Improving resident outcomes with GAPN organization level interventions.

This research tested the effectiveness of the second tier of interventions in a two-tiered nursing intervention model designed to improve quality of care for residents in long-term care facilities (LTCFs). The first tier of the model called for gerontological advanced practice nurses (GAPNs) to provide direct care and to teach staff to implement care protocols for residents with incontinence, pressure ulcers, depression, and aggression. Results of the first-tier study indicated significant improvement in resident outcomes in incontinence, pressure ulcers, and aggression. In the second tier, GAPNs added a set of organization-level (OL) interventions including membership on the LTCF quality assurance committee and collaborating with staff on problem-solving teams. Analysis following the addition of OL interventions revealed significant improvement in both depression scores and in the trajectory of depression in residents of the LTCF where OL interventions were used.