Editorial: Welcome to the International Journal of Older People Nursing
Welcome to the first issue of the International Journal of Older People Nursing (OPN). For us, the editors, this is an exciting stage in a process that began some time ago, when we first began to think about developing a journal that would be useful to nurses working with older people. This usefulness, we felt, would come from the way in which such a journal would provide information about current developments in practice, and also in the way that it would stimulate discussion about important issues and ideas in nursing older people. Whilst there are many international peer-reviewed journals available for nurses, few provide an exclusive focus on older people nursing. It is this focus that OPN aims to provide and, given the challenges that older people face, having a coordinated response from nurses is important.
The world has realized that it is growing older. Newspapers and television programmes are full of stories about the new ‘demographic time bomb’, which has been redefined not so much as a fall in birth rate, but as an increase in longevity. Pension and retirement plans are promoted in the press and on billboards, as we worry about the collapse of care services. Therefore, older people become not a blessing, but a burden, and their care is begrudged.
In many respects, concern over an ageing population is to be welcomed, because it encourages us to think about our own ageing. Older people are not ‘them’ but they are ‘us’, or at least us a bit further down the line. However, this thinking is very fragile, and we can quickly revert to thinking of older people as different, as not us. Susan Sontag (1978) once wrote movingly of illness and the way that ‘well people’ respond to it. She talked about the ‘island of the dispossessed’ a metaphorical and attitudinal place in which we put people and illness. They can wave to us from their shores, and we might wave back if we have time, but being ill is being in a different place, and once you have made that journey, it is difficult to get back. Being old seems in many ways similar – we have an island for older people, and we like them to go there and stay there. The way that many services have traditionally been structured and delivered reinforced this attitude of them (the old) and us (the young).
As nurses, then, we need to be aware of and resist the pressure to view older people as ‘different’. We need to be working to ensure that the issues and challenges facing older people are kept at the forefront of debates about care, practice and services, and that their voices are heard in discussions about the matters that concern them most. We have been doing this at an individual level, with the development of person-centred practice (a topic that we focus on in the practice development section of this edition) as we plan care in collaboration with older people and others significant to them. We also need to think through ways in which we can develop partnerships with older people as a group, and develop practice at a broader strategic level.
We hope that OPN will make a significant contribution to this thinking, and to the development of knowledge and practice in older people nursing. To achieve this, we hope that contributions to the journal will further enhance creative, responsive and thoughtful debate by respecting the following key principles:
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Older people should be partners in the development of nursing knowledge: This might be through involvement in teaching, research and the shaping of practice. We would therefore welcome papers that report on and debate processes or outcomes of partnership work. In this edition, one of us (Jan Reed) sets the scene on this topic, by reflecting on her experience of attempting to work in partnership with older people in collaborative research. Given the ‘newness’ of this approach to research in health care, we welcome such reflective and experiential accounts in the journal.
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Nursing is viewed in a multi-disciplinary and multi-agency context: Other academic and professional disciplines have much to offer in terms of expertise and perspectives, in the way that they can provide new insights, knowledge and perspectives for nursing. In this edition, Peri Ballantyne provides an in-depth review of the literature on social factors associated with breast cancer among older women and implications for nurses. We therefore welcome papers that come from a wide range of disciplines and backgrounds.
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Methodological innovation: Developing inter-disciplinary person-centred partnerships with older people requires methodological innovation in order that the complexity of older people's experience can be meaningfully explored and addressed. Catherine Monaghan's paper using ‘dialogues’ to understand moral dimensions of dementia care provides a good illustration of this. We welcome papers that are methodologically innovative and provide a critical foundation for the development of knowledge.
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Practice should be ‘person-centred’: The concerns and interests of older people should be the touchstone for discussion, rather than the professional or organizational concerns of nurses. In this edition, the ‘practice development’ section is devoted to the issue of person-centredness. We hope to have set the scene for a lively debate through the journal on the topic of person-centred practice in all its guises. In addition, we welcome papers that start from the point of older people's views and experiences, and place them at the heart of the debate.
These principles, we feel, are starting points for OPN. They have been developed over many years, in formal and informal conversations with fellow professionals, academics and older people. However, we hope that they are challenged, explored and expanded upon in the course of publication. We anticipate that the papers you, as readers and writers, offer, will stimulate and encourage creative and responsive developments in nursing older people. This journal is a vehicle for taking up the challenge and placing older people and the nursing care they may need on the ‘mainland’ of health care delivery.
