MILLER, Nursing For Wellness in Older Adult - P61

roles, certification requirements, and scope of
practice. State board requirements differ to some

Since the early 1990s, the John A. Hartford
degree, and this causes problems related to
Foundation has demonstrated a major commitment
consistency and portability (Duffy, 2009). In 2008,
to improving nursing care of older adults through
the Advanced Practice Registered Nurse (APRN)
many initiatives directed toward increased nursing
Work Group and the APRN Joint Dialogue Group
knowledge and evidence-based clinical practice. In
published recommendations for nationally
1992, the foundation funded a major initiative called
recognized standards for education, accreditation,
the Nurses Improving Care to the Hospitalized
certification, and licensure of APRNs. Criteria that
Elderly (NICHE). The NICHE program is ongoing
are included in the recommended definition of an
and includes more than 225 hospitals nationwide. It
APRN include graduate-level education; national
has been shown to improve quality of care for older
certification; advanced clinical knowledge and
adults as well as job satisfaction for nurses. Studies
skills; ability to as- sume responsibility and
of outcomes at NICHE hospitals have demonstrated
accountability for health promotion; and licensure to
improvements in clinical care, cost effectiveness,
practice in one of four specific APRN roles, which
nursing knowledge, and nurse perceptions of the
are certified registered nurse anesthetist, certified
geriatric nursing practice environment and quality of
nurse-midwife, clinical nurse specialist, or certified
geriatric care (Boltz et al., 2008). In 2007, the
nurse practitioner. The regulatory model further
Hartford Foundation collaborated with the American
specifies that APRNs be qualified to practice with
Journal of Nursing to develop and promulgate a
one of six population groups, with one group being
series of 28 cost-free web-based articles and
adult–gerontology. Each of the
corresponding videos that nurses and nursing
six areas of specialization will be certified and
students can use to improve their care of older adults.
regulated by appropriate professional organizations,
Pertinent videotapes and articles are listed in the
and the target date for fully implementing this model
Clinical Tool sections of chapters in this book.
in all states is 2015 (APRN Consensus Work Group,
Figure 5-1 lists milestones in gerontological nursing
2008). It is anticipated that nurses with
development and major initiatives directed toward
gerontological specialization will be more in demand
improving nursing knowledge in care of older
than ever because expertise in caring for older adults
adults.
will be essential to implementing the new model
(Duffy, 2009).
Roles for Gerontological Nurses The Roles of advanced practice nurses include teacher,
concurrent emphasis on the need to improve the re- searcher, consultant, administrator, expert
quality and cost of health care for the growing clinician, inde- pendent practitioner, care/case
numbers of older adults has stimulated the manager, individual/group counselor, and
development of new models of care. Most of these multidisciplinary team member/leader. Advanced
models include innovative and expanded roles for practice nurses often manage acute and chronic
nurses. Because these models and the associated conditions of older adults in their roles as primary
roles for gerontological nurses are described in detail care practitioners. GAPNs are knowledgeable about
in Chapter 6, this section focuses on recent normal aging changes as well as common pathologic
developments related to advanced practice nurses. conditions of older adults, and their skills include
A gerontological advanced practice nurse (GAPN) is comprehensive assessments of older adults and
provision of in-depth prevention and health
a registered nurse who holds a degree higher than a
promotion services. Advanced practice nurses have
baccalau- reate and demonstrates clinical expertise in
an important role in long-term care facilities in
the care of older adults. Categories include
improving quality of care through direct care and
gerontological nurse practitioners and gerontological
staff education. Their role in providing direct care in
clinical nurse specialists. State boards of nursing
long-term care facilities has been ex- panding since
define and regulate advanced practice nurses, their
Medicare began covering services of nurse guidelines have been increasing exponentially and
practitioners in 2003. are widely available through reliable Internet sites.
Some excellent resources, such as the Cochrane
Review and the Joanna Briggs Institute, are available
Evidence-Based Practice for only through membership organizations, but many
Gerontological Nursing Standard VII of the trustworthy guidelines are available through
ANA Standards of Professional Geron- tological nonprofit agencies, educational institutions, and
Nursing Performance m andates that gerontological public agencies (e.g., the National Guideline
nurses improve current nursing practice and the Clearinghouse). The Hartford Foundation for
future health care for older adults by participating in Geriatric Nursing offers many cost-free resources
the generation, test- ing, utilization, and evaluation that specifically address evidence-based nursing care
of research findings (ANA, 2001). This standard of older adults (available at
requires nurses at the basic level of practice to ask http://consultgerirn.org/resources). Clin- ically
questions about the care of older adults, participate oriented chapters in this text include evidence-based
in studies to address these questions, and apply practice summarizing pertinent evidence-based
research findings to improve clinical care of older protocols. In addition, the “Resources” sections at
adults. An important role for gerontological nurses is the chapter ends provide information about Internet
to examine evidence from systematic literature sites for evidence-based guidelines and clinical
reviews so that best approaches for care of older practice tools. These sites can be accessed through .
adults can be developed (Houde, 2009).
In recent years, resources for evidence-based
Gerontological Nursing and Health Promotion CHAPTER 5 61

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