by the GAPN through regularly scheduled rounds is critical to the integration and application of knowledge.40 Because the GRN is unit-based and supported by an advanced practice nurse, she or he is more likely to integrate evidence-based practice. The GRN uses the SPICES (Sleep disorders, Problems with eating and feeding, Incontinence, Confusion, Evidence of falls, and Skin breakdown) model of screening developed by Fulmer,41 as a guide to identify patients who require additional assessment, preventive measures, and treatment.
The GRN also acts as a resource to other staff, providing consultation and training on issues related to care of the older adult patient. With support from the GAPN, the GRN is active in quality improvement activity. The GRN/GAPN partnership leads an interdisciplinary process that identifies areas for improvement, establishes measurable and time-specific aims and measures, and selects interventions that are based on evidence. They commonly use the PDSA (Plan-Do-Study-Act) cycle42 to test or evaluate the change on a small scale, using what is learned to modify the implementation before disseminating throughout the unit. Some examples of GRN quality initiatives include an oral care protocol to minimize the occurrence of ventilator-associated pneumonia and collaboration with a state quality initiative to reduce unit-acquired pressure ulcers. Experts recommend the GRN model as a leading approach to advancing care of the hospitalized older adult. Units that institute the model in the future could add to nursing science by measuring the model's effectiveness in the ICU.