- Read the article and provide a summary of the article and any research done. 2-3 paragraphs will be sufficient
- Look at the statistics used in the article. What was the research question (hypothesis)? What parameter would be of interest in this study (population means, population proportion, population standard deviation, etc.) What was the statistical test run in the analysis? (Did they run a regression analysis, Z-test, T-test, ANOVA, etc.) Write 2-3 paragraphs on this.
Geriatric Nursing 41 (2020} 3457346 l:Ll:-Sl:'\\-*'1R Contents lists available at ScienceDirect Geriatric Nursing iournal homepage: www.9njournal.ccm um mgmmmsm NICHE Section Improving care for older adults in the Emergency Department warrants _ greater investment in geriatric nursingStat! \"W Lauren J. Hunt. PhD. RN, FNPBCa'b'* ' Department of Physiological Nursing. University of California. 2 Kore't Way. Box EDEN, San Francisco. CA 94143, United States b Global Brain Health Institute, University ofCalifornia. San Francisco, United States ARTICLE INFO ABSTRACT Article history: Available online 13 April 2020 Keywords: Emergency Department Geriatrics Nursing Care delivery innovations Older adults use the Emergency Department (ED) more than any other age group besides infants. Despite high utilization. both the physical environment and care processes in the traditional ED are poorly suited to address the complex needs of older adults. As a result, older adults often experience poor outcomes in the ED. Geriatric nursing has been at the forefront of etforts to develop Geriatric Emergency Department Inter ventions (GEDI's) to try to address these decits and improve care. As frontline providers with frequent patient contact. nursing brings critical viewpoinu to these issues. This article provides some resources and other ideas for how frontline nurses can improve care for older adults in the ED. Ultimately. to have meaning; ful impacts on care of older adults in the ED. there is a dire need for greater nancial investment specic to geriatric nursing education. training. and research in the ED. 0 2020 Elsevier Inc. All rights reserved. The recent COVID-19 pandemic. with its high infection and death rates among older adults, has underscored just how critical the role of the Emergency Department (ED) is in the care of older adults. But even in \"normal" times. older adultsparticularly the oldest old and those with underlying health conditionsfrequently rely on the ED for care. In the United States (U.S.), older adults account for over 15% of the almost 150 million visits to the ED annually. Older adults in the ED tend to have a higher level of medical urgency, are more likely to undergo extensive diagnostic testing, have longer stays in the ED, and are more likely to be admitted to the hospital subsequent to the ED visit.1 These statistics are even more stark for older adults with additional vulnerabilities. such as older adults with dementia.2 Despite their high utilization of the ED. the traditional ED environ- ment is poorly suited to address the complex needs of older adults. Both the physical design and the processes of care in the ED are designed for the purpose of rapid triage and diagnosisgoals which are not necessarily aligned with the characteristics and needs of older adults.3 For example, equipment crowded into a small exam area and slippery linoleum oors increase fall risk for older adults. Constant beeping of equipment, lack of space for caregivers to accompany patients. and bright uorescent lights on all night may increase risk 'Correspondence to: Department of Physiological Nursing, University of California, 2 Koret Way, Box 605N, San Francisco, (A 94143, United States. E-mail address: lauren.hunt@ucsf.edu httpsjfdoicrgf 10.101 Slj.gerinurse.2020.04.011 0197-45723 see front matter 9 2020 Elsevier Inc. All rights reserved. of delirium. Providers are expected to assess patients in mere minutes, but it is difcult if not impossible to assess the complex medical conditions and subtle presentations of older adults under such circumstances. As a result of the mismatch between care deliv- ery in the ED and needs of older adults, older adults often experience poor outcomes as a result of ED visits. These poor outcomes are well- documented. and include falls. delirium, functional decline, and increased mortality.4 Trailblazing initiatives over the past couple of decades have