriatric care has become increasingly vital in nursing. Nursing students pursuing a Master’s in Science in Nursing (MSN) are poised to enter a healthcare landscape requiring specialized knowledge and geriatric care skills. This article aims to provide nursing students with an overview of geriatric care, present a series of PICOT questions, and propose evidence-based project ideas, nursing capstone project concepts, research paper topics, research questions, and essay ideas, all related to geriatric care.

What You'll Learn

Understanding Geriatric Care

Geriatric care involves providing comprehensive healthcare services to elderly individuals to address their unique physical, psychological, and social needs. As the elderly population grows, nursing students must be well-equipped with the knowledge and competencies to provide effective and compassionate care to this demographic.

PICOT Questions on Geriatric Care

• P: Elderly population with chronic pain; I: Implementation of individualized pain assessment tools; C: Use of generic pain assessment tools; O: Improved pain management and patient satisfaction; T: 6 months.

In a healthcare setting, does the implementation of individualized pain assessment tools for the elderly population with chronic pain lead to improved pain management and patient satisfaction compared to using generic pain assessment tools over six months?

• P: Elderly patients with dementia ; I: Introduction of structured music therapy sessions; C: Absence of structured music therapy; O: Reduced agitation and improved social interaction; T: 12 weeks.

Among elderly patients with dementia, does the introduction of structured music therapy sessions reduce agitation and improve social interaction compared to those who do not receive structured music therapy over 12 weeks?

• P: Nursing home residents; I: Implementing regular exercise programs; C: Lack of structured exercise programs; O: Enhanced physical function and reduced fall rates; T: 9 months.

Among nursing home residents, does the implementation of regular exercise programs lead to enhanced physical function and reduced fall rates compared to those without structured exercise programs over nine months?

• P: Geriatric patients undergoing surgery; I: Utilization of comprehensive preoperative assessment tools; C: Traditional preoperative assessment methods; O: Decreased postoperative complications and improved recovery; T: 1 year.

In geriatric patients undergoing surgery, do comprehensive preoperative assessment tools lead to decreased postoperative complications and improved recovery compared to traditional preoperative assessment methods over one year?

• P: Elderly individuals with diabetes; I: Implementation of personalized diabetes self-management education; C: Standard diabetes education programs; O: Better glycemic control and quality of life; T: 6 months.

Among elderly individuals with diabetes , does the implementation of personalized diabetes self-management education result in better glycemic control and quality of life compared to standard diabetes education programs over six months?

• P: Geriatric patients in long-term care facilities; I: Introduction of regular reminiscence therapy sessions; C: Absence of structured reminiscence therapy; O: Improved cognitive function and decreased feelings of isolation; T: 8 weeks.

In long-term care facilities, does the introduction of regular reminiscence therapy sessions lead to improved cognitive function and decreased feelings of isolation among geriatric patients compared to those without structured reminiscence therapy over eight weeks?

• P: Elderly individuals with multiple chronic conditions ; I: Implementation of interdisciplinary care teams; C: Conventional care approaches; O: Enhanced care coordination and improved quality of life; T: 1 year.

Among elderly individuals with multiple chronic conditions, does implementing interdisciplinary care teams lead to enhanced care coordination and improved quality of life compared to conventional care approaches over one year?

• P: Geriatric patients with depression; I: Integration of mindfulness-based interventions ; C: Standard pharmacological treatments; O: Reduced depressive symptoms and enhanced emotional well-being; T: 10 weeks.

In geriatric patients with depression, does the integration of mindfulness-based interventions result in reduced depressive symptoms and enhanced emotional well-being compared to standard pharmacological treatments over ten weeks?

• P: Elderly individuals at risk of malnutrition ; I: Implement regular nutritional assessments; C: Irregular or no nutritional assessments; O: Improved nutritional status and reduced hospitalizations; T: 6 months.

Among elderly individuals at risk of malnutrition, does the implementation of regular nutritional assessments lead to improved nutritional status and reduced hospitalizations compared to irregular or no nutritional assessments over six months?

• P: Geriatric patients in hospice care; I: Introduction of end-of-life planning discussions; C: Absence of structured end-of-life planning discussions; O: Enhanced patient and family satisfaction with care; T: 3 months.

Among geriatric patients in hospice care, does the introduction of end-of-life planning discussions lead to enhanced patient and family satisfaction with care compared to situations without structured end-of-life planning discussions over three months?

Evidence-Based Project Ideas on Geriatric Care

• Assessing the Effectiveness of Multidisciplinary Teams in Geriatric Care Facilities.
• Developing and Implementing Fall Prevention Strategies in Geriatric Care Units.
• Evaluating the Impact of Comprehensive Medication Management in Geriatric Patients.
• Investigating the Role of Palliative Care in Enhancing Quality of Life for Elderly Patients.
• Implementing Cognitive Stimulation Activities for Dementia Patients in Long-Term Care.
• Exploring the Benefits of Music Therapy in Managing Behavioral Symptoms of Alzheimer’s Disease.
• Enhancing Family Involvement and Communication in Geriatric Care Settings.
• Evaluating the Use of Telehealth for Remote Geriatric Patient Monitoring.
• Investigating the Efficacy of Mindfulness-Based Stress Reduction in Geriatric Populations.
• Examining the Barriers and Facilitators of End-of-Life Planning Discussions in Elderly Patients.

Nursing Capstone Project Ideas on Geriatric Care

• Developing an Elderly-Centered Care Model for Acute Care Hospitals.
• Designing and Implementing Geriatric Care Training for Nursing Staff.
• Creating a Comprehensive Geriatric Assessment Tool for Home Healthcare.
• Establishing a Supportive Community for Elderly Individuals Aging in Place.
• Evaluating the Impact of Virtual Reality on Pain Management in Geriatric Patients.
• Investigating the Role of Nutrition in Preventing Cognitive Decline in the Elderly.
• Designing a Respite Care Program for Caregivers of Elderly Patients with Dementia.
• Exploring Strategies to Promote Physical Activity and Mobility in Nursing Homes.
• Developing a Geriatric Medication Adherence  Program Using Technology.
• Assessing the Effectiveness of Telemedicine Consultations for Geriatric Mental Health.

Geriatric Care Nursing Research Paper Topics

• The Impact of Social Isolation on the Mental Health of Geriatric Individuals.
• Ethical Considerations in End-of-Life Care Decision Making for the Elderly.
• The Role of Geriatric Nursing in Addressing Elder Abuse and Neglect.
• Exploring the Relationship Between Nutrition and Frailty in the Elderly.
• Innovative Approaches to Pain Management in Geriatric Palliative Care.
• Cultural Competence in Providing Geriatric Care for Diverse Populations.
• The Use of Assistive Technologies in Enhancing Independence Among the Elderly.
• Barriers to Effective Pain Management in Non-Verbal Geriatric Patients.
• The Role of Nurse Practitioners in Geriatric Primary Care.
• Geriatric Care Transitions: Challenges and Strategies for Success.

