Funding from the Independence Blue Cross (IBC) Foundation, a leading health insurer serving southeastern Pennsylvania, enabled the National League for Nursing to bring ACE.S workshops and webinars to faculty and their clinical affiliating agencies serving older adults in five Pennsylvania counties. The funding (2012-2014) assisted the NLN to expand ACE.S (http://www.nln.org/facultyprograms/facultyresources/aces/index.htm) to practice environments long identified by nurse educators as necessary to enhance geriatric content and relevant student experience. ACE.S resources are available to all schools of nursing at no charge.
During the project, the NLN, in partnership with Community College of Philadelphia, conducted workshops to share ACE.S resources with local faculty and affiliated nursing staff, provided follow-up webinars, and recognized innovation by presenting IBC Foundation Excellence in Geriatric Practice and Education Awards. Evaluation of the grant included both quantitative and qualitative data. For all workshops, more than 80 percent of faculty and staff from affiliated agencies indicated their intent to use the ACE.S resources with students in both the classroom and during clinical experiences. Qualitative data, obtained from focus groups of practicing nurses in both acute care and long-term care settings, revealed the following:
* Staff nurses initially were hesitant to use Hartford Institute for Geriatric Nursing tools (http://www.ConsultGeriRN.org), which they saw as cumbersome and time-consuming. However, when they saw the simplicity of SPICES, an inclusive way to think about assessments, and CAM (a confusion assessment method tool), they were much more willing to incorporate these tools into practice. The nurses felt that the consistency provided by SPICES in giving reports and documenting daily assessments made it a concise and effective approach. The CAM gave the nurses a baseline assessment to determine confusion in both newly admitted and long-term patients. The overall theme was that tools need to be simple, pertinent to practice, and incorporated into what is already being done, and not an additional task.
* Direct care workers wanted their voices heard more. They felt that while they had much experience with the clients they served, they were not officially part of the team. There was a noted change in their investment with older adults when they were asked for their input on care issues and when the SPICES tool was introduced to them as a way to organize their observations.
* Staff nurses responded positively to the discussion of the ACE.S Essential Nursing Action of Situational Decision Making/ Considering Risks and Benefits. There was a noted disparity between understanding the concept of risks and benefits and using the concept in practice. Nurses labeled many patients noncompliant who did not adhere to the recommended treatment regimen. Through workshops and webinars, they developed an awareness of this disparity. They also voiced frustration with not knowing how to advocate for their patients. They felt that by advocating for something that may be considered risky by the rest of the team, they would receive limited support and lose too much time. Staff felt an overwhelming pressure from administration to keep clients safe. Many talked about how they would want more choice and would be willing to take risks to optimize quality of life.
* The nurses on the acute care units dedicated to older adults felt connected with the notion of function, with the physical and psychological functioning of their clients directly related to heart failure status. They expressed frustration about the level of compliance with treatment protocols. They felt that a risk/benefit analysis would likely decrease the frustration by nurses who tried to "change" patients and assumed a patriarchal approach.
* The concept of geriatric syndromes was of great interest to the nurses; evidence-based practice was very much a part of their practice. However, they were not familiar with the complications and outcomes of geriatric syndromes.
Seven IBC Foundation Excellence in Geriatric Education and Practice Awards were presented in June 2014 to nursing programs and collaborating nursing staff from affiliating clinical agencies that used resources from the NLN's ACE.S workshops to provide innovative care in practice environments. Honorees spanned the gamut of higher education, from LPNs and hospital certificate programs to doctoral degree-granting universities and one practice partner. (See Table.)