INQRI Director Receives Award for Leadership in Gerontological Field

The Gerontological Society of America (GSA) chose INQRI Director Mary Naylor as the 2015 recipient of the Doris Schwartz Gerontological Nursing Research Award.

This honor, presented by GSA's Health Sciences Section, is given to a member of the Society in recognition of outstanding and sustained contribution to gerontological nursing research. Naylor will receive the award at GSA's 68th Annual Scientific Meeting in November.

Among her accomplishments, Naylor developed the Transitional Care Model, which utilizes nurses to reduce hospital readmissions among elderly patients after they have been discharged. As many as one-third of re-hospitalizations are considered preventable, so reducing readmissions not only improves patients’ quality of life, but reduces health care costs.

In addition to her work with INQRI, Naylor is the Marian S. Ware Professor in Gerontology and director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing. Naylor leads an interdisciplinary program of research designed to improve the quality of care, decrease unnecessary hospitalizations, and reduce health care costs for vulnerable community-based elders.

Naylor was also the 2012 recipient of GSA's Maxwell A. Pollack Award for Productive Aging.

Resnick to Head Gerontological Society

Congratulations to former INQRI Grantee Barbara Resnick, who was recently voted president-elect of the Gerontological Society of America (GSA).

Resnick, who currently serves as professor and Sonia Ziporkin Gershowitz Chair in Gerontology at the University of Maryland School of Nursing in Baltimore, will begin as president-elect in 2015-2016, and then become president for the 2016-2017 term.  GSA is devoted to research and education in all aspects of gerontology, including medical, biological, psychological and social.

“I am honored to serve in the role of GSA’s president-elect, and in the future, as its president,” Resnick said in a news release. “GSA has the opportunity to be a leader in interdisciplinary work in the areas of gerontology and geriatrics, including educational aspects, research, practice and policy.”

Resnick and fellow INQRI grantee Sheryl Zimmerman developed a successful intervention designed to deliver Function Focused Care to residents in assisted living facilities. Their intervention was designed to maintain and improve function, physical activity, muscle strength, psychosocial outcomes (efficacy expectations and life satisfaction) and decrease adverse events (pain, falls and hospitalizations) among assisted living residents. Residents in intervention treatment sites demonstrated fewer declines in function and spent more time in moderate level physical activity at 4 months and more overall counts of activity at 12 months when compared to residents in control sites. There were also fewer transfers to the hospital among those in the treatment sites.

Nurses Lead Innovations in Geriatrics and Gerontology

This story originally appeared in the July 2014 issue of Sharing Nursing's Knowledge, a monthly email newsletter from the Robert Wood Johnson Foundation.

Nurse-led initiatives are intended to help the nation’s health care system prepare for a crush of elderly people with multiple chronic conditions.

Nurses have been leading health care innovations since the dawn of the profession. They have ushered in broad-scale changes in areas ranging from better hygiene practices for wounded soldiers to public health visits to overcrowded urban homes to reproductive health services for women.

In more recent decades, nurses have begun developing innovations in geriatric care to help meet the massive health care needs of an aging population. They are finding new ways to improve the quality of care for older adults and ensure that it takes family and community considerations into account; improve access to highly skilled health care providers with training in geriatrics; narrow disparities that disproportionately affect older minorities; avoid preventable hospital readmissions; and more.

Their work answers the call from a groundbreaking report on the future of nursing that was released in 2010 by the Institute of Medicine (IOM). It urges nurses to continue their long legacy of innovation “as the health care needs of the population change from acute and infectious disease to that of an aging population with chronic disease.”

The country is, indeed, undergoing dramatic demographic changes. As Baby Boomers age and immigration patterns change, America is becoming older and more diverse. By 2050, the number of Americans age 65 and older will hit 40 million, about 20 percent of the population, according to the U.S. Census Bureau. These changes will strain the health care system and the nursing profession, the largest segment of the health care workforce.

Experts say the nursing workforce is not adequately prepared for a crush of elderly patients who are living longer, and sicker, with more chronic and complex health conditions. To meet these growing health care demands and bridge gaps in services for older Americans, the IOM said nurses “must continue to develop innovative care models based on current successes” in rural aging and other areas.

Fortunately, many nurses are already leading efforts to meet current and future health care needs. “Nurses are beginning to home in on the chronicity and the larger number of older people coming down the pike,” said Jennie Chin Hansen, RN, MS, FAAN, CEO of the American Geriatrics Society and a member of the study committee supported by the Robert Wood Johnson Foundation (RWJF) that drafted the IOM’s nursing report.

She pointed to the Transitional Care Model, developed by Mary Naylor, RN, PhD, FAAN, national program director for RWJF’s Interdisciplinary Nursing Quality Research Initiative (INQRI). The model utilizes nurses to reduce hospital readmissions among elderly patients after they have been discharged from the hospital. As many as one-third of re-hospitalizations are considered preventable, so reducing readmissions not only improves patients’ quality of life, but reduces health care costs.

