Advanced nurse practitioners can lead comprehensive geriatric assessment in acute hospitals

Simplified Chinese Trauma Advanced Practice Nurses' Core Competency Scale: A development and psychometric validation study

BACKGROUND

The core competency of trauma advanced practice nurses (APNs) is directly related to the quality of trauma nursing work.

OBJECTIVES

To develop an instrument to measure trauma APNs' core competency and examine its psychometric properties.

DESIGN

A cross-sectional psychometric validation study.

PARTICIPANTS

A total of 762 trauma nurses recruited from several tertiary hospitals in 14 different provinces of China between June 2023 and May 2024 provided valid data for analysis.

METHODS

The Simplified Chinese Trauma Advanced Practice Nurses' Core Competency Scale (TAPNCCS-SC) was developed through five steps. Step 1) Creation of the operational definition: Based on the onion model, an operational definition of core competencies for trauma nurses is proposed. Step 2) Item generation: Based on the theoretical model, literature review, semi-structured interviews, and Delphi consultation, a preliminary scale was developed. Step 3) Item content validation: 6 experts reviewed items for content validity; Step 4) Pilot study: 21 nurses were selected to test the readability of the preliminary scale; and Step 5) Psychometric evaluation: Item analysis, content validity, exploratory and confirmatory factor analyses, convergent validity, internal consistency reliability, and half-reliability were conducted.

RESULTS

The TAPNCCS-SC consists of 34 items and three dimensions (knowledge and skills, professional competencies, and occupational qualities). The explained variance of the 3-factor was 81.86 %. The CFA showed an acceptable-fitting 3-factor model (χ2/df = 3.653, RMSEA = 0.088, SRMR = 0.402, CFI = 0.920, IFI = 0.920, and TLI = 0.914). For convergent validity, AVE was 0.784-0.804 and CR was 0.974-0.980. The internal consistency and split-half reliability for the total scale were 0.991 and 0.945, respectively. The I-CVI ranged from 0.83 to 1.

CONCLUSIONS

The proposed scale exhibits high reliability and validity and is suitable for assessing the core competency of trauma APNs, which can help nursing managers plan relevant training and enhance trauma care competency.

Fast-track and person-centred care in geriatric traumatology in a German-speaking Swiss hospital - A practice development project

INTRODUCTION

Elderly persons have an increased risk for negative health-related outcomes, including higher mortality rates. A centre for geriatric traumatology was established in a German-speaking Swiss hospital to provide more specialised, person-centred care and to lower negative health outcomes. Adaptations and changes in the patient pathway were made by implementing fast-track and person-centred care to better address individual needs.

METHODS

The current patient pathway was analysed by an interprofessional and interdisciplinary geriatric traumatology expert team. The practice development methodology and the Person-Centred Practice Framework (PCP-Framework) were used throughout this engagement process. In consensus within the expert team, the sample was defined as elderly persons aged 65 years or older with suspected hip joint closed fractures. The focus was on three elements of "practice environment" from the PCP-Framework. These were: (1) supportive organisational systems; (2) the physical environment; (3) appropriate skill mix.

RESULTS

Several adaptations and changes were made addressing the three elements of "practice environment". These were for example: (1) use of specific assessments, shared decision-making; (2) proper and effective use of aids; (3) integration of Advanced Practice Nurses. The adaptations in the patient pathway were integrated into the standard operating procedures.

CONCLUSIONS

Through active engagement with the practice development methodology and the focus on person-centredness, the process of care for elderly persons was adapted. Thus, by addressing individual needs, fast-track and person-centred care in geriatric traumatology is provided. Further research is needed to evaluate and to verify implications in clinical practice.

[Supporting the frail elderly: from resilience to reducing hospitalizations]

The frail elderly population will most certainly continue to grow in the coming years. Consequently, the number of hospitalizations and the iatrogenic dependence linked to them will increase. In this context, it seems interesting to question frailty. Indeed, accompanying, in ambulatory care, these patients towards a resilient behavior is one of the roles of advanced practice nurses, which it would be judicious to deepen in order to decrease the recourse to hospitalization.

Use of a nursing-led geriatrics consult service to deliver age-friendly care

The Elder Veteran Program (EVP) is a nursing-led approach to deliver inpatient consultative geriatrics care at our academic Midwestern Veterans Hospital. From April to December of 2021, EVP modified its workflow using a Plan-Do-Study-Act approach to include previously under-addressed components of the IHI's "4M's" of Age-Friendly Care (Medication, Mobility, Mentation, and What Matters), with three months of retrospective data review as a Plan phase, three months of monthly Do and Study phases, and a three month Act phase to analyze post-intervention care. We found improvements in frequency of documentation of Medication, Mentation, and What Matters in EVP notes, and maintenance of Mobility documentation. Next steps include translating these documentation and workflow changes into other relevant outcome measures and outreach to other departments. Overall, our project demonstrates a novel way to integrate these Pillars into a hospital system, by leveraging an existing nursing-led geriatric consult service focused on prevention and education.

