The American Academy of Nursing's Edge Runners initiative spotlights nurse-designed care models that curtail costs, elevate healthcare quality, promote health equity, and boost patient satisfaction. This program acknowledges groundbreaking ideas that revolutionize healthcare, emphasizing nurses' leadership, ingenuity, and resolve.
Addressing Critical Healthcare Gaps Through Innovative Nursing Models
Across the globe, the demand for emergency care is rising, with rates steadily increasing worldwide. This surge underscores the need for efficient and effective emergency care strategies. Moreover, significant healthcare gaps persist in various areas, including dementia care, support for new graduate nurses, and access to forensic care for survivors of sexual assault, particularly in rural areas.
Streamlining Emergency Department Care: The HIRAID® Model
Emergency departments (EDs) are often characterized by complexity, uncertainty, urgency, constant interruptions, and high levels of uncertainty. Recognizing and responding to deteriorating patients is a crucial nursing responsibility in the ED, influencing the trajectory of inpatient care. Nurses are typically the first clinicians to assess patients; therefore, their assessment and management decisions are vital for patient safety. Effective communication and handover are also central to ensuring patient safety and positive experiences.
To address these challenges, the HIRAID® framework provides a structured approach to guide emergency nursing assessment and care post-triage. This model incorporates the core elements for assessment and treatment, allowing for simultaneous execution of framework elements and continuous reassessment throughout the patient's ED stay. The HIRAID® model is evidence-based and designed specifically for emergency nurses, aiming to improve the quality of handover, including the relevance and completeness of information. Surveys involving 1,205 emergency nurses from 29 EDs have demonstrated improvements in handover quality with the implementation of the HIRAID® model.
Integrated Memory Care (IMC) Model: Transforming Dementia Care
For the millions of Americans living with dementia and their family caregivers, achieving independent and safe living is a significant burden. These costs arise due to the lack of preparedness of healthcare and social services to support these goals. The Integrated Memory Care (IMC) model directly tackles these challenges through a comprehensive dementia care practice led by advanced practice nurses.
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The IMC model, developed without grants or philanthropy, addresses the complexities of dementia illnesses. Nurse practitioners serve as primary care providers, collaborating with an interprofessional team. Since its inception in 2015, the IMC has served over 3,000 patients, leading to changes in national dementia care payment policies. The IMC team includes a clinical social worker, registered nurses, a medical assistant, and patient access coordinators. Dementia Care Assistants offer specialized companionship services in senior living communities.
Clinic patients receive routine primary care or cognitive visits every three months, while those in senior living communities are visited every two months. Geriatric psychiatry NPs provide consultation for complex prescribing needs. The team also completes regulatory forms and manages certain prescribing activities. The clinical social worker leads caregiver support groups and facilitates educational programs. Registered nurses provide first-line triage and protocol-driven management for minor acute illnesses, as well as annual wellness visits. Dementia Care Assistants engage in weekly 1:1 customized companionship and engagement activities with patients. In 2020, the IMC reported an ambulatory care-sensitive hospital admission rate of less than 2% over four years, compared to the substantial costs associated with hospitalizations for patients with dementia.
Iowa Online Nurse Residency Program (IONRP): Supporting New Graduate Nurses
A significant percentage of new graduate nurses (NGNs) leave their first job within the first year, impacting nurse well-being, patient care, and organizational finances. To address this, the Future of Nursing Iowa Action Coalition launched a task force in 2012. This task force, comprising nurse executives, educators, leaders from hospital-based NRPs, an NGN, and a nursing student, aimed to create a standardized, accessible residency program.
The Iowa Online Nurse Residency Program (IONRP) is the first fully online transition-to-practice program for NGNs, bridging the gap between education and practice. Delivered through a hub-and-spoke structure, the IONRP offers customizable services to partnering healthcare organizations. These organizations provide unit-specific and facility orientation, focusing on technical skills and organizational policies.
The IONRP offers two options: an all-online option, where NGNs complete the curriculum and connect with peers nationwide via webinars, and a blended option, where NGNs complete the curriculum and connect with peers within their organization. The program utilizes a multimodal learning approach, including microlearning videos, expert podcasts, downloadable content, self-checks, reflection activities, and monthly challenges. Peer cohort discussions provide support and practical tips for practice improvement. NGNs also undertake a professional experience project. The IONRP has been implemented in over 54 healthcare organizations across 13 states, resulting in cost savings for employers. For example, an NGN from a home health agency improved dyspnea management, increasing the agency's measure from below state and national averages to a higher level.
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SAFE-T Model: Expanding Forensic Care for Sexual Assault Survivors in Rural Areas
Survivors of sexual assault require specialized care, including forensic examination, medical treatment, and psychological support. However, rural areas often lack Sexual Assault Nurse Examiners (SANEs) due to staffing, cost, and education barriers. This disparity limits access to expert forensic care for survivors in these communities.
The SAFE-T System model aims to address this gap by connecting rural healthcare providers with expert SANEs through a telehealth-enabled forensic system. This model ensures accurate evidence collection and best examination practices. Rooted in community partnership, the SAFE-T System comprehensively supports and sustains SANE-led care in underserved areas. The model utilizes the Expanded Chronic Care Model Framework, focusing on continuous learning, problem-solving, and adaptation while supporting research, policy, and practice elements.
