Generational Differences in the Nurse Workforce

This paper explores generational differences in the nurse workforce and their different approaches to two specific age groups: children and elderly. The paper investigates the practical side of these issues, differences in practice, and methods of communication and care. At the beginning of the paper, the code of ethics relationship with the patient is described.

Generational Differences in the Nurse Workforce and How This Impacts Practice

Humanity and charity are ethical foundations of professional nurses. By taking and sharing human and medical ethical values, professional nurses proclaim the uniqueness of their profession and the consequent special nature of ethical relationships with colleagues and patients. The major tasks of professional nurses are (Silver, 2001):

• Integrated comprehensive care for patients
• Alleviation of their suffering
• Recovery and rehabilitation
• Health promotion and disease prevention.

A complex of comprehensive care is a complex of medical and social interventions performed by a nurse in a multidisciplinary team taking care of patients. Comprehensive care includes giving medical prescriptions, intervention performed by nurses in independent nursing care, activities together with other multidisciplinary team members, and aims to achieve the best health outcomes, including the highest life quality of a patient in a particular situation. Depending on the particular situation, a sick or healthy person, the family and patient’s environment, social, occupational, other groups of people, or society as a whole can be the patient. To each of them, a nurse must find their unique approach, especially if they are people of all ages e.g. children, elderly, etc. Before turning to age differences, it is useful to identify the main principles of the code of ethics for nurses in general.

If anyone talks about the right of a patient to quality care, he should say that a nurse must respect the inalienable right of everyone to the highest attainable standard of physical and mental health, the best level of social adaptation, and the right to receive adequate medical care.

The main component of nursing activities is professional competence. A nurse must always respect and maintain professional standards of activity. Continuous development of specialized knowledge, and skills, and increasing cultural level are the primary professional duties of nurses.

If to talk about the humane treatment of the patient and respect for his legal rights, it is important to say that a nurse must remain compassionate and respectful towards the patient’s life above all. The ethical value system of the patient in holistic understanding is the basis of nursing care regardless of cultural, ethnic, religious, philosophical, or other patient characteristics.

A nurse must always be ready to provide high-quality care to patients regardless of their age or gender, nature of the disease, race, religion or political opinion, social or financial status, or other differences. By doing this the nurse shows respect for the human dignity of the patient. When providing care, the nurse must respect the patient’s right to participate in the planning and implementation of treatment. In this case, the patient’s decision regarding the strategy of health care is a priority, even in cases where the decision contradicts the one made by medical workers.

The nurse has no right to violate the ancient ethical precept of medicine: “First of all – do not harm!”

The nurse must be truthful and honest. Absolute honesty in all matters regarding the health of the patient is a prerequisite to effective nursing care. The nurse must respect the right of the patient or his legal representative (when the nurse has to do with the child or patient by the law recognized as incapable) to provide consent to any medical intervention or refuse it.

If the nurse possesses some information or it has become known because of his/her professional duties, the nurse should keep this information about the diagnosis, treatment, or prognosis of a disease secret. The nurse should also keep information about the personal life of a patient a secret, even after the patient’s death.

A nurse must respect the right of a dying patient to humane treatment and a dignified death. No one should ever die alone and suffering without professional nursing support where such support can be provided.

If to talk about the work of a nurse in an emergency, it is important to say that nurses should improve their knowledge and competence in caring for victims of disaster. They also must be able to make chest compressions, temporarily control bleeding, and impose all kinds of dressings. The interests of the individuality of patients should always have a priority for nurses over the interests of science and society. While participating in scientific research, nurses must especially protect those patients, who are not able to take care of themselves (children and people with severe mental disorders). The ethical duty of nurses includes preserving and contributing to the traditions of the profession and the succession of generations.

In cases where the performance of professional duties is contrary to the moral values of a nurse, the latter must take action as quickly as possible to resolve ethical conflict and minimize its impact on health care. The moral duty of a nurse as a member of the medical community is to take care of the accessibility and high quality of nursing treatment.

A detailed examination of nursing of specific age groups (children and the elderly) was made at this point. These differences in generations introduce adjustments to nursing. The principles discussed above apply to all people, regardless of their age. But some specific situations must be considered.

Work with Children

Ill children are separated for some time not only from their parents but also from children’s groups. That is why attention to the interior design of children’s departments should be paid. Nurses must ensure that they resemble a kindergarten or school and have appropriate furniture, toys, books, etc. It is advisable to organize a child’s education by an individual program.

