New graduate orientation program in a geriatric psychiatric inpatient setting

With the geriatric population increasing, so will their needs for mental health care. However, attracting nurses to work with mentally ill older adults can be challenging. This article describes and illustrates methods successfully used by one hospital to attract, orient, and mentor new graduate nurses to work in geropsychiatric nursing--the New Graduate Residency Program (NGRP). The importance of supportive collaborative roles within nursing leadership staff is emphasized. Although the NGRP is a viable option for meeting the needs of older patients, additional strategies are needed to increase the numbers of geropsychiatric nurses overall, and these are discussed.     

NEW GRADUATE ORIENTATION PROGRAM IN A GERIATRIC PSYCHIATRIC INPATIENT SETTING

With the geriatric population increasing, so will their needs for mental health care. However, attracting nurses to work with mentally ill older adults can be challenging. This article describes and illustrates methods successfully used by one hospital to attract, orient, and mentor new graduate nurses to work in geropsychiatric nursing—the New Graduate Residency Program (NGRP). The importance of supportive collaborative roles within nursing leadership staff is emphasized. Although the NGRP is a viable option for meeting the needs of older patients, additional strategies are needed to increase the numbers of geropsychiatric nurses overall, and these are discussed.     

Portuguese nurses' knowledge of and attitudes toward hospitalized older adults

Portugal is impacted by the rapid growth of the aging population, which has significant implications for its health care system. However, nurses have received little education focusing on the unique and complex care needs of older adults. This gap in the nurses′ education has an enormous impact in their knowledge and attitudes and affects the quality of nursing care provided to older adults. A cross‐sectional study was conducted among 1068 Portuguese nurses in five hospitals (northern and central region) with the following purposes: (i) explore the knowledge and attitudes of nurses about four common geriatric syndromes (pressure ulcer, incontinence, restraint use and sleep disturbance) in Portuguese hospitals; and (ii) evaluate the influence of demographic, professional and nurses' perception about hospital educational support, geriatric knowledge, and burden of caring for older adults upon geriatric nursing knowledge and attitudes. The mean knowledge and attitudes scores were 0.41 ± 0.15 and 0.40 ± 0.21, respectively (the maximum score was 1). Knowledge of nurses in Portuguese hospitals about the four geriatric syndromes (pressure ulcers, sleep disturbance, urinary incontinence and restraint use) was found inadequate. The nurses' attitudes towards caring for hospitalized older adults were generally negative. Nurses who work in academic hospitals demonstrated significantly more knowledge than nurses in hospital centers. The attitudes of nurses were significantly associated with the hospital and unit type, region, hospital educational support, staff knowledge, and perceived burden of caring for older adults. The study findings support the need for improving nurses' knowledge and attitudes towards hospitalized older adults and implementing evidence‐based guidelines in their practice.     

Surgical considerations in the elderly

The number of older adults in America is rising every year. This increase in the elderly population will have a direct impact on health care delivery and perianesthesia nursing. Consequently, nurses need to increase their knowledge regarding the geriatric patient undergoing surgery. Areas of particular importance for nurses are preoperative assessment, medications taken by the elderly, preoperative instructions, intraoperative nursing care, postoperative nursing care, and discharge planning. Also of particular concern for the elderly surgical patient are nutrition, skin integrity, pain management, and promotion of sleep and comfort. The geriatric client requires extra time when being prepared for both elective and emergency surgery. A little planning goes a long way, and nurses need to enhance their communications skills to promote positive outcomes for the geriatric surgical patient. Caring for the elderly surgical patient can be a significant challenge, but if nurses work together as part of the perianesthesia/perioperative team, the experience can be extremely rewarding.     

Care provision for older adults: who will provide?

The aging of the baby boomers comes at a time of a growing nursing workforce shortage: registered nurses, nurse aides, and nursing faculty. Older adults have multiple physical, social, and psychological conditions, making the assessment, planning, and delivery of health care more complex than that of younger adults. Not surprisingly, this age group also utilizes the majority of health services in the country. Thus, most nurses will provide care to older adults in a variety of settings. However, the majority of nurses have little to no background in geriatric nursing. These multiple forces: aging population with complex needs, nursing work force shortage, and lack of geriatric knowledge, along with fewer resources, will have a grave impact on health care in this country in the near future. This article reviews issues related to an aging population, the projected nursing workforce shortage, and the lack of geriatric nursing education; it concludes with suggestions for future health care delivery to the geriatric population in the US     