Nursing Research Questions on Geriatric Care

• How does advanced age impact the response to pain medications in geriatric patients?
• What are the key factors influencing medication non-adherence in elderly individuals?
• How does early palliative care integration affect the quality of life of geriatric patients with terminal illnesses?
• What strategies can improve sleep quality among elderly patients in long-term care?
• What are the cultural perceptions and attitudes towards aging and geriatric care in different societies?
• How does cognitive decline influence the ability of elderly patients to manage their chronic conditions?
• What are the long-term effects of elder abuse on the physical and mental health of the elderly?
• How can geriatric care models be adapted to provide culturally competent care for minority elderly populations?
• What are the barriers to effective communication between healthcare providers and elderly patients with cognitive impairments?
• How can telehealth interventions be optimized to meet the unique needs of geriatric patients?

Essay Topic Ideas & Examples on Geriatric Care

• The Psychological Impact of Loneliness on Elderly Individuals and Nursing Interventions.
• Cultural Sensitivity in Geriatric Care: Challenges and Strategies for Nursing Professionals.
• Exploring the Ethical Dilemmas of Withholding Treatment in Geriatric Palliative Care.
• The Role of Family Dynamics in Shaping End-of-Life Decision Making for the Elderly.
• A Comparative Analysis of Different Models of Geriatric Care: Pros and Cons.
• Ageism in Healthcare: Addressing Bias and Stereotypes in Geriatric Nursing.
• The Intersection of Technology and Geriatric Care: Opportunities and Challenges.
• Integrating Complementary Therapies in Geriatric Pain Management: A Holistic Approach.
• Enhancing Geriatric Mental Health: The Role of Psychotherapy and Medication.
• A Critical Examination of the Financial Burden of Long-Term Care for the Elderly.

As nursing students pursuing an MSN, you enter a field where geriatric care is paramount. The aging population requires dedicated and knowledgeable nursing professionals who can provide compassionate, evidence-based care. The PICOT questions, project ideas, research topics, and essay ideas presented here offer a broad spectrum of opportunities for you to explore and contribute to the field of geriatric care. Remember, your work has the potential to impact the lives of elderly individuals and their families significantly. Should you need assistance developing these ideas into comprehensive projects or papers, don’t hesitate to seek our writing services . Together, we can contribute to improving the quality of senior care and making a meaningful difference in the lives of our aging population.

Frequently Asked Questions (FAQs) About Geriatric Nursing

Q1: What are the nursing responsibilities in geriatric care?

A1: Nursing responsibilities in geriatric care include assessing and managing age-related health conditions, administering medications, promoting mobility, providing emotional support, addressing cognitive changes, and collaborating with interdisciplinary teams to ensure holistic care for elderly patients.

Q2: How do you take care of a geriatric patient?

A2: Taking care of a geriatric patient involves conducting thorough assessments, developing personalized care plans, ensuring medication adherence, assisting with daily activities, promoting social engagement, and monitoring for any signs of complications or changes in health status.

Q3: What is geriatric nursing in nursing?

A3: Geriatric nursing focuses on providing specialized care to elderly individuals, addressing their unique physical, emotional, and cognitive needs, and promoting their overall well-being during the aging process.

Q4: What are the eight most common conditions found in geriatric patients?

A4: The eight most common conditions in geriatric patients include cardiovascular diseases (hypertension, heart disease), osteoarthritis, diabetes, dementia (Alzheimer’s disease), falls and fractures, depression, respiratory diseases (COPD), and sensory impairments (vision and hearing loss).

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Geriatric Nursing Research Paper Topics

Geriatric nursing research paper topics are an essential part of the healthcare sector as they focus on addressing the unique needs of the elderly population. This area of study encompasses a wide range of topics, from managing chronic diseases to addressing mental health issues, providing palliative and end-of-life care, and supporting caregivers. As the global population continues to age, the demand for specialized geriatric nursing care and innovative solutions is on the rise. This article will delve into the significance of geriatric nursing, discuss various research paper topics it offers, and highlight the services provided by iResearchNet to support students in their academic pursuits.

100 Geriatric Nursing Research Paper Topics

Geriatric nursing is a critical and specialized field that focuses on the healthcare of the elderly. The importance of this field has magnified in recent years due to the increasing aging population worldwide. Older adults often have unique health needs, including managing chronic diseases, addressing mental health issues, ensuring proper nutrition and hydration, and providing palliative and end-of-life care. Moreover, the support of caregivers and the utilization of technological innovations are also pivotal aspects of geriatric nursing. This comprehensive list of geriatric nursing research paper topics aims to cover the breadth and depth of this important nursing specialty and provide a solid foundation for students and researchers interested in this field.

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Chronic Diseases

• The impact of diabetes on the elderly population.
• Strategies for managing hypertension in older adults.
• The role of nursing in managing arthritis in the elderly.
• Chronic obstructive pulmonary disease (COPD) management in older adults.
• Heart failure management strategies for the elderly.
• The relationship between chronic kidney disease and aging.
• Strategies for managing osteoporosis in the elderly.
• The impact of chronic pain on the quality of life of older adults.
• Managing gastrointestinal diseases in the elderly.
• The role of nursing in the management of cancer in older adults.

Dementia and Alzheimer’s

• Strategies for managing behavioral symptoms in dementia patients.
• The role of nutrition in preventing Alzheimer’s disease.
• Non-pharmacological interventions for managing dementia.
• The impact of caregiver support on the progression of dementia.
• Technological innovations for managing Alzheimer’s disease.
• The role of nursing in managing the comorbidities of dementia patients.
• Strategies for managing sleep disturbances in dementia patients.
• The impact of physical activity on the progression of Alzheimer’s disease.
• Ethical considerations in the management of dementia.
• Strategies for enhancing the quality of life of Alzheimer’s disease patients.

Mental Health

• The prevalence of depression among the elderly population.
• Strategies for managing anxiety disorders in older adults.
• The impact of social isolation on the mental health of the elderly.
• The role of nursing in managing suicidal ideation in older adults.
• Strategies for managing psychosis in the elderly.
• The impact of cognitive-behavioral therapy on the mental health of older adults.
• The role of nursing in managing the mental health of elderly patients with chronic diseases.
• Strategies for managing stress in older adults.
• The impact of mindfulness and meditation on the mental health of the elderly.
• The role of nursing in managing the mental health of elderly patients in long-term care facilities.

Palliative and End-of-Life Care

• Strategies for managing pain in older adults receiving palliative care.
• The role of nursing in providing emotional support to older adults receiving end-of-life care.
• Strategies for managing symptoms in older adults receiving palliative care.
• The impact of advanced care planning on the quality of end-of-life care.
• The role of nursing in managing the spiritual needs of older adults receiving palliative care.
• Strategies for managing caregiver stress in palliative and end-of-life care.
• The impact of hospice care on the quality of life of older adults.
• Ethical considerations in palliative and end-of-life care for the elderly.
• The role of nursing in managing the physical needs of older adults receiving palliative care.
• Strategies for enhancing the quality of life of older adults receiving end-of-life care.

Medication Management 

• The impact of polypharmacy on the health of older adults.
• Strategies for preventing medication errors in the elderly population.
• The role of nursing in managing medication adherence in older adults.
• The impact of medication reconciliation on the health outcomes of older adults.
• Strategies for managing drug interactions in the elderly population.
• The role of nursing in managing side effects of medications in older adults.
• Strategies for managing medication-related falls in the elderly.
• The impact of medication therapy management on the health of older adults.
• Strategies for managing over-the-counter medications in the elderly population.
• The role of nursing in managing medication costs for older adults.

