The Duke-NICHE program: an academic-practice collaboration to enhance geriatric nursing care

The Duke-Nurses Improving Care of Healthsystem Elders (NICHE) is an example of an academic-practice partnership between a university-based school of nursing and a health system that aims to improve care of older adults by simultaneously enhancing the expertise of frontline nursing staff, accelerating the implementation of evidence-based care approaches, and generating scientific knowledge at the point of care. This article describes the processes used to develop the partnership, and reports initial outcomes and lessons learned. Although challenging to develop and sustain, academic-health system partnerships hold potential to improve care through both improved implementation of evidence and stimulating new research at the point of care.     

Development of an academic-practice partnership model to anchor care coordination and population health

The National Academy of Medicine's The Future of Nursing 2020–2030 recommends the expansion of the role of nurses throughout the continuum of health care in an effort to improve the health of the nation while decreasing costs. To accomplish this goal, nursing students and nurses must be well prepared to perform at their highest capacity to meet health care demands. Currently the U.S. health care delivery system is undergoing rapid changes that affect approaches to delivering care services. These changes call for education and practice reforms in nursing. This article introduces an innovative academic-practice partnership model (the University of Maryland Nursing [UMNursing] Care Coordination Implementation Collaborative), including its background, development, and blueprint for a large implementation project. The implementation model integrates nursing education and practice in areas of care co-ordination and population health, which have a significant impact on the Triple Aim of health. The project also uniquely integrates education, practice, and research, with the ultimate outcome of higher quality patient care.     

Fostering interprofessional collaborative practice in acute care through an academic-practice partnership

An interprofessional collaborative practice (IPCP) environment was implemented in four inpatient acute care unit accountable care teams (ACT) through an academic-practice partnership. An action research methodology was implemented to empower healthcare professionals and promote ownership and sustainment of the IPCP strategies. Healthcare professionals on the ACT units, students, and faculty engaged in the multi-year project. Interventions included staff engagement exercises and coaching and support of individual ACT unit IPCP strategies and education. Healthcare professional outcome data were collected in the form of participant surveys, measuring collaboration about care decisions and the extent to which professionals engaged in a culture of safety, collected at baseline and 6-month intervals. Healthcare outcome measures of the ACT units were also collected at baseline and 6-month intervals. Students had clinical learning experiences in the IPCP settings and completed post clinical surveys. Implementation of the interventions resulted in a positive trend in the healthcare professionals, although statistical significance was not observed. Student outcome data demonstrated statistically significant positive learning outcomes. Healthcare outcome measures demonstrated a significant decrease in readmissions and an overall decrease in catheter-associated urinary tract infections over time. Other measures were not significantly impacted. In conclusion, an academic – practice partnership can strengthen and support an IPCP environment by allowing healthcare clinicians to be directly involved in the selection and implementation of IPCP strategies and contribute to improved professional, healthcare and student outcomes.     

Sustained impact of an academic-practice partnership

Academic-practice partnerships foster innovation and transition to nursing practice in healthcare systems. The purpose of this paper is to describe the impact of a public-private academic-practice partnership for Doctor of Nursing Practice (DNP) education designed to transform a large healthcare system's nursing workforce and model of care. The conceptual framework is organized around Rogers's (2003) principles of diffusion of innovation in organizations. A logic model illuminates how inputs, activities, outputs and outcomes resulted in sustained impact for graduates, the college and the healthcare organization. Partnership outcomes include education of baccalaureate and master's-prepared employed nurses (n = 95) in a DNP program for advanced practice nursing (APN) roles in the healthcare system; dissemination of scholarship; and revision of the healthcare system's research approval process. Sustained impact includes advancement of DNP-prepared graduates to complex leadership and practice roles; development of new programs and advanced practice roles based on scholarly project findings; expansion of population-specific patient programs; and extension of continuum- and access-to-care models in the healthcare organization. Recommendations include continuing development of academic-practice partnerships for transition to practice and advancement of roles and levels of champions to achieve sustained impact of academic-practice partnerships in healthcare organizations.     

Measuring quality of care with an inpatient elderly population. The geriatric resource nurse model

Nurses provide health services to an increasing number of older adults in acute care settings. Acute care nurses are committed to giving patients the highest quality care while recognizing the importance of delivering care in a cost-effective manner. In this study, a unit-based, nurse-centered geriatric program is evaluated. The program is designed to enhance the knowledge and skill of staff nurses in providing care to elderly patients. Both quantitative and qualitative methods are used to assess geriatric resource nurses' (GRNs) influence on quality and cost outcomes of the elderly participants. Patients age 65 years and older were randomly selected from two general medical units of a major academic tertiary care center in the southeastern United States. Data were collected during an 18-month period in 1996 and 1997. A total of 129 participants provided data for quantitative analysis. A subset of 34 participants (17 from the unit where GRNs were on staff and 17 from a control unit) was interviewed about their experience during hospitalization. This information was analyzed for common themes and trends using appropriate qualitative techniques. Demographic variables and common measures of illness severity and complexity showed comparable patient populations on the two units. However, results of quantitative analyses indicated significant differences between groups on admission for several of the health status measures. Participants on the unit without GRNs were found to have more problems with pain, incontinence, and mobility. Administrative measures showed the number of patients readmitted to the hospital within 31 days of discharge and the length of stay associated with this initial readmission were significantly lower on the unit with GRNs. The use of vest-type physical restraints was also less frequent on this unit. Elderly patients in both groups indicated they have special needs related to normal aging changes and chronic illnesses, resulting in higher levels of fragility and decreased energy reserves. They identified specific functional areas for which help was needed. These include assistance with bathing, eating, sleeping, mobility, and elimination. Fewer participants on the intervention unit reported decline in activities of daily living (ADL) function during hospitalization than did control participants. Participants in both groups stressed the importance of nurses' demonstrating understanding and caring when working with older individuals.     

