How to Care for Grandma and Grandpa? Nursing Innovations Forge New Paths

 To improve and refine the quality of health care that the elderly receive in America will require not only more health care workers but professionals that are trained in geriatric care and understand the specific needs of the elderly. Currently, only approximately 2% of nurses are trained in geriatric care.

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 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.

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