Posthospital home care for frail older adults in rural locations.

After discharge from the hospital, older patients often require continued home care, including both professional and nonprofessional services. These needs can be exacerbated by health status (i.e., frailty) and geographic residence (i.e., rurality). It was the purpose of this study to examine patterns of postdischarge home care and outcomes for frail elders from rural locations. Seventy frail older adults being discharged from an acute urban-based hospital to home in a rural setting were recruited. Baseline data were collected before discharge from the hospital, and then calls were made at 48 hr and 2 and 4 weeks after discharge to evaluate use of resources and out-of-pocket expenses. Nonprofessional services were used most frequently, and the most intense time of use was at the 2-week postdischarge period. These findings suggest that discharge planning should include obtaining information about availability of both professional and nonprofessional services in the home community and arranging for appropriate delivery of both.     

BedSAFE. A bed safety project for frail older adults

In response to heightened awareness of patient safety, restraint reduction, and the potential for life-threatening entrapment caused by bed rails, a quality improvement program entitled BedSAFE was conducted to systematically and safely decrease the use of bed rails in three nursing home care units. This article describes an interdisciplinary process of individualized patient assessment, selection of appropriate alternatives for residents, compliance monitoring, training, and monitoring of patient outcomes including falls and injuries related to falls from bed.     

Trauma nursing: an advanced practice case study.

Trauma is the leading cause of death in people less than 40 years of age. Blunt or penetrating trauma injuries may be a result of gunshot wounds, stabbings, head injuries,burns, falls or motor vehicle collisions. Unlike other patients entering the health care system, trauma victims have no time for hospital preparation. The physiologic and psychosocial complications resulting directly from the traumatic incident provide response patterns not typical of other patients. Further to this unpredictability, the trauma patient usually sustains multiple system injuries, making it difficult to design critical pathways in care plans. The complexity is heightened by the patient's unique perception of the traumatic event, which can be even more important than the physical injury in determining the ultimate impact of the trauma.     

Enhancing psychiatric nursing practice: role of an advanced practice nurse.

In response to demands for alternative health models that deliver cost-effective quality care, one large Midwestern medical center implemented a change in their nursing practice model. The change involved the introduction of unit-based nursing leadership teams that included advanced practice nurses (APNs). This article reports the findings from an investigation that employed a case study design to evaluate the process and outcomes of integrating an APN on a psychiatric unit with experienced nurses. Data collection methods included a nursing survey (n = 34), interviews with nine randomly selected nurses, and two multidisciplinary open forums. Consistent with the staff nurses' survey ratings of important advanced practice role functions, responses from the nursing interviews and open forums suggested nurses' professional development to be the most positive outcome. Role confusion was identified as a negative outcome. Recommendations for improved integration and use of APNs in today's psychiatric health environments were identified.     

Challenges and solutions for care of frail older adults

Frail older adults are at risk for negative outcomes and are the most significant consumers of health resources across both acute and community settings. Both formal systems and families are involved in this care of frail elders. This article reviews health care issues for frail older adults and addresses the impact of frailty on the future health care system. It also presents challenges for future care, creative solutions that are currently being tested and explored, and suggestions for future nursing priorities. Challenges in the care of frail elders include: the organization and sustainability of the continuum of services, resource allocation, and cultural competence in service delivery. Creative solutions include intensive case management programs, targeting at risk older adults, partnerships with families, enhanced use of telemedicine and assistive technology, and promoting healthy aging. Nurses have the potential to improve elder health across settings through clinical practice, education, leadership, and research.     

Examining nursing practice with older adults through a historical lens

Scholars have suggested that negative views toward older individuals are prevalent in Western society and that health care practices with older adults are influenced by these beliefs. In this article, a historical lens is used to examine health practices and social ideas about aging to provide a clearer understanding of the current challenges to nursing practice with an aging population. Parallels between nursing practices of the past and present are discussed. It is suggested that negative beliefs about older adults are related to social ideas that originated in antiquity and yet continue to influence social institutions and practices with an older population.     

Cognitive remediation therapies for older adults: implications for nursing practice and research.

Among older adults, 20%-56% report having cognitive problems, and such cognitive complaints frequently correspond to actual neuropsychological impairment. The loss of cognitive abilities can be frustrating and frightening and can have a negative impact on instrumental activities of daily living and quality of life. Cognitive remediation interventions have been shown to be successful in improving mental function in older adults in many situations and may increase the number of everyday activities they are able to carry out. Nurses, given their direct contact with older adult patients, are able to inquire about or observe cognitive loss, make appropriate referrals, and emphasize steps such as cognitive remediation and other interventions that promote successful cognitive aging.     

