Advanced nurse practitioners can lead comprehensive geriatric assessment in acute hospitals.

With an increasingly ageing population comes a greater risk of frailty, a distinct health state in which multiple body systems gradually lose their inbuilt reserves. The ability to recognise important frailty markers and conduct specialist comprehensive assessments of potentially frail older people admitted to acute hospitals is important to improve their health and well-being. This article explores the role of the advanced nurse practitioner (ANP) in identifying frailty and leading comprehensive geriatric assessment (CGA) for older people admitted to acute hospital settings. A small evaluation of CGA led by an ANP in a district general hospital found that a well-rounded assessment of patients living with frailty could be carried out, and that such assessments reduced unscheduled readmission within 28 days of discharge and overall length of hospital stay by six days. In a challenging climate, in which healthcare services seek to deliver effective and efficient care to the frail older population, ANPs can ensure a timely and specialist approach to CGA.

Meaningful engagement between secondary school students and older patients in an acute hospital.

This article discusses the development and outcomes of a project involving a shared care acute hospital ward (mental health and medical) and a local secondary school in South Wales. The project enabled meaningful interaction between school pupils and patients with dementia, depression and delirium. It also provided secondary school pupils with the opportunity to understand the role of hospital-based healthcare staff and the needs of older patients.

How nurses can support informal carers of people living with dementia.

There are 7 million carers in the UK, of whom 11% care for people with dementia. One in five people aged 50-64 are carers. This article explores the difficulties faced by informal carers, and highlights the need to support and care for them, as well as the person living with dementia. It suggests how nurses working in hospital settings can recognise and understand the physical and emotional health needs of informal carers through appropriate engagement, assessment and inclusion.

Recognition and clinical management of sepsis in frail older people.

Sepsis is a common condition caused by the body's immune and coagulation systems being 'switched on' by the presence of infection, either through bacteria or viruses in the blood. If untreated, sepsis can be life-threatening and is a leading cause of death in hospital patients worldwide. However, awareness of sepsis is low. This article provides an overview of the important role played by nurses in acute hospital settings in the early identification and treatment of suspected sepsis in frail older patients, and in escalating the care and management of deteriorating patients. It also explores recommendations in the 2016 National Institute for Health and Care Excellence guideline on sepsis recognition, diagnosis and early management.

Advanced nurse practitioner-led referral for specialist care and rehabilitation.

In response to the need for appropriate and timely care of frail older patients admitted to hospital, a dedicated advanced nurse practitioner (ANP)-led referral service was developed. The service has continued to evolve over the 13 years since its implementation in accordance with changing service demands. This article describes the role of the ANP in care of the elderly/rehabilitation medicine and focuses on one area of clinical practice developed by the team: an ANP-led referral service. The aim of developing the service was to ensure that patients who required specialist care and rehabilitation could be identified and assessed as soon as possible after admission, with the premise that they could be transferred to a bed in care of the elderly medical wards. This was perceived by the ANPs to be advantageous for patients, who would receive care from a specialist team, and for care of the elderly staff who could use their knowledge and skills appropriately and safely.

An advanced nurse practitioner-led service - consequences of service redesign for managers and organizational infrastructure.

AIM: A service review of a secondary care advanced nurse practitioner-led service. BACKGROUND: An acute hospital-based elderly care rehabilitation service evolved over a 9-year period from a traditional consultant/junior doctor configuration to a consultant/advanced nurse practitioner configuration. The review evaluated the advanced nurse practitioner team's role in the clinical setting, and the constraints experienced as a result of the traditions of the hospital organization. EVALUATION: The review drew its conclusions from opinion data collected from 38 professionals and non-professionals within the rehabilitation service. KEY ISSUES: The organizational infrastructure and traditions that had an impact on service delivery by the advanced nurse practitioner team. There is a demand for senior management to act on developmental constraints. CONCLUSIONS: The advanced nurse practitioner-led rehabilitation service was fit for purpose and an emerging model of a non-medical led care. However, important organizational constraints were identified. IMPLICATIONS FOR NURSING MANAGEMENT: An advanced nurse practitioner team, working in collaboration with medical consultants, was a model for future service redesign in the acute hospital setting. Nevertheless, it presented challenges to senior health-care managers on current organizational infrastructures.