Falls and Injuries

• Strategies for preventing falls in the elderly.
• The role of nursing in managing bone fractures in the elderly.
• The impact of home modifications on fall prevention in older adults.
• Strategies for managing head injuries in the elderly.
• The role of nursing in managing fall-related injuries in older adults.
• The impact of exercise on fall prevention in the elderly.
• Strategies for managing fall-related fear and anxiety in older adults.
• The impact of assistive devices on fall prevention in the elderly.
• Strategies for managing fall-related hospitalizations in older adults.
• The role of nursing in managing rehabilitation after fall-related injuries in the elderly.

Nutrition and Hydration 

• Strategies for managing malnutrition in the elderly.
• The role of nursing in managing dehydration in older adults.
• The impact of dietary interventions on the health of older adults.
• Strategies for managing obesity in the elderly.
• The role of nursing in managing nutritional deficiencies in older adults.
• The impact of oral health on nutrition and hydration in the elderly.
• Strategies for managing dysphagia in older adults.
• The impact of nutritional supplements on the health of older adults.
• Strategies for managing special diets in the elderly.
• The role of nursing in managing tube feeding in older adults.

Caregiver Support

• Strategies for managing caregiver burnout in geriatric nursing.
• The role of nursing in providing support to family caregivers of older adults.
• The impact of respite care on caregiver wellbeing in geriatric nursing.
• Strategies for managing caregiver stress in geriatric nursing.
• The role of nursing in providing education to caregivers of older adults.
• The impact of support groups on caregiver wellbeing in geriatric nursing.
• Strategies for managing the transition from home to long-term care for caregivers.
• The impact of caregiver interventions on the health of older adults.
• Strategies for managing financial stress for caregivers of older adults.
• The role of nursing in providing emotional support to caregivers of older adults.

Technological Innovations

• The impact of telemedicine on the care of older adults.
• Strategies for managing electronic health records in geriatric nursing.
• The role of nursing in managing wearable devices for older adults.
• The impact of smart homes on the care of older adults.
• Strategies for managing online support groups for older adults.
• The role of nursing in managing digital health interventions for older adults.
• The impact of virtual reality on the care of older adults.
• Strategies for managing mobile applications for older adults.
• The role of nursing in managing telehealth for older adults.
• The impact of artificial intelligence on the care of older adults.

Ethical Issues

• Strategies for managing end-of-life decisions in geriatric nursing.
• The role of nursing in managing informed consent in older adults.
• The impact of advanced directives on the care of older adults.
• Strategies for managing privacy and confidentiality in geriatric nursing.
• The role of nursing in managing decision-making capacity in older adults.
• The impact of ethical dilemmas on the care of older adults.
• Strategies for managing resource allocation in geriatric nursing.
• The impact of cultural sensitivity on the care of older adults.
• Strategies for managing conflicts of interest in geriatric nursing.
• The role of nursing in managing ethical dilemmas in the care of older adults.

Research in geriatric nursing is of paramount importance as it aims to enhance the quality of life of older adults, a demographic that is rapidly growing worldwide. It encompasses a wide range of topics from managing chronic diseases, mental health issues, providing palliative and end-of-life care, to supporting caregivers, and employing technological innovations. With the increasing complexity of health issues faced by the elderly population, it is imperative for nursing professionals and researchers to delve into these critical areas of geriatric nursing. This comprehensive list of geriatric nursing research paper topics serves as a starting point for students and researchers to explore the myriad of issues faced by the elderly and develop innovative solutions to address these challenges.

Geriatric Nursing and the Range of Research Paper Topics It Offers

Geriatric nursing, a specialized field focused on providing comprehensive healthcare to older adults, is of paramount importance in today’s aging society. The demand for skilled healthcare professionals in this area is continually rising as the global population of individuals aged 65 and older is expected to nearly double by 2050. This surge highlights the significance of geriatric nursing and the need for ongoing research to address the myriad of challenges faced by the elderly population. Moreover, it underlines the necessity for a wide range of geriatric nursing research paper topics to encourage the next generation of nurses to focus on this critical specialty.

Significance of Geriatric Nursing

The significance of geriatric nursing extends beyond merely catering to the needs of an aging population. It involves a holistic approach that addresses the physical, psychological, social, and spiritual needs of older adults. Elderly individuals often present with multiple chronic conditions, polypharmacy, decreased physical function, and cognitive decline. Geriatric nurses, therefore, play a pivotal role in managing these complexities and optimizing the quality of life for older adults.

Chronic diseases, such as diabetes, heart disease, and osteoporosis, are prevalent among the elderly. Geriatric nurses are equipped with specialized knowledge and skills to manage these conditions, monitor treatment effects, and provide necessary education to patients and their families. Moreover, they play a critical role in preventing complications and hospital readmissions, which are common and costly occurrences in this age group.

Another vital aspect of geriatric nursing is addressing mental health issues. Older adults are at a higher risk for developing mental health problems such as depression, anxiety, and dementia. Geriatric nurses are trained to identify early signs of these disorders, provide appropriate interventions, and offer support to both patients and their families. Furthermore, they play a key role in managing behavioral symptoms associated with dementia and other cognitive impairments.

Caregiver support is also a crucial element of geriatric nursing. Family caregivers often experience significant stress and burden while caring for their elderly loved ones. Geriatric nurses provide essential support and education to these caregivers, helping them manage their stress and equipping them with the necessary skills to provide adequate care. Additionally, geriatric nurses act as advocates for older adults, ensuring their needs and preferences are communicated and respected in the healthcare system.

Range of Geriatric Nursing Research Paper Topics

The vast array of challenges encountered in geriatric nursing necessitates a diverse range of research topics. Research in this area is essential to develop evidence-based practices, improve patient outcomes, and inform policy decisions. Some key areas of focus include chronic diseases, mental health, and caregiver support, among others.

Chronic diseases are prevalent in older adults and often require complex management strategies. Research topics in this area could include the effectiveness of various interventions for managing chronic diseases, strategies for preventing complications, and the impact of polypharmacy on treatment outcomes.

Mental health is another critical area of research in geriatric nursing. Topics could include the effectiveness of non-pharmacological interventions for managing depression and anxiety, strategies for managing behavioral symptoms in dementia patients, and the impact of social isolation on mental health in older adults.

Caregiver support is also a crucial area of research. Topics in this area could include the effectiveness of support groups for caregivers, strategies for managing caregiver stress and burden, and the impact of caregiver interventions on patient outcomes.

Technological innovations are also becoming increasingly important in geriatric nursing. Research topics in this area could include the effectiveness of telehealth interventions, the impact of wearable devices on monitoring chronic diseases, and the use of virtual reality for pain management in older adults.

Ethical issues are also a critical area of focus in geriatric nursing research. Topics could include decision-making capacity in older adults, the impact of advanced directives on end-of-life care, and strategies for managing conflicts of interest in geriatric nursing.