Risk factors for poor outcome in older patients admitted in a surgical intensive care unit

BACKGROUND

The benefit of a stay in an intensive care unit (ICU) is not certain for older patients, particularly in the surgical context.

AIMS

The objective of this study was to identify the factors associated with an unfavourable outcome in this population.

DESIGN

Prospective, descriptive, monocentric study conducted in the surgical ICU of a French university hospital.

METHODS

Patients aged ≥75 years admitted in the surgical ICU for a predicted length of stay ≥48 hours were included. Patients received an initial and a 6-months nutritional and functional assessment performed by physicians and nurses. The outcome was considered as favourable if the Katz Activities of Daily Living (ADL) variation (ADL delta = 6-months ADL - ICU admission ADL) was between 0 and -0.5 point 6 months after ICU discharge and unfavourable if the ADL delta decreased by more than 0.5 points or if the patient had died 6 months after ICU discharge.

RESULTS

Fifty-six patients-32 (57%) male-aged 79 [77; 83] y were included. ICU mortality was 19%; 6-month mortality was 22%. Median ADL delta was -0.5 [-0.5-0] points. A low ADL score (P = .0438) and a low albumin level (P = .0213) at admission were the two independent factors associated with an unfavourable outcome.

CONCLUSION

Mortality and loss of independence were high in this elderly population during and after their surgical ICU stay. The benefit of a systematic collaboration between intensive care specialists, ICU nurses, and geriatricians, to assess and manage nutritional and functional problems and to prevent a pejorative outcome in patients over 75 years old admitted in surgical ICU needs to be studied.

RELEVANCE TO CLINICAL PRACTICE

There should be systematic screening for objective markers of undernutrition and frailty on ICU admission of older patients as they are associated with a poor prognosis.

Implementing a multidisciplinary rapid geriatric observation unit for non-critical older patients referred to hospital: observational study on real-world data

BACKGROUND

Geriatric rapid observation units may represent an alternative to hospitalization in older patients with non-critical acute illness.

AIMS

To describe the characteristics and outcomes of patients admitted to a geriatric observation unit called URGe (Unità Geriatrica Rapida), implemented in an Italian hospital and characterized by multidisciplinary medical staff with geriatric expertise, fast-track access to diagnostic resources, regular use of point-of-care ultrasound and predicted length of stay (LOS) < 72 h.

METHODS

The medical records of patients admitted to URGe during a 3-month period (452 subjects, 247 F and 205 M, median age 82 years, IQR 77-87) were retrospectively examined. The primary study endpoint was transferral from URGe to regular wards. Baseline covariates included demographics, comprehensive geriatric assessment, acute illnesses, comorbidities, vital signs and routine laboratory tests.

RESULTS

Despite elevated burden of multimorbidity (median number of chronic diseases 4, IQR 2-5) and frailty (median Rockwood Clinical Frailty Scale score 4, IQR 3-6), only 137 patients (30.3%) required transferral from URGe to regular wards. The main factors positively associated with this outcome were Rockwood score, fever, cancer and red cell distribution width (P < 0.05 on multivariate logistic regression model). The rate of complications (mortality, delirium, and falls) during URGe stay was low (0.5%, 7% and 2%, respectively). Overall duration of hospital stay was lower than that of a group of historical controls matched by age, sex, main diagnosis, multimorbidity and frailty.

CONCLUSIONS

The URGe model of acute geriatric care is feasible, safe and has the potential of reducing unnecessary hospitalizations of older patients.

The characteristics and practice proficiency of nurse practitioners who care for older adults

Roughly 54 million Americans are 65 years of age or older. Given the number of comorbid diseases reported in older adults, healthcare tailored to the specific needs of this population is imperative. Nurse practitioners (NPs) are uniquely positioned to provide care to older adults; yet little is known about the geriatric-oriented NP workforce. In this study, four professional organizations distributed a survey link to their members who were queried on their demographic, employment, and practice characteristics; one organization's members responded to a previous survey, providing two time points for comparison. Compared with 2016 respondents, there was minimal growth in diversity, fewer who practice in suburban or rural areas, and restrictions on clinical education related to the ongoing pandemic. The findings from this study should alert policymakers of the need to address the development of an adequate workforce of clinicians who specialize in geriatrics.

Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review

OBJECTIVES

In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK.

DESIGN

A scoping review was undertaken following JBI methodological guidance.

METHODS

13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative.

RESULTS

191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway.

CONCLUSION

This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.