Relationships with family members are a very difficult and important part of the nursing process. IAchild’s illness causes great concern for all family members and especially for the mother. A nurse should come to the mother’s rescue, try to calm her down and make her confident that everything possible will be done in these cases. Even when taking care of patients with severe chronic diseases when the possibility of healing is minimal, the human factor of health workers, sincere sympathy, and careful attention cause gratitude in relatives and ease their grief. A nurse should purposefully influence parents by ensuring their active participation and parental assistance in providing treatment for the child. Parents should never give up on hope, but unrealistic expectations should not be supported. It is unnecessary to give promises when there is no confidence that the patient will get better in the nearest future.

In the case of chronic illness of the child, a nurse should strive to create an atmosphere of mutual understanding and mutual assistance, which contributes to the success of treatment and its dynamic progress (Janice, 2001).

In this way, the work of a nurse with a child requires precise knowledge of the psychology of children (healthy and sick) at different age periods as well as the ability to build the right relationship with rules of ethics, the ability to create an atmosphere of mutual understanding, and friendship with their parents and use their beneficial effect on the course of the therapeutic process.

The work of nurses in children’s clinics involves more psychological and physical activities. Therefore, the nurse should be a psychologist, a teacher, and a mentor. The success of the operation is dependent not only on professional skills, but also on personal qualities, psychological traits, characteristics of the nervous system, and orientation of the personality.

Specific communication, especially with the child and his parents, is important in organizing the work of nurses in every healthcare pediatric institution. Thus, it has become a fundamental contradiction between the social need for qualified competent medical professionals, who are capable of finding independent creative solutions and achieving professional objectives, and the level of psychological and pedagogical training of nurses.

The Specifics of Communication in Pediatrics

In pediatrics, the relationship between health professionals and patients becomes especially important when it is related to mental health. Primarily, the child is a developing person to whom an adult should provide an environment for the normal development of the psyche. First of all, adults, particularly medical professionals, create a safe environment for the child.

Existing psychological problems of parents and healthcare professionals create obstacles to the formation of such an environment for the developing individual. One of the most important conditions for the establishment of mutual understanding between the patient and healthcare professional is support. If a child realizes that people around him are willing to help rather than do something unpleasant because of force, he will likely be more actively involved in the treatment process.

When the nurse shows understanding, and the child and his parents are confident that their complaints can be heard, it becomes fixed in their minds. Empathy is the key to establishing cooperation with the patient. Nurses should be able to put themselves in the patient’s place and look at the world through their eyes. It is important to understand and take into account the internal picture of the disease, all that the patient feels and experiences, not just his local sensation, but overall well-being, self-observation, understanding of the illness, and its causes. While dealing with children, it is advisable to consider the following psychological characteristics of childhood (Silva & Ruth, 1999):

1. Contact with children facilitates their gullibility, suggestibility, lack of understanding of the risk of disease, manipulation or surgery, optimism, and lack of psychiatric facilities;
2. Communicating with children impedes fear, polarity, inadequate reactions, negativism, low-conscious volitional qualities, a tendency to simulation and dissimulation, and rare but dangerous psychosomatic reactions when fear manipulations can turn into the complicated breakdown of compensatory mechanisms.

When communicating with children, especially in situations threatening the child’s life, it is necessary to consider that the same disease is perceived differently at different ages. The older the child, the more conscious and more tragic he feels about his condition, and psychological trauma is worse for him. The difference of views depends on the child’s cognitive level, psychosocial development, and living experience. Therefore, it is extremely important to prevent psychogenic (information) iatrogeny, which may be caused by ill-considered discussion, doctor messages about life-threatening diagnoses without preparation, confusing medical information, or excessive taciturnity.

The relationship between a health worker and a sick child in each case forms individually, depending on the characteristics of the condition and the patient’s personality, his nosology, and the individual psychological characteristics of a nurse. Health workers must communicate with a child, mixing all models depending on the situation and using his psychotherapeutic potential. It should be mentioned that the child comes to reception accompanied by relatives, and sometimes their reaction to the words of the healthcare provider can determine the manner (positive or negative) of further cooperation between the healthcare professional and the child (Gilligan, 1982).

There is an important intermediate – the mother, parents, and relatives in the “nurse-child” system. Unfortunately, the kid often cannot describe his complaints, the nature and location of the pain, and the time of onset by himself. In this regard, a pediatrician or a nurse generally makes a diagnosis based on complaints presented by parents, objective examination of the child, and additional survey data. Thus, medical ethics has specific requirements for health professionals who work with children. After all, their work is based not only on direct contact with children but also on dealing with the immediate family, especially with the mother and her perception of the health of her baby. No mother tells the child “We’re going to the hospital, where you will be hurt.”

