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

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Annual Report pdf
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Strategy No. 1: Increasing Individual Nurse Competence

Equipping Nurses at the Bedside with Geriatric Resources

In addition to infusing geriatrics into nursing education, the Hartford Institute has also been committed to disseminating best practices in nursing care of older adults to all practicing nurses. The basic philosophy underlying these materials is to provide knowledge about best practices in a format that is accessible, easily implemented, and can be adapted to any health care environment.

One of the most important and well-received initiatives is the ongoing Try This series, which was launched in 1998. Try This is a series of evidence-based assessment tools, each of which focuses on one topic that is specific to caring for older adults, such as predicting pressure ulcer risk, falls risk assessment, assessing pain in older adults, and avoiding restraints in patients with dementia. Each issue is a two-page document with a description of why the topic is important when caring for older patients on the first page and an assessment tool that can be administered in 20 minutes or less on the second page. Each document also includes a list of resources for obtaining more detailed information about the topic, and is available free of charge on the Hartford Institute's Web site, as a hard copy, and in a format for viewing on a handheld computer. The content encourages nurses to understand the special needs of older adults and utilize the highest standards of practice in caring for the elderly. The issues in the series are routinely updated and are useful for many health professionals besides nurses.

The Hartford Institute has also created nursing protocols, which are more comprehensive than the Try This pamphlets. Protocols address key clinical conditions and circumstances likely to be encountered by a hospital nurse caring for older adults and represent best practices for acute care of the elderly as developed by nursing experts around the country. In 1999, Dr. Mezey and Hartford Institute staff and consultants compiled a group of best practices in geriatric nursing into the book "Geriatric Nursing Protocols for Best Practice." A second edition of the book,7 published in 2003, was named Gerontological Book of the Year by the American Journal of Nursing. These protocols were also accepted by the Agency for Healthcare Research and Quality for all health disciplines. An expanded third edition is forthcoming in 2007.

"The protocol book is not meant to be a textbook," says Dr. Capezuti. "In order to be practical for use by nurses in the hospital, we designed it to be small and easy to use. The text is in the form of summaries and case studies, utilizing bullet points and tables to make the information quickly accessible. The protocols are also in a form that can be easily adapted to a hospital's policies and procedures."

To further connect to individual nurses, the Hartford Institute also collaborates with nursing journals to provide nurse experts to write on geriatric topics. Hartford Institute staff work with The American Journal of Nursing, Geriatric Nursing and the Journal of Gerontological Nursing, and also with national publications read by nurses who are not necessarily geriatric specialists. These include magazines such as Nursing Spectrum and Advance for Nurses, as well as newsletters and journals of nursing specialty organizations.

The American Journal of Nursing publishes a bimonthly series entitled "A New Look at the Old," made possible through a grant from the Atlantic Philanthropies to the Hartford Institute, providing authors and reviewers for the articles. For example, Howard Butcher, PhD, RN, a Hartford Institute Scholar, wrote an article on late life depression, and columnist Jane Brody used the article as the basis for a New York Times health article in January 2005.

Advance for Nurses recently published an article on the Geriatric Resource Nurse model with sidebar interviews of nurses trained to work with older patients. Several articles by Hartford Institute staff have been published in the New York metropolitan region issue of Nursing Spectrum. In addition, Hartford Institute faculty and staff have published over 150 scholarly articles about geriatric nursing topics.

Preparing Nurse Researchers to Bring New Evidence
and Therapies to the Bedside

gerontological society of america in dallas
At the November 2006 meeting of the Gerontological Society of America in Dallas, Texas, 28 alumnae of the Geriatric Nursing Research Summer Scholars Program gathered with Hartford Institute co-director Elizabeth Capezuti (seated, fifth from right). The 127 scholars who participated in the Geriatric Nursing Research Summer Scholars Program between 1996 and 2006 have launched studies on a wide variety of geriatric nursing topics, including:

Improving cognitive function in elderly in long-term care

Effectiveness of commonly used dietary supplements in managing the symptoms of chronic illness in the elderly

Health empowerment in homebound older women

Tailoring physical activity interventions for older adults

Consumer directed care in gerontological nursing education and caregiver–consumer relationships

Outcomes of tube-feeding versus hand–feeding in later stage dementia

Effect of nursing home environments on the physical, psychological and social characteristics of nursing home residents and staff

Effective critical care management of delirium

How the meaning of home may be used to create individualized interventions to foster quality of life in long-term care settings

Evaluation of an intervention to increase communication and negotiation skills of home health care family dyads

Health promotion, older adults' physical exercise and cardiovascular disease

Reduction of cardiovascular risk factors and improvement of overall health status of older women

Identification of strategies and interventions for supporting eating habits in people with dementia

Comparing transition as it impacts the continuity of social relationships and quality of life in assisted living residents

Caring for people with Alzheimer's disease and family caregivers

Sexuality and intimacy in older adults

Exploration of changes in nutritional status and patterns of recovery in older and younger persons undergoing traditional vs. "off-pump" CABG surgery

Transitions of older women and their adult daughters as health needs arise

7- Mezey M, Fulmer T, Abraham I, editors. Geriatric Nursing Protocols for Best Practice, 2nd Edition. New York: Springer Publishing Co., 2003. Visit the Hartford Institute for Geriatric Nursing Web site: www.hartfordign.org