Geriatric Resource Nurse (GRN) Leadership Training Program: Module 4C Sustaining and Evaluating Program Success

Transcription

1 Geriatric Resource Nurse (GRN) Leadership Training Program: Module 4C Sustaining and Evaluating Program Success Geriatric Resource Nurse (GRN) Leadership Training Program: Module 4C Sustaining and Evaluating Program Success 2013 NICHE All Rights Reserved Objectives Describe NICHE resources to support the development and sustainability of the Geriatric Resource Nurse Model Describe outcomes for program evaluation and ongoing sustainability Developing the Geriatric Resource Nurse Model: Making the Case Defining the need: Why is this information important? Why learn something new? 1

2 The Geriatric Resource Nurse Often the first step in developing improvement in care for older adults and system changes Clinical intervention that features education, coaching and mentorship Prepares the bedside nurse as a geriatric expert who then becomes a resource to peers and colleagues Geriatric education provides a foundation for certification as a Certified Gerontological Nurse St.Pierre, J., Twibell, R., (2012). Developing Nurses Geriatric Expertise Through the Geriatric Resource Nurse Model. Geriatric Nursing, 33(2), Evidence-Based Education Embedding practice change at the bedside: NICHE recommends continuing education that includes active learning approaches such as bedside coaching by trained educators or clinical mentors to bring didactic knowledge into daily practice What resources does the NICHE Program offer? 2

3 Your portal to evidence-based knowledge, protocols and strategies to support your process to improve the care of older adults within your health care facility or system NICHE Program for Members Only The Knowledge Center: Training and Education Programs Core Curricula: for Nurses, Patient Care Associates & Other Disciplines The Knowledge Center The Geriatric Resource Nurse Core Curriculum Initial educational initiative: 14 modules and 20 contact hours containing essentials of care for the older adult patient in the acute care setting Fully interactive slides including Introduction to the topic Learning objectives Topic significance Consequences Nursing strategies Expected clinical outcomes Post tests Additional online resources 3

4 Curriculum-based Resource: NICHE Evidence-Based Protocols M. Boltz, E. Capezuti, T. Fulmer, D. Zwicker (2012) (Eds.), Evidence-Based Geriatric Nursing Protocols for Best Practice (4 th ed.). New York: Springer Publishing Co. Introducing Core Curriculum Education Online self-study modules Didactic education (16 20 hours) Designing and modifying based on your needs Include other disciplines appropriate to your site How are GRNs educated in your facility? Rita LaReau MSN, GNP BC Rita LaReau # 1 GRN with strong educational component 4

5 Geriatric Patient Care Assistant (GPCA) Newly updated curriculum (2nd Edition, 2012): Supports the role of the patient care associate/patient care technician Provides best practice care to older adults Interactive seven module series addresses issues that are relevant to the healthcare worker who plays a pivotal role in the older adult's recovery and comfort Available in the NICHE website Knowledge Center for Members Only Interdisciplinary and Hospital Personnel Education Introduction to Gerontology: (5 contact hrs.; 2 nd edition, 2012) - Increase sensitivity to aging process - Improve recognition of age-related changes - Enhance communication skills - Available on the NICHE website Knowledge Center for Members Only Specialty Nursing Practice Nursing Care of Older Adults with Cancer Contains six modules addressing: Cancer demographics in older adults Age-related changes and cancer Nursing considerations related to radiation and chemotherapy Symptom management and psychosocial issues 5

6 Specialty Nursing Practice Critical Care Nursing of Older Adults Contains clinical and management aspects related to the specialized needs of critically ill older adults that address the critical care environment, infection and immune function, respiratory failure, heart failure, sleep, and delirium Elder Mistreatment Course Only one in ten cases of elder abuse are reported and there is a serious underreporting by clinical professionals Lack of appropriate screening instruments This course gives health professionals the knowledge and skills needed to recognize the clinical indicators of elder mistreatment and identifies the actions required when elder mistreatment occurs On-going Education Needs: Training and Education Programs Webinars and In-service Materials 6

7 Resources to keep current Live and archived Webinars (CE s) Pressure Ulcers Falls Catheter - Associated UTI s CHF series Medication Management Restraints More Try This The Try This Series features multiple topics relevant to the care of older adults Examples include: Mental Status Assessment: The mini-cog Katz assessment of Activities of Daily Living Lawton IADL (Instrumental Activities of Daily Living) Hearing Screening in Older Adults The How to Try This series is comprised of articles and videos presenting cases studies demonstrating the use of the Try This: series. How to Try This articles and videos are listed under their respective Try This article. Specialty Practice Nursing This Try This Series highlights assessment tools specific to specialty practice nurses in the care of older adults Examples include: Informal Caregivers of Old Adults at Home: Let s PREPARE Perioperative assessment of the Older Adult 7

