NYU Langone Health, Departments of Nursing, 550 First Avenue, New York, NY 10016, United States of America.
Appl Nurs Res. 2019 Oct;49:13-18. doi: 10.1016/j.apnr.2019.07.003. Epub 2019 Jul 9.
This paper recounts the history and experiences of one academic medical center that sought to improve the care of elderly patients by adopting and adapting the Geriatric Resource Nurse (GRN) model recommended by the Nurses Improving the Care of Healthsystem Elderly (NICHE) program. A formal evaluation examined the perceptions, opinions and attitudes of non-GRN nursing peers, Nurse Managers (NMs) and members of the Inter-Professional Advisory Board (IAB) regarding GRN practices and the institution's NICHE program.
A qualitative research design with purposive sampling was utilized.
Semi-structured interviews and focus groups conducted in the fall/winter 2017 were analyzed using standard content analysis methods of isolating and grouping contextual themes without a predefined framework.
The institution's GRN training program, a hybrid of the national NICHE program and organization-developed components, has strong support among NMs, members of the IAB and other RNs. However, there exist many misconceptions, erroneous information and misunderstandings about the program and the roles and expectations of GRNs that have hindered the likelihood of producing desired outcomes.
Training GRNs was insufficient in disseminating and implementing evidenced-based geriatric practices in this hospital. Future work in this area would benefit from integrating concepts and methods from dissemination and implementation science when developing, launching, and sustaining NICHE programs.
Integrating principles and models of dissemination and implementation science can increase consistent use of evidence based practices and the likelihood of improved geriatric patient outcomes in NICHE hospitals.
本文讲述了一家学术医疗中心的历史和经验，该中心通过采用和改编护士改善医疗保健系统老年人照护计划（Nurses Improving the Care of Healthsystem Elderly，NICHE）推荐的老年资源护士（Geriatric Resource Nurse，GRN）模式，试图改善老年患者的护理。一项正式评估考察了非 GRN 护理同行、护士长（Nurse Managers，NMs）和跨专业咨询委员会（Inter-Professional Advisory Board，IAB）成员对 GRN 实践和机构 NICHE 计划的看法、意见和态度。
采用了定性研究设计和目的性抽样。
在 2017 年秋季/冬季进行了半结构式访谈和焦点小组，使用标准的内容分析方法，在没有预先设定框架的情况下，对语境主题进行分离和分组。
该机构的 GRN 培训计划是国家 NICHE 计划和组织开发组件的混合体，在 NMs、IAB 成员和其他注册护士中得到了强烈支持。然而，对于该计划以及 GRN 的角色和期望，存在许多误解、错误信息和误解，这阻碍了产生预期结果的可能性。
在这家医院，培训 GRN 不足以传播和实施基于证据的老年实践。在这一领域的未来工作中，在开发、启动和维持 NICHE 计划时，从传播和实施科学中整合概念和方法将获益匪浅。
整合传播和实施科学的原则和模型可以增加基于证据的实践的一致性使用，并提高 NICHE 医院老年患者的预后。
