RESUMEN
Advanced practice nurses (APRNs) make significant contributions to the mental health of older adults. Despite the surge in the number of older adults, the number of APRNs choosing educational preparation for geropsychiatric nursing (GPN) is limited. The purpose of the GAPNA GPN Position Statement is to sustain a new vision for the nursing profession that will improve the care of older adults with psychiatric and mental health disorders. This position paper was written by a diverse group of APRNs with the collective intent to reflect respect, decrease stigma, remove controversy, and uphold a positive, person-centered approach to mental disorders among older adults and their families. The GAPNA GPN Position Statement was written to advance excellence in the GPN subspecialty, provide holistic care for older adults and make recommendations for practice. Blending gerontological and psychiatric nursing results in a subspecialty at the top of the APRN Consensus Model pyramid.
Asunto(s)
Enfermería de Práctica Avanzada , Geriatría , Trastornos Mentales , Enfermería Psiquiátrica , Anciano , Enfermería Geriátrica , Humanos , Salud MentalRESUMEN
ABSTRACT: Managing pain can be challenging, especially in patients with serious illnesses and a history of substance use disorders. This article discusses the challenges of addressing pain in these patients and offers perspectives regarding their clinical management.
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Manejo del Dolor/enfermería , Índice de Severidad de la Enfermedad , Trastornos Relacionados con Sustancias/epidemiología , HumanosRESUMEN
This article provides a brief overview of the early development of geropsychiatric nursing (GPN) as background for examining its advancement subsequent to the 2010 Future of Nursing (FON) Report. The FON's education, practice and leadership recommendations form the three pillars that have supported geropsychiatric nursing's continuing evolution, framed within a practice and policy perspective. Lessons learned are relevant to developing the next phase of FON recommendations. The importance of overcoming challenges faced by the field of GPN is supported by the aging global population, the directions of nursing as a discipline, and the clear necessity of an intra- and inter-professional approach to mental health and aging.
Asunto(s)
Educación en Enfermería , Geriatría , Liderazgo , Investigación en Educación de Enfermería , Enfermería Psiquiátrica/organización & administración , Conocimientos, Actitudes y Práctica en Salud , HumanosRESUMEN
Advanced Practice Registered Nurses (APRNs) must be prepared to care for the rapidly increasing numbers of older adults with mental health needs. All 363 graduate nursing programs in the United States were surveyed regarding the nature and extent of geropsychiatric nursing (GPN) content across program curricula and their perceptions of the influence that the APRN Consensus Model has exerted on preparing the next generation of APRNs to meet the growing needs of the older adult population. Of the 202 schools responding, 138 reported GPN content in one or more clinical programs, with the majority of content in non-PMHNP programs. Only 17 schools reported offering a GPN program, track, or minor. The majority of schools (n = 169) perceived that they were adequately well-prepared to meet the APRN Consensus Model's guidelines regarding inclusion of aging-related didactic and clinical educational experiences in all APRN education programs; nearly two thirds (n = 132) perceived a moderate to significant influence of the Consensus Model on institutional infusion of GPN into curricula. Compared with a similar survey 10 years ago, there was little change in the proportion of schools reporting GPN in clinical programs and few schools provide GPN programs, tracks, or minors. Implications for nursing education and practice are discussed.
Asunto(s)
Enfermería de Práctica Avanzada/educación , Educación de Postgrado en Enfermería/métodos , Enfermería Geriátrica/educación , Investigación en Educación de Enfermería/métodos , Enfermería Psiquiátrica/educación , Encuestas y Cuestionarios , Curriculum , Humanos , Estados UnidosRESUMEN
The purpose of this secondary data analysis was to describe the bedtime patterns of persons with dementia in the nursing home and make recommendations for nursing practice. Nursing staff observed, researcher observed, and actigraph data on bedtimes were compared with nighttime facility routines. Seventy per cent (n = 14) of all participants (n = 20) were in bed before 8:30 pm and 30% (n = 6) of the participants went to bed after 8:30 pm. All participants who went to bed before 8:30 pm (n = 14) took evening medications and 64% (n = 9) were dependent upon nursing care for nighttime activities of daily living (ADLs). Results suggested that bedtimes may be influenced by nighttime tasks. An understanding of these unique sleep patterns may facilitate the development of nonpharmacological, person-centered interventions for building sleep cycles around individual preferences versus facility-driven routines.