8 Dementia Care This Try This Series focuses on tools and strategies in the assessment of older adults with dementia Examples Include: Recognizing Dementia in the Hospitalized Older Adult Avoiding Restraints in the Person with Dementia Resources: Discussion Boards Discussion boards are linked with education courses Both provide contact with NICHE hospitals nationwide, building a community of support for all sites Allow for the posing of questions that promote the exchange of strategies Supporting the Patient and Family Caregiver NICHE Resources 8

9 Patient and Family Resources Need to Know : informational sheets, written in simple, easy-to-understand terms, helps to prepare and inform people of the realities of hospitalization. Pressure Ulcers Series Functional Decline More Delirium Managing Medications Dementia Transitions Available at: The Family Preferences Index Family members are an important but often underappreciated resource in caring for hospitalized older adults Can be administered as a structured interview or as a questionnaire The nurse can use the responses to the index to plan care that builds a partnership with the family Care Transitions Discharge Preparation Checklist A checklist for patients and caregivers of tasks to be completed in preparation for discharge from a hospital, nursing home, or other health care setting 9

10 Patient & Family Coordinated Care Kit NICHE & AARP joint program to help nurses provide support for caregivers Ask Me, Too & Ask Me Now communication notebooks to assure caregiver questions are being asked on a daily basis Building NICHE Clinical Management Tools Organizational Strategies & Clinical Improvement Models The Importance of the Team Quality care of older adult patients often involves complex issues beyond the scope of expertise and training of any one provider, optimum care requires teamwork 10

11 Organizational Strategies Some examples include: Medications Appropriateness of Prescribing Criteria in Older Adults: State of the Art Behavioral Health Rapid Response Describes a team of healthcare professionals who respond to patients experiencing behavioral changes or mental health crisis Medication Reconciliation Describes a process for transitions in care to help reduce medication errors and reconciliation failures Vaccines Provides guidance so that hospitals and other organizations can develop influenza and pneumonia vaccine policies that identify, inform, and educate at-risk populations Patient Family Advisory Councils This strategy will assist hospitals to introduce and implement the council concept and help increase patient/caregiver satisfaction levels Resource: Clinical Improvement Models Clinical Improvement Models: A road map to systems level adoption of clinical best practice Restraint Reduction Pressure Ulcer Prevention Program Reducing the Risk for Fall-Related Injuries Keeping NICHE in the Forefront Keeping the administration appraised Regular presentations targeting priorities of the audience Regular items in newsletters, standing item on committee agenda Create an Action Plan Convening a regular on-going steering committee Encouraging ANCC Certification/professional development Studies indicate decreased medical error Improved nursing satisfaction/financial rewards, clinical ladder/synergistic with Magnet St.Pierre, J., Twibell, R., (2012). Developing Nurses Geriatric Expertise Through the Geriatric Resource Nurse Model. Geriatric Nursing, 33(2), Conely, M. C., Burket, T. L., Schumacher, S., Lyons, D., DeRosa, S. E., Schrim, V. (2012). Implementing Geriatric Models of Care: A Role for the Geronotological Clinical Nurse Specialist Part I. Geriatric Nursing, 33(3),

12 How does leadership support the GRN role? Deborah M. Conley, MSN, APRN CNS, GCNS BC, FNGNA Deb Conley #3 Sustaining the GRN role A Crosswalk: Joint Commission Standards and NICHE Resources Compliance with the Joint Commission Standards assures hospitals and other health care facilities are meeting state-of-the-art quality and safety standards Media Kit & Marketing Resources By communicating the right messages in the right way, you can Champion care of older adults in the facility Optimize NICHE training program Recruit more staff for your NICHE hospital team Market your hospital as a quality elder care facility Coordinate the NICHE paradigm with skilled nursing facilities 12

