Improving the quality of geriatric nursing care: enduring outcomes from the geriatric nursing education consortium.

The nation's aging demography, few nursing faculty with gerontological nursing expertise, and insufficient geriatric content in nursing programs have created a national imperative to increase the supply of nurses qualified to provide care for older adults. Geriatric Nursing Education Consortium (GNEC), a collaborative program of the John A. Hartford Foundation, the American Association of Colleges of Nursing, and the New York University (NYU) Nursing Hartford Institute for Geriatric Nursing, was initiated to provide faculty with the necessary skills, knowledge, and competency to implement sustainable curricular innovations in care of older adults.

Ensuring specialty nurse competence to care for older adults: reflections on a decade of collaboration between specialty nursing associations and the Hartford Institute for Geriatric Nursing.

Geriatric preparation of specialty nurses is critical because their direct care and administrative responsibilities profoundly impact the care of countless older patients in all settings. For a decade, the Hartford Institute for Geriatric Nursing, NYU College of Nursing, has worked with 54 national specialty nursing associations, and intensely with 14, to develop strategies for new standards for quality care for older patients. A successful blueprint for specialty associations to sustain and enhance these outcomes will be presented.

Ensuring a nurse practitioner workforce prepared to care for older adults: findings from a national survey of adult and geriatric nurse practitioner programs.

Purpose: To present the findings from a needs assessment of adult primary care (ANP), gerontological (GNP), and adult acute care (ACNP) nurse practitioner faculty regarding the transition to adult-gerontology NP (A-GNP) programs.

Data Sources: Data were obtained from two sources: (a) an online survey to identify the faculty's primary needs in order to facilitate success in this transition and (b) telephone focus groups to explore survey responses in greater depth.

Conclusions: The survey and the focus group findings indicate that there is a strong need for (a) access to a set of nationally recognized competencies for A-GNPs; (b) teaching/learning resources to support faculty in implementation of A-GNP programs; and (c) formal faculty development opportunities to facilitate faculty efforts to engage in curricular redesign and innovations and assure that NP students acquire strong competence in gerontology content.

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.

A Bill of Rights for Hospitalized Older Adults.

Acute-care hospitals have few structures, programs, or staff prepared to address the special needs of older adults. To address this issue, the Hartford Institute for Geriatric Nursing [including the Nurses Improving Care for Hospitalized Elders (NICHE) program] and the Coalition of Geriatric Nursing Organizations proposed language for a Bill of Rights for Hospitalized Older Adults. The Bill of Rights moves from general value statements to the specific knowledge, skills, and actions necessary to provide quality of care to older adults.

Teaching strategies for atypical presentation of illness in older adults.

Atypical presentation of illness is a phenomenon where "seeing is believing." Expert geriatric nurses and clinicians know all too well the early signs and symptoms of this phenomenon, which frequently masquerades bacterial infections, pain, acute myocardial infarction, heart failure, or other serious medical ailments in older adults. Students, however, as novices to clinical practice, require interactive learning approaches to reflect on the patient's illness presentations, help with developing the necessary skills to analyze and synthesize clinically relevant data, and witness resolution of an atypical presentation when found and treated.

Nursing delegation and medication administration in assisted living.

Assisted living (AL) residences are residential long-term care settings that provide housing, 24-hour oversight, personal care services, health-related services, or a combination of these on an as-needed basis. Most residents require some assistance with activities of daily living and instrumental activities of daily living, such as medication management. A resident plan of care (ie, service agreement) is developed to address the health and psychosocial needs of the resident.

Expanding the knowledge base of resident and facility outcomes of care delivered by advanced practice nurses in long-term care: expert panel recommendations.

In 2003, a panel of nationally recognized experts in geriatric practice, education, research, public policy, and long-term care convened to examine and make recommendations about care quality and safety issues related to advanced practice nurses (APNs) in nursing home practice. This article reports on the panel recommendation that addressed expanding the evidence base of resident and facility outcomes of APN nursing home practice. A review of the small but important body of research related to nursing home APN practice suggests a positive impact on resident care and facility outcomes.

Nursing homes as a clinical site for training geriatric health care professionals.

