Gerontological Advanced Practice Gerontological Advanced Practice Nursing (GAPN) plays an essential role in improving care for the elderly. This branch of nursing, which focuses on aging populations, has seen significant advancements in recent decades. GAPNs, including Geriatric Nurse Practitioners (GNPs) and Gerontological Clinical Nurse Specialists (GCNS), have become integral in enhancing patient outcomes, reducing hospitalizations, and improving satisfaction among patients and their families. This article explores the key areas of gerontological advanced practice nursing, focusing on the evolution of nursing, literature reviews, GAPN roles, evaluation methods, and the benefits and future needs of APNs.
Gerontological Advanced Practice Nursing
Over the last three decades, research has shown that Advanced Practice Nurses (APNs) significantly improve the quality of care, increase both patient and staff satisfaction, and reduce costs across various health care settings. APNs, including those specializing in gerontological care, have positively impacted health care by addressing the unique needs of older adults (Feldman, Ventura, & Crosby, 1987; Naylor, Brooten et al., 1999).
GAPNs focus specifically on providing advanced care for older adults. This group includes both Geriatric Nurse Practitioners (GNPs) and Gerontological Clinical Nurse Specialists (GCNS), who have specialized training in caring for aging populations. These roles have expanded significantly over the years, with approximately 4,000 certified GNPs and over 1,000 certified GCNSs currently practicing in the United States (American Association of Colleges of Nursing, 2004).
Advancement in Nursing
The field of gerontological nursing began evolving in the late 1960s and 1970s when graduate nursing programs started offering gerontological specialties. The GAPN role emerged as an umbrella term for professionals trained to care for elderly patients, encompassing both GNPs and GCNSs. GCNS roles traditionally include educator, researcher, practitioner, manager, and consultant. In contrast, GNPs are trained to conduct advanced health assessments, diagnose conditions, and prescribe medical treatments under collaborative agreements with physicians.
While the scope of practice for GNPs and GCNSs varies by state, research shows that the roles share more similarities than differences. Current nursing leaders are debating the potential for role integration (Fenton & Brykczynski, 1993; Soehren & Schumann, 1994). Such integration could strengthen the gerontological nursing field by combining the strengths of both roles.
Literature Review in Nursing and Outcomes
Numerous studies have reported that APNs positively influence health care outcomes, including reduced mortality, morbidity, length of hospital stay, functional and mental status, and patient satisfaction. They also help reduce the burden and cost of care. Patients under the care of APNs often receive better preventive care, more effective management of chronic conditions, and improved education about their health (Feldman et al., 1987; Naylor, Munro, & Brooten, 1991).
The Program of All-Inclusive Care for the Elderly (PACE), which originated in San Francisco in 1971, exemplifies the success of gerontological nursing. PACE provides health and social services to frail older adults, enabling them to remain in their communities rather than entering institutions. PACE’s model requires GAPNs to be part of the interdisciplinary care team, and the program has since expanded to nine states, demonstrating its effectiveness in delivering quality care at a reduced cost (Eng, Pedulla, Eleazer, McCann, & Fox, 1997).
GAPN Role and Quality of Nursing Care
GAPNs have demonstrated their value in long-term care (LTC) settings, where they have been shown to decrease hospitalizations, reduce pharmaceutical usage, and improve satisfaction among patients, families, and staff. One significant contribution of GAPNs has been the reduction of restraint use in nursing homes, where they work to provide alternative interventions to manage patient behavior (Evans et al., 1997).
In a landmark study by Kane and colleagues (1989), GNPs were shown to provide cost-effective care by reducing hospital utilization in nursing homes. Another study found that nursing home residents followed by GNP/MD teams saved approximately $72 per resident per month compared to residents followed by physicians alone (Burl et al., 1998). These studies underscore the financial and clinical benefits of GNPs in geriatric care.
How ANPs Evaluate Nursing Success
GNPs often take leadership roles in nursing home management, where their expertise leads to measurable improvements in patient outcomes. For example, Grzeczkowski and Knapp (1988) evaluated a 120-bed nursing home under the direction of a GNP and found decreased medication usage, lower rates of urinary and respiratory infections, reduced use of urinary catheters, and fewer pressure ulcers. These results highlight the GNP’s ability to work within interdisciplinary teams and apply their extensive knowledge of geriatric care to improve health outcomes.
How GAPN Evaluate Nursing Issues
GAPNs receive specialized education on geriatric issues such as falls, delirium, polypharmacy, and the distinction between normal and abnormal physical changes in aging adults. This training equips them to anticipate and manage common health problems in older adults, allowing them to intervene early and improve patient outcomes. GAPNs also play critical roles in various models of care designed to improve hospital care for elderly patients, such as Geriatric Evaluation and Management (GEM) units, Acute Care of the Elderly (ACE) units, and Nurses Improving Care to the Hospitalized Elderly (NICHE).
Studies have shown that GAPNs can significantly reduce hospital lengths of stay and readmission rates for older adults. For example, Miller (1997) found that patients cared for by GNPs had a mean reduction of 2.78 days in length of stay compared to patients without GNP involvement. Additionally, Naylor and colleagues (1999) conducted a randomized clinical trial that demonstrated a reduction in hospital readmissions and cumulative days of rehospitalization for patients managed by GNPs.
All-Inclusive Care for the Elderly (PACE)
The PACE program, as mentioned earlier, has been a highly successful model for providing comprehensive care to elderly adults. It integrates health and social services, allowing older adults to remain in the community rather than transitioning to institutional care. The success of PACE programs in multiple states has led to a reduction in health care costs and improved patient outcomes, with GAPNs playing a vital role in the interdisciplinary teams that deliver care.
Benefits of GPNs
Research consistently shows that GNPs provide high-quality, cost-effective care in ambulatory and long-term care settings. For instance, McDowell, Martin, Snustad, and Flynn (1986) compared the care provided by GNPs to that of board-certified geriatricians and found that GNPs were equally effective in managing polypharmacy and improving functional status. Other studies have shown that GNPs prescribe fewer medications compared to physicians, which can reduce the risk of adverse drug interactions in older adults (Mahoney, 1994).
The role of GNPs in providing ambulatory care is also significant. By conducting comprehensive assessments, GNPs can identify potential health issues early and offer preventive care that helps maintain the health and independence of older adults.
Needs of APN
Despite the demonstrated success of GAPNs, further research is needed to refine the understanding of their impact on health care outcomes. Meta-analysis has been useful in synthesizing data from various studies, but future research should focus on several key areas:
- Conceptual Definitions: Research must establish clear definitions of variables and outcomes to ensure consistency in findings.
- Outcome Measures: Studies should examine the processes involved in care delivery and their relationship to outcomes, rather than focusing solely on the provider.
- APN Educational Backgrounds: Future research should address how different educational backgrounds affect the outcomes of care provided by GAPNs.
- Methodology: More blind, randomized clinical trials are needed to ensure rigor in research and to assess the internal and external validity of findings (Brown & Grimes, 1995).
Conclusion
Gerontological Advanced Practice Nursing has evolved significantly over the past several decades, with GNPs and GCNSs playing critical roles in improving the care of older adults. The evidence is clear that GAPNs enhance the quality of care, reduce hospitalizations, and lower costs, all while improving patient and staff satisfaction. However, continued research is needed to address gaps in our understanding and ensure that the role of GAPNs continues to evolve to meet the needs of an aging population. By focusing on education, research, and interdisciplinary collaboration, GAPNs can further enhance the care provided to elderly individuals across various health care settings.