Geriatric pain competencies and knowledge assessment for nurses in long term care settings

Pain in older adults is a prevalent problem that affects quality of life and challenges nurses, particularly those caring for older adults living in long term care settings. Despite the national priority of pain management, insufficient knowledge of nurses about geriatric pain is a documented barrier to effective geriatric pain management in all long term care settings. To address this knowledge gap, a website (GeriatricPain.org) was developed by the National Geriatric Pain Collaborative with a grant from the MayDay Fund to provide a single site for evidenced-based, easy-to-use, downloadable resources on pain management. This paper describes the development of the most recent addition to the website, a set of evidence-based core geriatric pain management competencies and a geriatric pain knowledge assessment, and discusses their potential uses in improving pain care for older adults. Geriatric Pain Competencies and Knowledge Assessment for Nurses in Long Term Care Settings.     

Using clinical simulations in geriatric nursing continuing education

Accompanying an increased number of older adults in the population is the need for knowledgeable and clinically competent nurses to provide care for this group, especially those experiencing sudden changes in health status. A continuing education program was designed to improve geriatric nursing competencies through the use of clinical simulations. Three-day nurse educator institutes and one-day workshops for registered and licensed practical nurses were offered to 312 nurses. The clinical simulations that were developed specifically focused on acute health events or conditions. Specific geriatric clinical competencies were also emphasized. Different types of clinical simulations included unfolding cases, use of a human patient simulator, and online case studies. Geriatric nursing knowledge significantly increased and clinical simulations were well-received. Clinical simulations involving the human patient simulator were highly rated. Clinical simulations are an excellent teaching strategy to help nurses increase knowledge and skill in caring for older adults.     

When your patient can no longer live independently: a guide to supporting the patient and family

This article uses a case study format to illustrate the Expanded Family Life Cycle Theory of Carter and McGoldrick (1999). This theory provides nurses and other health care providers with tools for assessing and planning care for older adults facing stressful life transitions. The individual and family are assessed as a unit embedded within their community. This multicontextual framework is applied to an elderly woman's transition from independent living to supervised living in a facility and illustrates the ease of use for practicing nurses. Suggestions are also offered to assist health care providers in supporting older adults and their families in making this significant transition.     

Portrayal of nursing to incoming students: results of a national survey of geriatric and pediatric web images on baccalaureate nursing program web sites.

In the face of a rapidly aging America and given that older adults are the population that avail health care services the most, there is a clear mandate to stimulate nursing student interest in care of older adults. The purpose of this study was to determine if web sites of baccalaureate nursing (BSN) programs stimulate interest in care of older adults by quantifying and comparing images of older adults and children on baccalaureate nursing program web sites and examining the characteristics of these images. The reality that nurses primarily care for older adults is not reflected in images on BSN program web sites. This creates both a skewed perception of the nursing profession and a lost opportunity to stimulate interest in geriatric nursing.     

The OASIS program: redesigning hospital care for older adults

A major factor in poor outcomes for hospitalized older adults is the health care delivery system. If acute care is not designed to address their altered response to illness and treatments, functional needs, and psychosocial issues, they are at significant risk for hospital-acquired complications and loss of functionality. Each health system should develop its own acute geriatric care program based on its resources and a plan for geriatric competency for all its health care workers. The OASIS pilot was created by taking elements from programs around the country that have succeeded in reengineering care for older adults. This pilot addressed the acute care of older patients scattered across 2 medical units in a 500+ bed community hospital. Outcomes demonstrated that coordinated, geriatric specific care had a positive, measurable impact on the quality of care, costs, and provided geriatric support to physicians and hospital staff.     

Effect of a geriatric nurse education program on the knowledge, attitudes, and certification of hospital nurses

Although nurses are the primary care providers for hospitalized and vulnerable older adults living in the community, they are generally not prepared in geriatric care. This study examined the effect of a 21-hour nursing education program on nurses' knowledge and attitudes regarding care of older adults and the geriatric nursing certification of the participants. The program was offered to 92 nurses in three cohorts over a 1-year period. Participants completed pre- and posttest measures of geriatric knowledge and attitudes. Significant differences were found between pretest and posttest knowledge and attitudes. Program evaluation and success in achieving certification in gerontological nursing also indicated a positive effect of the program.     

