geropalliative care nurse residency outcomes...• educating nursing staff to care for the aging...
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The meaning of care.
Geropalliative CareNurse Residency Outcomes
Deborah M. Conley, MSN, APRN-CNS, GCNS-BC, FNGNANebraska Methodist Hospital and College
Fran Henton, PhD, RNNebraska Methodist College
AgeWISE NursesPeggy Dyer, RN-BC, ONC, Diane Fuhs, RN-BC
Terry Meidlinger, BSN, RN, PCCN
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Objectives
1. Review the AgeWISE Geropalliative Care Nurse Residency Model.
2. Examine AgeWISE outcomes which impact professional nurse development and growth.
3. Describe nurses’ experiences with the AgeWISE Geropalliative Care Nurse Residency program.
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PartnershipsAgeWISE is an initiative of Massachusetts
General Hospital, Boston, MA.It is funded in part by The Center to Champion
Nursing in America which is an initiative ofAARP, the AARP Foundation and the Robert Wood Johnson Foundation.
• Massachusetts General Hospital’s Yvonne L. Munn Center for Nursing Research provides direction and oversight for the program.
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Goals of AgeWISE• Conceived by Edward E. Coakley, RN, MSN,
MA, MEd, Director Emeritus for Patient Care MGH
• Started at MGH in 2006 with over 108 RNs trained.
• Objectives of AgeWISE:– improve the quality of care for older adults
and their families (patient-level outcomes)– achieve new competencies and greater
satisfaction in their jobs (nurse-level outcomes) and
– positively impact the healthcare system (systems-level outcomes).
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Geropalliative Care“ Geropalliative care involves the thoughtful
application of what can and should be done to avoid needless suffering and to enhance quality of life for all older adults, even in the absence of disease. It is both a philosophical stance and a structured, interdisciplinary delivery model that guides the care of patients and families during the last five years of life, irrespective of disease states.”
Susan M. Lee, RN, PhD, Nurse Scientist and AgeWISE Project Director
“Our aim was to foster the rich complementarily of nurses across the experience and age spectra.”
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AgeWISE Nurses
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Key Rationale
• Educating nursing staff to care for the aging population is critical as the estimates show that one in five Americans will be age 65 or older by the year 2030.
• Everyday, 10,000 people turn 65 years of age and 100 citizens turn 100 (NIA, 2011).
• “The AgeWISE nurse residency program is an excellent way to approach this endeavor and fits well with all the hospitals’ strategic initiatives.” (D. Conley, NGNA SIGN newsletter, March 2011)
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Initial Competitive Application Process
NMHNMH selected as one of the six hospitals Criteria had to be met including:
– Magnet andand NICHE hospital – Strongly affiliated with a college of nursingcollege of nursing–– DoctoralDoctoral--prepared nurseprepared nurse as Site Director – Doctoral-prepared Research Nurse Research Nurse
Liason/evaluatorLiason/evaluator
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Initial Competitive Application Process
– Capacity for two successive sixtwo successive six--month residenciesmonth residencies, involving 10 nurses in each cohort on one or two units
– Provide requisite data for programmatic evaluation (i.e., NDNQI, HCAHPS, etc.)
– Act as a regional resourceregional resource in further dissemination (NMH 2011 & 2012 Research Day, NHPC 2011 & 2012, August 16th 2012 Omaha, NICHE-AgeWISE Conference)
– Engage in transformative learningtransformative learning– Provides Palliative Care ServicesPalliative Care Services
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2010-2012 Selected Hospitals
•• Nebraska Methodist Hospital, Omaha, NE Nebraska Methodist Hospital, Omaha, NE • NYU Langone Medical Center, NY, NY • St. Joseph’s Regional Medical Center, Paterson, NJ • Sanford USD Medical Center, Sioux Falls, SD • Strong Memorial Hospital, URMC, Rochester, NY • UH Case Medical Center, Case Western Reserve,
Cleveland, OH
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Second Selection of Hospitals 2011-2013
• Abington Memorial Hospital, Abington, PA
• Beaumont Hospital - Royal Oak, Royal Oak, MI
• Dartmouth-Hitchcock Medical Center, Lebanon, NH
• Northwest Community Hospital, Arlington Heights, IL
• OSF Saint Francis Medical Center, Peoria, IL •• Roswell Park Cancer Institute, Buffalo, NY
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AgeWISE Boston Summits
• Education• Immersion into Geropalliative Care• Team Building within and across hospitals
• Curriculum Review• Nursing Research
• Site Visits from AgeWISE Director
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Residency SeminarsCourse/Curriculum
Provides:– Implementing EBP in gerontological, palliative, & end of
life nursing care.– Mentorship and coaching—novice and expert dyad.– Reflective practice skill building.– Assistance to develop portfolio for career advancement.– Encourages certification for ANCC Gerontological Nurse
& Hospice & Palliative Nurse.– Transformative learning paradigm for adult learning.
