Value-added outcomes: The use of advanced practice nurses in long-term care facilities

The purpose of this study was to determine the effect on clinical outcomes for newly admitted nursing home residents when advanced practice gerontolog ical nurses (APNs) worked with staff to implement scientifically based prot ocols for incontinence, pressure ulcers, depression, and aggressive behavio r. Use of APNs in this manner differs from the usual way APNs have been use d in nursing homes, in which their primary focus has been to augment the ph ysician's role. The APN treatment was randomly assigned to two nursing home s and usual care was assigned to a third. Trajectories from admission to 6 months revealed that residents with APN input into their care (n = 86) expe rienced significantly greater improvement or less decline in incontinence, pressure ulcers, and aggressive behavior, and they had higher mean composit e trajectory scores compared with residents receiving usual care (n = 111). Significantly less deterioration in affect was noted in cognitively impair ed residents in the treatment group. Findings suggest that APNs can be effe ctive links between current scientific knowledge about clinical problems an d nursing home staff.