Geropsychiatric Nursing Research Articles

Theoretical Substruction of Resilience Theory: Dementia Caregivers' Burden and Their Care Recipients' Behavior.

Theoretical substruction is vital in clarifying models and guiding research. In this article, the process of theoretical substruction was examined through resilience theory to provide an example of the congruence between theoretical and operational definitions in nursing research. The author examines the significance of resilience theory in the context of dementia caregivers' burden and their care recipients' behavioral problems. The steps of theoretical substruction are included, and a model of resilience is presented that includes middle-range concepts, relational statements, and propositions derived from the research literature. The rigorous process of theoretical substruction provides an example of a theoretically sound basis for exploring the role of positive thinking in the lives of dementia caregivers and their care recipients. Geropsychiatric nurses working with dementia patients and their caregivers should consider the role of positive thinking in decreasing caregivers' burden.

THE GEROPSYCHIATRIC NURSING COLLABORATIVE: ADDRESSING BEHAVIORAL NEEDS OF PERSONS WITH DEMENTIA

Abstract Over the last decade, the Geropsychiatric Nursing Collaborative (GPNC) has sought to improve care of older adults with mental health needs such as those with dementia. Geropsychiatric nurses are well-poised to deliver person-centered care to address the psychosocial needs of persons with dementia, which may include behavioral expressions. In this interdisciplinary symposium, we will highlight approaches members of the GPNC are taking to address mood and behavior in persons with dementia. The first session will describe how persons with mild-cognitive impairment draw upon their inner strength after they receive a diagnosis. The second session will discuss how common behavioral expressions such as anxiety, depression and apathy contribute to difficulty with everyday functional activities in persons with Alzheimer’s disease. The third session will describe an interprofessional communication tool to improve communication of behavioral expression in the nursing home setting. The last session will share findings from a nurse practitioner-led team care management model to address cognitive vulnerability in older adults with dementia, depression, and/or delirium. Together, these presentations describe how geropsychiatric nurses are investigating mood and behavioral symptoms in persons with dementia and addressing their mental health needs with innovative person-centered interventions.

Effectiveness of a Problem-Based Geropsychiatric Nursing Clinical Internship Program

Clinical internships that effectively incorporate the care of older adults with mental health disorders are sparse in many countries, including Taiwan. This study investigated the effectiveness of a problem-based geropsychiatric clinical internship program for nursing students in Taiwan. We conducted a quasi-experimental study among 126 nursing students. Experimental and control groups received problem-based geropsychiatric and general psychiatric practice sessions, respectively. Knowledge, attitude, skills, and self-reflection were evaluated before (T1) and after (T2) measurements. There were no significant differences between the groups in knowledge, attitude, skills, and self-reflection at T1. At T2, knowledge was significantly higher in the experimental group (t = 2.39, p = 0.02). Attitude, skills, and self-reflection ability did not differ between the groups at T2. Our results showed that clinical problem-based approaches can be applied in geropsychiatric mental health nursing internship programs. The problem-based approach was helpful in improving nursing students’ knowledge about psychiatric symptoms and the health problems of older adults with mental illness. However, it did not significantly enhance or change the attitudes, skills, or the ability to self-reflect among students.

Supporting evidence for geropsychiatric nursing as a subspecialty of gerontological advanced practice nursing

Advanced practice nurses (APRNs) make significant contributions to the mental health of older adults. Despite the surge in the number of older adults, the number of APRNs choosing educational preparation for geropsychiatric nursing (GPN) is limited. The purpose of the GAPNA GPN Position Statement is to sustain a new vision for the nursing profession that will improve the care of older adults with psychiatric and mental health disorders. This position paper was written by a diverse group of APRNs with the collective intent to reflect respect, decrease stigma, remove controversy, and uphold a positive, person-centered approach to mental disorders among older adults and their families. The GAPNA GPN Position Statement was written to advance excellence in the GPN subspecialty, provide holistic care for older adults and make recommendations for practice. Blending gerontological and psychiatric nursing results in a subspecialty at the top of the APRN Consensus Model pyramid.

Advances in geropsychiatric nursing: A decade in review

This article provides a brief overview of the early development of geropsychiatric nursing (GPN) as background for examining its advancement subsequent to the 2010 Future of Nursing (FON) Report. The FON's education, practice and leadership recommendations form the three pillars that have supported geropsychiatric nursing's continuing evolution, framed within a practice and policy perspective. Lessons learned are relevant to developing the next phase of FON recommendations. The importance of overcoming challenges faced by the field of GPN is supported by the aging global population, the directions of nursing as a discipline, and the clear necessity of an intra- and inter-professional approach to mental health and aging.