Nursing homes can be ideal clinical teaching and learning environments for acquiring geriatric specialty and interdisciplinary team skills, particularly those regarding assessment, care planning, management, monitoring, and collaborating in an interdisciplinary milieu. Little is known as to how geriatric specialty training programs use nursing homes to meet expected specialty competencies, or the types of clinical experiences in nursing homes required by academic geriatric training programs. This article describes the expectations of 5 clinical health care disciplines (dentistry, medicine, nursing, pharmacy, and social work) and nursing home administration regarding desirable nursing home characteristics that support gaining geriatric competencies.

A panel data analysis of the relationships of nursing home staffing levels and standards to regulatory deficiencies.

Objective: To examine the relationships between nursing staffing levels and nursing home deficiencies.

Methods: This panel data analysis employed random-effect models that adjusted for unobserved, nursing home-specific heterogeneity over time. Data were obtained from California's long-term care annual cost report data and the Automated Certification and Licensing Administrative Information and Management Systems data from 1999 to 2003, linked with other secondary data sources.

Hospital nurses' perception of the geriatric nurse practice environment.

Purpose: To test the relationship between nurses' perceptions of the geriatric nurse practice environment (GNPE) and perceptions of geriatric-care delivery, and geriatric nursing knowledge.

Design: A secondary analysis of data collected by the New York University Hartford Institute Benchmarking Service staff using a retrospective, cross-sectional, design.

Methods: Responses of 9,802 direct-care registered nurses from 75 acute-care hospitals in the US that administered the GIAP (Geriatric Institutional Assessment Profile) from January 1997 to December 2005 were analyzed using linear mixed effects modeling to explore associations between variables while controlling for potential covariates.

Healthcare professional training: a comparison of geriatric competencies.

Health professionals specializing in geriatrics are a unique but scarce resource who nevertheless play a critical role in shaping the care of older adults. An interdisciplinary didactic and clinical training milieu would have the potential to maximize training opportunities for geriatric healthcare professionals. The fact that little is known about the concordance between discipline-specific geriatric competencies hampers the creation of interdisciplinary geriatric training opportunities.

Changes in the Geriatric Care Environment Associated with NICHE (Nurses Improving Care for HealthSystem Elders).

The aging of the U.S. population has profound implications for acute care nursing practice.

Rethinking teaching nursing homes: potential for improving long-term care.

To meet the special needs of and provide quality health care to nursing home residents, the health care workforce must be knowledgeable about the aging process. Health professionals are minimally prepared in their academic programs to care for older adults, and few programs have required rotations in geriatrics. Teaching nursing homes (TNHs) have shown promise as sites for the preparation of a health workforce to care for older adults in nursing homes as well as improvement of quality outcomes.

Recognition of dementia in hospitalized older adults.

Many hospital patients with dementia have no documented dementia diagnosis. In some cases, this is because they have never been diagnosed. Recognition of Dementia in Hospitalized Older Adults proposes several approaches that hospital nurses can use to increase recognition of dementia.

Factor structure of the geriatric care environment scale.

Background: Older adults comprise approximately 60% of all adult, nonobstetric hospital admissions. Nurses Improving Care for Health System Elders (NICHE) is a national program aimed at system improvement to achieve patient-centered care for older adults. The NICHE hospitals use the Geriatric Institutional Assessment Profile (GIAP) to assess their institutional readiness to provide quality care to older adults and to document improvement in geriatric care delivery.

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.

Geriatric competencies for RNs in hospitals.

Nurses in staff development are responsible for assuring nurses' competence in the delivery of care. Older patients are the predominant population in hospitals, yet there are no instruments that specifically assess the competency of nurses to deliver care to older patients. This article reports on the development and testing of an instrument, Geriatric Competencies for RNs in Hospitals, and makes recommendations as to how staff development educators can use the geriatric competency instrument with staff nurses.

Adult ambulatory care visits to nurses and physicians: methodological limitations of the medical expenditure panel survey data.

The 1997 Medical Expenditure Panel Survey (MEPS) data report that approximately 80 million adult ambulatory visits are made to nursing personnel. Adults who visit nursing personnel and who visit physicians are similar with regard to sex and income. As compared to nursing personnel, physician visits are longer and more likely to involve diagnosis or treatment.