230 ENCYCLOPEDIA OF NURSING RESEARCH
Farrell, M., Schmitt, &c Heinemann, 2001).
Well-developed team skills are necessary for
clinicians to represent their various disci-
plines when developing a geriatric interdisci-
plinary care plan (Farrell, M., et al.). Geriatric
interdisciplinary team care has been shown
to improve patient outcomes through the de-
velopment of team skills and a willingness to
collaborate more effectively (Grant, Finoc-
chio, & the California Primary Care Consor-
tium Subcommittee on Interdisciplinary Col-
laborative Teams in Primary Care, 1995;
Drinka & Clark). The process of team func-
tioning is dependent on the team skills and
attitudes of the individual team members,
their ability to identify ineffective team be-
haviors, and their ability to develop an inter-
disciplinary plan of care (Drinka & Clark;
Heinemann, Schmitt, & Farrell, 1994).
In addition to team skills, positive atti-
tudes toward health care teams contribute to
effective geriatric interdisciplinary team care
(Leipzig et al., 2002; Farrell, M., et al.). Atti-
tudes toward geriatric interdisciplinary team
care of nurses, physicians, and social workers
have been shown to have an impact on team
success, as reflected in, for example, hospital
readmission rates (Sommers et al., 2000).
Negative attitudes toward geriatric interdisci-
plinary team care that contribute to sources
of team conflict include: (a) differing disci-
plinary and personal perspectives, (b) role
competition and turf issues, (c) differing in-
terprofessional perceptions of roles, (d) varia-
tions in professional socialization processes,
(e) physician dominance of teams and deci-
sion making, and (f) the perception that phy-
sicians do not value collaboration with other
groups (Abramson & Mizrahi, 1996; Leipzig
et al., 2002).
In 1995, the John A. Hartford Foundation
of New York City funded the Geriatric Inter-
disciplinary Team Training (GITT) program,
a large multisite national team training pro-
gram designed to create models to train 2,500
health care professionals in interdisciplinary
team care. From 1997 to 2000, the eight
GITT sites measured the effectiveness of this
training intervention by conducting a prepost
training evaluation of the GITT participants.
The GITT program was foremost a training
model and therefore the core measures that
were collected were focused on the trainees,
the ultimate unit of analysis. The purpose of
the core measures was to evaluate the effec-
tiveness of the intervention, the team train-
ing program.
The results from the GITT study demon-
strated an overall effect of GITT training at
posttest on measures of attitudinal change,
change in test of geriatric care planning, and
the test of team dynamics (Fulmer, Hyer, et
al., 2004). Changes were greatest for attitudi-
nal measures including team skills and mod-
est for knowledge changes in geriatric care
planning and test of team dynamics. At the
level of the individual variables, significant
changes were observed between the pre- and
posttest mean scores for overall team skills
scale and for the overall attitudes scale and
each of its subscales. The GITT program
serves as a model for implementing and evalu-
ating geriatric interdisciplinary team train-
ing programs.
The need to improve the effectiveness of
geriatric interdisciplinary team care has never
been more urgent then in today's health care
environment. Providing comprehensive care
to older adults with multiple illnesses, disabil-
ities, increased social problems, and frag-
mented care compounds the demographic im-
perative we face in our aging society. Effective
geriatric interdisciplinary team care has been
shown to improve patient outcomes by im-
proving functional status (Sommers et al.,
2000), perceived well-being (Boult et al.,
2001; Knaus et al., 1996), mental status and
depression (Eng et al., 1997). In addition,
effective geriatric interdisciplinary team care
has been shown to reduce medical errors
(IOM, 2001).
ELLEN FLAHERTY
Geriatrics
The term geriatrics evolved from the Greek
word geras, "old age," and it refers to the
branch of medicine that covers the diagnosis

and treatment of the diseases and syndromes
that occur primarily among older people. A
board-certified medical practitioner of geriat-
ric medicine is called a geriatrician. In the lay
press the term has sometimes been overgener-
alized to include comprehensive health care
and preventive services for older adults, but
this blurs the original meaning of the term.
In the specialty of nursing devoted to care
of the aged, there has been considerable lin-
guistic confusion and philosophical contro-
versy about what to call the practice specialty.
Various attempts were made to clarify and
specify terminology and make the terms fit
the consensual philosophy and goals of prac-
titioners within the specialty, but no term has
been found that pleases everyone.
A specialty referred to as geriatric nursing
was first suggested in an anonymous 1925
editorial, "Care of the Aged," in the Ameri-
can Journal of Nursing, and the first nursing
textbook on the topic was published in 1950.