Evaluating the Effectiveness of an Educational Intervention for Care of Anemic Patients in a Long-Term Care Geropsychiatric Unit: A Pilot Study.

Anemia is one of the most common age-related health conditions. When concurrently present with psychiatric conditions, the problem is confounded. The primary objective of the current research was to evaluate the effectiveness of an educational intervention for geropsychiatric nurses about nutritional deficiency anemia, anemia of chronic disease, and unexplained anemia in older adults. Fifty nurses employed by an inpatient psychiatric facility participated in the pilot study. A 10-item knowledge evaluation questionnaire was administered prior to and following a 45-minute educational intervention. Analysis of a paired samples t test indicated a significant difference between pretest scores (mean = 36.8, SD = 16.3) and posttest scores (mean = 90.8, SD = 10.66) (p < 0.001). Despite initial knowledge gaps, significant improvement in nursing knowledge was noted following the intervention. As a result of improved knowledge, RNs may be better able to recognize and respond to signs and symptoms that commonly go unnoticed in geropsychiatric patients with anemia. [Journal of Gerontological Nursing, 46(8), 12-16.].

Integrating Geropsychiatric Nursing and Interprofessional Collaborative Practice Competencies Into Adult-Gerontology Clinical Nurse Specialist Education.

Specific changes to the national clinical nurse specialist (CNS) certification are necessitating a move away the psychiatric/mental health (P/MH) CNS population focus. However, a rapidly increasing older adult population with P/MH comorbidities such as depression and anxiety means that the adult-gerontology CNS (AGCNS) will likely be coordinating much of the complex care needs of this vulnerable population. Therefore, strategies are needed to ensure AGCNSs are competent in advanced practice P/MH nursing. In addition, at this critical time in the redesign of healthcare, the Institute of Medicine has made interprofessional practice center stage for healthcare professional education. Therefore, the purpose of this manuscript is to propose aligning the current AGCNS population-focused competencies with the CNS geropsychiatric nursing competency enhancements and interprofessional collaborative practice education competencies. Examples of the proposed alignment and educational application strategies are presented. When AGCNS educational curricula encompass P/MH nursing at an advanced level from an interprofessional perspective, future AGCNSs will continue to be positioned to make significant contributions to the design of care systems and monitor and trend important outcomes, while ensuring safe and efficient, high-quality healthcare for older adults with P/MH comorbidities.

The Current State of U.S. Geropsychiatric Graduate Nursing Education: Results of the National Geropsychiatric Graduate Nursing Education Survey.

Advanced Practice Registered Nurses (APRNs) must be prepared to care for the rapidly increasing numbers of older adults with mental health needs. All 363 graduate nursing programs in the United States were surveyed regarding the nature and extent of geropsychiatric nursing (GPN) content across program curricula and their perceptions of the influence that the APRN Consensus Model has exerted on preparing the next generation of APRNs to meet the growing needs of the older adult population. Of the 202 schools responding, 138 reported GPN content in one or more clinical programs, with the majority of content in non-PMHNP programs. Only 17 schools reported offering a GPN program, track, or minor. The majority of schools (n = 169) perceived that they were adequately well-prepared to meet the APRN Consensus Model's guidelines regarding inclusion of aging-related didactic and clinical educational experiences in all APRN education programs; nearly two thirds (n = 132) perceived a moderate to significant influence of the Consensus Model on institutional infusion of GPN into curricula. Compared with a similar survey 10 years ago, there was little change in the proportion of schools reporting GPN in clinical programs and few schools provide GPN programs, tracks, or minors. Implications for nursing education and practice are discussed.

Trends and Opportunities in Geropsychiatric Nursing: Enhancing Practice Through Specialization and Interprofessional Education

Forecasted changes in the demographics of the United States suggest there will be an unprecedented need for health care professionals with specific training in geropsychiatric care. An aging society, the dearth of geropsychiatric health care professionals, the shortage of educators, and the lack of interprofessional geropsychiatric education require new strategies for nursing education to address these issues. The vision of the Institute of Medicine serves as a foundation for transforming geropsychiatric nursing and interprofessional education to prepare the next generation of nurses and the geropsychiatric workforce to improve the mental health care of older adults. This article aims to describe the importance and implications of implementing the recently released Geropsychiatric Nursing Competency Enhancements and the Core Competencies for Interprofessional Collaborative Practice to improve the mental health care of older Americans. A secondary aim is to discuss how to overcome barriers in implementing interprofessional education in geropsychiatric nursing care.

