A Concept Analysis of Vulnerability During Transitions.

AIM: Define the concept of vulnerability during transitions. BACKGROUND: There is a need to produce RNs with the knowledge, skills, and attitudes (KSAs) necessary to care for the growing older adult population. The NLN Advancing Care Excellence for Seniors (ACE.S) project developed a framework to help faculty and pre-licensure students develop these KSAs. Key to this framework is the concept of vulnerability during transitions. METHOD: Rogers and Knafl's evolutionary method of concept analysis. RESULTS: The analysis revealed two antecedents (use of multiple medications to treat disease, fragmentation of the health care system), two attributes (inadequate continuity of care, poor communication and coordination of care among health care providers, patients, and families), and two consequences (readmission to a previous or new care setting, potential negative health outcomes). CONCLUSION: Knowledge of the antecedents, attributes, and consequences of vulnerability during transitions will facilitate improved care for older adults in all setting.

Complexity of Care: A Concept Analysis of Older Adult Health Care Experiences.

PURPOSE: To define the term complexity of care. BACKGROUND: The aging population and lack of gerontological preparation in pre-licensure nursing programs are pressing issues. The NLN Advancing Care Excellence for Seniors (ACE.S) project developed a framework to facilitate faculty and student understanding of older adults' care needs. Integral to the framework is the concept of complexity of care. METHOD: Rogers and Knafl's evolutionary method of concept analysis was used. RESULTS: The analysis identified three antecedents (focus on treatment and cure of disease, multiple comorbidities, and life experiences and culture), five attributes (polypharmacy, use of advanced technologies, novel care models, a fragmented health care system, and the relational nature of caregiving), and two consequences (impact on quality of life and impact on quality of care). CONCLUSION: Defining the concept of complexity of care will facilitate student understanding of the unique health care needs of older adults.

A concept analysis of individualized aging.

AIM: This analysis sought to define the concept of individualized aging. BACKGROUND: The growing older adult population and shortage of health professionals with adequate knowledge of their specialized needs will strain the health care system. The National League for Nursing's Advancing Care Excellence for Seniors (ACES) project has addressed this challenge. The ACES framework identifies three unique concepts integral to delivering high quality care. Clarification of these concepts is needed for educational and research purposes. METHOD: Rogers and Knafl's evolutionary method of concept analysis was used. RESULTS: The analysis identified two antecedents (past experiences and biological aging processes), three attributes (heterogeneity, living with age-related changes and multiple chronic conditions, and risk for complications), and two consequences (complexity of care over time and variability in health outcomes). CONCLUSION: Knowledge of the antecedents, attributes, and consequences of individualized aging will allow health care providers to improve the care of older adults.

Factors Influencing RNs' Perceptions of Quality Geriatric Care in Rural Hospitals.

The rapidly aging population and their frequent use of hospital services will create substantial quality challenges in the near future. Redesigning rural hospital work environments is the key to improving the quality of care for older adults. This study explored how the work environment influences registered nurses' (RNs') perceived quality of geriatric care in rural hospitals. We used an exploratory mixed-methods research design emphasizing the qualitative data (in-depth, semi-structured interviews). Quantitative data (questionnaire) measuring the RN work environment were also collected to augment qualitative data. Four themes emerged: (a) collegial RN relationships, (b) poor staffing/utilization, (c) technology benefits/challenges, and (d) RN-physician interactions, which were identified as key factors influencing the quality of geriatric care. We concluded that rural hospital work environments may not be optimized to facilitate the delivery of quality geriatric care. Targeted interventions are needed to improve overall quality of care for hospitalized older adults in rural settings.

Utilization of a benchmarking database to inform NICHE implementation.

An integral part of NICHE (Nurses Improving Care for Healthsystem Elders) is a benchmarking service that provides member sites with the ability to evaluate staff perceptions of the care environment compared with other NICHE sites. The NICHE Database includes more than 100,000 surveys (Geriatric Institutional Assessment Profile). This study aimed to explain how secondary analyses of this aggregate database can inform effective geriatric programming in hospitals. We found that nurse age and experience influence nurse perceptions of organizational alignment to NICHE guiding principles and that those perceptions improve following NICHE implementation. The NICHE Database addresses knowledge generation in key areas of geriatric nursing practice and assists hospitals' systemic capacity to effectively embed NICHE Guiding Principles: evidence-based geriatric knowledge, patient-family centered care, healthy and productive practice environment, and multidimensional metrics of quality. It contributes to the growing field of implementation science that seeks to promote the uptake of research findings into clinical practice.

Work environment factors other than staffing associated with nurses' ratings of patient care quality.