Asunto(s)
Demencia/fisiopatología , Casas de Salud , Sueño , Actigrafía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Personal de EnfermeríaRESUMEN
Coping with declining health, physical illnesses and complex medical regimens, which are all too common among many older adults, requires significant lifestyle changes and causes increasing self-management demands. Depression occurs in community-dwelling older adults as both demands and losses increase, but this problem is drastically underestimated and under-recognized. Depressive symptoms are often attributed to physical illnesses and thus overlooked, resulting in lack of appropriate treatment and diminished quality of life. The purpose of this study is to assess prevalence of depressive symptoms in community-dwelling older adults with high levels of co-morbidity and to identify correlates of depression. In this sample of 533 homebound older adults screened (76.1% female, 71.8% white, mean age 78.5 years) who were screened using the Geriatric Depression Scale (SF), 35.9% scored greater than 5. Decreased satisfaction with family support (p << 0.001) and functional status (p ≤ 0.001) and increased loneliness (p < 0.001) were significant independent predictors of depression status in this sample; thus, these factors should be considered when planning care.
Asunto(s)
Trastorno Depresivo/psicología , Anciano , Trastorno Depresivo/epidemiología , Trastorno Depresivo/terapia , Humanos , Prevalencia , Calidad de Vida , Estados Unidos/epidemiologíaRESUMEN
Forecasted changes in the demographics of the United States suggest there will be an unprecedented need for health care professionals with specific training in geropsychiatric care. An aging society, the dearth of geropsychiatric health care professionals, the shortage of educators, and the lack of interprofessional geropsychiatric education require new strategies for nursing education to address these issues. The vision of the Institute of Medicine serves as a foundation for transforming geropsychiatric nursing and interprofessional education to prepare the next generation of nurses and the geropsychiatric workforce to improve the mental health care of older adults. This article aims to describe the importance and implications of implementing the recently released Geropsychiatric Nursing Competency Enhancements and the Core Competencies for Interprofessional Collaborative Practice to improve the mental health care of older Americans. A secondary aim is to discuss how to overcome barriers in implementing interprofessional education in geropsychiatric nursing care.
Asunto(s)
Educación Basada en Competencias/métodos , Educación en Enfermería , Enfermería Geriátrica/educación , Enfermería Geriátrica/tendencias , Estudios Interdisciplinarios , Enfermería Psiquiátrica/educación , Enfermería Psiquiátrica/tendencias , Anciano , Humanos , Grupo de Atención al Paciente , Desarrollo de Programa , Estados UnidosRESUMEN
The leadership of a professional association is charged with developing a strategic plan to operationalize the organization's goals, tactics, and progress. Within the context of its values and goals, a strategic plan steers the organization toward its mission. While there are a variety of models and approaches used in strategic planning, the National Gerontological Nursing Association (NGNA) has historically used goal-based methodology. This method is congruent with the organization's leadership preferences, consistent with the mission-driven culture of the organization, and collaborative in its approach. In 2009 the NGNA Board of Directors initiated a plan for the organization's transformation to a more dynamic and member-driven association through a deliberate process. This article addresses the process used to arrive at the 20102011 NGNA strategic initiatives, including a discussion of pertinent data revealed in the 2011 needs assessment survey and NGNA's future initiatives focused on networking, communication, and membership benefits. This process is relevant for all organizations and groups seeking improvement in serving their constituents.
Asunto(s)
Eficiencia Organizacional , Innovación Organizacional , Técnicas de Planificación , Demografía , Liderazgo , Evaluación de Necesidades , Sociedades de Enfermería , Estados UnidosRESUMEN
Nurse leaders are first and foremost, registered nurses. Nursing leadership is critical for improving the care and quality of life for older adults. Visionary nurse leaders collaborate, motivate, influence, and inspire the achievement of values and goals to improve the quality of life for older adults in long-term care. Professional registered nurses are transformational servant nurse leaders who hold the key to nursing home reform.
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Enfermeras Administradoras , Anciano , Humanos , Liderazgo , Casas de Salud , Calidad de VidaRESUMEN
Geropsychiatric nursing (GPN) leaders in long-term care settings have a 25-year tradition of innovation that has strikingly improved mental health and quality of life for older adult residents. The impact of the Coronavirus disease of 2019 (COVID-19) on the mental health of older adult residents and today's evolving health care systems requires additional GPN leaders well-prepared to advocate, plan, and deliver care for this vulnerable population. In this article, the authors discuss GPN leadership in the context of its history, the role of professional organizations, and educational competencies. A leadership exemplar is provided as well as recommendations for clinical practice and research.
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COVID-19 , Liderazgo , Anciano , Humanos , Cuidados a Largo Plazo , Salud Mental , Calidad de VidaRESUMEN
Editor's note: This article is by 22 nursing gerontology experts who are all advocates of nursing home reform. They are listed at the end of this article.
