Experience of Nursing Practice roles of Advanced Practice Nurse (APN) Sunee Suwanpasu RN, APNs Aging, Ph.D. Nursing Department, King Chulalongkorn Memorial HospitalThai Red Cross Society ฝ่ายการพยาบาล โรงพยาบาลจุฬาลงกรณ์ สภากาชาดไทย “ The Future of Nursing and Caring for Geriatric Patients” Conference in Bumrungrad Hospital 31 October 2013
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Experience of Nursing Practice roles of
Advanced Practice Nurse (APN)
Sunee Suwanpasu RN, APNs Aging, Ph.D.
Nursing Department, King Chulalongkorn Memorial HospitalThai Red Cross Society
• Optimizing functional status is a central tenet of geriatric practice (editorials in JGIM)
ฝายการพยาบาล โรงพยาบาลจฬาลงกรณสภากาชาดไทย
ฝายการพยาบาล โรงพยาบาลจฬาลงกรณสภากาชาดไทย
เปาหมายทส าคญในการดแลผสงอายในโรงพยาบาล
• Preserve functional capacity of older patients
• Increase safety: falls; pressure ulcer, acute confusion state
• Help increase comfort
• 40.4% of patients developed functional decline following hospitalization ( Wu et al. 2006)
• Before admission’ advanced age, Lower MMSE, IADL disabilities Presence of pressure ulcer, ADL disabilities, low social activities (HARP study)
• Hospitalization, Hypoalbuminaemia, pressure ulcer, LOS, tendency to fall (WU etal., 2006)
• Bed rest, or acute inactivity associated with hospitalization or disease state, posed a potent threat to muscle tissue and function capacity (Covinsky et al., 2003:Brown et al.2004; Janssen, 2006)
reasoning and ethical decision making)สมรรถนะท ๘ มความสามารถในการใชหลกฐานเชงประจกษ (Evidence-Based Practice)สมรรถนะท ๙ มความสามารถในการจดการและประเมนผลลพธ (outcome management and
evaluation)
ฝายการพยาบาล โรงพยาบาลจฬาลงกรณสภากาชาดไทย
การพฒนาระบบ
จดการดแลผ สงอาย
ในโรงพยาบาล
การจดการและ
ประเมนผล
การดแลโดยตรง(มผลลพทและเปนทประจกษ
*การเปนทปรกษา
*การน าการเปลยนแปลง
ฝายการพยาบาล โรงพยาบาลจฬาลงกรณสภากาชาดไทย
Nurses Improving Care for Health system Elders
(NICHE)
• The NICHE nursing care models
– Geriatric Resources Nurse (GRN model)
• Provide excellent bedside nursing to hospitalized older adults
• Develop a corps of nurses armed with the clinical competencies to meet the needs of older adult, and serve as a resources to other staff
• Develop incentives and improve moral for nurses caring for the older adult
• Provide a mechanism for professional growth of nurses
• Enhance the nurse/patient relationship and patient satisfaction
• Promote the effectiveness of the interdisciplinary team
• Increase implementation of evidence-based clinical practice
• Facilitate safe and effective discharges
• Promote continuity of care between the hospital and other setting
Focus on the care needs of the older patients
ฝายการพยาบาล โรงพยาบาลจฬาลงกรณสภากาชาดไทย
From the beginning
•Advanced Practice geriatric Nurse
•GRNs unit-based RN’s volunteer with a knowledge requirement
•Nursing clinical round
•Internal medicine physician provide consultation
Lecture
- Small talk
Regularly scheduled
-2 times for wks
Clinical teaching rounds with a
geriatric expert to address specific
patient issues and integrate new
geriatric knowledge
Having the staff nurses routinely
monitor and address common
geriatric syndromes and
share their knowledge with
other staff
Evaluation
Chula GRN model: improving the care of older
patients in medicine unit
ฝายการพยาบาล โรงพยาบาลจฬาลงกรณสภากาชาดไทย
During round
GRN present a brief synopsis of • The patient’s history
• Course of hospitalization
• Treatment and expected outcome
• Unresolved issues
• Comprehensive assessment of hospitalized older patients
Chula SPICCES
Patient Name:
Date:
SPICCES EVIDENCE YES No
Sleep disorder
Problems with Eating or Feeding
Incontinence
Caregivers preparedness
Evidence of falls
Skin breakdown
REMARK...................................................................................................................................................................................................................Adapted from a frameworks of six 'maker conditions of Fulmer, T. (1991) The Geriatric Nurse Specialist Role: A new Model. Nursing Management, 22(3), 91-93
Best practices in Nursing Care to older adults (The Hartford Institute for Geriatric Nursing)
• Resistance exercise and Walking program with coordination with PT& OT
• Guidelines and position stands outlining nutritional standards of care for hospital patients; a high quality protein with each meal and essential amino acid (EAA)
• Behavioral Methods for Urinary IncontinenceBladder training, habit training, biofeedback, pelvic muscle exercises, timed voiding and prompted voiding.
•Ensure assistive devices
•Use environmental enhancement for eldercare
•Skin care
•Minimizing the use of sedative-hypnotic •Medication drug reconcile