[Draft: legislation on occupations in geriatric nursing. (Geriatric nursing legislation), 4 December 1989].
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Providing quality care to their growing elderly population is a top priority for Japanese nurses. As geriatric nursing has become a significant subspecialty in the US, this expertise was sought by the Japanese Hospital Administration in collaboration with Kyoto University. The result: a geriatric nursing programme developed to meet the specific needs of Japanese nurses in caring for the elderly, but yet adaptable to meet the needs of nursing students and registered nurses in other countries.
This study investigated nursing staff attitudes toward the geriatric nurse practitioner as an agent of change in a long-term care facility, based on two University of Miami GNP students' practicum in a county nursing home. Nursing personnel were surveyed before and after the practicum to measure their acceptance of the GNP. While nursing staff initially held a wait-and-see attitude, posttest ratings were favorable. Recommendations for improving quality of care in the setting were made by student participants, and a six-month follow-up revealed that a number of changes had been implemented.
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We compared measures of quality of care and health services utilization in 30 nursing homes employing geriatric nurse practitioners with those in 30 matched control homes. Information for this analysis came from reviews of samples of patient records drawn at comparable periods before and after the geriatric NPs were employed. The measures of geriatric nurse practitioner impact were based on comparisons of changes from pre-NP to post-NP periods. Separate analyses were done for newly admitted and long-stay residents; a subgroup of homes judged to be best case examples was analyzed separately as well as the whole sample. Favorable changes were seen in two out of eight activity of daily living (ADL) measures: five of 18 nursing therapies; two of six drug therapies; six of eight tracers. There was some reduction in hospital admissions and total days in geriatric NP homes. Overall measures of medical attention showed a mixed pattern with some evidence of geriatric NP care substituted for physician care. These findings suggest that the geriatric NP has a useful role in nursing home care.
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