Implementation of geriatric acute care best practices: initial results of the NICHE SITE self-evaluation.

Nurses Improving Care of Healthsystem Elders (NICHE) provides hospitals with tools and resources to implement an initiative to improve health outcomes in older adults and their families. Beginning in 2011, members have engaged in a process of program self-evaluation, designed to evaluate internal progress toward developing, sustaining, and disseminating NICHE. This manuscript describes the NICHE Site Self-evaluation and reports the inaugural self-evaluation data in 180 North American hospitals. NICHE members evaluate their program utilizing the following dimensions of a geriatric acute care program: guiding principles, organizational structures, leadership, geriatric staff competence, interdisciplinary resources and processes, patient- and family-centered approaches, environment of care, and quality metrics. The majority of NICHE sites were at the progressive implementation level (n = 100, 55.6%), having implemented interdisciplinary geriatric education and the geriatric resource nurse (GRN) model on at least one unit; 29% have implemented the GRN model on multiple units, including specialty areas. Bed size, teaching status, and Magnet status were not associated with level of implementation, suggesting that NICHE implementation can be successful in a variety of settings and communities.

Processo de enfermagem ao binômio idoso hospitalizado/acompanhante utilizando a CIPE®: estudo de caso / The nursing process to the binomial old hospital / companion using the CIPE®: case study

Trata-se de um estudo descritivo, com abordagem qualitativa, tipo estudo de caso, cujo objetivo foi aplicar o Processo de Enfermagem fundamentado na Teoria das Necessidades Básicas de Horta e na CIPE®, em um paciente idoso hospitalizado e seus acompanhantes. Foram elencados oito diagnósticos de enfermagem distribuídos entre as necessidades psicobiológicos e psicossociais relacionados à nutrição, eliminação, sono e repouso, locomoção, cuidado corporal, integridade cutaneomucosa e regulação neurológica, comunicação, gregarismo, orientação no tempo e no espaço. Diante dos dados, conclui-se que a enfermagem precisa se aproximar mais do acompanhante para fortalecê-lo nessa missão, assim como aperfeiçoar o cuidado de forma mais efetiva ao idoso hospitalizado. Verificou-se também que a utilização da teoria de enfermagem em parceira com sistemas de classificação, inspira o enfermeiro a criar possibilidades cada vez mais especializadas que permitem a execução de um plano de cuidados.

This is a descriptive study, with a qualitative approach, more specifically a case study, which aim was to apply the nursing process based on the Theory of Basic Needs of Horta and the CIPE® in an elderly patient who was hospitalized and also his accompanying people. Eight nursing diagnoses were listed and labeled according to its psychobiological and psychosocial needs related to nutrition, elimination, sleep and rest, mobility, body care, skin and mucosal integrity and regulating neurological communication, gregariousness, orientation in time and space. According to the outcome, we conclude that nursing needs to get closer to the accompanying person to strengthen him in this mission, as well as improve care to the hospitalized elderly. It was also found that the use of nursing theory associated with classification systems inspired nurses to create increasingly specialized opportunities that allow the execution of the care plan.

Este es un estudio descriptivo y cualitativo, tipo estudio de caso, cuyo objetivo es la aplicación del proceso de enfermería basado en Ia Teoría de las Necesidades Básicas de Horta y la CIPE® en un paciente hospitalizado anciano y sus acompanantes. Ocho diagnósticos de enfermería fueron listados entre las necesidades psicobiológicas y psicosociales relacionadas con la nutrición, la eliminación, el sueúo y el descanso, la movilidad, el cuidado del cuerpo, la piei y la integridad de la mucosa y la regulación de la comunicación neurológica, el gregarismo, la orientación en tiempo y espacio. De acuerdo con los resultados, se concluye que la enfermería tiene que acercarse al acornpanante para fortalecerlo en esta misión, así como mejorar de manera más efectiva la atención alos ancianos hospitalizados. También se encontró que el uso de la teoría de enfermería, en colaboración con los sistemas de clasificación, inspira los enfermeros para la creación de oportunidades cada vez más especializados que permitan la ejecución del plan de atención.

[The configuration of the work of nurses in care of the elderly in the Family Healthcare Strategy]. / A configuração do trabalho da enfermeira na atenção ao idoso na Estratégia de Saúde da Família.