The Program for All-Inclusive Care for the Elderly (PACE) is an example of a nurse-driven innovation in geriatric care. A replication of a program spearheaded many years ago by Chin Hansen, PACE is a now a federally legislated program in which interdisciplinary teams of providers give frail elders coordinated health, medical, and social services support by a one-stop system, a process that enables many to live in their own homes for longer periods of time.

Another nurse-led innovation, Nurses Improving Care for Healthsystem Elders (NICHE), was developed to better meet the needs of older adults in a health care system that, in general, lacked access to gerontology-trained providers and to care coordination services. The NICHE program is helping hospitals and, increasingly, community health systems, provide older Americans with “sensitive and exemplary care.” Under the program, “nurses are empowered by knowledge to provide high-quality care for older adults and, in doing so, teach others about the uniqueness of caring for older adults,” said Tara Cortes, PhD, RN, FAAN, executive director of the Hartford Institute for Geriatric Nursing in New York and an alumna of the RWJF Executive Nurse Fellows program (1999-2002).

And that’s just the beginning:

Promoting cancer screening among older African American women

Nurses all over the country are studying ways to improve care for older Americans. In North Carolina, for example, Dee Baldwin, PhD, RN, FAAN, a nurse educator at the University of North Carolina-Charlotte and an RWJF Executive Nurse Fellows program alumna (2000-2003), has spent decades exploring ways to prevent cancer in older African American women, who are more likely to die from the disease than other groups.

In 1992, Baldwin launched Project Breast Health, a culturally sensitive educational program to encourage more African American women to take advantage of cancer screening services. She also led an effort to hire lay navigators to raise awareness about breast and cervical cancer among older women in African American communities and developed electronic computer messaging to target the population. “We tried to look at different ways to reach people.”

Improving the quality of care in assisted-living facilities

Anna Beeber, PhD, RN, an RWJF Nurse Faculty Scholar (2011-2014) also from North Carolina, is exploring ways to improve the quality of care in assisted-living facilities. She is conducting research that examines staffing, service delivery, and resident outcomes in order to help assisted-living communities better match services with resident needs. “We really don’t know in assisted-living communities what, if any, influence nurses have on quality of care,” she says. And that is a critical piece of information that has the potential to improve care for the roughly 1 million Americans who currently live in the country’s 22,000 assisted-living facilities.

Increasing the number of geriatrics-trained nurses

In North Dakota, Jane Strommen, PhD, project coordinator of the North Dakota Gerontology Consortium, an initiative supported by Partners Investing in Nursing’s Future (PIN), is working to ensure that older people have more access to geriatrics-trained nurses. She and her team are promoting gerontology nursing via marketing materials, nursing conferences, nursing-themed summer camps, and stipends for nurses and nurse educators who study gerontology and geriatric nursing. “We have a growing population of older adults in our state, and we know the need for nurses who have the skills and training to care for them is just going to increase,” she says.

Creating safer homes

And in Maryland, Sarah Szanton, PhD, ANP, an RWJF Nurse Faculty Scholar (2011-2014) and associate professor of nursing at Johns Hopkins University, has come up with an innovative program to use “handymen” to turn older people’s homes into safe environments. Her goal is to enable elderly people to continue living in their homes as long as they are willing and able—and to stay out of nursing homes, which create considerable taxpayer expense. Read more about Szanton’s work here.

These projects are among the many nurse-led efforts under way across the nation to improve care for older Americans—a natural outgrowth, Chin Hansen says, of nurses’ skills, abilities, and population focus. “One of the things that nurses have always done is advocate for the patient and the family,” she says. They will continue to do that as their patients get older, and they will likely have a greater ability to transform health care as more earn master’s and doctoral degrees and assume positions of leadership in health care and society. Says Chin Hansen: “More nurses are being sought out for their leadership and their ability to change the current culture of medical care towards health and health care in an aging America.”

Nursing Program Shows Promise for Reducing Deaths from Chronic Illnesses

In a newly published study in this month's PLoS Medicine, Kenneth Coburn and colleagues found that community-based care management reduced deaths of geriatric patients suffering from multiple chronic illnesses by 25%. The intervention included individualized plan comprising education, symptom monitoring, medication counseling for adherence to treatment and monitoring community health and social service referrals.

To read more about the study, click here.

To access the study, click here.

The intervention included an individualized plan comprising education, symptom monitoring, medication counseling for adherence to treatment, help identifying, arranging, and monitoring community health and social service referrals in addition to group interventions such as weight loss maintenance and exercise classes.