老年专科护士培训中卒中照护教学的创新

依据北京护理学会制订的老年专科护士培训大纲安排教学内容,在老年脑血管病护理中借助教学医院特色科室的优势,在卒中照护教学中,细化教学内容,包括基础护理、康复护理、心理护理;改革教学方法,采用案例教学法和工作坊对30名学员进行培训。在卒中照护教学结束后,对学员进行访谈。学员表示卒中照护教学内容及方式实用且新颖,尤其认可心理护理的教学内容,表明经培训后,掌握了规范化的心理护理流程,可融会贯通地应用于临床。在老年专科护士培训后,进行关于教学设施及条件、教学方式、教学内容等方面的满意度问卷调查,30名学员总体满意度为98.7%。     

共管照护模式在老年髋部骨折患者中的研究进展

随着老龄化进程的加深,老年髋部骨折已成为全球面临的严重公共卫生问题之一。老年髋部骨折患者预后差,国际脆性骨折联盟呼吁通过多学科协作改善患者功能结局。共管照护模式,即骨科-老年科医师共同管理老年髋部骨折患者,是国际上一种有效的老年髋部骨折照护模式。该文围绕共管照护模式的概念、产生和发展、护士在共管照护模式中的角色、模式类型、效果评价等方面进行阐述,旨在为国内医疗机构有效实施本土化的共管照护模式提供理论依据。     

Acute care for elders (ACE): a holistic model for geriatric orthopaedic nursing care

The normal aging process brings about inevitable and irreversible changes in physical, psychosocial, and spiritual health. These normal changes are partially responsible for the increased risk of developing health-related problems in the hospitalized elder population. The Acute Care for Elders (ACE) model provides an effective, proactive, inexpensive framework for addressing the complex health needs of older adults. When ACE principles are used for the clinical management of clients with orthopaedic problems, interdisciplinary conferences provide the structure for maintaining the continuity of care. Mobility as well as independent functioning, comfort level, mental status, depression, skin health, nutrition, and response to treatment, are discussed and nurse initiated guidelines for preventive and restorative interventions are implemented. Follow-up phone calls and/or home visits are important indices of thorough discharge planning. The theory of comfort is used to assure that holistic needs are addressed. Nurses who practice the ACE model are excited about demonstrating the highest level of competency in geriatric nursing, whereby patient functioning is maximized, comfort and dignity are promoted, functional decline is prevented, and patients are successfully returned to their homes.     

Implementing SAFE™ care: Evaluation of a geriatric model of care for real-world practice

Systems Addressing Frail Elders (SAFE^TM) Care is a geriatric model of care that identifies high-risk hospitalized older adults, and provides targeted interprofessional interventions for risk factors associated with frailty. This post, mixed methods study sought to evaluate SAFE^TM Care implementation retrospectively at one public academic medical center and describe practical “real-world” considerations for implementation using the Consolidated Framework for Implementation Research (CFIR). In addition to barriers and facilitators, hidden characteristics to consider for implementation include initiating conditions, skills and experiences of implementers, interpersonal challenges, unique facilitators and barriers, surprising conditions, and threats to and requirements for sustainability. Implementation of SAFE^TM Care demonstrated effective adoption and implementation, but faced multiple threats that led to failed sustainability. The public sharing of these successes and failures will help implementers understand and make progress in adapting such important geriatric programs and quality improvement initiatives.     

Long-term care choices for geriatric residents.

Nursing home residents have been customarily excluded from participating in making decisions about their own care. However, gerontological nurses have demonstrated that giving residents choices about their daily activities enhances resident independence and self-esteem. Study results indicate that residents in long-term care facilities are not receiving opportunities to make choices about their daily activities as often as choices are made for them. Many of the choice-giving behaviors did not take any more of the caregiver's time. The study assumed that choices about daily activities, dressing, and group participation were important to residents. Future study should include a survey of residents to determine what type of choices are important to them. Residents could be asked to prioritize activities that they would most like to have a choice about.     

Transforming RN roles using an academic-practice partnership to improve healthcare access for underserved populations

There is a national call to improve healthcare access for underserved populations by preparing BSN students to practice at the full scope of their license in community-based, integrated primary care settings upon graduation. In response to this call, a robust academic-practice partnership—using interprofessional education and practice and primary care and leadership development— is preparing BSN students to practice in community-based integrated primary care settings where culturally diverse rural and urban underserved populations receive care. In this article, academic-practice partners describe the implementation, lessons learned, and initial outcomes of a grant-funded program that is transforming nursing education and practice. All partners viewed communication, collaboration, and flexibility as key to a successful partnership. Our work serves as a template to help others shift nursing culture to create a sustainable RN workforce prepared to improve the health and wellbeing of underserved populations.