GERONTOLOGICAL NURSING RESEARCH & EDUCATION

Web Health Research No.4 2001-12-19 RICH

GERONTOLOGICAL NURSING RESEARCH & EDUCATION

History and State of the ScienceToni Tripp-Reimer, RN, PhD, FAAN

The University of Iowa

College of Nursing* 전남대학교 간호과학연구소 추계학술대회 (2001.12.4) 발표된 자료임 . 제공 . 이은주 ( 전남의대 간호학과 , RICH IP)


History of Gerontological Nursing

Intertwined ComponentsIntertwined Components Education, Practice, Education, Practice,

ResearchResearch

Impinging Societal ForcesImpinging Societal Forces Status/Role of EldersStatus/Role of Elders Status/Role of WomenStatus/Role of Women Status/Role of NursingStatus/Role of Nursing


Origin of Gerontology/Geriatrics

Real Origin in 20Real Origin in 20thth century century Long HistoryLong History

BC: Hindu LegendsBC: Hindu Legends 1500: Search for Fountain of Youth 1500: Search for Fountain of Youth

Need emerged with Industrial RevolutionNeed emerged with Industrial Revolution Changes in Family StructureChanges in Family Structure


U.S. Special Elder Environments

1811: 1811: First Naval Home First Naval Home 1851: Soldier’s Homes Constructed1851: Soldier’s Homes Constructed

Dayton: 6000 residentsDayton: 6000 residents

1904: First Almshouse Home for 1904: First Almshouse Home for Aged Aged

But no real commitment to aged as But no real commitment to aged as vulnerable groupvulnerable group


Roots of Geriatrics

1818thth-19-19thth Cent Physicians Cent Physicians 1867 Charcot: Clinical Lectures on Diseases of 1867 Charcot: Clinical Lectures on Diseases of

Old AgeOld Age 1909: Nascher: “Geriatrics”1909: Nascher: “Geriatrics” 1914: Diseases of Old Age1914: Diseases of Old Age

Senility: a life periodSenility: a life period Geriatrics should be a branch of MedicineGeriatrics should be a branch of Medicine

Geriatrics as a specialty did not advance in USGeriatrics as a specialty did not advance in US


British Origins of Geriatrics

19301930s: Marjory Warrens: Marjory Warren Isleworth Infirmary WorkhouseIsleworth Infirmary Workhouse Rehab and EquipmentRehab and Equipment Improved moraleImproved morale Comprehensive Geriatric Eval and Comprehensive Geriatric Eval and

ManagementManagement US: 40 years later before GEMUS: 40 years later before GEM British Most advancedBritish Most advanced European Union: geriatrics is a specialty, but European Union: geriatrics is a specialty, but

not in several countriesnot in several countries


Geriatric Nursing: Geriatric Nursing: Education/PracticeEducation/Practice

Young Specialty AreaYoung Specialty Area First text not till 1950First text not till 1950 Early writing in Gero NursingEarly writing in Gero Nursing 1896 Hampton1896 Hampton 1922 Harmer1922 Harmer


Nursing Education Trends

11stst Half of 20th Century: Disease pathology Half of 20th Century: Disease pathology and Nursing Proceduresand Nursing Procedures

WW II: Comprehensive Care of the PatientWW II: Comprehensive Care of the Patient Mid-Century Reform in Nursing Ed: CollegesMid-Century Reform in Nursing Ed: Colleges 1960s: Social Reform and Expanded role of 1960s: Social Reform and Expanded role of

Nurse: MSN advanced practice rolesNurse: MSN advanced practice roles


Breakthroughs in Gerontological Breakthroughs in Gerontological Nurse TrainingNurse Training

61: 61: ANA: Specialty Group in ANA: Specialty Group in GeroGero

62: First Conference Group62: First Conference Group66:ANA Division of Geriatric 66:ANA Division of Geriatric

Nursing/ 76: GerontologicalNursing/ 76: Gerontological 70: First Practice Standards70: First Practice Standards


Master’s Degree Programs

66: 66: Duke Univ: First Gero MSN: Clinical Duke Univ: First Gero MSN: Clinical Specialist ProgramSpecialist Program