Geriatric nursing is a critical specialty that addresses the unique needs of the elderly population. With the growing number of older adults worldwide, there is an urgent need for ongoing research to develop evidence-based practices, improve patient outcomes, and inform policy decisions. A wide range of geriatric nursing research paper topics, from chronic diseases to ethical issues, provides an opportunity for students and professionals to contribute to this essential field. Ultimately, research in geriatric nursing will help optimize the quality of life for older adults and support their caregivers in this challenging journey.

iResearchNet’s Custom Writing Services

In today’s fast-paced academic environment, students are often burdened with a multitude of tasks, including assignments, examinations, and research papers. Balancing these responsibilities while maintaining a high academic standard can be challenging, especially for students pursuing a specialized field like geriatric nursing. That’s where iResearchNet steps in to provide exceptional writing services designed to alleviate the academic pressure faced by nursing students and professionals alike. Whether you need help in developing a research paper, conducting in-depth research, or formatting your paper, our team of expert degree-holding writers is here to assist you.

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iResearchNet is dedicated to providing high-quality writing services to nursing students and professionals. Our team of expert degree-holding writers, commitment to quality, and customer-centric approach set us apart in the industry. Whether you need help with a geriatric nursing research paper or any other academic assignment, we are here to assist you every step of the way. Place your order today and experience the iResearchNet difference!

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• Polaro SHI, Montenegro LC. (2017). Fundamentals and practice of care in Gerontological Nursing. Revista Brasileira de Enfermagem, 70(4):671-672. doi:10.1590/0034-7167.2017700401

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Free Geriatrics Essay Examples & Topics

In recent years, we have entered the era of population ageing. It is a process that leads to complications with physical and mental health. However, we are now more than prepared to take care of the elderly members of society. Geriatrics (also known as geriatric medicine) is the specialized care for the health of the elderly and older adults.

With the prevalence of the geriatric population, their needs have to be studied. This is where gerontology comes into play. It is the study of the process of growing older and everything that comes with it. Experts analyze the physiology and psychology of aging, as well as its social and societal aspects.

If you have to write a gerontology or geriatrics essay, you’ve come to the right place. Our specialists have prepared some ideas for your thesis that you can look at in your work. You can also use our geriatrics and gerontology research topics to create your original work. Finally, under the article, you will find care of the older person assignment samples for you to consider.

9 Awesome Gerontology Thesis Ideas

Writing care of the older person essay or a paper on the process of aging is not an easy task. Harder yet is to come up with a good geriatrics or gerontology thesis. These kinds of academic assignments depend on accurate research and reliable facts. Furthermore, they are relatively large in volume. In other words, you will have to spend some time collecting evidence and citations.

With all these steps, it is no wonder you don’t want to waste any more time choosing a topic. We are here to assist you exactly with that.

Take a look at these geriatrics and gerontology thesis ideas:

• The effect of COVID-19 on the nursing care plan: exploring how old age homes respond to the challenges brought on by the pandemic.
• Accuracy of cancer diagnosis practices in geriatric care and problems faced when determining the syndromes of the disease.
• Communication issues with people who have dementia: a decline in health care and elderly neglect.
• Advancements of the neural blockade treatment in palliative care for senior citizens.
• Determining a reliable way to assess the extent of elder abuse in aged care facilities in the United States.
• The intersection of frailty and ageism: an assessment of the social exclusion of the elderly from everyday activities.
• Rehabilitation practices for physically impaired elderly patients following surgical intervention.
• Exclusion from tests and trials: assessing the safety and efficacy of vaccines in research about elderly patients.
• Methods of reducing the risk of cognitive decline in adults to reduce the risk of fall in older age.

19 Interesting Topics in Geriatrics & Gerontology

For care of the older person essays or research papers on a related subject, you will need a more straightforward idea. We have those, too! Our topic generator will create a unique title for you for any kind of assignment.

You can also check our list of interesting topics in aging:

• How do adult education classes bridge the gap between technology and aging?
• Developing an exercise routine for older adults with physiological issues.
• The difficulties in self-care of the elderly patients with disabilities.
• Examining the personal experience of caregivers in private nursing homes.
• The life expectancy of older adults with unhealthy habits.
• Analyzing the demography of HIV+ positive older adults.
• Tracing the cognitive decline over the life course of middle-class women.
• The difference in the prevalence of geriatric diseases based on race, gender, and income of older adults.
• Nonsurgical management of fractures in elderly patients.
• The importance of nursing interventions in the case of eldercare.
• The difference in blood pressure-related issues between older men and women.
• Changes in the management of elderly health care facilities in the last twenty years.
• Exploring the habits of pharmacy visits in adults over sixty years old.
• The professional development of a carer in a Japanese hospice.
• How to properly assess the needs of an older person with Alzheimer’s.
• Analyzing the findings from the 2021 International Conference on Aging Diseases and Elderly Care.
• What kind of geriatric assessment is capable of meeting the needs of the elderly?
• Methods of cardiovascular care for elderly patients with disabilities.
• Assessing the risks and benefits of polypharmacy among the elderly.

Thank you for reading! We hope that you managed to find the ideal topic for your essay or capstone among our suggestions. You can now proceed to read care of the older person assignment samples that we have below. You can cut them down with our summarizing tool to look through them faster.

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Article Contents

Design and methods, acknowledgments.

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Advantages and Challenges: The Experience of Geriatrics Health Care Providers as Family Caregivers

Decision Editor: Nancy Schoenberg, PhD

• Article contents
• Figures & tables
• Supplementary Data

Clare M. Wohlgemuth, Heidi P. Auerbach, Victoria A. Parker, Advantages and Challenges: The Experience of Geriatrics Health Care Providers as Family Caregivers, The Gerontologist , Volume 55, Issue 4, August 2015, Pages 595–604, https://doi.org/10.1093/geront/gnt168

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Very little is known about family caregivers who are also geriatrics health care professionals. This exploratory study examines the dual roles of such professionals, the impact of their geriatrics expertise on the care of family members, and the influence of those caregiver experiences on their clinical practice.

The research team recruited 16 geriatrics health care professionals who participated in 60- to 90-min individual interviews, based on a semistructured guide. Questions explored participants’ dual experiences as geriatrics professionals and as family caregivers. Interviews were audio recorded, transcribed, and analyzed using qualitative data analysis software. Using a thematic analysis approach, the authors identified recurring themes, coding responses into both major themes and subthemes.

The authors found 3 major themes: (a) dual role advantages and disadvantages, (b) emotional impact of dual roles, and (c) professional impact of family caregiving. Participants reported their own geriatrics expertise provided both advantages and disadvantages in caring for their older family members. Although their expertise introduced a significant emotional intensity to their personal caregiving experiences, those experiences positively influenced their professional insight, empathy, and advocacy for the caregivers of their own patients.

In addition to the well-known burdens of caregiving, a further set of complex stressors is imposed on geriatrics health care professionals serving as family caregivers. The challenges they face despite their expertise also highlight critical challenges facing all caregivers.

Caregiving of older adults is a major social issue with enormous implications for health care and with an estimated cost of $450 billion in the United States alone ( Feinberg, Reinhard, Houser, & Choula, 2011 ). More than 60 million Americans were family caregivers in 2009. The issues of caregiving are complex and involve hands-on help and supervision, financial management/support, emotional support, medical and legal decision making, and health care. It has been well documented that caregivers suffer emotional distress, stress related to their own family and work responsibilities, health issues, and isolation. Earning potential and income are also affected. The Caregiving in the U.S. survey found that 65% of caregivers in 2009 reported shifting their work schedule or taking time off to provide care. Twelve percent of survey respondents reduced their work hours and 9% gave up work entirely ( National Alliance for Caregiving and American Association of Retired Persons, 2009 ).

