UROLOGIC NURSING / November-December 2011 / Volume 31 Number 6
The purpose of this article is to describe the role of the acute care
gerontological clinical nurse specialist (GCNS) and provide an exem-
plar of using GCNS expertise in the implementation of gerontological
nursing best practices in hospitalized patients with delirium.
© 2011 Society of Urologic Nurses and Associates
Urologic Nursing, pp. 337-343.
The Gerontological Clinical Nurse
Specialist’s Role in Prevention,
Early Recognition, and Management
Of Delirium in Hospitalized Older Adults
Deborah Marks Conley
family care, even with increasing
pressure to decrease costs and im -
prove patient outcomes. Support
for nursing practice at the bedside
is an essential cost-effective step
toward this endeavor. Employing
the expertise of the advanced
practice registered nurse (APRN),
a gerontological clinical nurse
specialist (GCNS) can increase
awareness and facilitate rapid
identification of critical prob-
lems, such as delirium in the
aging inpatient population. Im -
plementation of gerontological
nursing best practices in hospital-
ized patients with delirium has
demonstrated a positive impact
on the overall outcome for these
rofessional nurses con-
tinue to focus on provid-
ing best practices for safe
and effective patient and
Explain the development of the advanced practice nurse role.
Describe the role of the gerontological clinical nurse specialist.
Discuss delirium in the older adult population and evidence-
based practice tools used for screening.
Deborah Marks Conley, MSN, APRN-
CNS, GCNS-BC, FNGNA, is a Geronto -
logical Clinical Nurse Specialist-Advanced
Practice Registered Nurse, Nebraska
Methodist Hospital, Omaha, NE, and
Nebraska Methodist College, Omaha, NE.
Note: Objectives and CNE Evaluation Form
appear on page 343.
Statement of Disclosure: The author
reported no actual or potential conflict of
interest in relation to this continuing nursing
Key Words: Advanced practice registered nurse (APRN), gerontological
clinical nurse specialist (GCNS), delirium, Hartford Center
for Geriatric Nursing, geriatrics, older adult, gerontological
Urologic Nursing Editorial Board Statements of Disclosure
In accordance with ANCC-COA governing rules Urologic Nursing Editorial Board state-
ments of disclosure are published with each CNE offering. The statements of disclosure for
this offering are published below.
Susanne A. Quallich, ANP-BC, NP-C, CUNP, disclosed that she is on the Consultants’
Bureau for Coloplast.
All other Urologic Nursing Editorial Board members reported no actual or potential con-
flict of interest in relation to this continuing nursing education article.
Demographics of Aging
The United States population
is aging exponentially. Each day,
10,000 individuals turn 65 years
of age, and 100 individuals turn
100 years old (National Institute
on Aging [NIA], 2011). An esti-
mated 50% of all hospital admis-
sions are age 65 or older (NIA,
2011). Demands are being placed
on health care systems to meet the
specialized needs of this popula-
tion and enhance gerontological
UROLOGIC NURSING / November-December 2011 / Volume 31 Number 6
diagnostic testing, altering cur-
rent treatment or managing the
environment. Prompt assessment
for causative factors and engaging
the interdisciplinary team early
promotes positive outcomes on
American Association of Colleges of
Nursing (AACN). (2011). The doctor
of nursing practice (fact sheet).
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mechanically ventilated patients:
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Confusion Assessment Method for
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Fick, D., & Mion, L. (2008). How to try
this: Delirium superimposed on
dementia. American Journal of
Nursing, 108(1), 52-60.
Hartford Institute for Geriatric Nursing
(HIGN). (2011). Home page. Retrieved
Inouye, S.K., Bogardus, S.T., Charpentier,
P.A., Leo-Summers, L., Acampora,
D., Holford, T.R., & Cooney, L.M., Jr.
(1999). A multi-component interven-
tion to prevent delirium in hospital-
ized older patients. The New
England Journal of Medicine, 340(9),
Inouye, S.K., Foreman, M.D., Mion, L.C.,
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its symptoms: Comparison of nurse
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Inouye, S.K., van Dyck, C.H., Alessi, C.A.,
Balkin, S., Siegal, A.P., & Horwitz,
R.I. (1990). Clarifying confusion: the
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new method for detection of deliri-
um. Annals of Internal Medicine.
Joel, L. (2009). Advanced practice nursing
essentials for role development (2nd
McCabe, B., & Raudonis, B. (2010).
Gerontological nursing: Scope and
standards of practice. Silver Spring,
MD: American Nurses Association.
National Association of Clinical Nurse
Specialists (NACNS). (2004). State -
ment on clinical nurse specialist
practice and education (2nd ed.).
Harrisburg, PA: Author.
National Gerontological Nursing Asso -
ciation (NGNA). (2011). About the
National Gerontological Nursing
Association. Retrieved from http://
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What’s new. Retrieved from http://
www. nia. nih.gov/NewsAndEvents/
Nurses Improving Care for Healthsystem
Elders (NICHE), (2011). The NICHE
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S., & Inouye, S.K. (2011). Sustain -
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National CNS Competency Task Force.
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Gerontological Nursing Resources
The Hartford Institute for Geriatric Nursing (HIGN) at New York University
designates health care organizations that implement and sustain system-wide
gerontological nursing best practices at Nurses Improving Care for Healthsystem
Elders (NICHE) facilities. NICHE is the leading organization designed to support
health care professionals in improvement of clinical skills and nursing competence
in the care of older adults. NICHE organizations have demonstrated improved
patient outcomes, higher satisfaction scores, and improved compliance with Joint
Commission standards (HIGN, 2011; NICHE, 2011).
In 2002, HIGN and the American Nurses Association (ANA) launched the
Nurse Competence in Aging (NCA) program, a five-year initiative to increase the
knowledge and skills of nurses in specialty areas and nursing organizations in the
delivery of appropriate and evidence-based care to older adults. The Society of
Urologic Nurses and Associates (SUNA) participated in this initiative in 2005.
Additionally, HIGN supports the new Resourcefully Enhancing Aging in Specialty
Nursing (REASN) project, which focuses on enhancing gerontological nursing
care and increasing involvement of specialty nursing associations in improving
nursing competencies in providing care to older adults (HIGN, 2011).
Another key gerontological nursing resource is the National Gerontological
Nursing Association (NGNA). This professional nursing organization focuses on
improving the quality of nursing care provided to older adults across diverse care
settings (NGNA, 2011).
The Hospital Elder Life Program (HELP) is a patient care program designed
to prevent delirium in hospitalized older adults. Its Web site provides clinicians
and families with resources about HELP and materials about delirium (www.
The CAM Tool and the CAM-ICU “Try This” Series can be accessed at
Vanderbilt University Medical Center CAM-ICU tool and resources can be
found at www.ICUDELIRIUM.org