However, the actual birth of the specialty
occurred in 1962, when the American Nurses
Association (ANA) formed the Conference
Group on Geriatric Nursing Practice. In 1966
the ANA officially created the Division of
Geriatric Nursing, and in 1976 the name was
changed to the Division of Gerontological
Nursing (ANA, 1982). The ANA published
the first set of Standards of Practice for Geri-
atric Nursing in 1970. The Journal of Geron-
tological Nursing began operation in 1975,
and Geriatric Nursing: Care of the Aged was
first published in 1979. The ANA division's
name change and the titles of these two jour-
nals reflect the ongoing debate about proper
terminology for the nursing specialty.
Many people rejected the term geriatrics
because it did not properly reflect nursing's
interest in the entire continuum of health and
disease, including health promotion, disease
prevention, care of acute illness, and long-
term care. Others rejected it as a medical term
that did not convey inclusion of the art of
nursing.
Although the ANA division's name change
to the Division of Gerontological Nursing
pleased some nurses, others said it introduced
a new error in terminology. The main criti-
Geriatrics 231
cism about this new label was that gerontol-
ogy refers to the study of or science-work
about the aging processes and the biological,
psychological, sociological, and economic ex-
periences of normal aging (Lueckenotte,
1996). Using an "ology" term did not logi-
cally lend itself to the name of a clinical spe-
cialty in a practice field. This problem led
some leaders in the field to lobby for the term
gerontic nursing to identify the specialty. Ge-
rontic nursing as defined by Gunter and Estes
(1979) is more philosophically palatable than
geriatric nursing and more linguistically cor-
rect than gerontological nursing. Gerontic
nursing was defined as a nursing specialty
that includes the art and practice of nurtur-
ing, caring, and comforting older adults. Sup-
porters of this term maintained that it in-
cluded both the science and the art of nursing.
Detractors argued that it left out health pro-
motion and disease prevention.
A review of the titles of the most popular
clinical textbooks in nursing today still shows
considerable ambivalence. Nursing textbook
titles include: geriatric nursing, gerontologi-
cal nursing, clinical gerontological nursing,
gerontologic nursing, gerontic nursing, and
care of the aged; however, the latter three are
less in evidence than a decade ago. Interest-
ingly, the National Institute on Aging at NIH
(2004) acknowledged the single-term di-
lemma by naming its clinical research pro-
gram the "Geriatrics and Clinical Gerontol-
ogy Program" (GCG). The Geriatrics branch
supports research on health issues of the
aged, including disease and disability in older
persons—both specific conditions and multi-
ples morbidities. The Clinical Gerontology
branch sponsors research on clinically related
issues regarding aging and research on aging
changes over the life span.
An ideal term for the nursing specialty
would cover the full range of knowledge
needed and services to be provided in this
practice field that has age of client as its sole
parameter. The specialty is practiced at all
levels of the health continuum, with persons
who are aged 60+ to 115+, in any and all
types of settings where older adults are to be
found, and for periods of time that stretch
232 ENCYCLOPEDIA OF NURSING RESEARCH
from minutes to decades. Finding a fitting
replacement for the term geriatrics or geriat-
ric nursing has already challenged some of
the best minds in the profession for over 40
years. The search for a single ideal term is
not likely to end soon.
Even without a clear title for the specialty,
nurse researchers have made significant con-
tributions to knowledge about older adults
across the spectrum from health promotion
through end-of-life care. As genetic knowl-
edge and stem cell research opens new vistas
for inquiry, myriad unanswered questions
about preventing and arresting the chronic
illnesses and disabilities of old age will pro-
vide ample fodder for the fertile intellects of
present and future nurse scientists for many
years to come.
JOANNE SABOL STEVENSON
Gerontological Advanced Practice
Nursing
During the last 3 decades, research examining
the proliferation of Advanced Practice Nurses
(APNs) has demonstrated that APNs improve
quality of care, increase patient and staff sat-
isfaction, while being cost effective across
health care settings (Feldman, Ventura,
Crosby, 1987; Master et al., 1987; Miller,
S. K., 1997; Naylor, Brooten, et al., 1999;
Ramsay, McKenzie, & Fish, 1982; Sox,
1979; Spitzer et al., 1974).
During the late 1960s to 1970s graduate
nursing programs began developing special-
ties in gerontological nursing. GAPN is an
umbrella term refering to Geriatric Nurse
Practitioner (GNP) or Gerontological Clini-
cal Nurse Specialist (GCNS). Currently there
are near 4,000 certified GNPs and over 1,000
certified GCNSs (American Association of
Colleges of Nursing, 2004). GAPN sub-
groups presently require gerontological-fo-
cused graduate education. Traditionally,
GCNS roles include educator, researcher,
practitioner, manager, and consultant. In ad-
dition to the GCNS roles, GNPs have the
ability to conduct advanced health histories
and physical assessments make diagnosis,
and prescribe appropriate medical treat-
ments—including pharmaceuticals within a
collaborative agreement with a physician.
