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Celebrating Ten Years of Improving Health Care for Older Adults
Making Best Geriatric Practice
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Strategy No. 1: Increasing Individual Nurse Competence

Preparing the Next Generation of Nursing Scholars

An important shift that's taking place in nursing is a move toward more evidence-based practice. Practice standards are derived from a consensus of leading experts drawing on both the literature and clinical experience. In recent years, there is a growing body of data about nursing best practices that comes from well-designed clinical trials. These types of studies result in data that can be looked to as authoritative sources for creating sound recommendations for nursing.

The professionals who carry out this research are nurses who choose an academic career. From its inception, the Hartford Institute recognized the need to support up-and-coming geriatric nurse researchers. By training scholars in the basic principles of a successful research career—including writing a research proposal, obtaining grant funding, recruiting participants, analyzing results, presenting findings at professional meetings, and publishing—the Hartford Institute is making a major investment in the future of nursing through the Geriatric Nursing Research Summer Scholars Program.

An Opportunity to Hone Research Skills and Make Connections

rose ann dimaria-ghalili
Rose Ann DiMaria-Ghalili, PhD, RN, shown here weighing a patient during a post-operative visit, continues to develop her research on nutrition and health outcomes and was selected as a 2007-2009 Claire M. Fagin Fellow with funding from the Hartford Foundation and the Atlantic Philanthropies. Older people tend to lose weight after they undergo surgery and that weight loss is often associated with adverse health outcomes. This was the conclusion Rose Ann DiMaria-Ghalili, PhD, RN, came to as a result of her early research. Her interest in nutrition and patterns of recovery in older adults undergoing surgery has been a mainstay of her career, and continues now that she is an associate professor in the School of Nursing at West Virginia.

In 2003, Dr. DiMaria-Ghalili attended the Hartford Institute for Geriatric Nursing Summer Research Scholars Program because she thought it would be a good way to hone her research skills and be mentored by expert geriatric nurses. As an outcome of her participation in the program, she has been able to disseminate the findings of her work on nutrition in older adults not only in research journals but also to nurses working at the bedside. Part of her research involves identifying the causes of weight loss in older adults undergoing surgery, and the other part is focused on developing interventions to prevent it.

"The Hartford summer program is one of the best programs I have ever attended," she says. During the program, she was able to develop her research proposal, which subsequently received funding from the American Nurses Foundation and University of Washington School of Nursing's Center for Women's Health and Gender Research. But just as important, Dr. DiMaria-Ghalili made contacts and became known as an expert in the area of nutrition in the elderly.

After the Summer Scholars Program, Dr. DiMaria-Ghalili was asked to collaborate on an article about nutrition in older adults for the American Journal of Nursing (AJN) as part of their series "A New Look at the Old." "I received requests for reprints of this article from all over the world, and the research was featured in a New York Times article8 based on the AJN article," says Dr. DiMaria-Ghalili. She was also asked to write the section "Nutrition in the Elderly" for the Nurse Competence in Aging Web site www.GeroNurseOnline.org.

"As a researcher, you want to publicize your work to the research community, but it's also important to get the message out to the practicing nurse," says Dr. DiMaria- Ghalili. And that's what she's been able to do. "My connection to the Hartford scholars program was the reason I was selected for these assignments and was able to have this impact," she says.

Each summer, 12 to 18 doctorally prepared nursing scholars from around the country are chosen to participate in the one-week, intensive seminar at New York University, which has been co-sponsored by the Merck Foundation and the American Journal of Nursing. Researchers from leading nursing schools around the country are invited to participate as guest faculty. To date, 127 scholars have graduated from the program. The goal of the seminar is to help scholars to hone specific research skills and gain a competitive edge for funding.

"The scholars come to the program to help them think through a research proposal," says Dr. Capezuti. "But it's much larger than that: it's also about helping them envision their career paths and future research interests." Many of the scholars come from smaller nursing schools where there may not be adequate mentorship for their work. During the seminar, the scholars have the opportunity to meet prominent researchers from outstanding universities and federal agencies who engage them in critical analysis of their work.

The Right People at the Right Time

pamela cacchione phd, gnp
Pamela Cacchione, PhD, GNP, (foreground) with members of the I-SEE research team Leah MacQuality, BSN, RN, and Mary Beth Barad, MSN,RN, with Betty Goode, a resident at Beauvais Manor, St. Louis, Missouri, seeks to help older patients maintain their independence by addressing hearing and visual problems. After obtaining her doctoral degree in 1998 with a dissertation on acute confusion in the elderly, Pamela Cacchione, PhD, GNP, was considering the next step in her academic career. Dr. Cacchione attended the Summer Research Scholars Program in 1999, and she credits it with changing her professional life and making her the successful clinical researcher she is today.