Currently, parents have access to information about diseases of childhood, drawn from special educational literature and the media. For this reason, enthusiasm regarding various means and methods of treatment sometimes advertised by the medical workers, can create difficulty during contact between health professionals and parents. And if this breaks the rules of ethics, there appears a cause for confusion. It is useful to know the following recommendations relating to the form of relationship with a child’s mother or relatives of young patients (Breier-Mackie, 2001):

1. A nurse should, first of all, establish contact with the child because as soon as the mother says that the child does not resist a nurse, she treats him with trust;
2. The confidence of a healthcare provider should be shown by his behavior, personal example, and human qualities. A quiet, attentive, optimistic, and accurate nurse preserving a healthy complexion, with good posture, who does not smoke is an example of a person who inspires confidence;
3. Convinced and clear presentation of information about a sick child in a friendly and gentle manner, demonstrating the highest professional level of nurse brings credibility to her personally and to the institution, which she represents;
4. Keeping a distance with goodwill facilitates understanding in difficult situations;
5. Display of such spiritual qualities as attention, kindness, and affection bring comfort in the consciousness of the mother, and immediate family.

At the same time, ethical conduct about the child does not depend on his age. Healthcare workers in contact with children should be psychologists and educators. Therefore, to take care of children, nurses must not only have deep theoretical knowledge, and the ability to use practical skills but also understand the subtle psychology of the sick child and his mother and understand clear ethical issues.

Work with Elderly

When taking care of elderly patients, attention should be paid to deontological aspects. A nurse must remember that the fact of hospitalization can have ambiguous consequences for elderly patients. Sick elderly usually experience the breaking of their traditional way of life and have difficulty adapting to unfamiliar surroundings. It was observed that after hospitalization elderly patients began to lose orientation in space and time, and their condition began to deteriorate progressively despite adequate treatment. For this reason, in the absence of strict indications for hospitalization, ithe elderly patient should remainat home as long as possible. If hospitalization is still considered appropriate, a nurse should try to convince the patient that hospitalization is temporary and after hospital examination and treatment he goes home (Gilligan, 1982).

While taking care of the sick elderly, a nurse should consider their psychological characteristics. Some patients trying to ignore age continue to lead the same lifestyle as at a young age, remaining equally physically active, feeling nervous, and not observing the diet, having less sleep and rest. This has an unfavorable effect on the disease, contributing to the progression and development of complications. A tactful and convincing explanation of the need for compliance with the prescribed regime has great importance in such cases (Fowler, 2008).

Elderly patients in conversations with each other and medical professionals constantly turn to the past, showing less interest in the present, and very little in the future. It is more difficult for older people to bear the loss of family and friends. It is hard for them to get new friends. Memory impairment is often observed. The patient often remembers what happened many years ago, but confuses current information and events of the recent past. All these features can make it difficult for a nurse to collect the necessary data, and, therefore, a nurse has to ask for help from relatives. In the care of these patients, a nurse should be especially considerate and attentive, patiently answering questions that patients may ask several times.

In conversations with sick elderly, reminding them of their age is unacceptable. Talking to older patients using words such as “granny”, and “grandpa”, even used with the best of intentions indicates the low culture of healthcare workers (Janice, 2001).

Sick elderly are long-ill people with chronic, often incurable diseases. Optimal therapeutic and protective regime plays a big role in the care of elderly patients. Such patients can have sleep disorders. They can often sleep or take a nap during the day and stay awake at night, reading, walking, eating, etc., causing doubts about the adequacy of their behavior in other people. In these cases, a nurse first needs to determine the causes of sleep disorders. These primarily include a variety of dysuric disorders. There may be other reasons for the sleep disturbance. A nurse should know that older people generally need to sleep less than younger people. If patients sleep additionally during the day, insomnia often becomes inevitable.

Reduction processes in elderly and senile patients are slower than in young people, which determines a longer period of rehabilitation therapy. But persistent and long-term treatment can be successful in the rehabilitation of patients who have had even a very severe disease. And it is impossible to overestimate the correct organization of care for older patients.

In conclusion of this work, it should be mentioned that ignoring generational differences in the nurse workforce can harm the patient seriously or make care impossible at all.