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GERONTOLOGICAL NURSING RESEARCH & EDUCATION

GERONTOLOGICAL NURSING RESEARCH & EDUCATION. History and State of the Science Toni Tripp-Reimer, RN, PhD, FAAN The University of Iowa College of Nursing * 전남대학교 간호과학연구소 추계학술대회 (2001.12.4) 발표된 자료임 . 제공. 이은주(전남의대 간호학과, RICH IP). History of Gerontological Nursing. Intertwined Components

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GERONTOLOGICAL NURSING RESEARCH & EDUCATION

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  1. GERONTOLOGICAL NURSING RESEARCH & EDUCATION History and State of the Science Toni Tripp-Reimer, RN, PhD, FAAN The University of Iowa College of Nursing * 전남대학교간호과학연구소추계학술대회(2001.12.4) 발표된자료임. 제공. 이은주(전남의대 간호학과, RICH IP) Web Health Research No.4 2001-12-19 RICH

  2. History of Gerontological Nursing • Intertwined Components • Education, Practice, Research • Impinging Societal Forces • Status/Role of Elders • Status/Role of Women • Status/Role of Nursing Web Health Research No.4 2001-12-19 RICH

  3. Origin of Gerontology/Geriatrics • Real Origin in 20th century • Long History • BC: Hindu Legends • 1500: Search for Fountain of Youth • Need emerged with Industrial Revolution • Changes in Family Structure Web Health Research No.4 2001-12-19 RICH

  4. U.S. Special Elder Environments • 1811: First Naval Home • 1851: Soldier’s Homes Constructed • Dayton: 6000 residents • 1904: First Almshouse Home for Aged • But no real commitment to aged as vulnerable group Web Health Research No.4 2001-12-19 RICH

  5. Roots of Geriatrics • 18th-19th Cent Physicians • 1867 Charcot: Clinical Lectures on Diseases of Old Age • 1909: Nascher: “Geriatrics” • 1914: Diseases of Old Age • Senility: a life period • Geriatrics should be a branch of Medicine • Geriatrics as a specialty did not advance in US Web Health Research No.4 2001-12-19 RICH

  6. British Origins of Geriatrics • 1930s: Marjory Warren • Isleworth Infirmary Workhouse • Rehab and Equipment • Improved morale • Comprehensive Geriatric Eval and Management • US: 40 years later before GEM • British Most advanced • European Union: geriatrics is a specialty, but not in several countries Web Health Research No.4 2001-12-19 RICH

  7. Geriatric Nursing: Education/Practice • Young Specialty Area • First text not till 1950 • Early writing in Gero Nursing • 1896 Hampton • 1922 Harmer Web Health Research No.4 2001-12-19 RICH

  8. Nursing Education Trends • 1st Half of 20th Century: Disease pathology and Nursing Procedures • WW II: Comprehensive Care of the Patient • Mid-Century Reform in Nursing Ed: Colleges • 1960s: Social Reform and Expanded role of Nurse: MSN advanced practice roles Web Health Research No.4 2001-12-19 RICH

  9. Breakthroughs in Gerontological Nurse Training • 61: ANA: Specialty Group in Gero • 62: First Conference Group • 66:ANA Division of Geriatric Nursing/ 76: Gerontological • 70: First Practice Standards Web Health Research No.4 2001-12-19 RICH

  10. Master’s Degree Programs • 66: Duke Univ: First Gero MSN: Clinical Specialist Program • 70s: Rapid expansion: GNP; Clin Spec • 83: First Geropsych: Case Western • 76-95: 141 gero nursing programs funded by Division of Nursing Web Health Research No.4 2001-12-19 RICH

  11. Impact of National Foundations • Teaching Nursing Home Program: Robert Wood Johnson Foundation • 11 Universities and 12 Nursing Homes • Involve faculty; recruit students; conduct interdisciplinary education • Kellogg Community College Nursing Home Partnership • Improve Patient Care • Develop Faculty’ • Curriculum: augment Gero content • Student objectives • John A. Hartford-AACN Web Health Research No.4 2001-12-19 RICH