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Course/CurriculumCourse:
– Twelve 8 hour seminars over 6 months– Mentored clinical experience
• Residency expert nurses mentor novice nurses– Community clinical experience – Delirium EBP Project at the hospital
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AgeWISE Graduation: 30 RNs
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AgeWISE Cohort # 1 GraduationAgeWISE Cohort # 1 Graduation
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AgeWISEAgeWISE Cohort # 2 GraduationCohort # 2 Graduation
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AgeWISE: An Evaluation of a Geropalliative Care Nurse
Residency Program
PI:PI:Susan Lee, PhD, RN Massachusetts General Hospital, The
Yvonne L. Munn Center for Nursing Research, AgeWISE National Program Director. Boston, Massachusetts
Co PIs:Co PIs:Deborah Conley, MSN, APRN-CNS, GCNS-BC, FNGNAFran Henton, PhD, RN
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Background
•• Educational interventionEducational intervention will build geropalliative care capacity among nurses in order to meet the needs of today’s aging population.
• Successfully delivered to 108 registered nurses at Mass General Hospital.
• Focuses on care of older adults who are nearing the last 2 – 5 years of life.
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Nature and Purpose of Study
• Descriptive study, survey and focus groups• Compare changes in:
– Knowledge– Attitudes– Competencies– and selected aspects of job satisfaction between
nurses who complete a 6 month nurse residency program in geropalliative care compared to a control group of nurses who do not complete the residency program.
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Nature and Purpose of Study1. Patient level unit outcomes/measures 2. Nurse level outcomes--evaluate the impact of
participating in a geropalliative care nurse residency program on:
– Nurses' knowledge, attitudes, and competencies of geropalliative care
– Nurses' intent to leave the job– Nurses' job enjoyment– Nurses' work engagement– Nurses' perception of the professional work
environment
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Nature and Purpose of Study
4.4. Identify the predictors of a successful program implementation as one of six sites in the US delivering material on geropalliative care.
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Inclusion Criteria
• RNs on the oncology surgical unit and the general medicine unit at Nebraska Methodist Hospital in Phase I.
• In Phase II, RNs on the progressive care unit and cardiac care unit at Nebraska Methodist Hospital.
• All RNs working on these units but not enrolledin the geropalliative care nurse residency program and on all other inpatient units at NMH were invited to participate as control groups.
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Subject Selection for Research
• Posters on the units and emails will be sent to all nurses on the 4 nursing units, as well as other inpatient nursing units asking them to participate as members of the control group.
• Information was shared at Unit Based Councils and staff meetings to recruit RNs to participate in the control groups.
• Compared to the other six hospital sites, NMH had the highest survey return rate.
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Research Timeline• Cohort 1
– February 2011---invited to participate in pre-survey via email
– August 2011 ---post survey via email– March through August 2011—1 focus group
• Cohort 2– August 2011---invited to participate in pre-survey via
email– March 2012 ---post survey via email– August 2011 through February 2012
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Preliminary FindingsQualitative Study
AgeWISE Nurses overwhelming reported:• Knowledge: Enhanced knowledge in geropalliative care has
given them the confidence to provide more specific and sensitivecare to patients.
• Empowerment: Reported more confidence in having difficult conversations with patients, families, and physicians related to their geropalliative care practice.
• Advocacy: Became stronger advocates for their patients so that the care their patients received was fully aligned with their needs, preferences, and values.
Lee, S. (2012)
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Preliminary FindingsQualitative Study
AgeWISE Nurses overwhelming reported:• Renewal and Personal Growth: feeling renewed and recommitted
in their nursing practice, ~~Jean Watson calls this a "deepeningpath" to practice.
• Creative: feeling more creative in their practices, what Watson calls creative use of self in knowing, being, doing (thumbprint, journals, photos and other EOL legacy projects).
• Moral Distress: Most nurses felt great angst when they perceived patients' were not fully informed of the consequences of an intervention (intubation, tracheostomy, PEG) or when the patients did not fully comprehend explanations by physicians.
Lee, S. (2012)
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Preliminary FindingsQualitative Study
• Preliminary analysis of the quantitative data suggests the AgeWISE nurses had improved job satisfaction, job engagement, knowledge and skills.
• No conclusions can be drawn yet about intent to leave or the practice environment.
Lee, S. (2012)
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Preliminary FindingsQualitative Study
• Data on predictors of a successful and sustainable geropalliative care residency program are being analyzed.
• What we know:– It is essential for Nursing Leadership (Chief Nursing
Officer level) to be actively involved in supporting and implementing AgeWISE.
– When CNOs are involved and know what AgeWISE nurses are doing; they are more likely to support the efforts through human and material resources.