There is rich data available about caregivers in the United States and strategies to minimize the physical and emotional burden of caregiving. Less is known, however, about the phenomenon of caregiving when the caregiver is also a health care professional, someone immersed in and knowledgeable about the health care system. Even less is known about the impact of the family caregiving experience on clinical practice and the approach to patients and families facing similar joys and struggles. The experiences of geriatrics health care providers, in theory those best equipped to deal with increasing frailty and end-of-life care, have rarely been described.

There have been several qualitative studies examining the experiences of nurses taking care of family members and the impact upon the nurses’ quality of life. Mills and Aubeeluck (2006) found four themes that emerged from interviews with nurses caring for a relative with a life-threatening illness: quality of life, personal and professional boundaries, disempowerment, and positive aspects of caregiving. They also found nurses had specific needs with regard to their dual caregiving roles. Ward-Griffin, Brown, Vandervoort, & McNair (2005) explored the challenges faced by women from four disciplines (nursing, medicine, social work, and physiotherapy) who provided care both in their professional work and to older family members in their private lives. This study found that these caregivers experienced trouble with blurred boundaries, delegation, and limit-setting, resulting in feelings of isolation, stress, and exhaustion. There also has been literature written by and about physicians acting as family caregivers. These authors speak to how intensely personal the experience is ( Fromme, Farber, Babbott, Pickett, & Beasley, 2008 ; Kane & West, 2005 ; Kleinman, 2009 ) and describe the caregiving experience of physicians as fraught with obstacles, such as poor communication and fragmented care, and ethical and moral distress in their dual roles ( Chen, Feudtner, Rhodes, & Green, 2001 ; Ward-Griffin et al., 2005 ).

It is unknown which strategies, interventions, and supports are needed to help those who are in both the professional role of health care provider and family caregiver. Further, the impact of the family caregiving experience on geriatrics health care providers’ own practices has not been studied. This inquiry was prompted by the authors’ own complex experiences as both geriatrics health care professionals and family caregivers. The purpose of this exploratory project was to describe the range of experiences, feelings, supports, perceived helpful interventions, and impact on family and work when geriatrics health care professionals act as family caregivers.

We conducted an exploratory qualitative study with 16 geriatrics clinicians who had also served as family caregivers. Participants were recruited through announcements at staff meetings and an e-mail flyer distributed to faculty and staff of the Section of Geriatrics at Boston Medical Center, Boston, MA. We asked colleagues to forward the flyer to other potentially interested colleagues. We defined geriatrics health care provider as an adult with professional training and experience in clinical geriatrics. We defined caregiver as an individual providing ongoing care to an older family member in the present or past. Interested participants contacted the researchers and were screened to be sure they met inclusion definitions. Written informed consent was obtained from all participants. The research protocol was approved by the Boston University Medical Campus Institutional Review Board.

Two authors (C. M. W. and H. P. A.) conducted 16 semistructured interviews (eight each) between July and October 2009. Interviews were between 60 and 90min long and were conducted at locations and times convenient for participants. Interviews were audio recorded and transcribed. Transcripts were identified by code number. Names or identifying information were altered or deleted from the transcribed files to protect confidentiality. The interview guide was designed to elicit information regarding how caregiving began, the personal and emotional impact, experiences of having dual roles, experiences with the health care system, family relationships, and the professional impact of caregiving ( Supplementary Appendix A ). Analysis of the interviews was conducted using qualitative data analysis software ( ResearchWare, Inc., 2009 ). We used a thematic analysis approach ( Crabtree & Miller, 1999 ) to identify, refine, and name themes. After all the interviews had been transcribed, each interviewer read through all of the transcripts and developed a running list of codes. The three authors then met to review the preliminary list of codes and used consensus decision making to combine codes that were highly similar in order to develop a more parsimonious code list. Each interviewer read all interviews and analyzed in depth the eight interviews conducted by the other interviewer, utilizing this code list. The authors met to review the results of this coding, examining examples of each code to ensure that both coders were interpreting and applying the codes in the same manner. Coding categories were further grouped and identified as themes based on the second round of analysis, resulting in the final scheme of themes and subthemes reported here. Pseudonyms have been assigned when respondents have been quoted.

Sixteen geriatrics health care professionals participated, including 12 nurses, 3 physicians, and 1 social worker ( Table 1 ). All were white, English-speaking, and the majority women and married. Participants entered the role of caregiver because of their own specific position in their families: they were the only child or only daughter and their role was determined by default, they were the one child without children, they worked part-time, or it was perceived that they had more time to devote to their older family member or due to geography. Most participants had more than one of these factors. Caregivers’ experiences spanned a spectrum: from providing significant hands-on personal care to providing important guidance to other primary caregivers. The role of caregiver either had evolved slowly or occurred due to an acute illness, with end-of-life issues common.

Caregiver Demographics ( N = 16)

Family dynamics, life experiences, coping styles, and the expertise/skill set of being a geriatrics health care provider shaped the caregiving experience. Each participant had his/her own unique story, but common experiences and feelings were present across participants. Three major themes were identified: (a) dual role advantages and disadvantages, (b) emotional impact of dual roles, and (c) professional impact of family caregiving. Several subthemes were found within these major themes (see Table 2 ).

Major Themes and Subthemes

Dual Roles Advantages and Disadvantages

Among all the participants, the role of caregiver developed from family needs and was influenced by being a geriatrics health care professional. Some participants assumed the role because it was easier to do the work of caregiving than to delegate. Some were perceived as the most reliable family member. All participants were highly devoted to their older family members. These factors are common among all caregivers regardless of professional training but seemed heightened by the health care backgrounds of these respondents. Participants viewed caregiving as a responsibility assumed because of their professional expertise; it was a pragmatic matter—they had the skills and used those skills automatically. One participant explained as below:

I don’t know that we ever had a lengthy conversation about it. It was the way she turned to me for medical things, the way she turned to my brother, who is a computer programmer, when her computer went on the fritz, or my sister, who is an attorney, when she needed something else taken care of. She has children in multiple professions, and she just uses them… – Taylor

Many participants described experiences in which their families recognized their expertise and relied upon their knowledge and skills. Families expected these caregivers to know what to do, even if the caregivers did not necessarily feel it was justified:

I think it was just perceived competence. You know, “[She’s] the nurse, [She] deals with old people… [She] will know what to do…” – Robin

Because the expertise of geriatrics health care providers spans a wide range of knowledge and skills including understanding of primary care, community resources, and end-of-life issues, participants used their expertise on an ongoing basis. They viewed use of geriatrics and general health professional knowledge and experience as important tools to help them fulfill their role as family caregiver. Participants described the dual roles of being both a family caregiver and a health care provider as inevitable and all encompassing. Participants did not feel it was easily possible to separate these roles. One participant described the complexity of the role overlap:

She says, “Talk to me like you would talk to your patients…” But of course I can’t, because I’m a family member who’s also a doctor...You want to be able to delegate this stuff to somebody who trusts, and as good of a doctor and caregiver and - medical caregiver and coordinator as you are. That’s the ideal world. I do not want to be her doctor. I do not want to be her case manager. I want to be able to be her daughter, and I hate being in the dual role. – Fran

These caregivers, by nature of having dual identities as family caregivers and geriatrics health care providers, had many and complex roles. These roles often created external and internal conflicts and a range of emotional struggles. Another respondent summarized the phenomenon well:

…In some ways you’re at an advantage, in some ways you’re at a disadvantage. You’re at an advantage because you deal with these issues professionally. But of course you deal professionally from a more detached perspective, because you’re in an objective, professional role. You’re not emotionally enmeshed in the situation. When it’s your own family member of course, you become emotionally enmeshed in the situation. Yet sometimes there’s comfort in ignorance. And as a geriatric care professional, you know what’s going on behind the scenes. You know perhaps what should be happening and is not happening. – Alexis

Participants expressed both advantages and disadvantages to possessing geriatric health care knowledge through their caregiving experiences. These advantages, challenges, and conflicts of professional expertise were categorized into subthemes.