  12. Current Status US Education/Practice • 2.6 million nurses licensed to practice • 2200 schools for basic preparation • 250 Graduate (MSN) programs • 1/3 with Gero Focus • 1-2 years in length • Certification through ANA • CNS in Gerontological Nursing • GNP • 72 Doctoral Programs Web Health Research No.4 2001-12-19 RICH

  13. Model Curricula-Recommendations • AACN-John A Hartford • Bureau of Health Manpower MSN: • Both specialty (GNP) and as emphasis track (geropsych; adult; family-older adult) • Integrated in Core courses BSN: • separate required undergrad course: lecture/clinical • integration throughout curriculum • use of innovative practice sites • increasing % gero questions on licensure exams Web Health Research No.4 2001-12-19 RICH www.aacn.nche.eduEducation/gercom.htm

  14. Translational Research into Practice and Education • NYU-Hartford Best Practices • 21 topics (attitudes, teaching, financing, falls) • U of Iowa GNIRC Evidence-Based Protocols • Acute Confusion/Delirium • Acute Pain Management • Advanced Directives • Bathing Persons with Dementia Web Health Research No.4 2001-12-19 RICH

  15. Evaluation of Evidence-Based Protocols • 23 protocols • 6 in development • > 20,000 reprints; major requesters: • Acute care hospitals • Long-term care • Academic settings Web Health Research No.4 2001-12-19 RICH

  16. Evolution of Gero Nursing Research • Nightingale • Turn of Century: 1900 • AJN • Dock: Almshouse Nursing and Michigan NA • Public Health Nursing • National League for Nursing Education • 1949: Division of Nursing formed—major funding initiatives Web Health Research No.4 2001-12-19 RICH

  17. Evolution of Gero Nursing Research (cont) • Research Institutes • ’53 Teacher’s College • ’55 American Nurses Foundation • ’57 Walter Reed Army Institute of Nursing • ’59 First Gero nursing research Unit: • Whittington Hospital: London • First major research initiative in Gero Nursing Web Health Research No.4 2001-12-19 RICH

  18. Investigation of Geriatric Nursing Problems in Hospital • 1st Major Gero Nursing Study in England • 1959-62 • Doreen Norton (MSc) SRN, Rhoda McLaren RGN, SCM, & A. Exton-Smith, MD • A series of studies: • Incontinence, • Pressure ulcers, • Clothing, Furniture and Equipment • Nursing Techniques Web Health Research No.4 2001-12-19 RICH

  19. Evolution of Gero Nursing Research: Funding Mechanisms • 1922 Sigma Theta Tau (1936 funds) • 1955 Nursing Research Grants of Division of Nursing (PHS) • 1986: National Center for Nursing Research (NIH) • 1993: National Institute for Nursing Research • 2001: budget over $100,000 million Web Health Research No.4 2001-12-19 RICH

  20. Early Reviews of State of Science • 67 Basson(NR) • 77 Gunter and Miller (NR) • 79 Brimmer (JGN) • 83 Kayser-Jones (JGN) Web Health Research No.4 2001-12-19 RICH

  21. Summary of Early Reviews • Primary Emphasis: Nurses’ attitudes toward older adults • Secondary Emphasis: descriptions of older adults and need identification • Problem focused approach: atheoretical • Single studies, single investigators • Very few programs of research Web Health Research No.4 2001-12-19 RICH

  22. Annual Review of Nursing Research series (1983-) • Stage I: Comprehensive Reviews • Vol 1 (83):Wolanin, Clinical Geriatric NR • Vol 4:(86)Adams, Aging: Gerontological NR • Stage II: Specific Topics (1990-2000) • Vol 8: Carlson & King Prevention of Pressure Sores. Cowan, Cardiovascular Nursing Research • Vol 9: Lambert Arthritis Given & Given Family Caregiving for the Elderly Maas & Buckwalter: Alzheimer’s Disease • Vol 10: McCormick & Palmer Urinary Incontinence • Vol 11: Foreman Acute Confusion in the Elderly Web Health Research No.4 2001-12-19 RICH

