American Association of Nurse Practitioners Research Agenda, 2023-2028.

ABSTRACT: This report highlights the 2023-2028 American Association of Nurse Practitioners Research Agenda (AANP-RA), which focuses on the research goals of AANP as an organization and is based on its mission and strategic plan. The purpose of the AANP Research Agenda is to outline research priorities that advance the AANP Strategic Plan and concurrently address gaps in nursing science. American Association of Nurse Practitioners supports research studies that are rigorously designed and conducted using quantitative, qualitative, and mixed-methods approaches, as well as implementation science with the potential to positively impact both NP practice and patient health outcomes. The AANP-RA strategy is guided by the PEARL acronym: examining NP Practice, Education, policy Advocacy, Research, and Leadership. A discussion of each area is presented along with suggested topics.

Supporting evidence for geropsychiatric nursing as a subspecialty of gerontological advanced practice nursing.

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.

A Medicare Current Beneficiary Survey-Based Investigation of Alternative Primary Care Models in Nursing Homes: Cost and Utilization Differences.

The current study used the Medicare Current Beneficiary Survey-Based (MCBS) Cost and Use files for 2006-2008 to investigate whether health care costs and service utilization of nursing home residents varied with nurse practitioner (NP) and physician assistant (PA) involvement, compared to the use of medical doctors (MDs) only. The sample included Medicare beneficiaries 65 and older residing in a nursing home for the entire study year (433 annual observations). A generalized estimating equations procedure was used to assess whether health care cost and utilization measures varied by cohort. Point estimates indicated that the annual per-person cost of non-institutional services (total medical cost less the cost of the nursing home itself) was $3,847 and $3,170 more for individuals in the MD-only and MD-dominant cohorts, respectively, compared to those in the NP/PA-dominant cohort. [Res Gerontol Nurs. 2016; 9(3):115-122.].

Transitioning from Departments to Schools of Nursing: A Qualitative Analysis of Journeys by Ten Deans.

Transitioning from a department to a school of nursing creates an environment that is more conducive to attracting qualified faculty and enhancing program growth to meet the projected nursing workforce needs. A comprehensive review of the literature revealed limited research to guide nursing programs considering this transition. This qualitative study explored the conditions and outcomes associated with successful or unsuccessful attempts to transition from a department to school of nursing from the perspective of 10 deans affiliated with the American Association of Colleges of Nursing (AACN). Meleis' transitions theory (2010) guided this study in its exploration of facilitating and inhibiting conditions. With institutional review board approval and participant permission, interviews were conducted in-person or by telephone, audio-recorded, and transcribed verbatim. Transcripts were independently reviewed and coded for emerging themes. Content analysis revealed the following themes: titles matter, support is essential, voice at the table, buy-in or dissension, it just brings nursing to totally different level, think differently, and legitimizing your position. For these deans, consideration of the facilitating and inhibiting conditions is critical in determining whether decisions are favorable and in support of the transition. Developing an understanding from the experiences of these 10 deans offers guidance to nursing academic administrators who are contemplating transitioning from a department to a school of nursing. Future research is needed to explore conditions relative to faculty governance and infrastructure, examine the experiences of those undergoing transitions, and expand study findings to develop a self-study guide for programs in assessing their readiness for such a transition.

A Medicare current beneficiary survey-based investigation of alternative primary care models in nursing homes: functional ability and health status outcomes.

This study assessed how the health status and functioning of Medicare beneficiaries residing in nursing homes varies systematically with nurse practitioners (NPs) and physician assistants (PAs) providing primary care services. A secondary analysis was conducted using data from the 2006, 2007, and 2008 Medicare Current Beneficiary Surveys. The study sample included 433 participant-year observations within one of three cohorts: (a) medical doctor (MD)-only, those who received primary care services exclusively from a physician; (b) MD-dominant, those who received some primary care services from an NP or PA, but those visits accounted for less than one half of total primary care visits; and (c) NP/PA-dominant, those who received more than one half of their primary care visits from an NP or PA. Participants in the MD-only cohort had significantly less orientation and independence in activities of daily living compared to participants in the NP/PA-dominant cohort. Other study variables did not vary significantly by practice model. Although the study provides some evidence that NP/PA involvement is associated with improved functioning, it is premature to draw strong inferences.

Bedside coaching to improve nurses' recognition of delirium.

Delirium is a widespread complication of hospitalization and is frequently unrecognized by nurses and other healthcare professionals. Patients with neuroscience diagnoses are at increased risk for delirium as compared with other patients. The aims of this quality improvement project were to (1) increase neuroscience nurses' knowledge of delirium, (2) integrate coaching into evidence-based practice, and (3) evaluate the effectiveness of this combined approach to improve nurses' recognition of delirium on a neuroscience unit. Institutional review board approval was obtained. A retrospective chart review of randomly selected patients admitted before the intervention was completed. The (modified) Nurse's Knowledge of Delirium Tool was electronically administered to nursing staff (n = 47), followed within 2 weeks by a didactic presentation on delirium. Bedside coaching was performed over a period of 4 weeks. The (modified) Nurses Knowledge of Delirium Tool was electronically readministered to nurses 4 weeks later to determine the change in aggregate knowledge. A postintervention chart review was conducted. SPSS software was used to analyze descriptive statistics with regard to chart reviews, documentation, and change in questionnaire scores. Findings reveal that neuroscience nurses recognize the absence of delirium 94.4% of the time and the presence of delirium 100% of the time after a didactic session and coaching. The postintervention chart review showed a statistically significant increase (p = .000) in the documentation of delirium screening results. Expert coaching at the bedside may be a reliable method for teaching nurses to use evidence-based screening tools to detect delirium in patients with neuroscience diagnoses.