Benefits of Professional Expertise

Participants described their health care expertise as a huge advantage in caring for older family members. All participants used their skills and knowledge as geriatrics health care providers to aid in their caregiving role. These skills included accessing medical knowledge of relevant health problems, providing personal care, navigating the health care system to locate suitable providers, home services, rehabilitation or long-term care facilities, initiating discussions on advance directives, recognizing illness trajectory, and advocating for the best care possible for their family members. Participants reported using both general medical knowledge and specific geriatrics knowledge, for example, related to minimizing functional decline, mitigating risks for delirium in the hospital, and advocating for appropriate end-of-life care. It was helpful to be able to speak the same language as care providers and use professional connections to gain expert help. Knowing how to access and navigate the health care system was felt to be critical to providing good care.

I had constant contact with the nurse, with the evaluation, with the physical therapy evaluation. But, again, being an insider, I had that much more advantage than the regular person on the outside. And that makes a very big difference. – Chris

Participants described a very intense sense of personal duty and high standards to provide optimal care for their family members. It was a matter of pride, compassion, and pragmatics to use their expertise in caregiving. They expressed the need to feel that they had done their best and had no regrets. They often described feeling they could better recognize their older relatives’ needs or provide the level of caregiving necessary compared with other family members. For these reasons, they felt they were better equipped and prepared to take care of their older family members.

I just feel like I have to do it because nobody is going to do it as well as I’m going to do it. So I have to do it. – Sam But I felt like I really mattered… I recognized when she was struggling, we went through all the machinations to get her to accept assisted living. She did much better there for several years… So I feel like I did a real good job there and I really had no regrets. And that’s probably why I think that’s wh[y] you do what you do, while they’re alive, because you want to feel like you did the best job you could and there’s no regrets when they’re gone. – Robin

Although their expertise helped their loved ones to receive optimal care, in some cases, their expertise created the setting for significant challenges and conflicts.

Challenges and Conflicts From Professional Expertise

Because of the participants’ professional backgrounds, they had high expectations for their own performance as caregivers and expected the same level of care from the providers and the health care systems caring for their older family members. Though there were many examples of participants having positive experiences with other health care providers and health care facilities, many experienced conflicts and disappointment. Conflicts especially arose over managing end-of-life issues and delirium. Issues with physical restraints were also a common problem. Advance directive discussions were sometimes contentious as there were examples of both providers recommending overly aggressive care or not aggressive enough care. Several participants described facing major conflicts with other providers when their standard of excellent geriatrics care was not met.

He was tied down. And I was irate! Absolutely irate. They did place a nasal gastric tube to provide him with nutrition, and he was delirious. So he was confused, and he started to pull the tube out. And of course their solution was to tie him down. Well I was irate. I came in the room, I untied the restraints. I said, “Nobody called us on this. Remove the order. I don’t care if he pulls out the nasal gastric tube. That’s his choice. And if he doesn’t 100% understand, it’s undignified at this stage of his life to tie him down.” And of course we met with tremendous resistance. How dare we question them. – Alexis

Participants sometimes described feeling awkward or uneasy about when to use their knowledge and skills, creating internal conflicts. Respondents described difficulties in finding the right balance of when appropriate to use one’s professional background and when not.

… I guess some of what I do is maybe not wanting to know, because the more I know, the scarier it is. So, if I don’t ask the questions, sometimes it’s better that I don’t know. And that’s sort of my own, perhaps, defense mechanism. But other times, I know but I don’t know how much to impart to other people because I don’t want to scare them or make a bigger deal of something. So, it’s trying to find that balance between having the knowledge and knowing what to do with it, or not having the knowledge or not wanting the knowledge kind of thing. – Dana

Participants described different perspectives disclosing or not disclosing their identities as health care providers. Some chose to step back, others wanted providers to know their professional backgrounds, so that they could hear information at a higher level. Some participants chose not to reveal their health care background unless it was necessary because they perceived it would make the providers self-conscious or nervous. Nuanced decisions of when or when not to voice concerns or make suggestions about therapies or plans varied by participant and situation.

I often didn’t start by telling them I was a geriatrician, but by the way I spoke, they knew I was in medicine. Sometimes I’d pull the geriatrician card...I never approached it as a know it all. I approached it as a collaborative partner. As someone who…has worked with other people and knows what works, and who practices this in my own practice, and knows as a family member that this is very important. – Fran

Participants’ professional experiences impacted their ability to intervene in ways other nonprofessional caregivers might not have been able to do so. And though the impact of their interventions was usually positive, respondents described internal angst over their use of health care knowledge. This is closely related to a second major theme, the emotional impact of dual roles.

Emotional Impact of Dual Roles

All participants described multiple ways in which the child/health professional dual role caregiving experience affected them emotionally. Participants often described mixed emotions that illustrated the impact of dual roles. Caregivers gladly provided care and felt a strong sense of reward, but there was a significant theme of emotional struggle:

…everything from extreme gratitude at being able to do it. Having the background and professional experience that makes some things easier is a relief. To anger and frustration at the system. Confidence that you can manipulate it. Grief. The difference between raising your children and launching them is being able to look forward to their maturing and miss them when they’re gone. But when your parents are in decline, there’s no way for it to end well. You know, you’ve seen enough of other people in the next stage that, you know, you know what’s coming…you know that you’re going to lose them. – Taylor

The participants experienced emotions common to all caregivers of any background: emotional exhaustion, guilt, and stress from struggling with multitasking to provide and coordinate care.

So I think at the end of her life, I knew she had a tough life. So I wanted to do what I could for her. But at times, I was stressed with that, and then I’d feel guilty because I was stressed…Well I felt guilty because sometimes I wouldn’t want to be there for her. I was overwhelmed with it. I felt guilty because I didn’t want to do something one day… and then I felt bad after that… – Tracy

Along with the many emotions common to all caregivers, the participants also experienced emotions that seemed specific to being a geriatrics health care provider. Multiple subthemes were expressed, including always being on call, deliberate stoicism, recognition as the child, and the burden of knowing.

Always on Call

Nearly all participants described the feeling of never being off duty, because their day job extended into their personal lives as caregivers.

