Advanced Practice Nurses Improve Health Care for Nursing Home Residents
COLUMBIA, Mo. – The nation's 65 and older population is projected to double in size by the year 2050, according to the U.S. Census. To improve health care for the nation's aging population, researchers from the Sinclair School of Nursing at the University of Missouri are studying how advanced practice nurses (APRNs) can improve nursing home care by serving as leaders of health care teams in nursing homes. Findings suggest that APRN-led health care teams reduce hospitalizations related to falls, dehydration and other health issues.
The MU nursing research team is five years into the Missouri Quality Initiative for Nursing Homes (MOQI), a program aimed at improving health care for older adults. A core component of the program is having APRNs work in select nursing homes to help coordinate care.
"With specialized training and certification, APRNs can play a key role in managing resident care, which helps decrease the likelihood of hospitalizations and improves care," said Lori Popejoy, associate professor of nursing and lead author of the study. "They are being successful as they guide less experienced staff to care for residents and leading health care teams to manage ill residents effectively."
Popejoy and the research team had APRNs routinely document actions they took to improve the care system in nursing homes, specifically problems related to mobility, hydration, medication management and the use of end-of-life plans. Examples of successful actions that APRNs initiated included:
- – Implementing fall huddles with nursing home staff to identify fall risk and identify solutions
– Setting up hydration stations around the nursing home that family, friends and staff can use to help residents stay hydrated
– Monitoring blood pressure and adjusting blood pressure medication accordingly
-Coordinating care procedures and discussions about end-of-life goals with licensed social workers
They also found that for the APRNs to be successful, leadership support was essential as nursing home management often served as a barrier to improving patient care.
"We have consistently seen the importance of APRNs in health care settings," said Marilyn Rantz, Curators Professor of Nursing and lead researcher for the MOQI program. "APRNs serve as 'expert clinicians,' helping guide staff members to think about problems differently and influence positive change."
"The APRN role in changing nursing home quality," recently was published in the Journal of Nursing Care Quality. The MOQI program includes key components of support for APRNs from social work, quality improvement and health information technology coaches in St. Louis.
Other MU nursing school researchers involved in the project include Amy Vogelsmeier, associate professor; Greg Alexander, professor; Marcia Flesner, clinical instructor; Annette Lueckenotte, clinical instructor and project supervisor; and Jessica Mueller, program coordinator. Other MU researchers involved in MOQI include Colleen Galambos, professor in the College of Human Environmental Sciences' School of Social Work; and Greg Petroski, biostatistician in the Medical Research Office.