Inouye S K, Acampora D, Miller R L, Fulmer T, Hurst L D, Cooney L M
Yale University School of Medicine, Yale-New Haven Hospital, CT 06504.
J Am Geriatr Soc. 1993 Dec;41(12):1345-52. doi: 10.1111/j.1532-5415.1993.tb06486.x.
To describe the structure and implementation of the Yale Geriatric Care Program, an innovative, nursing-centered model for developing geriatric nursing expertise throughout an acute-care hospital.
Descriptive study of an intervention in a prospective cohort of patients.
University teaching hospital.
Two hundred forty four patients aged 70 years and older on four non-intensive care intervention units during the study period (July 9, 1990 to July 31, 1991).
The Geriatric Care Program involved an integrated model of primary nurses, specially trained unit-based geriatric resource nurses, gerontological nurse specialists, and geriatric physicians. The intervention included surveillance and identification of frail older patients, unit-based geriatric educational programs for all nurses, special education and support for the geriatric resource nurses, and twice-weekly rounds of the Geriatric Care Team.
The Geriatric Care Program has been successfully implemented on four units. The interventions ranged from general clarification of goals in 226 (92%) to specific recommendations for management of immobility in 100 (41%), bladder/bowel problems in 99 (41%), pressure ulcer treatment or prevention in 61 (25%), confusion evaluation or management in 62 (25%), and adjustment of medications in 43 (18%). Overall, 68% of the specific recommendations were documented to have been implemented. Barriers to implementation of the program have included initial difficulties with recruitment and retainment of geriatric resource nurses (due to high nursing turnover and the increased time commitment required), breakdown in communication and carryover of recommendations between nursing shifts, and obstacles to communication between the nursing and medical staff.
An innovative model of care, in which geriatric nursing was integrated as part of standard nursing care on selected medical and surgical units, has been designed and implemented. Evaluation of the effectiveness and costs of this intervention are currently underway.
描述耶鲁老年护理项目的结构与实施情况，该项目是一种创新的、以护理为中心的模式，旨在培养急症医院中所有人员的老年护理专业技能。
对一组前瞻性患者进行干预的描述性研究。
大学教学医院。
研究期间（1990年7月9日至1991年7月31日），四个非重症监护干预科室的244名70岁及以上的患者。
老年护理项目采用了一种综合模式，包括责任护士、经过专门培训的科室老年护理资源护士、老年护理专科护士和老年科医生。干预措施包括对体弱老年患者进行监测与识别、为所有护士开展科室老年护理教育项目、对老年护理资源护士进行特殊教育与支持，以及老年护理团队每周两次的查房。
老年护理项目已在四个科室成功实施。干预措施涵盖范围广泛，从226例（92%）的一般目标明确，到100例（41%）针对活动障碍管理的具体建议、99例（41%）膀胱/肠道问题、61例（25%）压疮治疗或预防、62例（25%）意识模糊评估或管理，以及43例（18%）药物调整。总体而言，68%的具体建议已记录实施。该项目实施的障碍包括最初招募和留住老年护理资源护士存在困难（由于护士高离职率以及所需的更多时间投入）、护理班次之间沟通不畅及建议传递中断，以及医护人员之间沟通存在障碍。
设计并实施了一种创新护理模式，将老年护理整合为特定内科和外科科室标准护理的一部分。目前正在对该干预措施的有效性和成本进行评估。