Just unrelenting responsibility. Crushing. You know, always on call…Sort of low grade anxiety, not in the sense of not knowing what to do, but just waiting for the next shoe to drop. – Robin … I found myself getting really angry at my mother, because I’d be exhausted… and I would see that she was in failure. And why she didn’t call her doctor. And she said, “I wanted to wait for you.”…And I finally was able to say, “Mom, it’s not fair to me that you wait until I come up. I do this for a living. I need a break!” [and she said], “Oh, I guess you’re right.” And one time she said, “It’s just because I’m scared, and Dad isn’t here anymore. And you’re the safest person that I have.” – Marion

These descriptions illustrate how profoundly participants felt the burden of responsibility, anticipation of problems, and weight of continuous stress.

Deliberate Stoicism

Many participants discussed holding back emotions as something that they had to do for the good of their families. This approach was described as necessary and pragmatic.

And we didn’t do this work-up with this questionable nodule, because we weren’t going to treat it…But then, when the actual thing happens when she’s in the hospital, and when she was not doing so well--Well, you know, what are we doing? You know, [my family was] so nervous and having to bring them back to reality. That’s very hard, because I’m feeling it myself, but trying to be very stoic and trying to hold down the fort. That’s hard, very hard. – Sam

Disconnecting from ones’ emotions was described as being almost automatic and something caregivers learned to do in their professional lives because it was necessary. Some caregivers felt more comfortable than others stepping in and out of roles.

It’s not necessarily a feeling, but more just somebody’s got to do it, so I got to do it. So it’s not really an emotion thing, but more of just an intellectual so now you actually step out of the caregiver but into the provider role and you do these things … as a provider. – Vern

Remaining stoic and professional in the face of a loved one’s illness was very difficult for many. Stepping into the role of child was not necessarily viewed as easy. To be treated as both child and knowledgeable professional was something many participants wanted and needed.

Recognition as the Child

Caregivers spoke gratefully about providers who understood the internal conflicts of living dual identities and how emotionally difficult it was to be the child and a health care provider for their family member. Providers who met their high expectations and understood their unique stressors gave them a sense of relief. Being able to trust their parents’ care providers and having these care providers understand their own emotional turmoil greatly eased their stress. Being cared for and having feelings and opinions validated was very important to them emotionally.

It was this incredible cathartic for me when the right nurse came and could see, and started getting my family to communicate. And that she was my mother’s professional, not me… I had to learn to let her be the expert. When I realized that she was my mother’s nurse…She had great skills. And then I realized that she had the foresight to tell me that, “you’re the daughter.” – Marion

This respondent felt that having a nurse who understood her specific caregiving circumstances gave her permission to be the daughter and not her mother’s nurse.

Burden of Knowing

Even with having the right provider caring for one’s family member, participants described the emotional burden of knowing too much. The knowledge and experience professionals bring to the role of caregiver can mean having a different understanding about prognosis and expectations for recovery than other family members. Though all participants recounted innumerable advantages to having a health care background, many described experiences that revealed the burden of knowing too much. Participants discussed feeling emotionally separate from family because of their understanding of prognosis. Because of their clinical backgrounds, they often anticipated and recognized problems before family members. This caused multiple emotions including isolation, anxiety, and frustration. Participants described feelings of estrangement from other family members because they were perceived as being overly negative and overreacting.

And I just feel like it’s a struggle every time, kind of like I’m talking a different language, almost. They do eventually come around, but there’s several months of, “I don’t know what you’re talking about, I don’t see that with Mom. I think you’re overreacting...” And then finally three months later, “Oh yeah, I think I finally see what you’re saying.” And just those three months, you feel a little estranged from people, and then you kind of come back in and that gets fatiguing after a while... –Aubrey

Participants sometimes experienced rejection or resistance from family members when they tried to provide help. Participants described feelings of frustration when they were not allowed to contribute their expertise.

I would say that it was stressful because of the resistance… Maybe I was considered threatening in some way… But, whether it was the fact that I knew what I knew, whether that was a threat, that that’s where the resistance came from, but that was the hardest thing, is not being heard, not being heard-- or at least considered… the frustration and the disappointment. And there was anger, because it was like I was banging my head against a wall. And all I was really trying to do was to say “You know, these are the things we might need to put together. And these are the things that we can share, so that we all can pitch in and help, and all feel as though we’re part of the process.” –Charlie

Participants often described feelings of inadequacy when they did not live up to their own or their family’s expectations. Respondents felt family members often assumed they should know everything. They described situations in which they were expected to be the expert but were not, creating feelings of inadequacy, embarrassment, frustration, and anxiety.

He was having what we thought was chest pain, and I said to him, “You need to call 9-1-1,”… And he wouldn’t call 9-1-1 until we got there... he could be having an MI right in front of me and what am I going to do? And again, frustrated that he’s relying on me to take over… I’m not a CCU nurse... So I was scared and I was nervous and I wanted him to take care of what he needed to take care of and not rely on me to be the person to fix it all…. it’s frustrating …because they think I know everything, and I don’t .... –Dana

Respondents often had conflicted emotions, questioning if they had done the right thing regarding medical issues. Second guessing occurred about whether or not to use their clinical knowledge.

I saw signs in my dad… increased confusion, difficulty breathing, hemoptysis, and everything, you know. But did I bring an oximeter, which I had, to check? No. Nope.... I think to myself this day, did I not do it because I knew what his intentions were and I knew what difference does it make at this age. Or did I not do it because I didn’t want to see it. And that’s a question that I still haven’t answered. –Chris

Participants described the pain they felt in knowing more about what to expect of their parents’ decline and identifying difficult stages and issues to come, including the difficulties managing role reversal.

You’re losing them. And you know you’re losing them. Again, I had to override her, somebody that was very independent. Who did everything despite her disability. And I had to override her. The role reversal. It was very hard…. –Tracy

Participants were very devoted to their older family members and very committed to providing the best care possible for them. Their experiences as caregivers resulted in using what they learned to improve the care of their patients and to reduce caregiver stress. This was the third major theme identified in the analysis.

Professional Impact of Family Caregiving

Participants described many ways in which the caregiving experience enhanced their skills and increased their understanding of patient and caregiver needs. Four major subthemes arose: insight and empathy, lessons learned, advocating for the right care, and focusing on the caregiver.

Insight and Empathy

The caregiving experience gave participants new insights and empathy for patients and families and added respect for what it means to be a caregiver. Participants described many ways in which the caregiving experience taught them how to communicate more effectively and guide discussions about treatment options and advance directives.

…It’s given me tremendous insight. I truly understand at an emotional level what it’s like to care for an elder. The decisions you have to make. What you go through. And because of that, I’m better able to guide people through that process…I think unless you’ve been through an experience of caring for a frail elder, it’s very difficult to really understand the emotions involved, and the stress and anxiety involved, and all the different criteria involved. So I think my ability to guide families is enormously enhanced by having been through that situation. And I just think I’ve added a great deal to my professionalism…. –Alexis

Insight and empathy especially arose over more deeply understanding end-of-life issues. As one participant stated:

And I thought I knew what death was… I had no idea until my father died, what the loss of a parent was. Working for so long in geriatrics…thinking I was doing a good job with my patients and families. Until I lost my dad, I didn’t really get it, what death was like. –Marion

Lessons Learned

Participants described many ways in which their skills were enhanced. Many developed a deeper understanding of hospice principles. Participants used their trial and error caregiving experiences to advise families and share practical hints from their own caregiving experiences. Hands-on knowledge was acquired through humbling experiences:

I was squirting it into my mom’s mouth and finally Dad said, “You know, you have to put it in her, in a well right there.” And I said, “You do?” And it was like, well, I’ve ordered it many times… And yet, I haven’t had to administer morphine… So the physician, you kind of write the script, but you’re not ever administering it. So it was all those pieces that were sort of embarrassing to me that I didn’t know…. I do feel like I have a whole new appreciation of the practical end of caring for someone…I have a whole new understanding. –Morgan

Advocating for the Right Care

Participants discussed many ways in which the caregiving experience helped them to advocate more fully for their patients. They had personally witnessed weak points in the health care system. They felt better able to anticipate problems with transitions of care, including pre- and postoperative care and rehabilitation needs, because of what they experienced as caregivers. They felt better able to identify important services for their patients.