Factors affecting nursing students' intention to work as a geriatric nurse with older adults in Turkey: A cross-sectional study

The need for nurses specialized in geriatrics continues to increase with the aging world population. However, nurses and nursing students mostly do not consider geriatric nursing as a possible career in nursing. Therefore, understanding the factors that influence such a career preference is crucial to encourage geriatric nursing. The current study is cross-sectional and aims to investigate nursing students' intention to work as a geriatric nurse with older adults and the factors influencing those intentions. A total of 688 nursing students enrolled in the second, third, and fourth-years of the Bachelor of Nursing program in two universities were recruited. Data were collected using a questionnaire form developed by the researchers and the Kogan Attitude toward Old People Scale. Results indicated correlations between the fourth year in the program, living with older adults, taking a separate course on geriatric health, experience in providing care for older adults, and evaluating geriatric nursing as a possible career in nursing (P < 0.05). Additionally, the study demonstrated that students avert from a career in geriatric nursing due to the lack of knowledge and skills and negative experiences during internships and practice. In conclusion, nursing programs should include courses designed to focus on gerontology to improve nurse students' willingness to work with older adults.     

The Hartford Geriatric Nursing Initiative experience in geriatric nursing education: looking back, looking forward

This article traces the impact of the John A. Hartford Foundation’s (JAHF) Hartford Geriatric Nursing Initiative (HGNI) on the geriatric preparation of nursing students. With over 2.6 million practitioners, nurses play a critical role in assuring the health care of older adults. Older adults make up the majority of patient days in hospitals, home care, and nursing homes. Yet, when the JAHF began its investment in geriatric nursing, specific content on care of older adults was woefully absent in academic programs preparing entry- and graduate-level nurses. Clearly, the JAHF HGNI investment in nursing education has paid huge dividends. Baccalaureate nursing students are now likely to graduate with competencies in care of older adults. In the next 5 years, ongoing JAHF HGNI initiatives should yield similar outcomes in associate degree-prepared graduates and in advanced practice registered nurse graduates. This article traces the impact of the JAHF HGNI on nursing education.     

Review of current conceptual models and frameworks to guide transitions of care in older adults

Older adults are at high risk for gaps in care as they move between health care providers and settings during the course of illness, such as following hospital discharge. These gaps in care may result in unnecessary re-hospitalization and even death. Nurses can assist older adults to achieve successful transitions of care by taking a systematic approach and individualizing care to meet patient and family health literacy, cognitive, and sensory needs. This article reviews trends in transitions of care, models, partnerships, and health literacy. Models described include the Transitional Care Model, Care Transitions Program, Project BOOST (Better Outcomes for Older adults through Safe Transitions), Project RED (Re-engineered Discharge), Chronic Care Model, and INTERACT^II (Interventions to Reduce Acute Care Transfers). Approaches to transitions of care are discussed, and resources for geriatric nurses are provided.     

Geriatric Care Boot Camp Series: Interprofessional education for a new training paradigm

Interprofessional education of health care professionals caring for older adults is critical to address the unique needs of geriatric patients. An interprofessional education program – the Geriatric Care Boot Camp Series (“Series”) – was designed for health care professionals to fill this education gap. The program consisted of three half-day, intensive boot camps conducted over a one-year period. A total of 112 learners participated; more than half were nurses. Data analysis revealed statistically significant increases following each boot camp in attendees’ reported knowledge about caring for older adults; statistically significant increases in comfort caring for older adults were also seen among participants in two boot camps. Attendees found the interprofessional nature of the program beneficial and said they would attend a similar program again. The Series is easily replicable, appealing to the target audience, and fulfills the need to better educate health care professionals on caring for older adults.     

House calls: is there an APN in the house?

PURPOSE: To report how a group of geriatric advanced practice nurses (APNs) participated in a house calls program that increased access to care for homebound and frail community-dwelling elders. DATA SOURCES: Selected literature and author experiences, illustrated with clinical examples. CONCLUSIONS: Many frail older adults are unable to access healthcare due to functional impairments related to multiple, chronic medical conditions. Many of these adults inappropriately utilize the emergency department for episodic care. IMPLICATIONS FOR PRACTICE: The model of care maximizes utilization of APNs to provide cost effective, culturally sensitive, quality care. The goal of geriatric assessment and primary care in this practice is to add quality to later years of life, promoting dignity and comfort to older adults and their families.