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AgeWISE RNImpact Stories & Statements
• “Since being a part of the AgeWISE nurse residency program, I have had multiple opportunities to put my AgeWISE knowledge into practice. Recently, there was an older adult on our unit who had taken a turn for the worse. A decision had to be made quickly concerning the plan for this patient. Unfortunately, the patient could no longer speak for herself or make decisions. The patient’s family members were having an extremely difficult time agreeing on how to proceed with the patient’s care. I felt very bad for this family. Stressful times do not always bring out the best in people. We need to address these difficult decisions with our loved ones and patients proactively, before a crisis situation occurs. I was able to help the staff and family discuss goals of care.”
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AgeWISE RNImpact Stories & Statements
• “I wasn’t sure what AgeWISE was all about and I was very nervous about joining this class being a less experienced nurse. AgeWISE has really expanded my education from the start of my career and helped me to be more understanding and more comfortable when working with end-of-life issues. AgeWISE has made me more aware of the nursing care I am providing and the greater importance of being an advocate for my patients especially regarding end of life care issues. I feel like I am an important resource on my unit for other nurses to discuss AgeWISE education, strategies and working with specific complex cases/situations. AgeWISE Residency has changed the way I think and care for my older adult patients and helped me to expand in my care for them.”
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AgeWISE RNImpact Stories & Statements
• “I have noticed AgeWISE's impact on my nursing practice in my interactions with all older patients but especially with those with delirium, dementia and those making end of life decisions when they come to the end of their disease process. The effect I can see on patients and their families and the trust they place in me when I sit down and talk to them with more confident communication skills have given me a renewed sense of empowerment and belief that even in the course of one shift I can make a difference as a nurse.”
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Making a Difference
AgeWISE Bulletin Board
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AgeWISE RNImpact Stories & Statements
• “AgeWISE has opened the door to new avenues that has renewed my faith in nursing. I have been provided the tools to incorporate in my daily practice that focus on geropalliative care. I can take this knowledge to mentor others on my unit.”
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AgeWISE RNImpact Stories & Statements
• “I have totally enjoyed AgeWISE. It has unleashed a hidden passion of nursing for me--palliative and end-of-life care. AgeWISE has "given nurses permission" and the tools to address these topic. I am looking forward to more learning and exploring new avenues of my nursing career.”
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Conclusions/Summary• AgeWISE has impacted nurses professional growth and
development as well as their nursing practice.• AgeWISE RNs learned valuable knowledge and skills ~~
such as “tricks of the trade” to implement with individual patients and families.
• AgeWISE RNs are precepting and mentoring staff on their units.
• None of the AgeWISE RNs have left nursing or NMH.• 4 AgeWISE nurses are newly Gerontological Certified.• AgeWISE RNs are implementing gerontological,
palliative care, and end-of-life nursing principles.• Next cohort of AgeWISE fall 2012.• Quarterly AgeWISE interprofessional education fall
2012.
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NMH ContactsDeborah M. Conley, MSN, APRN-CNS, GCNS-BC, FNGNAGerontological Clinical Nurse Specialist, Asst. ProfessorNICHE Program Director and AgeWISE Site CoordinatorACE Unit CNSNebraska Methodist Hospital & CollegeOffice 402-354-4661 Pager [email protected]
Fran Henton, PhD, RNProfessor of NursingNebraska Methodist CollegeOffice [email protected]
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Contact information for AgeWISE at MGH
• Susan M. Lee, PhD, RNAgeWISE Project DirectorThe Yvonne L. Munn Center for Nursing Research275 Cambridge Street, 4th floorBoston, MA 02114PH: 617-724-3534FAX: [email protected]
• MGH AgeWISE TeamSusan M. Lee, PhD, RNBarbara Blakeney, MS, RNEdward E. Coakley, RN, MS, MA, MEdConstance Dahlin, MSN, ANP-BC, FAANDeborah D’Avolio, ANP-BC, PhDDorothy A. Jones, EdD, RNC, FAANMarion Rideout, MS, ANP
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References
• AgeWISE brochure and application http://championnursing.org/sites/default/files/u/MGHAgeWISE.pdfaccessed Feb 11, 2011
• NIA, www.nia.gov accessed Feb 11, 2011• NICHE Program http://www.nicheprogram.org/• Hartford Institute for Geriatric Nursing www.hartfordign.org• ELNEC http://www.aacn.nche.edu/elnec/• Mezirow, J. & Taylor, E.W. (2009) Transformative Learning in
Practice. San Francisco, CA: Josey Bass.• Lee, S. AgeWISE Qualitative Outcomes Study telephone
conference call with D. Conley, March 2012.• Conley, D. (2011) NGNA SIGN Newsletter, www.ngna.org