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Celebrating Ten Years of Improving Health Care for Older Adults
Making Best Geriatric Practice
Standard Practice

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Making Best Geriatric Practice Standard Practice

The vision behind the work of the John A. Hartford Foundation Institute for Geriatric Nursing is "to shape the quality of health care older Americans receive by promoting the highest level of geriatric competence in all nurses. By raising the standards of nursing care, the Hartford Institute aims to ensure that people age with optimal function, comfort and dignity."

The Hartford Institute strives to increase geriatric competence in all nurses, not just those specializing in geriatrics. Nurses in almost all specialties are realizing that, while they may not consider themselves geriatric nurses, there are age-related considerations they must take into account when treating older adult patients, whether they are cardiac care, oncology, critical care, or nurses of any specialty. Therefore, the Hartford Institute aims to bring core competencies in care of older adults to every nurse.

In 1996, the Hartford Foundation identified several possible candidates to lead the Hartford Institute for Geriatric Nursing. Two individuals in particular stood out because of their extensive research expertise in geriatric nursing and their proven abilities as previous Hartford Foundation grantees. Dr. Mezey, as director, and Dr. Fulmer, as co-director, were asked to develop the program.

Dr. Mezey's long and distinguished career has focused on raising the standards of nurses caring for older adults and ensuring that people age in comfort and dignity. As a professor at the University of Pennsylvania School of Nursing, she directed the geriatric nurse practitioner program and the Robert Wood Johnson Foundation Teaching Nursing Home Program.

Dr. Fulmer is an award-winning researcher who has devoted her academic career and care practice to a wide range of geriatric issues and in particular elder mistreatment. She is currently the dean, College of Nursing, New York University, and Erline Perkins McGriff Professor, as well as the co-director of the Hartford Foundation Institute for Geriatric Nursing.

In 2003, Elizabeth Capezuti joined the institute as co-director. She is an associate professor in the New York University College of Nursing, and has been an integral part of a team of researchers demonstrating the effectiveness of restraint reduction by advanced practice nurses in nursing homes and hospitals.

The Hartford Foundation built a one-year planning phase into the grant to ensure that the program would be well thought out and therefore poised for success. During the planning phase, Dr. Mezey, Dr. Fulmer, and their colleagues created a strategic plan to guide the activities of the Hartford Institute and to plan for the Institute space. They began by forming a National Board of Advisors, with Claire Fagin, PhD, RN, professor and dean emerita, University of Pennsylvania School of Nursing, serving as chair. "Dr. Fagin and the board members gave our team sage advice," says Dr. Mezey. "They encouraged us to be targeted and focused, to make initial inroads by influencing a small area first rather than trying to accomplish too much at one time."

The planning stage culminated in a clear sense of direction. With its strategic goals set, the directors of the Hartford Institute and the Hartford Foundation also understood the need to have flexibility to continually revise and rework the programs of the Institute as the work progressed and allies were identified to prepare all nurses to be ready to care for older persons. By working with partners, such as the American Association of Colleges of Nursing, American Organization of Nurse Executives, Gerontological Society of America, and many others, the activities and messages of the Hartford Institute would be more widely disseminated, benefit from the prestige of the partner organization, and ultimately become embedded within the wider field of nursing.

The Hartford Foundation hoped the Hartford Institute would become a national resource dedicated to providing the tools to bring a geriatric presence to the entire nursing profession. "Because older adult patients are the core business, then all nurses must have core competencies in geriatrics," says Dr. Capezuti. To accomplish this, the Hartford Institute devised broad-based, multifaceted strategies to influence nursing at the level of the individual nurse, at the level of health care systems, and by raising the profile of geriatric nursing within the wider health care arena.

These strategies are summarized in the vision statement of the Institute: "The Hartford Institute identifies and develops best practices in nursing care of older adults and infuses these practices into the education of every nursing student and the work environment of every practicing professional nurse. The Hartford Institute educates the public to expect best practice and encourages national leadership to establish best practice as the standard for geriatric nursing care." 3- Naylor MD, Brooten DA, Campbell RL, Maislin GM, McCauley KM, Schwartz JS. "Transitional Care of Older Adults Hospitalized With Heart Failure: A Randomized Clinical Trial." Journal of the American Geriatrics Society. 2004. Vo. 52, Number 5, pp. 675-684.

4- Cohen HJ, Feussner JR, Weinberger M, et al. "A Controlled Trial of Inpatient and Outpatient Geriatric Evaluation and Management." New England Journal of Medicine. 2002. Vol. 346, Number 12, pp. 905-912. Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. "A Randomized Trial of Care in a Hospital Medical Unit Especially Designed to Improve the Functional Outcomes of Acutely Ill Older Patients." New England Journal of Medicine. 1995. Vol. 332, Number 20, pp. 1338-1344.
Visit the Hartford Institute for Geriatric Nursing Web site: www.hartfordign.org