BACKGROUND: The impact of registered nurse (RN) staffing on patient care quality has been extensively studied. Identifying additional modifiable work environment factors linked to patient care quality is critical as the projected shortage of approximately 250,000 RNs over the next 15 years will limit institutions' ability to rely on RN staffing alone to ensure high-quality care. PURPOSE: We examined the association between RNs' ratings of patient care quality and several novel work environment factors adjusting for the effects of two staffing variables: reported patient-to-RN ratios and ratings of staffing adequacy. METHODOLOGY: We used a cross-sectional, correlational design and a mailed survey to collect data in 2009 from a national sample of RNs (n = 1,439) in the United States. A multivariate logistic regression was used to analyze the data. FINDINGS: Workgroup cohesion, nurse-physician relations, procedural justice, organizational constraints, and physical work environment were associated with RNs' ratings of quality, adjusting for staffing. Furthermore, employment in a Magnet hospital and job satisfaction were positively related to ratings of quality, whereas supervisory support was not. PRACTICE IMPLICATIONS: Our evidence demonstrates the importance of considering RN work environment factors other than staffing when planning improvements in patient care quality. Health care managers can use the results of our study to strategically allocate resources toward work environment factors that have the potential to improve quality of care.

Work environment factors other than staffing associated with nurses' ratings of patient care quality.

BACKGROUND: The impact of registered nurse (RN) staffing on patient care quality has been extensively studied. Identifying additional modifiable work environment factors linked to patient care quality is critical as the projected shortage of approximately 250,000 RNs over the next 15 years will limit institutions' ability to rely on RN staffing alone to ensure high-quality care. PURPOSE: We examined the association between RNs' ratings of patient care quality and several novel work environment factors adjusting for the effects of two staffing variables: reported patient-to-RN ratios and ratings of staffing adequacy. METHODOLOGY: We used a cross-sectional, correlational design and a mailed survey to collect data in 2009 from a national sample of RNs (n = 1,439) in the United States. A multivariate logistic regression was used to analyze the data. FINDINGS: Work group cohesion, nurse-physician relations, procedural justice, organizational constraints, and physical work environment were associated with RNs' ratings of quality, adjusting for staffing. Furthermore, employment in a Magnet hospital and job satisfaction were positively related to ratings of quality, whereas supervisory support was not. PRACTICE IMPLICATIONS: Our evidence demonstrates the importance of considering RN work environment factors other than staffing when planning improvements in patient care quality. Health care managers can use the results of our study to strategically allocate resources toward work environment factors that have the potential to improve quality of care.

Quality care for older adults: the NLN Advancing Care Excellence for Seniors (ACES) project.

There is a significant need to improve the amount and quality of gerontological nursing content in pre-licensure nursing programs in the United States.The National League for Nursing's Advancing Care Excellence for Seniors (ACES) project is designed to enhance gerontological nursing content in all pre-licensure nursing programs. Nurse educators can use the ACES framework to engage nursing students in studying the care of older adults through innovative and unique teaching/learning strategies, such as unfolding cases and simulation.The ACES framework, which includes the ACES Essential Knowledge Domains and Nursing Actions, is designed to enhance gerontological nursing content in pre-licensure nursing programs without adding additional content to curricula. Use of the ACES framework in pre-licensure nursing programs will help promote quality care of older adults in a variety of settings.

Gerontological nursing content in general medical/surgical textbooks: where is it?

To provide quality care to the rapidly growing aging population, nursing education will need to be transformed. Although several approaches will be used to meet this challenge, fundamental to most nursing programs is the use of a general medical/surgical nursing textbook. This article examines the quantity and quality of gerontological nursing content found in five general medical/surgical nursing textbooks published between 2009 and 2011. The analysis shows that gerontological nursing content is poorly covered and of low quality. The findings point to the need to work with publishers to improve the quality and depth of content related to care of older adults in nursing textbooks.

Early career RNs' perceptions of quality care in the hospital setting.

The purpose of this study was to explore early-career registered nurses' perceptions of high-quality nursing care in hospitals. The study findings contribute to ongoing work intended to explore and define what quality nursing care is and how it ultimately impacts patients. The final sample analyzed for this article consisted of 171 narrative responses from hospital-based registered nurses. We used Krippendorff's technique for qualitative content analysis to identify themes. Three themes emerged as integral to high quality nursing care: registered nurse presence, developing relationships, and facilitating the flow of knowledge and information. Development of nursing quality indicators should focus on nursing processes in addition to patient outcomes. Such a focus would better capture the complexity of hospital nursing care.