UCSF nursing school launches project to reform nursing homes

By Kristen Bole

Charlene Harrington, PhD, RN

The UCSF School of Nursing has launched a demonstration project to design and test nursing interventions to improve the quality of care in California nursing homes.

The California project, known as the Nursing Home Collaborative, is being coordinated by the UCSF/John A. Hartford Center for Geriatric Nursing Excellence, in the UCSF nursing school, as part of a broader effort by the American Academy of Nursing and four other Hartford centers throughout the United States. Those centers, which were formed in 2001, include the Oregon Health & Science University and the Universities of Arkansas, Iowa and Pennsylvania.

Over the next year, the collaborative aims to develop and refine a practice model to transform nursing home care, based on peer-reviewed research into what works and what does not, according to Charlene Harrington, PhD, RN, UCSF professor of sociology and nursing, who is co-leading the UCSF portion of the collaborative.

Activities during this first year will set the groundwork for a proposed five-year demonstration project to test interventions for elder care centers, aimed at improving the caliber of care they provide, she said. Ultimately, the collaborative aims to translate the findings from the current research into practical changes on a national scale.

“It’s no secret that our nursing homes are struggling to provide the care that our seniors both need and deserve,” Harrington said. “This project will give them tangible methods and practices to improve nursing care in order to achieve better outcomes.”

The UCSF project team will focus on developing core principles and interventions to include in the planned professional practice model.

These include expanded roles for geriatric nurse practitioners and clinical nurse specialists, improved staffing levels, and the development of expanded leadership and clinical skills among nursing home staff.

Harrington is co-directing the UCSF team with UCSF Hartford Center Director Margaret Wallhagen, PhD, RN. Eric Collier, MS, RN, is the project coordinator.

The project, whose first year is being funded through a $500,000 grant from Atlantic Philanthropies, is currently looking at potential nursing home sites to work with, Harrington said.

US nursing homes are a multi-billion-dollar industry, with roughly 17,000 nursing homes housing more than 1.7 million residents.

However, wide variation in the quality of care provided in these facilities has lead to considerable criticism, as well as repeated calls to improve the quality of care for frail elders.

In particular, several panels assembled by the Institute of Medicine have called for fundamental changes in how care is organized and delivered in the country’s nursing facilities.

“Research has demonstrated that we can make a difference in the care of older adults,” Wallhagen said. “The time has come to better synthesize and utilize this knowledge.”

In addition to collaborating with co-investigators from the four other Centers, the UCSF team is working with colleagues at Vanderbilt University and the University of California, Irvine.

The UCSF Center also has formed an advisory committee with representatives from Aging Services of California, the California Association of Health Facilities, the California Culture Change Coalition, the California Healthcare Foundation, and Lumetra, a quality improvement organization that is also working on initiatives through the Centers for Medicare and Medicaid (CMS).

The UCSF School of Nursing leads the nation in nursing research, from heart disease and cancer to pain management and healthy aging. The School consistently ranks first in funding from the National Institutes of Health, as a testament to the caliber of that research. Now celebrating its 100th anniversary, the School of Nursing has graduated more than 10,000 nurses since its creation after the Great San Francisco Earthquake of 1906 and is considered among the foremost nursing schools in the world in training the next generation of nursing leadership.

UCSF is a leading university that advances health worldwide by conducting advanced biomedical research, educating graduate students in the life sciences and health professions, and providing complex patient care.