Asunto(s)
COVID-19 , Centers for Medicare and Medicaid Services, U.S./normas , Política de Salud , Enfermeras y Enfermeros/normas , Personal de Enfermería/tendencias , Recursos Humanos/organización & administración , COVID-19/epidemiología , COVID-19/transmisión , Humanos , Casas de Salud , Personal de Enfermería/provisión & distribución , Estados UnidosRESUMEN
BACKGROUND AND AIMS: In recent years, the nursing profession used technology and pharmacology to relieve conditions such as pain, anxiety and insomnia that were once treated with massage. However, interest in massage has grown with the move to more holistic nursing. This review examines the physiological and psychological effects of slow-stroke back massage and hand massage on relaxation in older people and identifies effective protocols for massage in older people. DESIGN: Review. METHODS: Cooper's five-stage model was used in the review process. The search strategy included all studies without limiters for dates through June 2009 in the following databases: Ovid Medline, Cochrane databases, PubMed, EBSCO, CINAHL, Health Resource, PychINFO and EMB Reviews 1991-June 2009. The quality of the research was evaluated using the Research Appraisal Checklist. Twenty-one studies met the inclusion criteria for massage, relevance to older people and rigorous research. RESULTS: All studies using slow-stroke back massage and hand massage showed statistically significant improvements on physiological or psychological indicators of relaxation. The most common protocols were three-minute slow-stroke back massage and 10-minute hand massage. CONCLUSION: Physiological and psychological indicators suggest the effectiveness of slow-stroke back massage and hand massage in promoting relaxation in older people across all settings. RELEVANCE TO CLINICAL PRACTICE: Studies are needed to analyse the feasibility and cost effectiveness of massage to develop best practices for massage interventions in older people.
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Dorso , Mano , Masaje/métodos , Relajación/fisiología , Relajación/psicología , Anciano , Enfermedad de Alzheimer/terapia , Demencia/terapia , Femenino , Humanos , Masculino , Masaje/psicología , Terapia por RelajaciónRESUMEN
BACKGROUND: The use of telehealth technology to conduct virtual site visits is an innovative strategy for evaluating the performance of nurse practitioner (NP) students in remote settings. Although there is an abundance of studies on telehealth for the remote monitoring and assessment of patients, there are limited data on its use for evaluating NP students during clinical learning experiences. PURPOSE: The purpose of this project was to understand the perspectives of NP students and faculty on the feasibility of using virtual site visits to evaluate the students' performance during clinical experiences. METHODS: Online surveys were used to collect student and faculty perspectives on the use of virtual technology during clinical site observations. RESULTS: Overall, students and faculty reported positive experiences with the virtual site visits. CONCLUSION: Virtual site visits are feasible in most clinical settings.
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Actitud del Personal de Salud , Evaluación Educacional/métodos , Docentes de Enfermería/psicología , Enfermeras Practicantes/educación , Estudiantes de Enfermería/psicología , Telemedicina , Comunicación por Videoconferencia , Docentes de Enfermería/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Investigación en Educación de Enfermería , Investigación en Evaluación de Enfermería , Estudiantes de Enfermería/estadística & datos numéricosRESUMEN
BACKGROUND: Heart failure (HF) is associated with high rates of hospitalizations, morbidity, mortality, and costs. Remote patient monitoring (mobile health, mHealth) shows promise in improving self-care and HF management, thus increasing quality of care while reducing hospitalizations and costs; however, limited information exists regarding perceptions of older adults with HF about mHealth use. OBJECTIVE: This study aimed to compare perspectives of older adults with HF who were randomized to either (1) mHealth equipment connected to a 24-hour call center, (2) digital home equipment, or (3) standard care, with regard to ease and satisfaction with equipment, provider communication and engagement, and ability to self-monitor and manage their disease. METHODS: We performed a pilot study using a mixed-methods descriptive design with pre- and postsurveys, following participants for 12 weeks. We augmented these data with semistructured qualitative interviews to learn more about feasibility, satisfaction, communication, and self-management. RESULTS: We enrolled 28 patients with HF aged 55 years and above, with 57% (16/28) male, 79% (22/28) non-Hispanic white, and with multiple comorbid conditions. At baseline, 50% (14/28) rated their health fair or poor and 36% (10/28) and 25% (7/28) were very often/always frustrated and discouraged by their health. At baseline, 46% (13/28) did not monitor their weight, 29% (8/28) did not monitor their blood pressure, and 68% (19/28) did not monitor for symptoms. Post intervention, 100% of the equipment groups home monitored daily. For technology anxiety, 36% (10/28) indicated technology made them nervous, and 32% (9/28) reported fear of technology, without significant changes post intervention. Technology usability post intervention scored high (91/100), reflecting ease of use. A majority indicated that a health care provider should be managing their health, and 71% reported that one should trust and not question the provider. Moreover, 57% (16/28) believed it was better to seek professional help than caring for oneself. Post intervention, mHealth users relied more on themselves, which was not mirrored in the home equipment or standard care groups. Participants were satisfied with communication and engagement with providers, yet many described access problems. Distressing symptoms were unpredictable and prevailed over the 12 weeks with 79 provider visits and 7 visits to emergency departments. The nurse call center received 872 readings, and we completed 289 telephone calls with participants. Narrative data revealed the following main themes: (1) traditional communication and engagement with providers prevailed, delaying access to care; (2) home monitoring with technology was described as useful, and mHealth users felt secure knowing that someone was observing them; (3) equipment groups felt more confident in self-monitoring and managing; and finally, (4) uncertainty and frustration with persistent health problems. CONCLUSIONS: mHealth equipment is feasible with potential to improve patient-centered outcomes and increase self-management in older adults with HF.