Filling the void in geriatric mental health: The Geropsychiatric Nursing Collaborative as a model for change

Mental health for older adults is a looming public health problem. Yet, geriatric mental health specialists are a scarce commodity, and few generalists have had formal education in either geriatrics or mental health. A multilevel collaboration using a diffusion of innovation model served to achieve change nationally in preparing entry-and advanced practice–level nurses to improve the mental health of older Americans. The John A. Hartford Foundation Geropsychiatric Nursing Collaborative at the American Academy of Nursing is the exemplar described here. The Geropsychiatric Nursing Collaborative developed and infused mental health competency enhancements for generalist and specialist nurses; identified and disseminated teaching-learning strategies to convey related key concepts using the POGOe (Portal of Geriatric Online Education) website; raised awareness through multiple presentations and publications; and notified deans of every school of nursing about these new resources. Fully embracing diffusion of innovation principles, the Geropsychiatric Nursing Collaborative is achieving change in this critical area of nursing practice.

S13-03 - Dialogue and challenge among different specialities

IntroductionThanks to social, technological, and medical advances occurred during the last century, the aging of the population has become a worldwide phenomenon (Kinsella, 2002). The high socio-economic impact of this demographic transition has recently stimulated a growing interest for the aging process (Lunenfeld, 2008) and elderly mental health has been receiving increasing attention (Mental Health in Older People. Consensus, 2008).ObjectiveOld age psychiatry, or psychogeriatric, deals with psychiatric conditions that predate the ageing process such as schizophrenia or depression, and with diseases occurring later in life like dementia and other cognitive disorders. To cope with the increased workload due to older people, Psychiatric Services are required to provide multidisciplinary, comprehensive and integrated care.AimsTo investigate the attitude of Bologna's Psychiatric Services in the care of elderly affected by psychiatric disorders.MethodsSelf-completed questionnaires administered to psychiatrists.ResultsPsychogeriatric is the second main priority of psychiatry for the new millennium. Psychiatrists working in liason-consultation settings take care of around 20 elderly patients per weeek. Sedation, insomnia and resistant-depression treatment are the most frequent interventions required to psychiatrists by colleagues of other specialities. Psychiatrists report feelings of un-satisfaction and worries for potential drugs side-effects. They “don't like much” dealing with elderly people especially with patients affected by un-treatable conditions such as dementia (narcissistic wound?).ConclusionAccessible and responsive services working in liason with other medical specialists, gero-psychiatric nurses, case manager and social workers might be a good response to the increasing needs of elderly with mental health disorders.

The SeniorWISE Study: Improving Everyday Memory in Older Adults

We tested whether at-risk older adults receiving memory training showed better memory self-efficacy, metamemory, memory performance, and function in instrumental activities of daily living than participants receiving a health promotion training comparison condition. We followed participants for 26 months. The sample was mostly female (79%) and Caucasian (71%), with 17% Hispanics and 12% African Americans; average age was 75 years, and average education was 13 years. The memory training group made greater gains on global cognition and had fewer memory complaints, but both groups generally maintained their performance on the other cognitive measures and instrumental activities of daily living (IADLs) throughout the 24-month study period. Black and Hispanic participants made greater gains than Whites did on some memory performance measures but not on memory self-efficacy. The unexpected finding that minority elders made the largest gains merits further study. This study contributed to the knowledge base of geropsychiatric nursing by providing evidence for an effective psychosocial intervention that could be delivered by advanced practice nurses.

Theoretical Substruction Illustrated by the Theory of Learned Resourcefulness

This article describes the process of theoretical substruction and uses this process to examine the significance of Rosenbaum's resourcefulness theory for nursing research and practice. The article discusses relocation as a phenomenon of interest to gero-psychiatric nurses working with elders who have relocated to retirement communities, illustrated by the theory of learned resourcefulness. The literature was reviewed to assess the congruence between the theoretical and operational systems suggested by Rosenbaum's resourcefulness theory. A model of learned resourcefulness is presented that includes middle-range concepts, relational statements, and propositions derived from the research literature. Theoretical substruction provides a mechanism for testing middle-range theories that may contribute to nursing knowledge development.

