Nurse-Led Models of Care: Practice and Policy to Support Aging in Place.

PURPOSE: Research demonstrates that aging in place is the goal of most adults aged >50 years. Unfortunately, multiple barriers to aging in place continue to exist, especially for vulnerable populations. Achieving this goal will require innovative nurse-led models of care and new policies for RN reimbursement. The current article describes a nurse-led clinic implemented in one community. METHOD: Using an evidence-based nurse-led model of care, a team of university faculty, students, and a family nurse practitioner designed and implemented a nurse-led clinic for a religious community in the Pacific Northwest. RESULTS: Today, the nurse-led clinic offers care coordination and primary care to support aging in place and is one example of a nurse-led model well-positioned to address the aging in place needs of vulnerable populations. CONCLUSION: Replication and sustainability of this nurse-led model requires sweeping policy change, including consideration of requiring all nurses to attain a National Provider Identification number to expand RN reimbursement and ultimately increase access to care. [Journal of Gerontological Nursing, 50(3), 13-17.].

Leveraging Regulation and Legislation to Improve the Care of Older Adults Through Home- and Community-Based Services.

An increase in demand for health care services for older adults is being negatively impacted by lack of a sufficient nursing workforce with competence in home- and community-based services (HCBS). The current article examines the unique challenges and opportunities in caring for older adults in HCBS settings, outlines the core competencies nurses must possess to provide this care, and proposes strategies to leverage legislative and regulatory initiatives to incorporate these competencies into nursing education and practice. Examining the American Association of Colleges of Nursing's Essentials Competencies through the HCBS lens, it is an ideal time to create a roadmap for nurses in practice, policy, and education to shape the health care workforce to meet the needs of a diverse and vulnerable population: older adults who depend on home- and community-based care for maintaining or improving their health outcomes and overall quality of life. [Journal of Gerontological Nursing, 49(12), 11-16.].

Congressional Laws Provide Resources to Support Family Caregivers.

Approximately 70% of adults aged ≥65 years will need some type of long-term care services, including unpaid care from relatives, friends, or partners. More than 53 million American adults provide upwards of $500 billion in unpaid health care as family caregivers. In 2018, Congress enacted two laws supporting family caregiving: the Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act and the Supporting Grandparents Raising Grandchildren (SGRG) Act, directing the Secretary of Health and Human Services to develop a national caregiving strategy. Advisory Councils for these two acts developed a total of 48 recommendations as the foundation for this strategy. Resources collected to inform these recommendations are now catalogued and publicly available. This opportunity for gerontological nurses to gain additional knowledge and access to services to support family caregivers and grandparents raising grandchildren will advance their work in assessing, documenting, and coordinating care for family caregivers and care recipients. [Journal of Gerontological Nursing, 48(9), 5-7.].

Leadership Development Activities and Benefits From the Robert Wood Johnson Executive Nurse Fellows Program.

The Robert Wood Johnson Foundation Executive Nurse Fellows (RJWF-ENF) program was the gold standard for executive career development of nurse leaders from 1997 to 2017. With more than two decades of experience, ENF program leaders encouraged the fellows to "trust the process" during the difficult times of leadership development and value the collegial relationships they could develop with other nurse fellows. This article describes the benefits of the Action Learning Model for leadership development through the experience of the Boom-X-2K action learning team from the RWJF-ENF final cohort of 2014-2017. The moniker Boom-X-2K was chosen to emphasize supporting the intergenerational development of nurse leaders from three generations: Baby Boomers (Boom), Generation X (X), and Millennials (2K). This article also describes the action learning team's end product: a self-assessment tool designed to evaluate leaders' self-assessed ability to influence. [J Contin Educ Nurs. 2021;52(7):344-348.].

The Shillam-Clipper Leadership Minimum Demographic Data Set: A Tool for Advancing Healthcare Research.

OBJECTIVE: The purpose of this research study was to develop an innovative, standardized taxonomy for leader demographic data to gather consistent and comparable data across healthcare leadership studies. BACKGROUND: Minimum data sets help ensure consistent data collection strategies for standardized comparison among similar variables across settings. A standardized approach to collecting demographic data of healthcare workforce leadership will provide the structure necessary for researchers to more adequately compare the role of demographic characteristics in research outcomes. METHODS: This study was conducted using systematic literature review methodology with comparative analysis across demographic data sets. Two separate literature reviews were conducted: the 1st for studies of approaches to establishing minimum data sets and another for studies of healthcare leadership. RESULTS: The outcome of this study is the Shillam-Clipper Leadership Minimum Demographic Data Set tool that includes a comprehensive list of minimum demographic variables applicable to healthcare leadership research, a glossary of operational definitions for the identified demographic variables, and a clearly articulated set of instructions for consistent and accurate data collection. CONCLUSION: This standardized taxonomy will result in a consistent data set that will improve the effectiveness of comparative research.