70s: Rapid expansion: GNP; Clin Spec70s: Rapid expansion: GNP; Clin Spec 83: First Geropsych: Case Western83: First Geropsych: Case Western 76-95: 141 gero nursing programs 76-95: 141 gero nursing programs

funded by Division of Nursingfunded by Division of Nursing


Impact of National Foundations Teaching Nursing Home Program: Robert Wood Teaching Nursing Home Program: Robert Wood

Johnson FoundationJohnson Foundation 11 Universities and 12 Nursing Homes11 Universities and 12 Nursing Homes Involve faculty; recruit students; conduct Involve faculty; recruit students; conduct

interdisciplinary educationinterdisciplinary education Kellogg Community College Nursing Home Kellogg Community College Nursing Home

PartnershipPartnership Improve Patient CareImprove Patient Care Develop Faculty’Develop Faculty’ Curriculum: augment Gero contentCurriculum: augment Gero content Student objectivesStudent objectives

John A. Hartford-AACNJohn A. Hartford-AACN


Current Status US Current Status US Education/PracticeEducation/Practice

2.6 2.6 million nurses licensed to practicemillion nurses licensed to practice 2200 schools for basic preparation2200 schools for basic preparation 250 Graduate (MSN) programs 250 Graduate (MSN) programs

1/3 with Gero Focus1/3 with Gero Focus 1-2 years in length1-2 years in length

Certification through ANACertification through ANA CNS in Gerontological NursingCNS in Gerontological Nursing GNPGNP

72 Doctoral Programs72 Doctoral Programs


Model Curricula-Recommendations AACN-John A HartfordAACN-John A Hartford

Bureau of Health ManpowerBureau of Health ManpowerMSN:MSN: Both specialty (GNP) and as emphasis track (geropsych; adult; Both specialty (GNP) and as emphasis track (geropsych; adult;

family-older adult) family-older adult) Integrated in Core coursesIntegrated in Core coursesBSN:BSN: separate required undergrad course: lecture/clinicalseparate required undergrad course: lecture/clinical integration throughout curriculumintegration throughout curriculum use of innovative practice sitesuse of innovative practice sites increasing % gero questions on licensure examsincreasing % gero questions on licensure exams

www.aacn.nche.eduEducation/gercom.htm


Translational Research into Translational Research into Practice and EducationPractice and Education NYU-Hartford Best PracticesNYU-Hartford Best Practices

21 topics (attitudes, teaching, financing, falls)21 topics (attitudes, teaching, financing, falls)

U of Iowa GNIRC Evidence-Based ProtocolsU of Iowa GNIRC Evidence-Based Protocols Acute Confusion/DeliriumAcute Confusion/Delirium Acute Pain ManagementAcute Pain Management Advanced Directives Advanced Directives Bathing Persons with DementiaBathing Persons with Dementia


Evaluation of Evidence-Based Protocols 23 23 protocolsprotocols

6 in development6 in development

> 20,000 reprints; > 20,000 reprints; major major requesters:requesters: Acute care hospitalsAcute care hospitals Long-term careLong-term care Academic settingsAcademic settings


Evolution of Gero Nursing Research NightingaleNightingale Turn of Century: 1900Turn of Century: 1900

AJNAJN Dock: Almshouse Nursing and Michigan NADock: Almshouse Nursing and Michigan NA

Public Health NursingPublic Health Nursing National League for Nursing EducationNational League for Nursing Education 1949: Division of Nursing formed—major 1949: Division of Nursing formed—major

funding initiativesfunding initiatives


Evolution of Gero Nursing Research (cont) Research InstitutesResearch Institutes

’’53 Teacher’s College53 Teacher’s College ’’55 American Nurses Foundation55 American Nurses Foundation ’’57 Walter Reed Army Institute of Nursing57 Walter Reed Army Institute of Nursing ’’59 First Gero nursing research Unit:59 First Gero nursing research Unit:

Whittington Hospital: LondonWhittington Hospital: London First major research initiative in Gero NursingFirst major research initiative in Gero Nursing


Investigation of Geriatric Nursing Investigation of Geriatric Nursing Problems in HospitalProblems in Hospital 11stst Major Gero Nursing Study in England Major Gero Nursing Study in England 1959-621959-62 Doreen Norton (MSc) SRN, Rhoda McLaren RGN, Doreen Norton (MSc) SRN, Rhoda McLaren RGN,

