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.].

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.

An Ecological Understanding of Caregiver Experiences in Palliative Care.

Palliative care is specialized health care to improve quality of life for patients with serious illness and their families through prevention and relief of suffering. A Palliative Care Institute was held in western Washington to capture community voices about diverse needs, strengths, and opportunities for improvement of palliative care. Researchers employed qualitative methods to obtain thematic data, provide real-time analysis, and engage in a multivoting technique to reflect stakeholder interest in individual themes and prioritize larger group interests. Bronfenbrenner's ecological systems framework was used to explore caregiver experiences. Within the microsystem, caregivers reported difficulties in interactions with medical providers as a key challenge. Within the mesosysytem, interactions between patients and medical providers and the impact on caregivers were explored. Within the exosystem, caregivers reported lack of control over the schedules of personal care staff. Macrosystem influences included impact of local culture on the development of palliative care services. Chronosystem influences include de-medicalization of childbirth and its impact on perceptions of palliative care. Implications include the need for social workers to be proactive in fostering trust and effective communication between care providers and caregivers, and the demand for health care provider training in communication with patients and families.

Development and implementation of a peer mentoring program for early career gerontological faculty.

PURPOSE: The Hartford Gerontological Nursing Leaders (HGNL) formerly known as the Building Academic Geriatric Nursing Capacity Initiative (BAGNC), in conjunction with the National Hartford Centers of Gerontological Nursing Excellence (NHCGNE), developed and executed a peer mentoring program beginning in 2011 to enhance both (a) the experience of newly selected scholars and fellows to the NHCGNE and (b) the ongoing professional development of HGNL members. The purpose of this article is to describe key strategies used to develop and execute the peer mentoring program and to present formative program evaluation. DESIGN: The program was launched in January 2011 with seven peer mentor and mentee matches. In June 2012, the peer mentoring committee solicited feedback on the development of the peer mentoring program and changes were made for the subsequent cohorts. FINDINGS: An additional 12 matches were made in the following 2 years (2012 and 2013), for a total of 31 matches to date. We have learned several key lessons from our three cohorts regarding how to structure, implement, and carefully evaluate a peer mentoring program. CONCLUSIONS: Informal evaluation of our peer mentoring program noted several challenges for both peer mentors and mentees. Having knowledge of and addressing those challenges may increase the overall quality and effectiveness of peer mentoring programs and, in turn, benefit academic nursing by strengthening the faculty workforce. CLINICAL RELEVANCE: Findings from development and implementation of a peer mentoring program for gerontological faculty could lead to new and adaptable programs in a variety of clinical and education settings.

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.

Teaching nursing within a population health context: From concept to exemplars.

As researchers in the health sciences improve their understanding of the underlying causes of poor health to include non-medical factors, nursing practice must expand and adapt to enable nurses to effectively contribute to population health improvement. The concept of population health has been incorporated into the current American Association of Colleges of Nursing (AACN) The Essentials: Core Competencies for Professional Nursing Education (2021) as a set of competencies for nurses at entry and advanced levels. This article provides a description of these competencies, and exemplars of how to include them meaningfully in nursing curricula at the entry level.

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.

Integrating the ELNEC undergraduate curriculum into Nursing Education: Lessons learned.

Nurses are called to lead and transform palliative care, compelling nurse educators to provide the requisite education to do so. All nursing students need to learn primary palliative care to be prepared to care for the growing number of patients with serious illness and their families. The American Association of Colleges of Nursing (AACN) Competencies And Recommendations for Educating nursing Students (CARES) document outlines 17 palliative care competencies to be attained by graduation from their pre-licensure programs. Integrating standardized primary palliative care education into curriculum remains a challenge for nurse educators. The End of Life Nursing Education Consortium (ELNEC) Undergraduate online modules represent one educational strategy that supports faculty and students in meeting AACN competencies as well as other national guidelines for palliative care education. Despite its ease of use, only about 25% of all undergraduate programs are incorporating these into their programs. Faculty continue to report barriers to implementing palliative care education, including saturated curricula, limited content expertise, and cost. This paper describes lessons learned from palliative care champion nursing schools to help overcome these barriers.

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.].

Hartford Gerontological Nursing Leaders: From Funding Initiative to National Organization.

In 2000, the John A. Hartford Foundation established the Building Academic Geriatric Nursing Capacity Program initiative, acknowledging nursing's key role in the care of the growing population of older adults. This program has supported 249 nurse scientists with pre- and postdoctoral awards. As a result of the program's success, several Building Academic Geriatric Nursing Capacity Program awardees formed an alumni organization to continue to advance the quality care of older adults. This group of Building Academic Geriatric Nursing Capacity Program awardees joined others receiving support from the John A. Hartford Foundation nursing initiatives to grow a formal organization, the Hartford Gerontological Nursing Leaders (HGNL). The purpose of this article is to present the development, accomplishments, and challenges of the HGNL, informing other professional nursing organizations that are experiencing similar accomplishments and challenges. This article also demonstrates the power of a funding initiative to grow an organization dedicated to impact gerontological health and health care through research, practice, education, and policy.

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.