gerontological nursing research in a time of change

Gerontological Nursing Research in a Time of Change

St. Mary’s Hospital, Phoenix Park, Nursing Showcase 6/9/17

Dr. Catriona Murphy

School of Nursing and Human Sciences, DCU

Diversity in this room

Transitional care

Management

• Population change

• Crossing boundaries

• Opportunities to engage in research at individual, local, health system and population level

Population change

Source: http://www.cso.ie/en/releasesandpublications/ep/p-cp3oy/cp3/assr/

Male

Changes in population >65 years since 2006

0 50 100 150 200 250

2006

2011

2016

85+ 80-84 75-79 70-74 65-69

Data extracted from CSO interactive tables1000’s

CensusYear

Changes in population >65 years since 2006

0 50 100 150 200 250

2006

2011

2016

85+ 80-84 75-79 70-74 65-69

211,236 47.3%

Data extracted from CSO interactive tables1000’s

143,336

Changes in population >65 years since 2006

0 50 100 150 200 250

2006

2011

2016

85+ 80-84 75-79 70-74 65-69

48,028

67,555 40.6%

Data extracted from CSO interactive tables1000’s

Impact

•33.7% of those aged 85 years and older utilised PHN services in the previous year (Murphy 2015)

• Equates to approx.16,200 in 2006 22,800 in 2017

Murphy C. Demographic and health profile of older adults using public health nursing services in Ireland: Findings from The Irish Longitudinal Study on Ageing (TILDA). Trinity College, Dublin: The Institute of Community Health Nursing and The Irish Longitudinal Study on Ageing; 2015.

Impact

• The main area of missed care was in health promotion particularly in relation to older people and chronic disease management

• There was a high degree of missed care where caseloads included disadvantaged groups (asylum seekers, homeless, migrants, travellers)

PHELAN, A., MCCARTHY, S., 2016. Missed Care: Community Nursing in Ireland. Dublin: University College Dublin and The Irish Nurses and Midwives Organisation.

Average age by electoral division 2016

http://census.cso.ie/p3map21/

A Changing Landscape

• Diversity as we age

• Diverse needs/ personal preferences

• Multicultural

• Marginalised groups

• Complex care needs

• Chronic disease and Multimorbidity

• Person centred care

• Context: two tier health system, socioeconomic status, social support, housing, transport

• Information/technology deficit

• Learning from countries further along the ageing trajectory

• Change in service delivery is slow to respond to the demographic changes

Crossing boundaries

Health Service Executive Workforce 2017 (n=106,000)

9%

33%

14%

16%

9%

19%

Staff Categories

Medical/Dental

Nursing

Health & Social Care

Management/Admin

General Support Staff

Patient and Client Care

HEALTH SERVICE EXECUTIVE 2016. National Service Plan 2017. Dublin: Health Service Executive.

Developing a network

• Strength in our diverse roles• Exposure to a range of practitioners with

similar interests or overlapping interests • Seek opportunities to engage in research

(E.g. quality care metric indicators for older person services)

• Provide evidence for improved nursing service provision in your local area

• Examine research translation in your area of practice

• Develop research skills and infrastructure within gerontological nursing

• Engage with practice, policy and strategy development at local and national level

Opportunities to engage in research at individual, local, health system

and population level

The Individual Patient Journey

Public patient involvement

• Engaging patients/service users/clients/carers as co-researchers from the outset

• Supports available in each third level institution

Population perspective

Focus on the individual Focus on the whole population

The Irish Longitudinal Study on Ageing (TILDA)

• Trinity College

• Economic, social and health information on over 50s in Ireland

• Funded by Atlantic Philanthropies, Irish Life and Department of Health

https://tilda.tcd.ie/

International longitudinal studies of ageing

The Irish Longitudinal Study on Ageing

• Nationally representative sample of community living adults over 50 years

• Brief overview of research project on hypertension prevalence and knowledge translation

Blood pressure ≥ 140/90 mmHg

Blood pressure and medications recorded

Hypertension definition:SBP≥140 mmHg or DBP ≥90 mmHg and/or on antihypertensive medication

This is equivalent to 797,000 in the population aged 50 years and older in Ireland

Hypertension prevalence

• Grant from the Health Research Board

• Challenge in shifting from a population perspective to impacting on patient care

• Community nurses/Practice nurses

• 17 Locations

• 12 Counties

• 386 nurses attended

• Lessons from dissemination phase

Knowledge Exchange and Dissemination

• Awareness raising: Public and professionals

• Media: radio interviews, newspaper

• Irish Heart Foundation’s blood pressure council

• British and Irish Hypertension Society member

• Undergraduate summer studentship

• Hypertension education day (November 30th)

• Lots done, more to do……

Further knowledge translation

TILDA resource

https://tilda.tcd.ie/

Exciting time to be involved in gerontologicalnursing research

• Constantly changing environment

• Improve our knowledge to improve patient care

• Develop research skills

• Support nurses engaged in research

• Develop networks: other nurses, other disciplines, patients/families/carers

• Demonstrate the complexity of nursing older adults and the impact of research on quality of care and client satisfaction with care received

• Enable visibility of the dynamism of gerontological nursing work

• Today is about all of the above

Don’t hide the light

Thankyou

Catriona.murphy@dcu.ie