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Revisiting the Issues and Changes in Gerontological Nursing

Most of the advanced countries today, like the United States of America and Europe, have an increasing rate of aging population. By 2030, America will have 72 million older adults, with the oldest old (individuals 85 years old and older) comprising the fastest-growing cohort of the elderly population. With the changing times, like global diversity and recent research concerning the “aging process”, an initiative to address the different challenges in taking care of the elderly population was conducted. The Institute of Medicine (IOM) undertook a consensus study to characterize the optimal health care workforce for older  persons. This article will review the results of this study and take a look at the greater picture of the significant changes it will provide.

gerontological nursingGerontological Nursing

Gerontological nursing falls within the discipline of nursing and the scope of nursing practice. It involves nurses advocating for the health of older persons at all levels of prevention. Gerontological nurses work with healthy elderly persons in their communities, acutely ill elders requiring hospitalization and treatment, and chronically ill or disabled elders in long-term facilities, skilled care, home care, and hospice. The scope of practice for gerontological nursing includes all older adults from the time of “old age” until death.

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Issues and Changes

The study have identified nine issues relevant to gerontological nursing, from those that are broad based to those that are more specific to the field. For the past years, there were efforts to change these issues in the manner of implementing several initiatives and programs.

A fragmented, uncoordinated health care delivery system, especially for older adults with chronic illnesses.

The current health care system is focused primarily on acute care, and its unprepared to provide care for older adults with chronic care. To address this issue, gerontological nurses must play an active role int he transformation of the current fragmented health care system. Some of the changes that have been going on for the past years are:

  • The adaptation of new nursing models for the delivery of care to older adults in acute, long-term care, assisted living, and home and community settings. Examples of these are the managed long-term care programs, nurse-managed clinics, mobile health units, and telenursing.
  • The use of the Geriatric Resource Nurse model which includes the assessment of the institution, clinical rounds, consultations, geriatric interest groups, nursing staff education about common geriatric syndromes, and the evaluation of patient outcomes and lengths of stay related to specialized geriatric nursing care.
  • Advanced practice geriatric nurses use the Geriatric Syndrome Management model in assessing and managing common syndromes such as falls, delirium, and incontinence.
  • The Acute Care for the Elderly model integrates geriatric assessment into the care of hospitalized older adults with the use of interdisciplinary teams.
  • The Nursing Home Collaborative (NHC) aims to improve the quality of nursing care for and quality of life of nursing home residents through organizational development and human capital development strategies. Plans include the develop-for-profit of registered-nurse-led, nursing-focused, not-for-profit, sustainable business to help nursing homes achieve recognition of excellence for the care of frail older adults.

Interdisciplinary team care in geriatrics.

Despite the awareness of the importance of interdisciplinary team care for older patients, the transfer of knowledge from research and team care programs in clinical practice has dwindled.

As such, five innovative interdisciplinary care models came into being in order to solve this issue:

  1. Care and Transition model – focus on the coordination of care when patients move among health care settings.
  2. Care Management Plus model – incorporates the use of information technology systems in facilitating care coordination of patients.
  3. Senior Health and Wellness Clinic model – focus on the older clients in the outpatient clinics where they receive ambulatory, community-based primary care from multidisciplinary providers.
  4. Virtual Integrated Practice model – allows solo or small-practiced practitioners to become members of interdisciplinary teams in various practice settings.
  5. Senior Resource Team model – combines the participation of a GNP, a geriatrician and a pharmacist in providing consultation in primary care practices. 

An insufficient number of nursing faculty with geriatric training and the need for more geriatric content in undergraduate curricula.

In 2008, only 29% of baccalaureate programs have faculty members who is certified in geriatrics. This factor propels to imminent problem of preparing students and nurses in the field.

Presently, the incorporation of gerontological nursing into the nursing curriculum is practiced in many colleges and schools of nursing. Faculty development for geriatric teaching is also being encouraged and more resource materials for faculty and students are made available.

Expanding clinical and leadership roles of gerontological nurses.

Today, the care for older adults is considered a nursing specialty. Thus, nurses who wish to pursue a specialization in gerontological nursing should possess best practice models for geriatric syndromes, case management and care coordination, and interdisciplinary collaboration strategies.

The issue lies on the fact that most nurses in nursing homes are prepared only in Associate Degree (AD) level. Even if they were introduced to the foundations of gerontological nursing, these nurses still lack the core concepts in nursing leadership and advanced health assessment in the care of older adults. To address this issue, there were several programs created to prepare AD-prepared nurses towards achieving geriatric competencies in clinical practice.

The need for geriatric knowledge among non-gerontological nurses.

Nursing is first and foremost caring for all individuals from womb to tomb. Regardless of the setting, nurses should be prepared to handle and take care of older adults. However, it was discovered that only on third of baccalaureate programs require exposure to geriatrics.

At present, continuing education for non-gerontological nurses are available as in-service trainings or online in order to augment this lacking competencies.

The need for more advanced practice preparation in gerontological nursing.

Ideally, a gerontological nurse should be an advanced practitioner in the field. But there are only a few practicing nurses who pursue graduate degrees in gerontological nursing.

One strategy to entice nurse is offering of scholarships to exemplary students with leadership potential and dedication to the care of older adults.

The need for more gerontological nursing research.

Nurse researchers prepared at doctoral and post-doctoral levels and who are experienced in the care of older adults are crucial to the future of gerontological nursing.

Hartford Foundation has played a major role in changing the face of gerontological nursing. Their numerous programs addressing the different issue in this nursing specialty includes the funding of predoctoral scholarships and post-doctoral fellowships to conduct researches on the field. After which, the journal Research in Gerontological Nursing was launched to disseminate the research findings.

Blended or separate roles for gerontological clinical nurse specialists and geriatric nurse practitioners.

The issue here focus on credentialing. Literature suggests the idea of merging the roles of nurse practitioner and clinical nurse specialist as a single advanced gerontological nursing. Nonetheless, only individuals prepared in gerontological nurse practitioner program is allowed to sit for the gerontological nursing practitioner examination.

This conflict led to the formulation of a draft that describes the APRN regulatory model, identifies titles to be used, defines specialties, describes the emergent new roles and population foci, and addresses strategies of implementation. In the case of gerontological nursing, adult care and gerontology is merged as a population focus (from young adults to older adults and frail elders). After undergoing education and certification processes, they will receive the titles “adult-gerontology clinical nurse practitioner” or “clinical nurse specialist”

Conclusion

The care for the aging population have changed dramatically. These past years, the entire health care system witnessed a transformation in the delivery of health care to the older adults. This is possibly because of the initiatives and programs that were implemented. There is no holding back on the idea that eventually gerontological nursing is ever more present and pro-active in any health care setting.