gerontological nursing research in a time of change
TRANSCRIPT
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