Factors associated with fear of falling among frail older adults

Some factors increase the fear of falling in frail older adults. Our aim is to quantify the influence of these factors. This cross-sectional study involved 229 community-dwelling prefrail and frail older adults aged 70 years and older. Fear of falling was moderate in 38.9% of our sample and high in 12.2%. Higher values were observed in women, those living alone, and those meeting criteria for slowness and feelings of exhaustion. A linear regression showed that being a woman, a history of falls, and depressive symptoms were related to higher fear of falling, while high levels of independence in basic and instrumental activities of daily living, along with good gait and balance, were associated with lower fear of falling. Screening for depressive symptoms and fear of falling in the comprehensive geriatric assessment of frail community-dwelling older adults could help to support preventive strategies.     

The nature of advanced practice nursing.

In attempting to define "advanced practice," we argue that nursing as such is teleological or goal-directed with those goals being defined by the patient or client in interaction with the nurse. In helping the patient meet identified goals, the nurse requires 2 kinds of knowledge-general and particular. General includes theory (know what/why), pattern recognition (know what), and practical knowledge (know how). Particular (know who) is personal knowledge about the patient. The advanced practice nurse, by virtue of graduate education, is able to move beyond the familiar and experientially learned. He or she makes a deliberate attempt to situate self in a dialectic between general and particular knowledge in such a way that the interplay opens possibilities. Knowing when a particular action would be most helpful is defined as practical wisdom. We argue that a highly developed sense of practical wisdom is the hallmark of advanced practice.     

Developing advanced rural nursing practice: a whole new scope of responsibility

Rural registered nurses’ experiences of advanced clinical nursing practice were explored whilst they were enrolled in an advanced primary care course of study. Thirty-two nurses employed in rural health services in Victoria, Australia, studied advanced practice nursing by distance education with a clinical component. At course conclusion, focus groups and a quantitative on-line survey were conducted to explore outcomes. Nurses reported positive self-perceptions of their educational preparation with scores of >7/10 for competence, confidence, preparedness for advanced practice and job satisfaction. Focus group discussions concurred with positive survey results. The course was valuable in developing skills and knowledge, enabling more holistic patient care. The main themes that emerged related to the advancement of the nurse as a professional, and enhancement of patient care. Within their scope of practice, nurses assessed, diagnosed and treated minor patient illness presentations either independently or collaboratively with medical advice. The context of rural health services dictated practice and levels of autonomy. Nurses perceived the new role reduced an overload of medical work, whilst increasing patients’ access to care. As a result of the course 24% of participants reported a change in their work role. Nurses employed in rural health services reported positive potential for advanced collaborative practice in rural health care, in association with medical professionals. Defined role boundaries, role responsibilities and dedicated advanced practice positions will be required to achieve implementation of the role.     

Professional development for an advanced practice nursing team

Since its development in 1998, the Cardiology Advanced Practice Nurse team has been plagued by retention issues. The coordinator for the team developed this leadership project while participating in the 2008 to 2009 Maternal-Child Health Leadership Academy sponsored by Sigma Theta Tau International and Johnson & Johnson. The focus of this project was to develop, implement, and evaluate initiatives to empower the advanced practice nurse team, promote their professional development, and ultimately improve retention of team members. Although evaluation data show progress toward addressing work environment issues, retention remains an ongoing problem.     

A new role for advanced practice nurses in Canada: bridging the gap in health services for rural older adults

This article is a report on the evaluation of a new nursing initiative in rural western Canada-the gerontological advanced practice nurse (GAPN) project. Using a qualitative approach in the i initial evaluative phase, the authors determined how the GAPN evolved, functioning primarily in a clinical nurse specialist role, and identified the successes and challenges of the project. The initial findings indicated health benefits to rural older adults. The project's success was attributed to strong support from key players, and attempts to address perceived gaps in rural health service. Challenges in developing the GAPN role included limited planning time, and lack of a clear definition about the role and responsibilities of the GAPN. The introduction of a GAPN, especially in underserved rural communities, has the potential to provide essential health care services to older adults, and to make major contributions to changing gerontology practice.     

Enriching geropsychiatric nursing in advanced practice nursing programs.

The need for advanced practice nurses with knowledge and skills in geropsychiatric nursing is real and looming larger than ever. By 2030, the number of older adults with major psychiatric illnesses is predicted to reach 15 million. Preparing advanced practice nurses with mental health and geropsychiatric nursing expertise is essential. This paper describes three innovative curricular models for addressing geropsychiatric nursing in graduate advanced practice nursing programs. These models can be implemented with vision, planning, modest resources, and the cooperation of the faculty.