Scopes of practice for both vary between
states. Literature demonstrates more similari-
ties between nurse practitioners (NPs) and
clinical nurse specialists (CNSs) than differ-
ences. Nursing leaders are currently debating
role integration (Fenton & Brykczynski,
1993; Soehren & Schumann, 1994; Lincoln,
P. E., 2000).
The literature reported APNs favorably in-
fluence health care outcomes such as: mortal-
ity, morbidity, length of stay, functional sta-
tus, mental status, stress level, and patient
satisfaction, burden of care, and cost of care.
Overall, studies demonstrated consumer ac-
ceptance and satisfaction with NPs, physician
comparative quality of care, increased pro-
ductivity, cost savings, saved physician time,
effective management of both preventive and
chronically ill care, and improved patient ed-
ucation (Feldman et al., 1987; Naylor, Mun-
ro, & Brooten, 1991).
The GAPN role impacts the quality of care
in long-term care (LTC) populations by de-
creasing hospitalizations, reducing pharma-
ceutical usage, and improving patient-family-
staff satisfaction. GAPNs hold an essential
role in reducing restraints in the nursing home
population (Evans, L. K., et al., 1997). Most
notably, the GAPNs provide cost-effective
quality care. Using a quasi-experimental de-
sign, Kane and colleagues (1989) compared
data of pre- and post-GNP time periods in
60 nursing homes (30-GNP; 30-control) dis-
persed throughout eight western states and
discovered that GNP provided cost-effective
care to residents primarily by reducing hospi-
tal utilization. Another study, a 1-year retro-
spective data analysis for 1,077 LTC resi-
dents, compared 414 residents followed by
GNP/MD teams and 663 residents followed
by MDs alone. Patients of the GNP/MD
teams yielded a $72 per resident per month
savings (Burl, Bonner, Rao, & Khan, 1998).
GNPs may succeed in nursing home man-
agement. Grzeczkowski and Knapp (1988)
evaluated a 120-bed nursing home after a
 Contributors xxix

Marlaine C. Smith, PhD, Theresa Standing, PhD, Patricia W. Stone, PhD,

RN, AHN-C, FAAN RN MPH, RN
Professor and Associate Assistant Professor Assistant Professor
Dean for Academic Case Western Reserve Columbia University
Affairs University School of Nursing
University of Colorado Frances Payne Bolton New York, NY
Health Sciences Center School of Nursing Patient Safety
School of Nursing Cleveland, OH
Denver, CO Triangulation Ora L. Strickland, PhD,
Caring RN, FAAN
Els Steeman, MSN
Center for Health Services Professor
Mary Jane Smith, PhD, RN Emory University
Professor and Associate and Nursing Research
Katholieke Universiteit Nell Hodgson School of
Dean for Graduate Nursing
Academic Affairs Leuven
Leuven, Belgium Atlanta, GA
West Virginia University
Robert C. Byrd Health Medications in Older Measurement and Scales
Science Center Persons
School of Nursing Neville E. Strumpf, PhD,
Karen Farchaus Stein, PhD, RN, FAAN
Morgantown, WV
RN, FAAN Edith Clemmer Steinbright
Drinking and Driving Associate Professor of Professor in Gerontology
Among Adolescents; Nursing Director of the Center for
Middle-Range Theories University of Michigan Gerontologic Nursing
School of Nursing Science
Bernard Sorofman, PhD Ann Arbor, MI
Professor University of Pennsylvania
Self-Concept School of Nursing
University of Iowa
Disturbances and Eating Philadelphia, PA
College of Pharmacy Disorders
Iowa City, IA Physical Restraints
Ethnography Joanne Sabol Stevenson,
PhD, RN, FAAN Sheri Stucke, PhD, FNP
Susan M. Sparks, PhD, Professor Emeritus Kresge Center Research
RN, FAAN Ohio State University Assistant
Project Officer College of Nursing Decker School of Nursing
National Library of Columbus, OH Binghamton University
Medicine and Binghamton, NY
Bethesda, MD Rutgers College of Nursing Osteoporosis
Electronic Network Newark, NJ
Adult Health; Alcohol Hussein A. Tahan, DNSc,
Ann M. Stalter, MS, RN Dependence; Drug RN, CNA
Clinical Instructor Abuse; Geriatrics Director of Nursing,
Wright State University Cardiovascular Services
Kathleen Stone, PhD, RN,
College of Nursing and Columbia University
FAAN
Health Medical Center
Professor Emeritus
Dayton, OH New York-Presbyterian
Ohio State University
Vulnerable Populations College of Nursing Hospital
Columbus, OH New York, NY
Endotracheal Auctioning Case Management
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