How to Care for Grandma and Grandpa? Nursing Innovations Forge New Paths
One participant in the geriatric care scene
is the John A. Hartford Foundation a philanthropic organization which advocates
on behalf of the elderly. Since 1996 they have been emphasizing the importance
of nurses and nursing in elevating the care of the elderly. The foundation
created a number of initiatives to increase the quality medical care the
elderly receive. One is the Hartford Institute of Geriatric Nursing. The vision statement realizes that
education, research, and policy are key factors in moving best practice to
standard practice but more importantly, education, research, and policy must translate
or affect nursing practice. It is affiliated with the New York University College
of Nursing and during its existence has been a pioneer in many areas of
geriatric nursing.
Let’s take a hypothetical grandparent who goes to the
hospital via the emergency department. What would an ideal care situation look
like?
If the hospital was part of the Nurses Improving Care for
Healthsystem Elders(NICHE) it would
have a set of protocols staff would follow for elderly patients. These
protocols would focus on the areas of care that affect the elderly the most.
Staff would try and avoid the use of restraints to prevent falls. They would
take concerted action to avoid pressure ulcers, and would manage pain to avoid
delirium and sleep disorders. The hospital would have a Geriatric Resource Nurse
that staff could consult. If Grandma had to stay in the hospital her ward might
be a Acute Care for the Elderly(ACE) unit where the physical environment is
specifically designed to prevent functional decline with a less institutional
like atmosphere.. Nurses would have resources like ‘Try This’ available at the
bedside through technology. The goal for Grandma would be to avoid preventable
adverse events, especially in terms of proper interventions and prescription
treatments. Hopefully Grandma’s stay would be short and she would not have to
return to the hospital again, and with comprehensive post stay transition care
could return to her own home.
Currently over 300 hospitals are part of the NICHE network. NICHE
is not a program per se. It provides the support, tools, and principles to
bring about a change in hospital culture towards the goal of patient centered
care for specifically for the elderly. Hospitals first complete the Geriatric
Institutional Assessment Profile(GIAP) to find out where their organization can
make changes to progress towards that goal.
The ‘Try This’ bedside resource is centered around
conditions specific to the elderly population and consist of two pages; the
first page describing the importance of the condition and the second page an
assessment that can be administered in a short time. There is also a book available
called Geriatric Nursing Protocols for Best Practice. It is presently in its
third edition and is also available for use at the bedside to enable nurses to
find information quickly.
The Foundation also created the Building Academic Geriatric
Nursing Capacity. Celebrating its tenth year this initiative partnered with
nursing schools and the American Academy of Nursing. The goal is to support the
next generation of nursing scholars, researchers and most importantly future
nurses. In 2004 the Atlantic Philanthropies also became a partner and there are
now 9 Hartford Centers of Geriatric Nursing Excellence, which are educational
institutions that are committed leaders in geriatric nursing maintenance and
expansion.
There is a movement to formally prepare nursing students in
geriatric care by changing and adding to the curriculum of nursing programs.
For instance in Minnesota 10 nursing schools have set a goal for increasing
geriatric topics in their curricula. It is called the West Central Initiative.
Highlighting
excellence in geriatric nursing will help advance its importance nationally.
The Foundation partnered with the AACN and has awards for curriculum excellence
in the baccalaureate program that increases student competence in aging. For
example, one award recipient Valparaiso College of Nursing integrated geriatric
content into every course. One required course is called the Aging Process. The
goal of this course was to change students’ attitudes towards the elderly. This
is accomplished by students role playing an elderly person for a day to
establish empathy and understanding. Students also make wellness presentations
to healthy older adults. In their senior year they work with the elderly in
extended care or rehabilitation units of hospitals. These activities create a
comprehensive compassionate education of aging and geriatric medical care. In
partnership with AONE, the foundation also created and award for hospitals that
strive towards best practices in geriatric care. Recognition of excellence can
be a motivating factor in change at the institutional level.
In the area of policy development the Foundation has
initiated forums to create the opportunity for discussion on geriatric care.
Strategic partnerships enable leveraging of resources to
attain a larger goal or greater impact. One example of this is the Foundation’s
partnership with the American Nurses’ Association, American Nurses
Credentialing Center(ANCC) and Atlantic Philanthropies. Called Nurse Competence
in Aging, the focus of this partnership was to increase geriatric
competence(comprised of skill knowledge and attitude) of nurse specialists ,
with a three part approach. The first is working through the 57 respective
specialty organizations to assist in their involvement in pursuing best
practices. A list of the activities of each association is online at
http://download.journals.elsevierhealth.com/pdfs/journals/0197-4572/PIIS0197457207003163.pdf.
If a specialty organization acquires funding through the NCA initiative it
becomes a Specialty Nursing Association Partner in Geriatrics(SNAPG).
The initiative also encourages nurse specialists to acquire
certification in geriatric care, to validate competence in that area.
At present too many assumptions are made about the medical
care of the elderly. What may be good care for a younger person may not be
ideal for someone older. Care for this age group must include more input from
the patient. The initiatives discussed in this article show there is a steady
increase in resources for all nurses who realize the importance of geriatric
competence.