School of Nursing Program To Serve as Model of Better Care
September 12, 2005
"School of Nursing Program To Serve as Model of Better Care"
The University of Rochester School of Nursing has been chosen as a test site for a program that looks to prove that the combination of a nursing school and a nursing home can dramatically improve the lives of residents with dementia. The Teaching Nursing Home (TNH) model, funded by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, also seeks to create a new corps of nurses and social workers experienced in geriatrics just as the population aged 65 and over booms.
Program administrators chose five “pockets of strength” - areas where universities and nursing homes already work together to improve care and conduct research - and invited them to submit proposals on why they should be TNH sites. The University of Rochester School of Nursing was one of the two selected, and will partner with Kirkhaven Nursing Home in Rochester for the test.
A teaching nursing home is designed to improve care by translating research into practice. Its first application locally will be to address a problem facing all nursing homes: rapid staff turnover. In a year’s time in a typical nursing home, more than 70 percent of direct care workers - those that feed, bathe and care for residents day to day - will leave their jobs. Overlooked in their efforts to improve care, employees depart in frustration, taking with them relationships built with residents and expertise in meeting the needs of individuals. Staff turnover is especially unnerving for patients suffering from dementias (up to 80 percent of residents in some facilities), who take comfort in familiarity.
“The ultimate goal of the teaching nursing home project is to change the culture of nursing homes to make them more like real homes than institutions,” said Nancy Watson, RN, Ph.D., director of the Center for Clinical Research on Aging at the School of Nursing. “To do that, we need to rethink the regimented approaches of the past, in how we educate, in how we conduct research, in how we provide care, and in how we empower employees. Rochester area universities and nursing homes have embraced change, and being selected as a test site confirms that.”
Like a teaching hospital, a teaching nursing home consists of medical staff and academic units combined to develop tailored best practices in care floor by floor. Social work and nursing students work with nursing home staff to implement of changes in daily practice generated, in this case, by direct care workers (certified nursing assistants) as part of “bottom-up innovation.” Graduate students from the School of Nursing, and the Collaborative Masters of Social Work Program between SUNY Brockport and Nazareth College, will participate in the test program as part of their coursework this year.
“The least empowered staff will finally have the chance to pick one aspect of life or care on the unit that they would most like to change, with the only limits being regulations, safety and budget,” Watson said. “Likely projects will include new approaches to meet residents’ needs, including the use of simple, research-proven techniques to make residents more comfortable. Staff may notice that holding a fleece covered hot water bottle or pain medicine reduces distress in residents with dementia. It may seem small, but across a region, small innovations in comfort and care add up to profound improvement.”
Success will be measured after one year by how many best practices are shared among the units of the nursing home, and by how many are implemented. Other measures will include surveys to determine whether employees experience more independence and job satisfaction. Staff turnover will also be compared to past years.
Along with happier residents and more empowered staff, a goal of the TNH model is to better prepare students and healthcare workers for stronger careers in geriatrics. Nursing education, for example, focused more on pediatrics in the past, but that must change as the number of Americans to reach retirement age doubles to nearly 72 million in the next 25 years. Retirement age patients typically have multiple medications and conditions to manage and blanket approaches to care do not suffice.
Should the TNH test be successful, Watson and other proponents will argue for its adoption nationwide, and use it to study and solve other issues facing nursing homes.
The Hartford Institute of Geriatric Nursing at New York University, which administers TNH program for HRSA, chose the School of Nursing as a test site in part because Watson established the Center for Clinical Research in Aging in 1999. Almost every academic and clinical experience in the nursing school includes inter-disciplinary collaboration, many of which are in local nursing homes. In addition, the school is ranked among the top four schools of nursing in geriatric research and is thirteenth in funding from the National Institutes of Health. Kirkhaven was selected because of its aggressive quality improvement program.
In 2002, the School of Nursing launched the Rochester Community Initiative to improve nursing home and dementia care. The initiative has improved quality of life for residents with dementia and improved direct care worker satisfaction and retention by building a network that links academic nursing experts with direct care providers. Taking a grass roots approach, the initiative developed workshops, resource guides, an email alert network, a website and conferences that enable exchange of ideas across facilities and disciplines in the region. In three years, more than 800 care providers from 100 facilities caring for an estimated 10,000 residents with dementia have participated.
The work has resulted in national attention, with the American Journal of Nursing inviting the School of Nursing to share innovations with a wider audience through a new, regular column. For more information on the Community Initiative, please visit www.dementianursing.org.