highlighted the importance of improving care for older adults in the ED, and we see new care models emerging. In 2014. multiple profes- sional organizationsincluding the American College of Emergency Physicians and the Emergency Nurses Association among oth- erscame together to create the Multidisciplinary Geriatric Emer- gency Department Guidelines.5 The purpose of these guidelines was to create standardized recommendations to guide the optimization of care of older adults in the ED. The guidelines include recommenda- tions on structure and processes of care. including stafng. care tran- sitions. infrastructure and policies and procedures. among many others. In 2018, the American College of Emergency Physicians began accrediting facilities as geriatric Emergency Departments. Due to these and other efforts. geriatric Emergency Department interventions and innovations (GEDl's) are becoming more common.'3 The gold standard of these innovations is the standalone geriatric ED 346 LJ. Hunt / Geriatric Nursing 41 (2020) 345-346 unit. These units are modeled upon similar approaches to pediatric critical that geriatric curriculum is infused into the training of all and psychiatric ED's and have designated areas designed specifically nurses. for the special needs of older adults. Physical spaces incorporate the An older adult with an active COVID-19 infection should not also needs of older adults, including nonskid floors, handrails, lighting have to worry about falls and delirium when presenting to the ED. It that follows diurnal patterns, and pressure-reducing air mattresses. is past time to increase efforts to improve care for older adults in the All staff are educated in geriatric principles and specialized geriatrics ED. As the junction between the outpatient and inpatient settings, providers are available for consult. Processes are implemented for there is tremendous opportunity to improve care older adults receive screening older adults for dementia, delirium, and other geriatric not only in the ED itself, but across the spectrum of care. With syndromes. increased recognition of the importance of improving care for older Nursing has been at the forefront of these efforts to improve care adults in the ED and the emergence of GEDI's, we have made some for older adults in the ED across the spectrum of education, practice, strides. But there is still a long way to go. Nursing, in particular geriat- and research. The Nurses Improving Care for Healthcare Elders ric nursing, has been and needs to continue to be at the forefront of (NICHE) has designed resources for patients and caregivers to help these efforts, and funding efforts should reflect the importance of them navigate the ED,' while the Emergency Nurses Association has geriatric nursing to the care of older adults in the ED. developed a comprehensive course on Geriatric Emergency Nursing Education aimed at training nurses to improve outcomes for older Funding adults in the ED. Another resource is the newly formed Geriatric Emergency Department Collaborative, which focuses on interdisci Dr. Hunt is supported through the National Institutes of Health plinary care of the older adult in the ED (see https://gedcollaborative. (KL2 TRO01870); UCSF Pepper Center (P30 AG04428); a National Pal- com/). A number of research studies have examined nurse-led multi- liative Care Research Center Career Development Award; and the disciplinary GEDI's. For example, a study of a Transitional Care Nurse Global Brain Health Institute/Atlantic Philanthropies. model, in which an ED nurse was trained to facilitate care transitions for older adults, reduced subsequent inpatient admissions by References 5%-16%." However, other studies have shown mixed results on the impacts of nurse-led interventions, demonstrating there is still more 1. Rui P, Kang K, Ashman JJ. National hospital ambulatory medical care survey: 2016 work to do to understand the best models of care. 10 emergency department summary tables. 2016. Available from: https://www.cdc. As frontline providers, nurses offer a unique perspective on caring govchs/datahamcs/web_tables/2016_ed_web_tables.pdf. Accessed March 12, 2020. for older adults in the ED. Nurses are the most numerous health pro- 2. Hunt LJ, Coombs LA, Stephens CE. Emergency department use by community- fessionals in the ED and often the first and most frequent point of dwelling individuals with dementia in the United States: an integrative review. J contact for patients. Given their vantage point, nurses bring critical Gerontol Nurs. 2018:1-17. https://doi.org/10.3928/00989134-20171206-01. 