1. Experience of Nursing Practice roles of
Advanced Practice Nurse (APN)
“ The Future of Nursing and Caring for Geriatric
Patients” Conference in Bumrungrad Hospital
31 October 2013
Sunee Suwanpasu RN, APNs Aging, Ph.D.
Nursing Department, King Chulalongkorn Memorial HospitalThai Red Cross Society

2. •
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Caregiver)

4. Advanced Practice Nursing

5. APNs in geriatric
APN
• • •
1.
specialization)
2.
expansion of
practice)
Long term care manager)
• • • -
3.
advanced practice)
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6. –
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• Older patients ??????
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7. The sixth vital sign
• Functional status: The sixth vital sign
• Optimizing functional status is a central tenet
of geriatric practice (editorials in JGIM)

8. •
• Preserve functional
capacity of older
patients
• Increase safety: falls;
pressure ulcer, acute
confusion state
• Help increase comfort
•
•
•
40.4% of patients developed
functional decline following
hospitalization ( Wu et al. 2006)
Before admission’ advanced age,
Lower MMSE, IADL disabilities
Presence of pressure ulcer, ADL
disabilities, low social activities
(HARP study)
Hospitalization, Hypoalbuminaemia,
pressure ulcer, LOS, tendency to fall
(WU etal., 2006)
Bed rest, or acute inactivity
associated with hospitalization or
disease state, posed a potent threat
to muscle tissue and function
capacity (Covinsky et al., 2003:Brown
et al.2004; Janssen, 2006)

9. Care Management)
Direct Care)
educating)
mentoring)
coaching)
Agent)
Collaboration)
empowering)
Consultation)
Change
Ethical
reasoning and ethical decision making)
Based Practice)
outcome management and evaluation)
Evidence-

11. Nurses Improving Care for Health system Elders
(NICHE)
•
Focus on the care needs
of the older patients
• The NICHE nursing care
models
– Geriatric Resources
Nurse (GRN model)
•
•
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Provide excellent bedside nursing to
hospitalized older adults
Develop a corps of nurses armed with the
clinical competencies to meet the needs
of older adult, and serve as a resources to
other staff
Develop incentives and improve moral for
nurses caring for the older adult
Provide a mechanism for professional
growth of nurses
Enhance the nurse/patient relationship
and patient satisfaction
Promote the effectiveness of the
interdisciplinary team
Increase implementation of evidencebased clinical practice
Facilitate safe and effective discharges
Promote continuity of care between the
hospital and other setting

12. Chula GRN model:
improving the care of older
patients in medicine unit
Lecture
- Small
talk
From the beginning
•Advanced Practice geriatric
Nurse
•GRNs unit-based RN’s volunteer
with a knowledge requirement
•Nursing clinical round
•Internal medicine physician
provide consultation
Evaluation
Having the staff
nurses routinely
monitor and
address common
geriatric
syndromes and
share their
knowledge with
other staff
Regularly
scheduled
-2 times
for wks
Clinical teaching
rounds with a
geriatric expert to
address specific
patient issues and
integrate new
geriatric
knowledge

13. During round
Chula SPICCES
Patient Name:
Date:
GRN present a brief synopsis of
• The patient’s history
• Course of hospitalization
• Treatment and expected
outcome
• Unresolved issues
• Comprehensive
assessment of hospitalized
older patients
SPICCES EVIDENCE
YES
No
Sleep disorder
Problems with Eating or
Feeding
Incontinence
Caregivers preparedness
Evidence of falls
Skin breakdown
REMARK.............................................................
...........................................................................
...........................................................................
Adapted from a frameworks of six 'maker
conditions of Fulmer, T. (1991) The Geriatric
Nurse Specialist Role: A new Model. Nursing
Management, 22(3), 91-93

14. Best practices in Nursing Care to older adults
(The Hartford Institute for Geriatric Nursing)
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Fall prevention program
Cognitive stimulation
Exercise
Delirium prevention
Nutrition
Caregiver preparedness
Pressure ulcers prevention
Incontinence management

15. • Behavioral Methods for Urinary Incontinence
Bladder training, habit training, biofeedback, pelvic muscle
exercises, timed voiding and prompted voiding.
• Guidelines and position stands outlining nutritional
standards of care for hospital patients; a high quality
protein with each meal and essential amino acid (EAA)
•Delirium prevention
•Caregiver preparation
• Resistance exercise and Walking program with
coordination with PT& OT
•Minimizing the use of sedative-hypnotic
•Medication drug reconcile
•Use environmental enhancement for eldercare
•Multidisciplinary team small talk
•Fall prevention protocol
•Ensure assistive devices
•Skin care
•Cognitive stimulation
Chula SPICCES
Sleep disorder assessment
Problems with Eating or Feeding
assessment
Incontinence assessment
Caregivers preparedness
assessment
Evidence of falls assessment
Skin breakdown assessment

16. 2nd round
1st round

17. 2nd round
1st round

18. 2rd round
1st round

19. 3th round
1st round

20. 2th round
1st round

21. Thank you and
Question