Elder abuse and neglect assessment.
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Biomedical subjects
Terry Fulmer
Publications and source records attributed to Terry Fulmer.
Elder abuse and neglect assessment.
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The future history of gerontological nursing.
Having established an academic and clinical infrastructure, geriatric nursing is well positioned to play a central role in improving the health of the nation's older adults now and in the future. Currently, whether working independently, in collaborative practice with physicians, or as members of geriatric teams, geriatric nurse practitioners and clinical specialists have been shown to improve care to older adults in the community, in hospitals, and in skilled nursing facilities. Sixty-three master's programs now prepare advanced practice geriatric nurses. Geriatric nurse researchers have contributed to our understanding of the most pressing problems that impact profoundly on the health and quality of life of older adults. Despite these advances, the number of geriatric nurse specialists remains small, with only 4200 certified specialists and a serious shortage of geriatric nursing faculty. Geriatric nursing is moving to ensure geriatric competency in all nurses who work with older adults in the future. The future should see the benefits of current efforts to infuse geriatric content into baccalaureate programs that prepare registered nurses, into master's programs that prepare adult and family nurse practitioners, and into the day-to-day practice of the nation's 2.2 million practicing registered nurses.
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Implementing a geriatric resource nurse model.
The aging of the American population and its effects on healthcare centers require strategies and programs to ensure best practices for older patients. The authors describe an educational program, modification of a Geriatric Resource Nurse Model, and the use of a Geriatric Nurse Practitioner in implementing and integrating the clinical, psychosocial, and financial aspects that influence care needed by elderly patients and their families.
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Elder mistreatment.
Elder mistreatment (EM) is a serious and prevalent syndrome that is estimated to affect between 500,000 to 1.2 million older adults in the United States annually (Pillemer & Finkelhor, 1988). This chapter reviews both the state of the published science and limitations in the knowledge base on the topic. The literature for this review was obtained through computer-assisted searches of PubMed (878 citations), the Cumulative Index of Nursing Research (CINAHL) (593 citations) and Psych-Info databases (443 citations). The search terms used were elder mistreatment, elder neglect, elder abuse, or domestic abuse of the elderly. No limit was placed on the age of publications because of the relative scarcity of research on the subject. Nonnursing articles were included because there are so few nurse researchers addressing this topic. The age limit for subjects in these studies was 65 years and older. Studies were limited to those conducted in the United States, and descriptive studies were included as they form the majority of the research to date. Findings indicate that frail, very old (over 75 years), older adults who have a diagnosis of depression or dementia are more likely to be mistreated (Dyer, Pavlik, Murphy, & Hyman, 2000; Coyne, Reichman, & Berbig, 1993; Fulmer & Gurland, 1996; Lachs & Pillemer, 1995; Lachs et al., 1997; Lachs, Williams, O'Brien, Pillemer, & Charlson, 1998; Lachs & Fulmer, 1993; Lachs, Berkman, Fulmer, & Horwitz, 1994). Those older adults who required assistance with activities of daily living had poor social networks and were at higher risk for EM (Lachs & Pillemer, 1995; Lachs et al., 1997; Lachs et al., 1998; Lachs & Fulmer, 1993; Lachs et al., 1994). Neglect, as a subcategory of EM, accounts for the majority of cases (Fulmer, Paveza, Abraham, & Fairchild, 2000; Pavlik, Hyman, Festa, & Bitondo Dyer, 2001; Fulmer & Gurland, 1996). There is still debate regarding the role of minority status, abuse in childhood, and the persons most likely to mistreat older adults. There is a critical need for replication studies and new research on this important topic. Problems with measurement, funding challenges, and the paucity of investigators conducting research on EM have left the field with several unanswered questions and some conflicting findings. This chapter summarizes the interdisciplinary literature and makes recommendations for future nursing research programs.
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Gerontologic nurse practitioner preceptor guide.
Geriatric nurse practitioners (GNPs) often serve as clinical preceptors for nurse practitioner students. The Nursing Interest Group of the John A. Hartford Foundation's Geriatric Interdisciplinary Team Training Program recognized a need for a condensed guide that clarifies the role of a GNP preceptor. This guide uses information from the literature to clarify the role of the preceptor, offer suggestions for clinical teaching, provide guidance to determine expectations for student performance, and delineate the progression of a nurse practitioner student. This article reviews the contents of the guide and offers suggestions for its use in clinical practice.
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Nurses Improving Care for Healthsystem Elders (NICHE): using outcomes and benchmarks for evidenced-based practice.
This article describes Nurses Improving Care for Healthsystem Elders (NICHE), a project begun in 1992 with four pilot hospitals. These pilot hospitals gathered baseline data using a geriatric institutional assessment profile (GIAP) with a pre- and postdesign to capture changes in staff attitudes, knowledge, and perceptions of the care of older adults. Based on the success of the pilot effort, NICHE, now in its eighth year, has evolved into a program that involves 32 health systems comprising 105 hospitals nationally. To date, more than 10,000 GIAPs have been collected by NICHE hospital staff. All NICHE settings are able to benchmark their GIAP data against comparable institutions (eg, urban, rural, university, community settings) to understand how they compare and then interpret the data at their unique sites. The opportunities for continuous quality improvement through the NICHE program are described.
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