The scope of this article was to describe the configuration of the work of nurses with the elderly within the Family Healthcare Strategy, highlighting the actions in which their activities are concentrated. It involved an exploratory-descriptive study of a qualitative nature, in which the informants were nurses working in the FHS in Florianópolis in the state of Santa Catarina. Data were collected through narrative interviews and the results were subjected to content analysis, resulting in three thematic categories and their subcategories: individual care: nursing consultation with the elderly; collective care: working in groups; home care: the visit as the scope of activity. The results revealed that the work of nurses in promoting the health of the elderly in the FHS is being structured in accordance with the day-to-day demands that arise in the population, resulting in some contradictions regarding the current model of care. This situation leads to the challenge of reviewing practices and rethinking ways of working to care for the elderly, striving to develop tools and methodologies based on politically and socially established know-how in order to gain and demarcate their sphere of action in the field of health.

A configuração do trabalho da enfermeira na atenção ao idoso na Estratégia de Saúde da Família / The configuration of the work of nurses in care of the elderly in the Family Healthcare Strategy

Este artigo teve como objetivo descrever a configuração do trabalho da enfermeira com o idoso na Estratégia de Saúde da Família (ESF), destacando as ações nas quais se concentram a sua atuação. Caracterizou-se como um estudo exploratório-descritivo de natureza qualitativa que teve como informantes enfermeiras que atuam na ESF do município de Florianópolis/SC. As informações foram coletadas por meio da entrevista narrativa e os resultados foram submetidos à técnica de Análise de Conteúdo, originando três categorias temáticas e suas respectivas subcategorias: O cuidado individual: a consulta de enfermagem com o idoso; O cuidado coletivo: a atuação em grupos; e, O Cuidado no domicílio: a visita como espaço de atuação. Os resultados mostram que o trabalho da enfermeira na promoção da saúde do idoso na ESF vem estruturando-se com as demandas que emergem no cotidiano da população, apresentando algumas contradições em relação ao modelo de atenção em curso, situação que a coloca diante do desafio de revisar suas práticas e repensar os modos de operar o trabalho na atenção ao idoso, com vistas a desenvolver instrumentos e metodologias fundamentados em conhecimentos políticos e socialmente instituídos no intuito de conquistar e demarcar seu espaço de atuação no campo da saúde coletiva.

The scope of this article was to describe the configuration of the work of nurses with the elderly within the Family Healthcare Strategy, highlighting the actions in which their activities are concentrated. It involved an exploratory-descriptive study of a qualitative nature, in which the informants were nurses working in the FHS in Florianópolis in the state of Santa Catarina. Data were collected through narrative interviews and the results were subjected to content analysis, resulting in three thematic categories and their subcategories: individual care: nursing consultation with the elderly; collective care: working in groups; home care: the visit as the scope of activity. The results revealed that the work of nurses in promoting the health of the elderly in the FHS is being structured in accordance with the day-to-day demands that arise in the population, resulting in some contradictions regarding the current model of care. This situation leads to the challenge of reviewing practices and rethinking ways of working to care for the elderly, striving to develop tools and methodologies based on politically and socially established know-how in order to gain and demarcate their sphere of action in the field of health.

Oulu Patient Classification instrument within primary health care.

UNLABELLED: As patients have become older their care needs have increased, and this has consequences for the working conditions within primary health care. OBJECTIVES: The aim of this study was to evaluate, whether the OPC instrument, which has been developed for hospital care, is valid and useful within primary healthcare for older people. MATERIALS AND METHODS: Reliability and validity testing of the OPC instrument was carried out at a health care centre in Eastern Finland spring 2004. A total number of 92 questionnaires were handed out, and the response rate was 67% (n=61) in order to test the validity. The inter-rater reliability was tested through parallel classification. A total number of 860 patient's were classified; in total 1722 classifications ware done. Cohens Kappa was chosen as the measurement for the consensus between the nurses' classification. RESULT: The consensus of the NI scores in total (OPC points) was 71%. The consensus measured with Kappa (k) showed a strong (0.65) consensus degree. DISCUSSION: It can be said that the OPC instrument achieved a high enough reliability and validity in order to be seen as a reliable and useful instrument to measure the NCI within primary healthcare for the elderly. CONCLUSION: The OPC instrument can be seen as providing a fairly comprehensive view of the patient's caring needs, without claiming to be covering everything.

Competency profile for registered nurses: NIC in gerontological nursing.

A number of RNs provide both direct care and leadership in geriatric-care facilities. In this specialized area of care, the contributions of the RN are not well recognized. In this issue, we focus on gerontological nursing and how NIC can be used to describe and communicate this highly specialized role.

Home care nursing for older adults: state of the science.

This article describes the state of the science of home care nursing for older adults and its implications for clinical practice. Selected peer-reviewed research articles published since 1990 were reviewed and categorized into five broad areas: nursing classification studies, critical transitions in the illness trajectory, family education and support, specific conditions prevalent in home care, and population diversity. The science of home care nursing has progressed considerably since 1990 with increasing sophistication of research conceptualization and design and increasing numbers of studies published.