Abstract
As the number of older adults in acute care rises, acute care specialty nurses must gain gerontological knowledge in their nursing practice with older patients. A blend of two bodies of knowledge and competencies is required to care effectively for older adults in the hospital. To this end, a gerontological enrichment program was developed to improve care to hospitalized older patients by augmenting acute care nurses competencies with gerontological skill, knowledge, and abilities. This article will explain the implementation details, the anticipated outcomes for nurses and older acutely ill patients, the evaluation process, and the strategies that are in place to maintain the gains.
Nurses working in acute-care hospitals are frequently required to care for older adults. In 1997/1998, older adults accounted for 35% of the 3 million discharges reported by Canada's inpatient hospitals, 52% of the 21 million patient days, and nearly one-third of all primary diagnostic and surgical procedures performed in hospitals during this time (Canadian Institute of Health Information [CIHI], 2000). In addition, when controlling for newborn and neonatal care, older adults were over represented in all leading causes of hospitalization in Canada, which included heart disease and stroke, respiratory illnesses, and digestive problems (CIHI, 2000).
The literature is fraught with examples of how risky being in a hospital can be for older adults (Creditor, 1993; Palmer, 1995). Risk factors associated with adverse functional outcomes acquired in a hospital are known to result from the normal consequence of physiological aging, the iatrogenesis of professional intervention, and environmental factors that include hospital systems and processes (Creditor, 1993; Illich, 1987; Inouye, 2000; Inouye et al., 1993; Palmer, 1995). Research suggested that older adults come to a hospital with characteristics indicative of vulnerability, which increases their susceptibility to the effects of hospitalization (Inouye, 2000; Inouye et al., 1993). This information highlights the demand placed on hospital nurses to manage clinical problems that require, in addition to their acute-care specialty expertise, knowledge, and skill in gerontological nursing.
This article describes one organization's method of enhancing gerontological expertise on acute medical/surgical units. The educational program, Care of the Acutely Ill Hospitalized Older Adult: A Clinical Resource Nurse Gerontological Enrichment Program, was created in the context of fiscal restraint, immediate current pressures, and existing organizational strengths.
The concept of a "knowledge enhanced" role is not new. Other organizations have developed enhanced clinical resource nurse (CRNs) roles for acute confusion management, elder, care wound and skin care, and pain management (Carson & Ross, 1993; Frances, Fletcher, & Simon, 1998; Fulmer, 1991; Inouye, Bogardus, Baker, Leo-Summers, & Cooney, 2000; Rapp, Orega, & Tripp-Reiner, 1998). Table 1 provides a job description summary of the CRN's role.
The CRN as a unit-based resource is intended to support nursing practice and contribute to quality service delivery. CRNs are baccalaureate prepared and have advanced knowledge in an acute-care specialty and expertise in teaching and learning. Given the preparation required for nurses to act in the role of a CRN, augmenting their existing knowledge with gerontological principles to assist bedside nurses in caring for older acutely ill patients was a logical next step.