Cognitive health and older workers: policy implications.

Cognitive health, memory complaints, and cognitive impairment among older workers have begun to receive attention in the research, practice, education, and policy arenas. With the aging population of the United States continuing to increase, projections are that the number of workers 65 and older is also expected to increase. Concerns regarding cognitive impairment and job performance in older workers are being raised. Being familiar with the policies and regulations that protect older workers and offering support and guidance to older adults as they contemplate major life transitions, such as retirement, are important role components for gerontological nurses. Using the five levels of analysis in the social ecology model, selected public policies to support older adults in the workforce are reviewed, and recommendations are presented for fostering positive workplace policies that can promote cognitive health.

The patient-centered medical home.

The patient-centered medical home (PCMH) is a comprehensive model of care that has the potential for improving primary health care for older adults. Nurse practitioners (NPs) have the potential to make a significant impact in PCMHs and to positively affect patient care outcomes. In particular, NPs with practice doctorates have the leadership skills to effectively lead PCMHs. Policies need further refinement to facilitate the leadership role of NPs within PCMHs.

Substance abuse in older adults: policy issues.

By 2020, it is projected that the number of older adults needing treatment for drug and alcohol addictions will increase dramatically. Although Medicare covers treatment for mental health issues, copayments can be prohibitive for those with lower incomes. The Positive Aging Act, an amendment to the Public Health Service Act, is a policy alternative that could address substance abuse in the older adult population by (a) demonstrating ways of integrating mental health services for older adults into primary care settings, and (b) supporting the establishment and maintenance of interdisciplinary geriatric mental health outreach teams in community settings where older adults reside or receive social services. Increasing funding to states to emphasize primary care provider education on the detection, evaluation, and treatment of substance abuse problems of older adults has the potential to better meet the substance abuse needs of this population. Educating primary care providers, including gerontological nurses, to recognize signs of substance abuse in this population and providing age-appropriate treatment options is critically important but will require funding beyond what is currently available.

Making healthy connections: introducing nursing as a career choice to middle school students.

The current economic climate has resulted in many experienced nurses returning to the workforce. Despite this, the nursing shortage is looming in our future and the recruitment of a diverse nursing workforce reflective of the population remains a high priority. The Merrimack Valley in northeastern Massachusetts has two large cities, Lawrence and Lowell, in which the Hispanic and the Southeast Asian populations are disproportionately higher than state and national levels. Through the University of Massachusetts Lowell's Bring Diversity to Nursing Project, partnerships with both city school systems were developed and after-school programs aimed at highlighting nursing as a career choice were initiated. Mr. Thompson's Heart is the focus of a middle school, pre-entry program developed by faculty. Introducing career choices in middle school gives students fundamental information about careers and how to begin investigating them. Mr. Thompson's Heart introduces nursing as a career choice combining career information with a focus on developing healthy lifestyle habits. Multiple hands on activities create excitement and interest in the nursing profession.

Caring for an aging population: review of policy initiatives.

Due to the aging population in the United States, there will be a need for a larger workforce that is prepared to provide care to an older adult population. The Institute of Medicine has noted challenges related to the preparation of a geriatric workforce due to lack of faculty, inconsistent curricula, and few training opportunities, and has made recommendations to increase the geriatric workforce. In this article, several policy initiatives are discussed that address the shortage of health professionals prepared to care for older adults. Initiatives by professional nursing organizations to improve the gerontological nursing workforce are also reviewed.

Dehydration reduction in community-dwelling older adults: perspectives of community health care providers.

Dehydration is a common problem among older adults and can negatively affect their health. This cross-sectional descriptive study used survey findings and focus group interviews to investigate dehydration problems among community-dwelling older adults and to identify strategies perceived to be helpful in preventing dehydration in this population. The survey sample (n = 18) and four focus groups (n = 36) included health care providers in the northeast United States from provider agencies representing emergency care, home care, primary care, and community health care. Survey findings indicated that 89% of participants identify dehydration as a problem affecting older adults, and 94% noted the need for a public campaign on dehydration awareness and reduction. Four major themes emerged: Intentional Avoidance and Caution, Lack of Awareness/Education/Understanding, Poor Access to Fluids, and Social and Environmental Influences. Strategies identified to promote hydration in community-dwelling older adults included community partnerships, community education, community engagement, and interdisciplinary approaches. This study provides useful information and detailed strategies recommended by health care providers for designing interventions to promote hydration for community-dwelling older adults.

Using antipsychotic drugs safely in older patients.

Do you know how to monitor an older adult who's receiving an antipsychotic drug? Learn the benefits and the pitfalls so you can keep your older patients safe.