So I think I’m more pushy about people having case management. Families, if they can have it, because it’s the direct care workers and case managers who are probably more important in all of this... It’s direct care workers and their quality and reliability. And the people who direct care across transitions that are, I hate to say it, even more important than any medical care that people get. –Fran

Focusing on the Caregiver

Participants not only felt great empathy for caregivers, but also felt they had a special perspective on caregiving, which they wanted to share. They understood deeply the magnitude of caregiver stress and felt compelled to give their patients’ family caregivers appropriate counseling and support. An important focus described was helping caregivers learn to set limits and try to take care of themselves.

…So it’s sort of giving people the guidance of how to set some limits because the individual that needs the help, the patient, doesn’t want to lose control but they have to understand what is within their control and what is not within their control. And then some support for the caregivers in terms of how to set limits with them about what they can or can’t do and what they’re willing to do and what they’re not willing to do…I think that’s what the caregivers could benefit from, learning to say no when they have to…. –Dana

Focusing on caregivers included reaching out to colleagues in need. Many participants described providing or benefiting from collegial support and wanting to reciprocate in turn. They described how invaluable it was for them to get support from colleagues which helped them to recognize family dynamics and validate their experiences in a safe place. Participants wanted to be a guide and sounding board for colleagues.

The other impact is I think I’m a better support to my colleagues, because it seems like there’s a lot of us the same age, going through the same things. I think I do a better job with my colleagues who are going through things...Or noticing and anticipating that they’re going to need assistance, even though they don’t know it. –Marion

The experiences of family caregiving appeared to have a significant impact on the professional lives of the respondents. These experiences, though often difficult, contributed to how the participants treated and communicated with patients and their families and how they reached out to colleagues facing similar challenges.

The analysis identified three major themes: (a) dual role advantages and disadvantages, (b) emotional impact of dual roles, and (c) professional impact of family caregiving. All included both positive and negative feelings. Common emotions identified included: unrelenting responsibility, constant stress, deliberate stoicism, isolation, grief, frustration, feelings of inadequacy, anger and guilt and also great joy, pride, gratitude, sense of accomplishment, insight, and a strong sense of personal reward. Participants felt their specialized knowledge created additional stress based on self- and family expectations to ensure positive outcomes by overseeing the care of their family member. These stressors varied from worry in anticipation of the next bad event to the loneliness of comprehending prognoses before other family members. Nevertheless, all participants reflected on the positive feelings associated with the caregiving experience and would do it again.

Geriatrics health care providers who function as family caregivers undergo a unique, highly emotional experience. It is made more complex by an in-depth knowledge of geriatric medicine, nursing, social work and an inside understanding of the health care system. The combined expectations of their own and family expectations to positively affect their family member’s care heightened the stress of the entire experience, consistent with previous findings that provider-caregivers felt an uncomfortably high expectation from family members to be involved in their loved one’s care ( Chen et al., 2001 ; Ward-Griffin et al., 2005 ). For the majority of participants, this led to feelings of isolation as well as the need to always “be on” and have all of the answers. Relaxation was perceived as limited or not possible at all.

Simultaneously, participants felt pride and satisfaction when their geriatrics expertise improved outcomes in the care of their older family members. Caregivers from all professions acted as highly informed advocates for their family members. Feelings of anger were elicited by perceived poor communication and care not meeting their high standards. Anger was also expressed when there was insensitivity to geriatric principles on the part of the provider(s) delivering the care.

The impact of personal experiences on participants’ professional practice was also powerful and positive. Most participants reported feeling more empathic and understanding of their patients’ caregivers’ needs and concerns. Participants reported a deeper appreciation of caregiver stress and utilized their own experience as a tool to support and problem solve their patients caregiver issues. Having lived their own family caregiver experiences, participants felt able to better address the emotional and instrumental needs of their patients and caregivers. It alerted them to the importance of discussing end of life earlier ( Mori et al., 2013 ) as well as the need for greater family education.

These findings build upon the small body of knowledge about health care professionals who serve as family caregivers. Consistent with Ward-Griffin coworkers (2005) and Chen coworkers (2001) findings, our study indicates that this phenomenon of dual role challenges may be common across health care disciplines. Our study was limited by a small sample size and mostly nurse participants. Comparing how individuals from nursing and other health professions approach their involvement in the care of older family members, as well as directly comparing geriatrics and non-geriatrics health care professionals, could be a next step.

This study demonstrates that in addition to the well-known stressors faced by lay caregivers, a further set of stressors affect geriatrics health care professionals who are family caregivers. Perhaps along with standard caregiver survival strategies ( Riess-Sherwood, Given, & Given, 2002 ), interventions tailored to address these unique stressors would help alleviate/moderate the wide range and intensity of emotions described in this study.

Potential interventions might include:

1. Developing a support group specific to provider-family caregivers to create a safe place among colleagues for expressing wide-ranging emotions and sharing ways to alleviate stress.

2. Creating a peer sponsorship program where two caregivers living the experience could offer mutual support and understanding. Peers could provide a sounding board for discussing how to balance the need to take charge versus letting family roles predominate ( Salmond, 2011 ; Wilson & Ardoin, 2013 ).

3. Mobilizing existing caregiver support resources along with resources for health care providers through a speakers’ bureau or website, which would provide ethical guidelines for maintaining boundaries ( Mitnick, Leffler, & Hood, 2010 ) and recommendations on managing dual role caregiving experiences.

4. Developing educational programs for health care providers who care for older family members of geriatrics and other health care professionals to focus on their specific needs.

Given the challenges reported by experienced geriatrics health care professionals, attention must also be focused on the lay caregivers who have more limited experience coping with aging and end of life. All caregivers need support in the use of communication and negotiation skills to effectively engage with providers regarding concerns about care. Both lay and health care professional caregivers would benefit from developing tools and techniques to discuss the many difficult issues and decisions related to increased frailty, dependence, and dignity of risk ( Mastel-Smith & Stanley-Hermanns, 2012 ). It is imperative to focus on empowering and teaching all caregivers and providers how best to have these difficult conversations with family members and with each other, given the inevitability of end-of-life issues in caring for older adults.

This work was supported by an internal interdisciplinary pilot grant through the Section of Geriatrics at Boston University School of Medicine.

We are very appreciative of the helpful comments of Rebecca Silliman, MD, PhD, Winnie Suen, MD, MSc, and Barbara Bokhour, PhD. We would also like to thank Emily Abrams for her support in finalizing this manuscript.

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An Understanding Of Geriatrics Health And Social Care Essay

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