What do we need in the last stage of life?

Report of a geriatric nurse

by Maria Froitzheim, Heike Hupe, Marilies Kupsch, Sylke Reeckmann, Cologne

Although Germany is one of the countries with the highest standard of living in Europe and the world, it performs poorly in terms of the number of caregivers compared to other European countries. German hospitals and nursing homes have long experienced a shortage of nursing staff, which has been exacerbated by the Corona crisis. Many smaller hospitals and intensive care units were already closed before the pandemic, jobs for nursing staff and doctors had been cut, and nursing staffing ratios had been changed. They saved even on hygiene articles, so that nursing homes, for example, repeatedly had neither enough gloves nor masks. The president of the German Nursing Council, Franz Wagner, sees a need for an additional 50,000 positions in the medium term.

The nursing emergency in Germany

Although this emergency became clearer at the beginning of the Corona crisis, nursing staff were applauded for their high level of commitment and demands for improvement were followed by promises and even some changes, the situation has not fundamentally improved to this day, but has worsened, with thousands of nursing staff quitting.
  The Corona crisis brought the gravity of the crisis to light. The cause of this deplorable state lies in the thirty-odd years of neoliberalism as an economic form, which put profit first and abandoned the common good as the supreme principle as well as the meaning and purpose of the economy. As in other areas of social coexistence, the health care system no longer focuses on people and their needs, but on the greatest possible material gain. This explains the underpayment and low appreciation of the work of nurses. There is a scarcity of qualified staff and temporary employment agencies sometimes pay higher wages which causes a   high fluctuation rate and a bad climate among the employees. Due to staff shortages, nurses work a lot of overtime. They are forced to work under undignified conditions against their own ethos and are therefore completely overworked.

Personal report of a geriatric nurse

The report of a geriatric nurse who for these reasons recently quit her job with a heavy heart in a private nursing home illustrates the discrepancy between what constitutes the work of caring for an old and sick person and what has sadly become commonplace in nursing care today as a result of neoliberalism.
  At the beginning of the crisis, after many years of working as an outpatient nurse Ms R., a sixty-year-old trained nurse, decided to take over the nursing management of a quarantine ward in an old people’s home. Due to her qualified training, her experience, and her high level of commitment, she brought with her the necessary security and calmness for this responsible task. She began her work with great pleasure, managed the ward successfully and soon enjoyed a high reputation among both the elderly and her colleagues. After the management of the quarantine ward was no longer necessary, Ms R. decided to work in another ward. Unfortunately, over time, conditions deteriorated. This was reflected in an ever-increasing shortage of nurses, and in poor management, which made the nurses feel unfairly treated and unappreciated. In addition, they were ordered to perform tasks not related to their profession (for example, to perform housekeeping duties). Ms R. tried to speak to the director of the home on behalf of her colleagues and to lobby for better conditions but was met with incomprehension and ignorance. After working under these undignified conditions for a long time, she quit, despite her concern for the elderly and her colleagues, in order not to become ill herself.

The life situation of the ageing person

Ms R. told us very impressively how she worked with the elderly and how she succeeded in getting closer to them and giving them hope. We have tried to summarise her experience:
  The life situation of the ageing person is similar to the phase at the beginning of life. Due to the loss of physical or even mental abilities, the old person becomes increasingly dependent on his or her fellow human beings and – like a small child– is in an emotionally overly sensitive position. Death is approaching the fear of pain, loneliness and dying increases. More and more, the question arises whether one has been a good person.
  When moving into a retirement home, a turning point is added to this already difficult situation, which often increases worries and fears. People with dementia also feel this way. Often, they are suddenly torn away from their familiar surroundings, their home, which still gave them a certain degree of safety. Their own free living and creative space increasingly falls away. The fear of being left alone, the difficulty of adjusting to a completely new, foreign environment and becoming dependent on unknown people often leads to disorientation, depression or sometimes even suicidal thoughts.
  The task of a nurse is now to take care of the people in this extremely sensitive state and to accompany them in their last stage of life, to help them in a caring and human way, to find solutions for the problems they face and to structure the path together with them. This path can be long or short. Sometimes the condition of the elderly person is not so bad when he/she moves in. Sometimes they deteriorate rapidly afterwards, some live in the home for several more years. Many lose touch with the outside world over time. The caregivers bring the world back to them to some extent in their seclusion. Their task is to understand the concerns and fears and, together with the elderly, to organise their special situation well. Ms R. reports that sometimes a conversation helps, sometimes a spontaneous gesture or a favour that goes beyond the normal work to make the old person feel seen.
  From her experience, she considers it essential that empathy and attention are characterised by a sense of hope and confidence: Over time, the elderly person and the caregiver get to know each other, become friends, share the burden, cooperate and slowly progress step by step at the pace set by the old person. The caregiver can help to reconcile with life and the new situation. The decisive factor is the type of attention, not the time.
  This kind of support requires a great deal of self-confidence and openness on the part of the caregiver. When interacting, he must be free of his own thoughts, worries and insecurities and radiate optimism. The caregiver must not refer to the old people’s peculiarities or bad habits and must not be afraid of them. Only in this way can they succeed in conveying trust, security, and safety to them.
  Some elderly people expressed to Ms R. that she was like a mother to them. A high sense of responsibility as well as willingness to try, independence and commitment was developed and trained by Ms R. already as a child in her own life situation. Her life experiences, a long, serious examination of herself and psychological knowledge help her to understand the old person and to form a bond with him, which gives hope and strength to alleviate suffering.
  However, Ms R. also points out that cooperation of the entire team who surround the elderly, especially the severely ill or dying person is required. In this situation, it is particularly important to gather and guide the observations and actions of all those involved, be it the relatives, the doctor, the priest, the housekeeper or the cleaner. This high responsibility is also in the hands of the nurse, as she knows the elderly person the best. She accompanies, comforts, and supports the relatives. The nurse’s experience in dealing with the seriously ill and knowledge of palliative care are important in relieving pain and calming the sick person. She recognises the first signs of death and initiates the necessary steps to accompany the person. She ensures that the dying person is not left alone but is cared for and protected as if by a mother at the beginning of their life.

Summary

All this shows what high demands, skills and knowledge, personal stability and resilience are required of geriatric nurses in their profession to be able to pursue it with joy and satisfaction. It also shows that their task can be a deeply humane and gratifying work if the conditions of the person both personally and professionally are given. 
  With her moving report, Ms R. gave us an insight into the situation of old people in general and into her experiences in a retirement home. In view of what this generation has created for us which was born out of hardship and need – the prosperity in which we live – we owe a debt of gratitude and good care for a dignified end of life. This has been shamefully forgotten in many cases today and is reflected, for example, in the shortage of nurses.
  Our elderly are also witnesses of the past, their wisdom and experience are a great asset from which the younger generation can benefit greatly. Of course, we also owe a great debt of gratitude to the geriatric nurses who, despite undignified conditions, take on the highly demanding task of accompanying our elderly people on the last part of their life’s journey unseen every day.

Thanks to Ms R. for her commitment and for her report!   •

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