SCM, & A. Exton-Smith, MDSCM, & A. Exton-Smith, MD A series of studies:A series of studies:

Incontinence, Incontinence, Pressure ulcers, Pressure ulcers, Clothing, Furniture and EquipmentClothing, Furniture and Equipment Nursing TechniquesNursing Techniques


Evolution of Gero Nursing Research: Funding Mechanisms 1922 Sigma Theta Tau (1936 funds) 1955 Nursing Research Grants of

Division of Nursing (PHS) 1986: National Center for Nursing

Research (NIH) 1993: National Institute for Nursing

Research 2001: budget over $100,000 million


Early Reviews of State of Science

67 67 Basson(NR)Basson(NR) 77 Gunter and Miller (NR)77 Gunter and Miller (NR) 79 Brimmer (JGN)79 Brimmer (JGN) 83 Kayser-Jones (JGN)83 Kayser-Jones (JGN)


Summary of Early Reviews

Primary Emphasis: Nurses’ attitudes toward Primary Emphasis: Nurses’ attitudes toward older adultsolder adults

Secondary Emphasis: descriptions of older Secondary Emphasis: descriptions of older adults and need identificationadults and need identification

Problem focused approach: atheoreticalProblem focused approach: atheoretical Single studies, single investigatorsSingle studies, single investigators Very few programs of researchVery few programs of research


Annual Review of Nursing Research series (1983-) Stage I: Comprehensive Reviews

Vol 1 (83):Wolanin, Vol 1 (83):Wolanin, Clinical Geriatric NRClinical Geriatric NR Vol 4:(86)Adams, Vol 4:(86)Adams, Aging: Gerontological NRAging: Gerontological NR

Stage II: Specific Topics (1990-2000) Vol 8:Vol 8: Carlson & King Carlson & King Prevention of Pressure SoresPrevention of Pressure Sores..

Cowan, Cardiovascular Nursing ResearchCowan, Cardiovascular Nursing Research Vol 9: Vol 9: Lambert Lambert ArthritisArthritis

Given & Given Given & Given Family Caregiving for the Family Caregiving for the ElderlyElderly

Maas & Buckwalter: Maas & Buckwalter: Alzheimer’s DiseaseAlzheimer’s Disease Vol 10:Vol 10: McCormick & Palmer McCormick & Palmer Urinary IncontinenceUrinary Incontinence Vol 11:Vol 11: Foreman Foreman Acute Confusion in the ElderlyAcute Confusion in the Elderly


Annual Review of Nursing Research Series (cont.)

Vol 12:Vol 12: Fulmer Fulmer Elder MistreatmentElder Mistreatment Vol 14: Cronin-Stubbs Vol 14: Cronin-Stubbs Delirium Interventions Acute CareDelirium Interventions Acute Care Vol 15:Vol 15: ____, ____, Interventions for cognitive impairment Interventions for cognitive impairment

and neurobehavioral disturbancesand neurobehavioral disturbancesGoeppinger & Lorig Goeppinger & Lorig Community-based ArthritisCommunity-based Arthritis

Vol 16:Vol 16: Given & Given Given & Given Health Promotion:for CaregiversHealth Promotion:for Caregivers Heidrich Heidrich Health Promotion in Old AgeHealth Promotion in Old Age

Vol 17:Vol 17: Snyder & Chlan Snyder & Chlan Music TherapyMusic TherapyAlgase Algase Wandering in DementiaWandering in DementiaMcDougall McDougall Cognitive Interventions: Older Cognitive Interventions: Older

AdultsAdults Vol 18:Vol 18: Moser Moser Heart Failure ManagementHeart Failure Management

Wyman Wyman Management of urinary incontinence in Management of urinary incontinence in adult ambulatory care populationsadult ambulatory care populations.


