|Author: Julia Elliott|
|Helping the Elderly Live More Active Lives|
|"A nurse practitioner considers the whole person when giving care," says Barbara Resnick, Ph.D., CRNP, FAAN, FAANP, associate professor of the Department of Adult Health at the University of Maryland School of Nursing. Resnick is a staunch advocate of health promotion for older patients. True to her holistic approach, she has successfully combined research and personalized care as she strives to help elderly patients preserve their level of functioning and quality of life.
"The purpose of health promotion and disease prevention is to reduce the potential years of life lost in premature mortality and ensure better quality of remaining life," Resnick explains. "As Americans live longer, it is suggested that health promotion is all the more important because these individuals will have more years to benefit from preventative strategies, and healthcare providers have to be educated in these areas so we can advise them. Older patients sometimes need to be motivated to take responsibility for their care. Nurse practitioners focus on health promotion naturally, because of their training."
Resnick's work is right in step with demographic trends in the U.S. Federal officials recently reported that life expectancy for Americans reached an all- time high of 77.2 years in 2001, and the Centers for Disease Control and Prevention noted that this represented an increase of two-tenths of a year over the figure for 2000. As the number of older adults increases, there will be a corresponding need for healthcare providers. It will be vital for these healthcare professionals to provide care focused on health promotion in addition to disease management to help their older patients live longer, more active lives.
"The current generation of older adults is far different from generations ago, and we have to meet the needs of this population," she says. "They are learning that being older does not mean giving in or giving up, but rather, learning how to maintain and maximize their health." According to Resnick, seniors today are more health- and nutrition-conscious, and less willing to accept a diagnosis or prescription without asking questions -- or seeking second or even third opinions. Her observations are based on her clinical involvement in a small continuing-care retirement community.
Every day, discoveries in the field of gerontology and changes in societal attitudes about aging are transforming both thinking and practice in the field of senior care services. Responding to the older population's increasing interest in pursuing physical fitness, mental stimulation and healthy eating plans, Resnick spends much of her time engaged in research that will help seniors attain all of these.
Specifically, Resnick focuses on learning how to best motivate older adults to adopt behaviors that will promote and maintain good health -- both in her research and in her hands-on care of the elderly. She has a combined clinical/faculty position. "I am full-time faculty, but I contract out and do clinical work 60 percent of my time. I do my clinical work as a geriatric nurse practitioner at Baltimore's Roland Park Place, a continuing-care retirement community. It involves providing care to approximately 25 patients a day in the outpatient, assisted-living and long-term care units." Resnick also handles emergency care, treating seniors who suffer strokes, fractures, cardiac events and traumatic injuries. In addition, Resnick does a lot of health promotion and prevention activities, including teaching residents one-on-one and in large groups and helping with end-of-life care and management. "The health promotion and prevention activities that our facility offers are wonderful tools to help the older adults in this community augment their quality of life," she observes.
"I also have two large federally-funded research studies going, which also keep me busy," says Resnick. "I do research at night and clinical work by day." Finding new ways to motivate older adults to exercise and maintain function is her overall mission in both endeavors.
As an assistant professor at the University of Maryland, Resnick has been doing pioneering work in restorative care that is gaining national recognition. Along with maintaining a clinical career as a geriatric nurse practitioner, Resnick is also principal investigator of a National Institute of Aging study entitled "Testing the Effectiveness of the Exercise Plus Program Following Hip Fracture," and of numerous other studies focusing on motivating older adults to engage in health-promoting activities such as exercise. Resnick reports that her current study has been a terrific experience for the women involved, and all of them are looking forward to the forthcoming outcome.
"Although the study has been going on about five years, we recruit the women right after their hip fractures and follow them for 12 months. After that, a trainer assists the participants as they receive randomized treatment, which includes exercise only, exercise and motivation, or motivation only. This offers a clear and concise picture to help us understand exactly what it takes to get people to change their behavior, particularly after hip fracture." Resnick is in the process of conducting interviews with the participants as the end of the study nears. "The experience and feedback from them has just been great," she enthuses.
As she completes one study, Resnick proudly notes that she is in the process of "rolling out" another one, funded by Agency for Healthcare Research and Quality. "It is to test the motivation intervention that focuses on implementing a restorative philosophy of care in long-term care settings. It really focuses on getting older adults to maintain functional activities and exercise," she explains. Jay Magaziner, a member of the Department of Epidemiology at the University of Maryland who has worked with Resnick on assorted projects -- including her current hip fracture study -- for many years, will be her co-investigator on this new study.