Fortuitously for Dr. Cacchione, associate professor, Saint Louis University School of Nursing, Missouri, one of the guest faculty members at the Summer Scholars Program in 1999 was Toni Tripp-Reimer, PhD, RN, Professor and Associate Dean for Research at the University of Iowa College of Nursing. At the time, Dr. Tripp-Reimer had put together a consortium of researchers in the area of acute confusion in long-term care, which was Dr. Cacchione's and her primary area of research interest. Working with Dr. Tripp-Reimer, Dr. Cacchione identified a topic that no other researcher was investigating-hearing and vision impairment as a risk factor for delirium or acute confusion.

Shortly after the Summer Scholars Program ended, Dr. Tripp-Reimer offered Dr. Cacchione a postdoctoral position at the University of Iowa. Even though it required a four-hour commute, Dr. Cacchione jumped at the chance. She made connections with other researchers doing similar work and built on the research idea that had begun in the Scholars Program. As a result of her participation in the one-week scholars program, Dr. Cacchione wrote a research proposal that eventually led to a four-year $1.47 million grant from the National Institute of Nursing Research, which is the largest research grant the Saint Louis University School of Nursing has ever received. The study is evaluating the impact of a nursing intervention called Individualized Sensory Enhancement in the Elderly (I-SEE) in a population of nursing home residents. "We assess things like medications to make sure they're not affecting vision or hearing," says Dr. Cacchione. "We also clean their glasses, clean out ear wax, and increase the lighting in the room." Dr. Cacchione and her colleagues hypothesize that improving vision and hearing in older patients will have a positive impact on cognitive performance, physical function, and social engagement. She has hired a research staff to implement the interventions and measure the outcomes.

When the researchers detected a cataract in one patient and referred her for surgery, the woman returned to the clinic and remarked "I can see colors again." "On a personal level, cases like that make the work of putting together a study worthwhile," says Dr. Cacchione.

Seven years after attending the Summer Scholars Program, Dr. Cacchione maintains strong ties to the Hartford Institute for Geriatric Nursing. She is the president of its Scholars alumni association, she contributed a chapter on vision in older adults to a textbook edited by another graduate of the Summer Scholars Program, and she continues to interact with scholars on the listserv and at the scholar's annual meeting at GSA.

"The program was the catalyst for my career," she says. "It was the right people at the right time and generated a tremendous amount of energy in me."

The participants also make important professional connections that will assist them throughout their careers. "Some of the scholars have never been to a Gerontological Society of America (GSA) meeting," says Dr. Capezuti. The faculty members encourage all scholars to participate in this scientific meeting, an important forum for exchanging research and ideas with colleagues. The Hartford Institute also hosts a scholars group meeting every year at the GSA Annual Meeting, a place where all alumni from the scholars program can gather for professional exchange.

While the scholars program is only one week, the impact is long lasting. So far, the graduates of the program have obtained over $25 million in research funds. In addition, scholars tend to stay in touch with one another, either directly or through the listserv. "In nursing, recruitment of faculty is important and we don't want people to fail," says Dr. Capezuti. "People often flounder when they're not connected to other professionals who are helping them."

Finding a Calling in Geriatric Nursing

abraham brody, rn, gnp
Abraham Brody, RN, GNP, visits with a home care patient and study volunteer. His work as an undergraduate research assistant at the Hartford Institute inspired him to seek a PhD in nursing at the University of California, San Francisco. In 1999, Abraham Brody, RN, GNP, was an undergraduate student in the Department of Biology at New York University, looking forward to one day becoming a pediatrician. His career aspirations were about to take a major turn in an example of the importance of mentoring and role models in geriatrics. In the spring of that year, Mr. Brody was simply looking for a job when fate stepped in, in the guise of Mathy Mezey, not only to change his planned career path but to give him what he now considers his calling—as a geriatric nurse.

Mr. Brody worked as a research assistant at the Hartford Institute from 1999 until he graduated in 2002, by which time he had become a devoted convert to nursing and specifically to geriatrics. He went to the University of California, San Francisco, where he received a Master in Science (MS) in Nursing and is now working toward a Doctor of Philosophy (PhD) in nursing. Presently, he is a scholar in the Hartford Geriatric Nursing Initiative's Building Academic Geriatric Nursing Capacity Program.

"Working with such a vibrant and intelligent group of people on topics that are of such gravity for a large number of people changed my career focus," he says. Mr. Brody had experienced the death of some of his elderly relatives, but at the Hartford Institute he realized that end-of-life care was something that could be studied in order to increase the quality of care. His current research is looking at how palliative and hospice care affect the quality of pain and symptom management at the end of life in the long-term care setting.

Mr. Brody also works as a nurse practitioner for a private home visit practice, where he performs geriatric assessments on homebound elderly people and nursing home residents. "I hope to improve their quality of life or, if they are at that stage, the quality of the dying process," he says.

"The Hartford Institute and the people who work there helped to convince me through their actions that geriatric nursing is a valuable and necessary field and that we need more people in it to take care of older adults," says Mr. Brody. "Without them, I would not be doing what I'm doing today."


8- Nagourney E. "Tea and Toast and a Danger That Can Be Hard to Spot." New York Times. April 12, 2005. Visit the Hartford Institute for Geriatric Nursing Web site: www.hartfordign.org