The SAFE-T model includes training, precepting, live telehealth consultation, and administrative support to develop local SANE programs. Hospital partners identify nurses for training, commit to a paid on-call SANE response, and provide paid time for training.
Simulation in Motion - Iowa (SIM-IA): Mobile Simulation-Based Continuing Education
Continuing education is crucial for healthcare providers, particularly in rural and critical access hospitals. However, access to hands-on, patient-centered training can be limited. Simulation in Motion - Iowa (SIM-IA) is a nurse-developed and led mobile simulation program that provides free continuing education to rural healthcare providers throughout Iowa.
SIM-IA utilizes three mobile simulation units located across Iowa, each with a lead educator and part-time educators. The education is standardized and adapted to local regulations and resources, developed based on evidence and reviewed by experts. Featured simulations are based on Healthcare Cost and Utilization Project data and published literature, addressing critical needs such as obstetric hemorrhage management and sepsis recognition.
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The program emphasizes debriefing sessions to enhance learning. Since 2022, SIM-IA has traveled over 80,000 miles, providing over 2,500 hours of free continuing education to 11,000 healthcare personnel during 650 simulations. SIM-IA has garnered interest from the State of Iowa and philanthropic donors for continued funding.
Dr. Spatz's Program: Promoting Human Milk and Breastfeeding
The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of an infant's life. However, breastfeeding rates remain suboptimal, with millions of infants worldwide lacking access to human milk. To address this, Dr. Diane L. Spatz developed a program focused on increasing breastfeeding rates in the United States.
Dr. Spatz's program provides clinicians with the framework and tools to change practice and achieve measurable results that are personalized, convenient, cost-effective, and innovative. The program emphasizes the critical role of nurses in lactation support. Prior to the implementation of Dr. Spatz's program at Children's Hospital of Philadelphia (CHOP), the percentage of NICU infants receiving human milk at discharge was approximately 30%.
Memory and Wellness Center (MWC) Caring Science Model: Improving Dementia Care Through Community Engagement
As the population ages, the prevalence of Alzheimer's disease and related dementias (ADRD) increases, particularly among Latino and Haitian communities. Caregivers often experience depression, stress, and a lack of knowledge about managing behavioral and psychological symptoms of dementia. The Memory and Wellness Center (MWC) has implemented a nurse-driven, dementia-specific model to improve health and health equity through community engagement.
The MWC model seeks to expand access to care grounded in caring science and transform support for community-resident older adults and their caregivers. The model integrates mind, body, and spirit to deliver individualized, convenient, cost-effective, and innovative care. The MWC model provides comprehensive care and support for individuals with ADRD and their families. The model has received significant grant funding and has been replicated nationally and internationally.
Transitional Care Nurse (TCN) Model: Improving Chronic Disease Management
The fee-for-service healthcare model in the United States can lead to fragmented care, medical errors, and wasted resources. To address this, the Transitional Care Nurse (TCN) model focuses on improving chronic disease management and care transitions.
The TCN model aims to provide a broader approach to impacting community health outcomes. Studies have shown significant improvements in patient outcomes, such as reductions in A1C levels for patients working with a Certified Diabetes Educator within primary care practices. The TCN model also supports senior citizens who prefer to remain at home rather than enter nursing home care.
AACN CSI Academy: Empowering Nurses to Lead Change
The AACN CSI Academy empowers staff nurses with the knowledge and support to become leaders who guide their peers in creating unit-based change that is easily scaled hospital-wide. The academy addresses key recommendations, including developing nurses' skills in leadership, project management, and quality improvement methods, ensuring lifelong learning, and preparing nurses to lead change. The program is delivered through experiential workshops led by AACN CSI national faculty.
Addressing Mental Health Challenges Through Diverse Therapeutic Approaches
A variety of therapists and counselors offer specialized support for individuals and families facing mental health challenges. These professionals utilize diverse approaches, including cognitive behavioral therapy (CBT), eye-movement desensitization and reprocessing (EMDR), dialectical behavior therapy (DBT), and internal family systems therapy (IFS), to address issues such as anxiety, depression, ADHD, trauma, and relationship difficulties. Many therapists also focus on serving specific populations, such as children, adolescents, members of the LGBTQ+ community, and individuals from diverse cultural backgrounds.
The Role of Free Fatty Acid Receptor 4 (Ffar4) in Heart Failure with Preserved Ejection Fraction (HFpEF)
Heart failure with preserved ejection fraction (HFpEF) is a complex clinical syndrome often associated with metabolic syndrome (MetS). Systemic inflammation linked to MetS may contribute to HFpEF remodeling. Free fatty acid receptor 4 (Ffar4) is a receptor that attenuates metabolic dysfunction and resolves inflammation. Studies have explored the role of Ffar4 in HFpEF-MetS, with findings suggesting that loss of Ffar4 can worsen diastolic function and microvascular rarefaction in male mice with HFpEF-MetS.