Read more at: http://medicalxpress.com/news/2012-07-nursing-deaths-chronic-illnesses.html#jCp

The intervention included an individualized plan comprising education, symptom monitoring, medication counseling for adherence to treatment, help identifying, arranging, and monitoring community health and social service referrals in addition to group interventions such as weight loss maintenance and exercise classes.

Read more at: http://medicalxpress.com/news/2012-07-nursing-deaths-chronic-illnesses.html#jCp

The intervention included an individualized plan comprising education, symptom monitoring, medication counseling for adherence to treatment, help identifying, arranging, and monitoring community health and social service referrals in addition to group interventions such as weight loss maintenance and exercise classes.

Read more at: http://medicalxpress.com/news/2012-07-nursing-deaths-chronic-illnesses.html#jCp

The intervention included an individualized plan comprising education, symptom monitoring, medication counseling for adherence to treatment, help identifying, arranging, and monitoring community health and social service referrals in addition to group interventions such as weight loss maintenance and exercise classes.

Read more at: http://medicalxpress.com/news/2012-07-nursing-deaths-chronic-illnesses.html#jCp

The intervention included an individualized plan comprising education, symptom monitoring, medication counseling for adherence to treatment, help identifying, arranging, and monitoring community health and social service referrals in addition to group interventions such as weight loss maintenance and exercise classes.

Read more at: http://medicalxpress.com/news/2012-07-nursing-deaths-chronic-illnesses.html#jCp

The intervention included an individualized plan comprising education, symptom monitoring, medication counseling for adherence to treatment, help identifying, arranging, and monitoring community health and social service referrals in addition to group interventions such as weight loss maintenance and exercise classes.

Read more at: http://medicalxpress.com/news/2012-07-nursing-deaths-chronic-illnesses.html#jCp

The intervention included an individualized plan comprising education, symptom monitoring, medication counseling for adherence to treatment, help identifying, arranging, and monitoring community health and social service referrals in addition to group interventions such as weight loss maintenance and exercise classes.

Read more at: http://medicalxpress.com/news/2012-07-nursing-deaths-chronic-illnesses.html#jCp

Too Little Mental Health Care For Baby Boomers

A recent report released by the Institute of Medicine has found that one in every five seniors suffers from a mental health or substance abuse issue and with the health care workforce lacking adequate training in these fields, many issues may arise over the next decade for treating this vulnerable population. With the health care sector preparing for the physical needs of the aging baby boomer population, this report serves as a critical reminder about the importance of a holistic approach to treating patients.

You can access a synopsis of the report here.

To read the full report, click here.

Latest News on Nurse Presenteeism

Yesterday, we told you about INQRI grantee Susan Letvak being inducted as an American Academy of Nursing Fellow later this year.

To learn more about Dr. Letvak's INQRI project, check out her team's latest article in the American Journal of Nursing, "Nurses' presenteeism and its effects on self-reported quality of care and costs."

You may also be interested in an earlier piece, published in Geriatric Nursing: "The Impact of Worker Health on Long Term Care: Implications for Nurse Managers."

As Boomers Age, Need for Nurses Increases

Earlier today, the Chicago Sun Times featured an article written by Maria Sonnenberg that outlined how the aging baby boomer population will require more nurses in the health care workforce then ever before. Ms. Sonnenberg focused on how nurses with valuable years of experience can act in mentorship roles for new graduates and facilitate young nurses growth in this ever expanding field.

Click here to read the full article.

Hospital Efforts To Keep Elderly Strong

Yesterday, Lindsey Tanner, reporting for the Huffington Post, described new initiatives being implemented by hospitals to encourage elderly patients to be more active and improve their quality of life. Ms. Tanner detailed how hospitals are utilizing nurses and volunteers to facilitate simple walking exercises that result in patients being just as healthy when discharged as they were on arrival.

Does this initiative sound familiar to you? It should!

Previous INQRI grantee Dr. Barbara Resnick focused her INQRI supported research efforts on Function Focused Care in assisted living communities that resulted in improved well-being for geriatric participants, in addition to improving the culture of safety for staff at the facilities that implemented the program.

Click here to read the HuffPost article.

Click here to read more about Dr. Resnick's work, including a video of a recent lecture she presented at the University of Pennsylvania's Institute of Aging.

New Nursing Program Promises to Advance Patient Care Quality and Safety

Yesterday, the Johns Hopkins University School of Nursing announced the acceptance of a new grant, funded by The Helene Fuld Health Trust of New York, that will prepare 200 new clinical nurses over the next five years in quality improvement and patient safety that is firmly grounded in leadership development. This initiative will specifically focus on the vulnerable elderly population, who are the responsibile for a high percentage of redadmissions in hospitals nationwide. This education intiative aligns with recommendations to bolster the nursing workforce made in IOM's Future of Nursing: Leading Change, Advancing Health report.

Click here to read the news article.

Click here to read other blogposts related to the IOM's report.