RESUMEN
Cognitive decline in older persons can be pathologic or occur as a part of the normal aging process. Delirium, depression, and dementia are geriatric syndromes and neurocognitive disorders that are the result of cognitive decline associated with pathology. This overview is a brief guide on cognitive decline and how to identify, manage, and treat associated neurocognitive disorders, including delirium, depression, and dementia.
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Cognición , Delirio/diagnóstico , Demencia/diagnóstico , Depresión/diagnóstico , Envejecimiento , Delirio/terapia , Demencia/terapia , Depresión/terapia , Humanos , Factores de RiesgoRESUMEN
Specific changes to the national clinical nurse specialist (CNS) certification are necessitating a move away the psychiatric/mental health (P/MH) CNS population focus. However, a rapidly increasing older adult population with P/MH comorbidities such as depression and anxiety means that the adult-gerontology CNS (AGCNS) will likely be coordinating much of the complex care needs of this vulnerable population. Therefore, strategies are needed to ensure AGCNSs are competent in advanced practice P/MH nursing. In addition, at this critical time in the redesign of healthcare, the Institute of Medicine has made interprofessional practice center stage for healthcare professional education. Therefore, the purpose of this manuscript is to propose aligning the current AGCNS population-focused competencies with the CNS geropsychiatric nursing competency enhancements and interprofessional collaborative practice education competencies. Examples of the proposed alignment and educational application strategies are presented. When AGCNS educational curricula encompass P/MH nursing at an advanced level from an interprofessional perspective, future AGCNSs will continue to be positioned to make significant contributions to the design of care systems and monitor and trend important outcomes, while ensuring safe and efficient, high-quality healthcare for older adults with P/MH comorbidities.
Asunto(s)
Competencia Clínica , Conducta Cooperativa , Enfermería Geriátrica , Relaciones Interprofesionales , Enfermeras Especialistas/educación , Enfermería Psiquiátrica , Anciano , Docentes de Enfermería , HumanosRESUMEN
Severe coronary artery bypass graft disease occurs at a rate of approximately 16%-31% within the first year of surgery. Clinical and laboratory variables, including postoperative lipid profiles closest to the 1-year follow-up, lipoprotein(a) levels, and homocysteine levels, were assessed as predictors of early (< or = 1 year) symptomatic coronary artery bypass graft disease. Of 77 living consecutive patients (from the practice of one cardiologist) who underwent bypass surgery, 60 were asymptomatic at 1 year, and 17 had developed recurrent symptoms and had an angiogram that confirmed >50% lesion in at least one saphenous bypass graft. Using multivariate analysis, the strongest predictors of early symptomatic coronary artery bypass graft disease within 1 year of bypass surgery were elevated levels of low-density lipoprotein cholesterol (>100 mg/dL) (odds ratio [OR], 8:1; p=0.034), homocysteine (>10 micromol/L) (OR, 8:1; p=0.019), and lipoprotein(a) (>30 mg/dL) (OR, 4:1; p=0.011). Male gender was associated with a reduced risk (OR, 1:9; p=0.01) of symptomatic graft disease within 1 year of surgery. The authors conclude that low-density lipoprotein, homocysteine, and lipoprotein(a) levels are associated with symptomatic coronary artery bypass graft disease at 1 year after surgery.