Annual Review of Nursing Research Series (cont.)STAGE III (2002)Entire Issue Volume 2

Archbold, Stewart and Lyons (Eds)Archbold, Stewart and Lyons (Eds)

PPart I: Managing Common Conditions in Eldersart I: Managing Common Conditions in Elders Physical Function;Pressure Ulcer Prevention; Pain; Interventions for Physical Function;Pressure Ulcer Prevention; Pain; Interventions for

irreversible dementia irreversible dementia Part II: Settings for Elder CarePart II: Settings for Elder Care

Transitional Care; Family Caregivers; End of Life; Nursing homesTransitional Care; Family Caregivers; End of Life; Nursing homes Part III: Public Health, Social, and Scientific TrendsPart III: Public Health, Social, and Scientific Trends

Home health services research; Telehealth Interventions; Genetics and Home health services research; Telehealth Interventions; Genetics and gerontological nursinggerontological nursing

Part IV: Neglected Areas of Research Part IV: Neglected Areas of Research Hearing impairment; Elder mistreatmentHearing impairment; Elder mistreatment


INCONTINENCE

Current Practice GuidelinesCurrent Practice Guidelines AHCPRAHCPR International Continence SocietyInternational Continence Society Cochrane CollaborationCochrane Collaboration

Interventions for Cognitively Intact WomenInterventions for Cognitively Intact Women PME, Bladder Training, MatchingPME, Bladder Training, Matching

Best Practices often not usedBest Practices often not used Match intervention to type of IncontinenceMatch intervention to type of Incontinence Match PME intervention to musculature deficitMatch PME intervention to musculature deficit


Decubitus Ulcers

Early studies: Verhonik (61)/ Norton Early studies: Verhonik (61)/ Norton (62)(62)

Measures: Norton Scale; Braden ScaleMeasures: Norton Scale; Braden Scale Rapid growth in State of ScienceRapid growth in State of Science Current ResearchCurrent Research

Use of TENS to Promote HealingUse of TENS to Promote Healing Measuring Wound Bacterial LoadMeasuring Wound Bacterial Load Instruments to monitor healingInstruments to monitor healing Unique hemodynamic features in CCUsUnique hemodynamic features in CCUs


Acute Confusion/ Delirium

Neelon/Champaign Etiology Taxonomy Environmental Domain: function, cog imp.Environmental Domain: function, cog imp. Metabolic: impaired liver, renal, malnutritionMetabolic: impaired liver, renal, malnutrition Physiologic: hypoxia, dehydrationPhysiologic: hypoxia, dehydration

Inouye Project HELPInouye Project HELP Good Nursing Care: sleep, hydration, Good Nursing Care: sleep, hydration,

Current: hydration intervention, urine Current: hydration intervention, urine color chart, improving vision/hearingcolor chart, improving vision/hearing


Transitional Care Model for Elders

68%68% 48%48% SavingsSavings 48% 48%

Hospital Days PatientsReadmitted

Costs

Control

Treatm ent

Naylor et al 1999 Comprehensive Discharge Planning and home Follow-up. JAMA 281: 613-620


Restraint Reduction

Strumpf & EvansStrumpf & Evans Requirements for Requirements for

changechange International VariationInternational Variation


Need-Driven Dementia Related Behaviors Reconceptualization of Reconceptualization of

‘Disruptive Behaviors’‘Disruptive Behaviors’ Agase, Beck, Whall, Agase, Beck, Whall,

KolanowskiKolanowski Anticipated by Ryden’s Anticipated by Ryden’s

goal seeking behaviorsgoal seeking behaviors


Research Trends and Summary

ContentContent Theoretical Theoretical

FrameworksFrameworks DesignsDesigns Structure and ProcessStructure and Process


NURSING’S CHALLENGE AND OPPORTUNITY NURSING:NURSING:

LARGEST HEALTH PROFESSIONLARGEST HEALTH PROFESSION OVERWHELMINGLY FEMALE AND OVERWHELMINGLY FEMALE AND

OFTEN CAREGIVERS FOR FAMILYOFTEN CAREGIVERS FOR FAMILY SCOPE OF PRACTICE FITS NEEDS OF SCOPE OF PRACTICE FITS NEEDS OF

OLDER ADULTSOLDER ADULTS

Therefore: NURSING HAS GREATEST Therefore: NURSING HAS GREATEST SOCIAL MANDATE, RESPONSIBILITY SOCIAL MANDATE, RESPONSIBILITY AND OPPORTUNITYAND OPPORTUNITY

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GERONTOLOGICAL NURSING RESEARCH & EDUCATION