  23. Annual Review of Nursing Research Series (cont.) • Vol 12: Fulmer Elder Mistreatment • Vol 14: Cronin-Stubbs Delirium Interventions Acute Care • Vol 15: ____, Interventions for cognitive impairment and neurobehavioral disturbances Goeppinger & Lorig Community-based Arthritis Vol 16: Given & Given Health Promotion:for Caregivers Heidrich Health Promotion in Old Age • Vol 17: Snyder & Chlan Music Therapy Algase Wandering in Dementia McDougall Cognitive Interventions: Older Adults • Vol 18: Moser Heart Failure Management Wyman Management of urinary incontinence in adult ambulatory care populations. Web Health Research No.4 2001-12-19 RICH

  24. Annual Review of Nursing Research Series (cont.) STAGE III (2002)Entire Issue Volume 2 Archbold, Stewart and Lyons (Eds) • Part I: Managing Common Conditions in Elders • Physical Function;Pressure Ulcer Prevention; Pain; Interventions for irreversible dementia • Part II: Settings for Elder Care • Transitional Care; Family Caregivers; End of Life; Nursing homes • Part III: Public Health, Social, and Scientific Trends • Home health services research; Telehealth Interventions; Genetics and gerontological nursing • Part IV: Neglected Areas of Research • Hearing impairment; Elder mistreatment Web Health Research No.4 2001-12-19 RICH

  25. INCONTINENCE • Current Practice Guidelines • AHCPR • International Continence Society • Cochrane Collaboration • Interventions for Cognitively Intact Women • PME, Bladder Training, Matching • Best Practices often not used • Match intervention to type of Incontinence • Match PME intervention to musculature deficit Web Health Research No.4 2001-12-19 RICH

  26. Decubitus Ulcers • Early studies: Verhonik (61)/ Norton (62) • Measures: Norton Scale; Braden Scale • Rapid growth in State of Science • Current Research • Use of TENS to Promote Healing • Measuring Wound Bacterial Load • Instruments to monitor healing • Unique hemodynamic features in CCUs Web Health Research No.4 2001-12-19 RICH

  27. Acute Confusion/ Delirium • Neelon/Champaign Etiology Taxonomy • Environmental Domain: function, cog imp. • Metabolic: impaired liver, renal, malnutrition • Physiologic: hypoxia, dehydration • Inouye Project HELP • Good Nursing Care: sleep, hydration, • Current: hydration intervention, urine color chart, improving vision/hearing Web Health Research No.4 2001-12-19 RICH

  28. Transitional Care Model for Elders 68% 48% Savings 48% Web Health Research No.4 2001-12-19 RICH Naylor et al 1999 Comprehensive Discharge Planning and home Follow-up. JAMA 281: 613-620

  29. Restraint Reduction • Strumpf & Evans • Requirements for change • International Variation Web Health Research No.4 2001-12-19 RICH

  30. Need-Driven Dementia Related Behaviors • Reconceptualization of ‘Disruptive Behaviors’ • Agase, Beck, Whall, Kolanowski • Anticipated by Ryden’s goal seeking behaviors Web Health Research No.4 2001-12-19 RICH

  31. Research Trends and Summary • Content • Theoretical Frameworks • Designs • Structure and Process Web Health Research No.4 2001-12-19 RICH

  32. NURSING’S CHALLENGE AND OPPORTUNITY • NURSING: • LARGEST HEALTH PROFESSION • OVERWHELMINGLY FEMALE AND OFTEN CAREGIVERS FOR FAMILY • SCOPE OF PRACTICE FITS NEEDS OF OLDER ADULTS • Therefore: NURSING HAS GREATEST SOCIAL MANDATE, RESPONSIBILITY AND OPPORTUNITY Web Health Research No.4 2001-12-19 RICH

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