Graduate education in geropsychiatric nursing: Findings from a national survey

By 2030, the numbers of older adults with mental illness will strain our health care system. Sufficient advanced practice nurses (APNs) with specialized knowledge to provide care will be critical. All 339 graduate nursing programs in the US were surveyed regarding the extent and nature of geropsychiatric nursing (GPN) content in their curricula. Of 206 schools responding, 15 reported having a GPN subspecialty. Regarding the 60 schools with a psychiatric/mental health nursing (PMHN) graduate program, only one third (n = 23) included some GPN content, while more than half (n = 116) of all schools reported integration of GPN content in a non-psychiatric nurse practitioner program. Thus, currently, the greatest numbers of APNs receiving education on mental health needs of older adults are prepared in non-psychiatric nurse practitioner programs. This article discusses the implications for nursing education and practice.

Geropsychiatric Nursing: An Underrecognized Specialty

Undergraduate nursing students often do not view geropsychiatric nursing as a specialty they would consider upon graduation. This article reveals that students who are given the opportunity to interact one-on-one with an older adult may change their viewpoint about becoming involved in this specialty.

A Commentary on the Future of Geropsychiatric Nursing Practice: Definition, Education, and Advocacy

Positioning geropsychiatric nursing (GPN) to meet the challenges of providing care to a growing population of older adults demands enhanced clarity in how the specialty defines the scope and focus of its practice. A distinctive professional profile will facilitate innovative approaches to other essential tasks: educating nurses as well as policy makers and the public about the unique contributions of GPNs to mental health care; advocating for more equitable treatment in the arenas of research support, reimbursement, and full participation on multidisciplinary clinical teams; and organizing GPNs into a critical mass capable of speaking with one compelling voice.

Geropsychiatric Nursing Practice in the United States: Present Trends and Future Directions

Demographic trends, diversification of geriatric health care service settings, and advances in education and science call for redefining the context and mission of geropsychiatric nursing (GPN) practice. The challenges of providing preventive, restorative, and palliative care for older adults who move across health care and residential settings demand that geropsychiatric nurses be theoretically well grounded, family centered, expert in multiple assessment skills, and clinically adept across the full biopsychosocial spectrum. This article provides “snapshots” of the educational and career paths that led four nurses into GPN practice. Noting that the extant literature is more descriptive of practice models than suggestive of efficacy, the article offers a series of recommendations that emphasize the need for evaluations of GPN practice.

A Dialogue With Senior Thought Leaders in Geropsychiatric Nursing: Summary and Synthesis

A highlight of the Geropsychiatric Nursing: State of the Future Conference (September 30, 2005, Philadelphia, PA) was the “Dialogue With Senior Thought Leaders.” Moderated by Claire Fagin, PhD, RN, FAAN, the panelists discussed among themselves and with the audience their perspectives on the current state and future direction of geropsychiatric nursing (GPN). Broad concepts emerged from this discussion and are summarized here: health disparities and minority health, implementation barriers and cost-effectiveness, emerging settings of care, evolving research and education for GPNs, development of a critical mass of support resources, and the issue of GPN certification. Directions for growth in these areas were identified.

Geropsychiatric Nursing: Planning for the Future

A strategic planning format comprised three small group sessions focused on research, education, or practice followed by a large group meeting in which common priority areas were identified. These were to achieve field identity and definition, enhance translational and interdisciplinary research and dissemination, and secure human and organizational resources. Meeting these goals will require effective strategies and fiscal resources to recruit scientists, educators, and clinicians to the field; change attitudes within and outside nursing; and build on previous successes in psychiatric mental health and gerontological nursing. Common strategies to address these priorities spanned three main areas: visibility, communication, and marketing; leveraging the related activities of partner organizations and other entities; and developing leadership.

Geropsychiatric Nursing Education: Challenge and Opportunity

With the emergence of the mental health needs of older adults as a foremost public health concern of the 21st century, the melding of gerontological and psychiatric expertise among frontline health care providers assumes unprecedented urgency. Undergraduate and graduate educational preparation and continuing education learning strategies to develop and support a geropsychiatric nurse workforce will be critical to enhancing the quality of lives of millions of older persons. Opportunities abound for creativity in curriculum development accompanied by systematic evaluation of workforce outcomes and dissemination of successful educational models. Attention to these needs will facilitate long-stymied efforts to achieve advanced practice certification in geropsychiatric nursing.