3. Hwang U, Morrison RS. The geriatric emergency department. J Am Geriatroc. Ideas for improving care for older adults in the ED, as well as help us 2007;55(11):1873-1876. https://doi.org/10.1111/j.1532-5415.2007.01400.x. understand when interventions fail. Bedside nurses have emphasized 4. Gruneir A, Silver MJ, Rochon J. Rochon PA. Emergency department use by older adults: a lit- the need for interdisciplinary, evidence-based protocols to help pre- erature review on trends, appropriateness, and consequences of unmet health care Med e Res Rev. 2011;68(2):131-155. https://doi.org/10.1177/ vent, detect, and manage geriatric syndromes. Put simply, there is 1077558710379422. no way to improve care for older adults in the ED without the 5. Carpenter CR, Bromley M, Caterino JM, et al. Optimal older adult emergency care: engagement of nursing. introducing multidisciplinary geriatric emergency department guidelines from the How else can nurses take an active role in improving care for older American college of emergency physicians, American geriatrics society, emergency nurses association, and society for academic emergency medicine. Acad Emerg adults in the ED? While there may not be resources to develop a Med. 2014;21(7):806-809. https://doi.org/10.1111/acem.12415. standalone Geriatric ED in their institutions, nurses can advocate for 6. Southerland LT, Lo AX, Biese K, et al. Concepts in practice: geriatric emergency smaller scale interventions that can still have a big impact. For exam- departments. Ann Emerg Med. 2020;75(2):162-170. https://doi.org/10.1016/j annemergmed.2019.08.430. ple, institutions could implement a geriatric practitioner model, 7. Nurses Improving Care for Healthsystem Elders. Need to know for patients and where a clinician geriatric expert, such as a geriatric nurse and/or families: emergency department. https:/icheprogram.org/sitesiche/files/2017- advanced practice nurse, are available for consultations for individual 12/Need-to-Know-Emergency-Department_2017_0.pdf. Accessed March 12, 2020. B. Emergency Nurses Association. Introduction to geriatrics, caring for older patients, as well as responsible for leading education efforts on the adults. https:/f.ena.org/eweb/DynamicPage.aspx?Action=Add&ObjectKeyFro unit. Moreover, nurse educators should ensure that they are teaching m=1A83491A-9853-4087-86A4-F7D95601C2E2&WebCode= principles of geriatric care to all of their staff and students. ENAProductDetail&DoNotSave=yes&ParentObject=CentralizedOrderEntry&Par entDataObject=Invoice%20Detail&ivd_formkey=69202792-63d7-4ba2-bf4e- Nurses can also help push for more financial investment in 10da41270555&ivd_prc_prd_key=100AD883-F6E7-4DB5-9CE2-AF697E97 research, education, and training specific to geriatric nursing through D57A&site=ENA2015. Accessed March 12, 2020. policy advocacy. While the National Cancer Institute receives $600 9. Hwang U, Dresden SM, Rosenberg MS, et al. Geriatric emergency department inno- vations: transitional care nurses and hospital use. J Am Geriatroc. 2018;66 billion in appropriations each year, the National Institute of Nursing 3):459-466. https://doi.org/10.1111/jgs.15235. Research receives a mere $300 million. Funding for the NINR should 10. Malik M, Moore Z, Patton D, O'Connor T, Nugent LE. The impact of geriatric focused be increased and efforts should focus on testing and implementing nurse assessment and intervention in the emergency department: a systematic review. Int Emerg Nurs. 2018;37:52-60. https://doi.org/10.1016/j.ienj.2018.01.008. nurse-led multidisciplinary GEDI's. Moreover, fewer than 1% of regis- 11. Boltz M, Parke B, Shuluk J, Capezuti E, Galvin JE. Care of the older adult in the emer- tered nurses specialize in geriatrics, and this number is declining. We gency department: nurses views of the pressing issues. Gerontologist. 2013;53 need more funding to increase the number of registered and 3):441-453. https://doi.org/10.1093/geront/gnt004. advanced practice nurses pursuing a focus on geriatrics, but it is also 12. Kovner CT, Mezey M, Harrington C. Who cares for older adults? Workforce impli- cations of an aging society. Health Aff Millwood. 2002;21(5):78-89. https://doi.org/ 10.1377/hithaff.21.5.78
