Nursing research and participant recruitment: organizational challenges and strategies.

Hospitals as research environments are crucial in advancing evidence-based practice and translational research. The authors discuss issues related to hospital-based nursing research such as institutional review board approval, the HIPAA, structure, unit characteristics, and nurse staffing as well as research-related issues such as study purpose and design, participant recruitment, and research personnel. Strategies and suggestions for nurse executives to assist researchers in overcoming recruitment challenges are presented.

Optimizing reserve in hospitalized elderly.

Aging is a multidimensional process that involves the physical, psychosocial, and spiritual domains. The reserves in each of these areas are challenged during the stressful experience of acute and critical care illness and hospitalization. It is imperative that hospital nursing staff recognize the vulnerability of the elderly and take appropriate evidence-based interventions to prevent avoidable decline and deterioration. There are opportunities for nurses to strengthen reserve in the elderly in the areas of practice, research, education, and policy.

Using nurse practitioners to implement best practice care for the elderly during hospitalization: the NICHE journey at the University of Virginia Medical Center.

The Nurses Improving Care to Health System (NICHE) program has provided a valuable framework for developing initiatives that address the needs of the elderly. Three NICHE models have been implemented within the University of Virginia Health System since 1992. These include the Geriatric Resource Nurse model, the Acute Care of the Elderly model, and, most recently, the Geriatric Consultation Service model. Nurse practitioners (NPs) with geriatric expertise have provided the leadership in implementing these initiatives to achieve the goal of improving geriatric care delivery within the health system. Each NP functions in a broad role that is tailored to meet the needs of the patients and staff and includes the role components of clinician, educator, team leader, and care coordinator. Sustainability and growth of NICHE is contingent upon demonstrating favorable outcomes that can be directly attributed to NICHE.

Identification, optimal management, and infection control measures for Clostridium difficile-associated disease in long-term care.

Residents of long-term care facilities are at an increased risk of exposure to Clostridium difficile and become more susceptible to infection after receiving antimicrobial therapy. An increasing number and more severe cases of C. difficile-associated disease (CDAD) have been reported over the last few years and have been linked to the emergence of a new, more virulent strain of C. difficile. These serious cases of disease have also been associated with a more atypical clinical presentation and have prompted the need for an improved means of early recognition and identification performed by the nursing staff. This article reviews the pathogenesis and risk factors for CDAD, changing epidemiology of CDAD, and characteristics of the newly identified strain. Also reviewed are the role of nursing in the identification of patients with CDAD; optimal management of CDAD; infection control strategies; and education of health care professionals, residents, and visitors in the long-term care setting.

Skin tears: a review of the evidence to support prevention and treatment.

Physiological changes that occur as part of the aging process put the elderly at risk for developing skin tears. Lack of consistent care in the management of skin tears in the authors' community sparked a literature search to determine best evidence for the management of skin tears. Medline and Cochrane Library databases were searched for studies and systematic reviews on skin tear prevention and treatment. The literature suggested that the greatest number of skin tears occurs among the elderly (65 years and older). Factors reported to be associated with the occurrence of skin tears in addition to age include immobility and a history of skin tears. In the absence of systematic risk factor research, clinicians continue to report that all variables that may be associated with these wounds must be considered when assessing the elderly. Several small studies suggest that most skin tears occur on the extremities and seasonal incidence variations also have been reported. Despite consistent sample-size limitations, the results of controlled clinical studies and case series consistently suggest that education and implementation of prevention protocols reduce the incidence of skin tears in extended care facilities by almost 50%. Studies to evaluate and compare the effectiveness and cost-effectiveness of skin tear treatments are limited but when appropriate care is provided most skin tears can be expected to heal after 7 to 21 days depending on the severity of the wound. A combination of skin protection, preventive measures, and treatments that facilitate moist wound healing appear to be most effective. Risk factor and epidemiological studies as well as research to validate the existing skin tear classification system and improve clinician ability to provide evidence-based risk assessments, preventive care, and treatment are needed.

Competent to care: strategies to assist staff in caring for elders.

A three-pronged approach used at the University of Virginia to improve the competency of staff in caring for older adults within the health system is highlighted. The Geriatric Resource Nurse Model was established more than a decade ago. Subsequent initiatives included the development of eight selflearning educational modules that address common concerns in hospitalized elders. Guidelines were created to highlight a variety of examples of age-appropriate care that managers could use in the staff evaluation process. Finally, the efforts to build a collaborative multidisciplinary environment supportive of exemplary geriatric care are described

Sustaining the Geriatric Resource Nurse Model at the University of Virginia.

This article describes the continued evolution of the Geriatric Resource Nurse Model at the University of Virginia, one of the original NICHE (Nurses Improving Care for Healthsystem Elders) sites established in 1994. The model developed slowly, unit by unit, a few nurses at a time, and has evolved with a multidisciplinary focus. Flexibility, mentoring relationships, a core curriculum, additional stimulating educational offerings, and a strong leadership team have been key influences on sustainability and growth.