13 Embedding and Sustaining NICHE Supporting the GRN Reinforcing and Embedding Ongoing programs: Exemplary NICHE sites recommend monthly 1-2 hour educational programs for geriatric resource nurses and other staff members who attended the initial education program and/or are concerned or interested in the care of older adults Ongoing coaching at the bedside: regular coaching by the NICHE coordinator, advanced practice nurse or others prepared in geriatric care at the bedside and also during clinical rounds Rounding The process of rounding enables the NICHE coordinator or APN to support and mentor the GRN (formal, informal, in-service): Identify geriatric syndromes: SPICES tool Assists with the application of new knowledge Shares expertise/model competencies Answers questions Offers support and council in professional development Can occur at several levels: Unit Bedside rounding Safety huddles at the beginning of the shift Local Interdisciplinary rounds Organizational Grand Rounds with formal presentation usually done via case study St. Pierre, J., Twibell, R., (2012). Developing Nurses Geriatric Expertise Through the Geriatric Resource Nurse Model. Geriatric Nursing, 33(2),

14 Resource: Education Briefs A series of short, downloadable educational powerpoints focused on providing the GRN at the beside with quick but pertinent evidence based education to inform and enhance practice: Teach-back Vaccinations Elder self-neglect The GRN s Bedside Guide: simple environmental modifications to enhance function and safety for older adults More Hard Wiring NICHE Embedding assessments, tools (such as the Try This), and protocols into the EMR Research influences practice and patient outcomes Committees, practice and quality councils Conely, M. C., Burket, T. L., Schumacher, S., Lyons, D., DeRosa, S. E., Schrim, V., (2012). Implementing Geriatric Models of Care: A Role for the Geronotological Clinical Nurse Specialist Part II. Geriatric Nursing, 33(4), Quality Outcomes and NICHE Exemplars Sustaining NICHE 14

15 Evaluation of Quality and Benchmarking Geriatric Institutional Assessment Profile (GIAP) Staff knowledge Perception of the geriatric care environment Clinical outcomes: Falls, fall injuries, pressure ulcers, catheterassociated UTIs and others Staff reported satisfaction Patient and family satisfaction surveys: Noise levels, attention to care needs, pain management Process measures: Consistency with established protocols and standards Evaluated through chart audit, observations, and interviews Examples: OOB for meals, use of pressurerelieving devices, timely removal of indwelling urinary catheters, communication between caregivers and patients/family What evidenced based practice and tools are used with NICHE? Sue Nickoley, MS, RN, GCNS BC Sue Nickoley, #20 Initiatives EBP and tools used with NICHE The Geriatric Institutional Assessment Profile The GIAP helps NICHE participating hospitals assess their institutional readiness to provide quality care of older adult patients prior to implementing NICHE and as a means of benchmarking for further evaluation GIAP identifies: Gaps in knowledge about geriatric care Attitudes and perceptions that influence how staff work with older adult patients Specific practice issues and concerns Organization attributes of the hospital relevant to geriatric care 15

16 NICHE Outcome Benefits Benefits of the GRN Program: Decreased physical restraint use Decreased LOS Less problems with pain, incontinence and immobility Other reported outcomes: Increased sensitivity to the needs of older adults Improved self-actualization and satisfaction of GRN (Novice to Expert) Increased cooperation and collegiality Nurse Level Outcomes GRN s have demonstrated the following changes in nurse level/nurse sensitive outcomes: Decrease in the incidence and severity of delirium Less reported pain Less facility acquired incontinence, infections and pressure ulcers Less faculty acquired loss of mobility/functional decline and fall related injuries Decrease use of indwelling catheters and decrease use of restraints Patient Level Outcomes Hospitals that utilize the GRN model demonstrate the following patient and family outcomes on post discharge surveys: Improved hospital experience Feeling of being cared for and cared about Lower stress levels Feeling of being in good hands Improved patient satisfaction 16

17 Organizational Outcomes NICHE sites have demonstrated improved organizational outcomes with GRN s in the following areas: Decreased length of stay by up to one day Reduced costs of care Improved staff job satisfaction Enhanced Magnet initiatives Nurses Role Satisfaction Studies reported improvements in nurses knowledge, confidence, attitudes and satisfaction with care following implementation of the GRN model The GRN model has changed the way I nurse I use SPICES as a guide to assessing my older patients I m more persistent and don t back down because I have the knowledge It s nice when coworkers come to up to you and say, I have a patient that is difficult, what do you think? I feel more like a leader. St. Pierre, J., Twibell, R., (2012). Developing Nurses Geriatric Expertise Through the Geriatric Resource Nurse Model. Geriatric Nursing, 33(2), NICHE Program Explore This website provides online access to: The NICHE journey, how to get started Online Leadership Training Program information Annual Conference information NICHE Knowledge Center (online tools and resources) Individual NICHE hospital websites Consumer Patient and Family resources 17

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