Clearly, Resnick has made helping present and future generations of older adults live longer and while staying as active and mentally sharp as possible the primary focus of her nursing career. Geriatrics was not Resnick's first specialty in the virtually limitless field of nursing, however. Although she has always been interested in the health concerns of the elderly, Resnick made a point of trying her hand at other areas of nursing. She worked at the National Institutes of Health, for example, right after graduation from nursing school because of a positive experience working on a cancer study there as a junior. "I wanted to make sure that I was making the right decision [choosing a career in geriatrics] so I would not have any regrets later," she explains.
It was as an undergraduate at the University of Connecticut that she learned about the role of the nurse practitioner and knew that it was the career for her. "When you function as a nurse practitioner, what you bring to that patient is not only medical management, but also nursing knowledge," says Resnick. "I can diagnose, manage and prescribe, but first I am a nurse. ...The focus as a nurse is on the patient and whole person, not only the disease. Nurse practitioners are taught to manage the disease within the individual patient."
When she completed her graduate studies and sought a job in the early 1980s, nurse practitioners were still relatively new to healthcare. Resnick heard about a facility that was just opening and in dire need of a nurse practitioner. "The physician who hired me had no idea what a nurse practitioner was, but was mandated to get one," she recalls. "Learning together, this wonderful mentor stood behind me through everything, as we admitted and cared for 300 residents." This story about Resnick's early NP days and the doctor who hired her has a pleasing: "I have the honor of being the nurse practitioner that takes care of him now."
Resnick notes that her affinity for geriatric patients stems from her exposure to the nursing home setting as a very young child. "I am a firm believer in early childhood exposure being a positive factor. Before I even started kindergarten, I went to visit my grandparents at the nursing home every day, and spent a great deal of time growing up in that environment."
The impact of this experience stayed with her, and when Resnick had her own children, she brought them into the nursing home atmosphere. "Whether it resulted in positive experiences with grandparents or just helped them understand this part of life, I [believe] it's a good way to instill a favorable attitude," says Resnick. Today, two of Resnick's children have followed their mother's example and joined the healthcare professions.
Her positive feelings about older patients have helped Resnick provide the best care possible for geriatric patients at all levels of care. Noting that every professional copes in his/her own way when one of their patients dies, Resnick says a positive attitude can help. Although she acknowledges that it is always sad when one of her patients dies, she feels comfort in knowing she played a role in this part of their lives. "I feel honored to have been able to assist them. When they die, a small part of them is still with me because I have been touched by the experience and the memories serve as my comfort."
Resnick's clinical expertise involves a variety of common problems associated with aging. She has published over 50 clinical and research-based articles and over 20 book chapters. Resnick is a recognized leader in advanced practice nursing through her previous work on the Board of the American Academy of Nurse Practitioners (AANP) and with the National Council of Geriatric Nurse Practitioners, and through her role on numerous interdisciplinary boards and committees. In addition to teaching nurse practitioner students, Resnick also serves as a consultant locally and nationally regarding the education and employment of nurse practitioners, and is a consultant for Hadassah-Hebrew University on the development of their master's program in clinical nursing.
To say that Resnick is an accomplished nursing professional is an understatement, but when she first considered a nursing career, not everyone around her was encouraging. "My father wanted me to enter medical school," she recalls, "and at first he thought I was 'nuts' to choose a profession that he referred to as a 'bedpan pusher.' But I explained my point: the nurse takes care of people and physicians take care of diseases. It was the people with the disease that I wanted to work with, and I eventually found the nurse practitioner role would let me do both." As a nurse practitioner, Barbara Resnick has proven the doubters wrong, spearheading groundbreaking research that may one day help all of us enjoy a more vital old age.
Barbara Resnick, Ph.D., CRNP, FAAN, FAANP, is associate professor of the Department of Adult Health Nursing at the University of Maryland School of Nursing in Baltimore, MD. She obtained her BSN with distinction from the University of Connecticut in 1978, and her MSN Gerontological Nurse Clinician credentials from the University of Pennsylvania in 1982. She received her Ph.D. in Direct Clinical Research from the University of Maryland in 1996.
Julia Elliott is a freelance writer from New York. She is on the editorial staff of NEWS-Line for Nurse Practitioners.