Geriatric Nursing Practice Gap

graphicDescription of professional practice gaps:

  1. A knowledge gap of evidence-based patient teaching strategies effective in reducing preventable memory and adverse changes in elderly patients.
  2. A practice gap in assessment skills to detect elder abuse.
  3. A practice gap in assessing signs and symptoms of urinary tract infections in the elderly that can be different from those of younger adults.
  4. A knowledge gap in the current nursing care of the needs of elderly patients in end-of-life care.

Evidence that validates professional practice gap

Several studies have identified the growing number of elderly patients seen in the healthcare system, almost 16% of the population in 2018. According to Fulmer et al. (2021), new trends in health care for an aging population include number one, creating an adequately prepared workforce, and number two, the development of new approaches to care delivery. The new approaches include serious illness care, dementia care models, and other evidence-based programs that focus on improving quality of life, including end-of-life care. 

NICHE five-point plan to improve the quality of care for older adults in healthcare systems
  1. Developing nursing leadership to advance the care of older adults
  2. Promoting a geriatric-friendly environment in healthcare settings
  3. Ensuring that all nursing staff are trained in geriatric care and that they have the resources and support they need
  4. Encouraging the implementation of evidence-based geriatric nursing practices
  5. Establishing partnerships with patients, families, and communities to improve care and outcomes for older adults
American Academy of Nursing. Nurses Improving Care for
Healthsystems Elders (NICHE)
https://www.aannet.org/initiatives/edge-runners/profiles/niche  

The Nurses Improving Care for Health System Elders (NICHE), has been in the foreground of identifying nursing professional practice gaps in the care of the elderly.

Squires et al. (2021) describe how nurses need to improve care for the health system elders. Studies by Squires et al. (2019) concluded that he NICHE practice model is significantly associated with improvements in clinical outcomes aligned with national quality measures including fall prevention and reduction; appropriate medication prescribing; dementia symptom management; delirium care; reduced catheter acquired urinary infections (CAUTIs); and expansion of advanced care planning services.

Capezuti et al. (2012) describe the high incidence of delirium, functional decline, pressure ulcers, and adverse event in the hospitalized, much of which could be prevented with improved nursing practices.

Educational needs that underlie the professional practice gap (Knowledge, skill, or practice)

The Nurses Improving Care for Healthysystem Elders (NICHE) focuses on educational practice needs that promote improved quality of care, patient safety, lower complications, and decreased length of stay. The GRN model emphasizes specialized geriatric care education and consultation.

Reference

American Academy of Nursing. Nurses Improving Care for
Healthsystems Elders (NICHE)
https://www.aannet.org/initiatives/edge-runners/profiles/niche 

Capezuti E, Boltz M, Cline D, Dickson VV, Rosenberg MC, Wagner L, Shuluk J, Nigolian C. Nurses Improving Care for Healthsystem Elders - a model for optimising the geriatric nursing practice environment. J Clin Nurs. 2012 Nov;21(21-22):3117-25. doi: 10.1111/j.1365-2702.2012.04259.x. PMID: 23083387; PMCID: PMC3532620.

Fulmer, T., Reuben, D. B., Auerbach, J., Fick, D. M., Galambos, C., & Johnson, K. S. (2021). Actualizing Better Health And Health Care For Older Adults. Health affairs (Project Hope), 40(2), 219–225. https://doi.org/10.1377/hlthaff.2020.01470

Squires A, Murali KP, Greenberg SA, Herrmann LL, D'amico CO. A Scoping Review of the Evidence About the Nurses Improving Care for Healthsystem Elders (NICHE) Program. Gerontologist. 2021 Apr 3;61(3):e75-e84. doi: 10.1093/geront/gnz150. PMID: 31681955.