Nursing homes: A Caring Staff Makes All The Difference

Earlier today, Robin Erb and Kristi Tanner, of the Detroit Free Press, published the final article of their three piece series focusing on the quality of care in nursing homes. The article gave a personalized view of how caring, compassionate staff can positively effect the quality of life experienced by nursing homes' residents.

Click here to read the article.

Click here to read the first article in the series.

Click here to read the second article in the series.

Publish Post

Study Finds Low Staffing and Poor Quality of Care at Nation’s For-Profit Nursing Homes

Yesterday, Elizabeth Fernandez, from the University of California, San Francisco, detailed a newly released study that analyzed the quality of care at nursing homes around the country. The study focused on the ten largest for-profit chains in the country, which control over 2,000 nursing homes, and this research is the first to study this specific group of for-profit nursing facilities. The research team found that these for-profit facilities kept labor costs low to increase profits, and with staffing levels being one of the strongest predictors of patient quality, the results may reflect the commitment to high-level patient care by these large institutions.

Click here the full news article with quotes from the study's authors.

Click here to directly access the article from Health Services Research (subscription required).

New Generation of Nurses Brings Holistic Approach To Care For Aging Population

This past Saturday, Christina Hennessy, of the Connecticut Post, detailed new, holistic approaches nursing graduates are utilizing when caring for the growing elderly population in the United States. The article, which is focused primarily on the current and future trends of gerontological care, highlighted the importance of the social, financial, psychological and physical aspects of care. This is in contrast to previous models of care that focused only on the treatment of a specific illness or disease.

To access the full article, click here.

Homes Can Be Classrooms For Nursing Students Too!

Last week, Cindy Stauffer, of lancasteronline.com, reported how an elderly community is assisting nurses in training become more comfortable with treating patients in their own home. This innovative approach to educating new nurses gives insight into how patients live and take care of themselves outside of a hospital. The Lancaster General College of Nursing & Health Sciences has created a course based upon a five week rotation in a community health setting. The students make home visits and perform many tasks a visiting nurse would conduct in order to familiarize themselves with treating patients outside of a typical health care facility.

Click here to read the news article.

Nurses Without Borders

Last week, Karen Stabiner, of the New York Times, described a range of charitable organizations nurses participate in across the country. Ms. Stabiner detailed the work of the faith community nurse movement, which contrary to its name, is not limited to individuals of any one religion. While these nurses do not provide direct health services, they assist elderly in day to day activities such as driving or helping them with any questions they might have regarding health insurance. These nurses provide critical time to rest for tired, over burdened caregivers who have little to no free time of their own.

Click here to read the fascinating article.

Recent INQRI Grantee's Work Recognized By Local TV Station

Last week, an INQRI funded interdisciplinary team led by Michele Balas, Ph.D. and William Burke, M.D of the University of Nebraska was featured on local ABC affiliate station, KHGI, in Nebraska. The article, which is a reprint of an Associated Press piece, highlights the goals and importance of the teams' work.

The main goal of this project is to implement, analyze, and disseminate an evidence-based, nurse-led, inter-professional, multi-component program focused on improving the care and outcomes of critically ill adults. The study will focus on applying a program of delirium screening, prevention, and treatment developed at Vanderbilt University.

Click here to read the article.

Click here to read more about this study and other recent INQRI grantees' work.

INQRI Projects Featured in Geriatric Nursing

The INQRI program is pleased to report that the latest edition of Geriatric Nursing features all INQRI projects in their selection of featured articles.

Please click here to read the letter from editor Barbara Resnick (also an INQRI grantee), "The Difference Nurses Are Making to Improve Quality of Care to Older Adults through the Interdisciplinary Nursing Quality Research Initiative."

Featured Articles:

The Impact of Worker Health on Long Term Care: Implications for Nursing Managers
Susan Letvak, Christopher J. Ruhm

SPEACS-2: Intensive Care Unit “Communication Rounds” with Speech Language Pathology Mary Beth Happ, Brooke M. Baumann, Jennifer Sawicki, Judith A. Tate, Elisabeth L. George, Amber E. Barnato

Age-Related Differences in Perception of Quality of Discharge Teaching and Readiness for Hospital Discharge
Kathleen L. Bobay, Teresa A. Jerofke, Marianne E. Weiss, Olga Yakusheva

Nurse Identified Hospital to Home Medication Discrepancies: Implications for Improving Transitional Care
Cynthia F. Corbett, Stephen M. Setter, Kenn B. Daratha, Joshua J. Neumiller, Lindy D. Wood

Satisfaction with Assisted Living: The Unexplored Role of Physical Activity
Barbara Resnick, Elizabeth Galik, Ann L. Gruber-Baldini, Sheryl Zimmerman

Geriatric Nursing

Volume 31, Issue 3, Pages 153-238, e1-e2 (May-June 2010)