Development of the Leadership Influence Self-Assessment (LISA©) instrument.

PURPOSE: This study aims to describe the development and psychometric evaluation of the Leadership Influence Self-Assessment (LISA©) tool. BACKGROUND: LISA© was designed to help nurse leaders assess and enhance their influence capacity by measuring influence traits and practices and identifying areas of strength and weakness. METHODS: Concepts identified in the Adams Influence Model and input from content experts guided the development of 145 items for testing. Administered to 165 nurse leaders, the assessment was subjected to exploratory factor analysis (EFA). FINDINGS: EFA yielded a four-factor solution that comprised 80 items. Cronbach's alpha for factors ranged between 0.912 and 0.938. All factor loadings were >0.4; the smallest factor contained 14 items. Items grouped together in the theoretical model also clustered together in the EFA. CONCLUSIONS: Preliminary psychometric testing supports validity and reliability of the LISA© and its potential use as a tool to assess influence capacity for purposes of leadership development and research.

Leadership Influence: A Core Foundation for Advocacy.

As the largest segment of the health care workforce, nurses have the greatest potential for advancing systems and services to improve health care delivery in the United States. This article presents a framework for nurse administrators to use in developing direct care nurses in their leadership influence competency as a means of increasing their advocacy potential. A systematic review resulted in establishing a nurse leadership influence framework based on the Kouzes and Posner leadership model. The framework includes leadership competencies by nursing professional organizations and was validated by 2 national nurse leader focus groups. Nurse administrators have the opportunity to adopt an evidence-based leadership influence framework to ensure development of advocacy competency in direct care nurses. The impact of nurse administrators systematically adopting a standardized leadership influence framework will result in setting a strong foundation for nurse advocacy. Successful long-term impacts will result in nurses skillfully integrating leadership influence and advocacy into all aspects of daily practice.

Online biostatistics: evidence-based curriculum for master's nursing education.

Rapid changes in health care delivery require nurses to attain advanced knowledge, skills, and attitudes in biostatistics to provide high-quality, safe patient care. Advances in educational technologies support the delivery of graduate nursing education in online formats. Given the diversity of learning styles among graduate nursing students and the specific challenges in delivering biostatistics content in traditional formats, it is vital to include different delivery formats to engage and meet the learning needs of graduate nursing students who take biostatistics courses online. This article describes the pioneering approach of one graduate nursing program to implementing best practices for delivering an online biostatistics course to help master's-prepared nurses attain both statistical literacy and statistical communication skills.

Faith community nurses & brown bag events help older adults manage meds.

Brown Bag Medication Review (BBMR) events, traditionally offered by pharmacists, improve medication management for older adults. This study incorporated faith community nurses (FCNs) in BBMR events, hypothesizing that support by the FCN during and following the event would reduce medication related problems and improve medication self-care practices of older adults. Results describe and support the role of FCNs in brown bag events.

Fibromyalgia symptoms, physical function, and comorbidity in middle-aged and older adults.

BACKGROUND: Multiple studies report on symptoms or physical function in people with fibromyalgia; however, limited studies have been focused on older adults with fibromyalgia. OBJECTIVES: The aims of this study were to describe the occurrence, frequency, severity, and distress of symptoms and to examine differences in symptoms and physical function between a middle-aged and an older group. METHOD: Questionnaires were mailed to a random sample of 533 adults with fibromyalgia over 50 years of age, using a large tertiary care database. These questionnaires included an investigator-developed 29-item symptom questionnaire that measured the frequency (1-4), severity (1-4), and distress (0-4) of FM symptoms. The participants also completed the Late Life Function and Disability Instrument and the Charlson Comorbidity Index. RESULTS: Fifty-three percent of the sample reported at least 20 symptoms in the last 7 days. The most frequent and severe symptoms were pain, nonrefreshing sleep, fatigue, stiffness, difficulty staying asleep, difficulty falling asleep, and profuse sweating. The most distressing symptoms were fear of symptoms worsening, followed by difficulty staying asleep, fatigue, nonrefreshing sleep, and restless legs. Participants reported moderate functional limitations (M ± SD = 52.7 ± 9.0). Comorbidities were low (1.7 ± 1.5; range = 0-7). The middle-aged group experienced a greater number of total symptoms (21.4 ± 5.9 vs. 19.3 ± 5.2; p < .01). DISCUSSION: Middle-aged adults with fibromyalgia were more symptomatic than older adults. Further study is needed to understand the relationship between fibromyalgia symptoms and age and physical function.