Incorporating Geriatrics Into Undergraduate Nursing Curriculum Jennifer Bright

Why It’s Important The older adult population is projected to grow to 19% of the population by the year 2030 (Wallace, 2005). According to Wallace, Grenier, Grossman, Lange and Lippman (2006), a substantial gap exists between the number of older adults requiring competent geriatric care and the number of nurses willing to provide it. Due to the growing number of older adults requiring complex care, nursing schools with a baccalaureate program are challenged to change their curriculum to meet the needs of these older adults.

Projected Growth of Older Adults Age 65 and Over

Hospital 48% PCP Visits 60% Home Care Visits 80% Nursing Home Beds 85% Students Who Choose to Work with Geriatrics 1.9%

AACN Essentials The AACN’s essentials contain, gerontological nursing competency statements necessary for nurses to provide high- quality care to older adults and their families. 19 competencies includes: rationale for change, suggested/essential content, and suggested teaching strategies. Example outcomes: incorporate professional attitudes, values and expectations about physical and mental aging in the provision of patient-centered care; plan patient-centered care with consideration of mental and physical health and well- being of informal and formal caregivers and intervene to achieve personal goals, and use online guidelines to prevent and/or identify and manage geriatric syndromes.

National League For Nurses- Advancing Care Excellence for Seniors 4 essential knowledge domains which enable nursing students and practicing nurses to translate their knowledge of individualized aging, complexity of care, and vulnerabilities during life transitions into actions that promote high quality care for older adults. 4 essential actions: assess function and expectations, coordinate and manage care, use evolving knowledge, and make situational decisions

NLN ACES Strategies Teaching Strategies- skills lab, classroom, simulation, and clinical. Outcomes: Students are expected to be able to assess, respond to and respect an older adult’s functional status and strengths, wishes, and expectations; manage chronic conditions, including atypical presentations, in daily life and during life transitions to maximize function and maintain independence, understand geriatric syndromes and unique presentations of common diseases in older adults, and analyze risks and benefits of care decisions in collaboration with the interdisciplinary team and the older adult, family, and caregivers.

Other Programs Texas Tech University Health Sciences Center, School of Nursing used a task force to create a new curriculum which included; a 3-hour didactic and clinical course with a focus on healthy aging that is required for all beginning students, a pharmacology course addressing medication therapy for older adults, a senior-level 30-hour practicum in long-term care, and strengthened geriatric content integrated throughout the curriculum. The NYU SoN integrated gerontological nursing content within 5 of 6 clinical courses and involved students in senior mentor projects.\ Tuskegee University created the holistic approach to the promotion of successful aging and risk reduction in which nursing students explore how older adults maintain functional and productive lifestyles through various health promotion and risk reduction strategies designed to improve an overview of aging.

How integrating geriatrics supports the mission and vision Widener University’s vision is to develop clinically prepared, scientifically oriented, professional nurses. According to the AACN (2010), in order to provide the quality of care needed to care for the older population, entry-level nurses must be prepared to display positive, professional attitudes and behaviors towards older adults. Nurses are also expected to recognize the individuality and complexity in the care of older adults while demonstrating respect and preserving dignity. Baccalaureate-educated graduates will need to be knowledgeable about identified risks and threats to patient safety for older adults and use evidence-based instruments and interventions to assess, reduce risk, monitor and intervene effectively to improve quality and safety.

How integrating geriatrics supports the mission and vision The mission of Widener University is to create a learning environment where curricula are connected to societal health issues and engage students through interactive teaching and experiential learning. NLN ACES program suggests using videos, case studies and concept maps. This focuses on assessing expectations, coordinating and managing care and making situational decisions with older adults as well as enhances students’ human flourishing and nursing judgment. NLN is using retirement communities to enhance a better understanding of older adults. These communities have older adults living in independent situations giving the students an opportunity to be exposed to and interact with well adults thus changing negative attitudes towards older adults.

Internal Factors Student interest, demographics, and faculty expertise. Only 1.9% of undergraduate student nurses identify working with older adults as their first career choice. Age, ethnicity and gender may also influence attitude towards geriatrics. As of 2005, 58% of baccalaureate nursing programs do not have full-time faculty certified in geriatric nursing.

External Factors Health and healthcare, accrediting bodies, and government regulations. The availability of healthcare resources, for example, the aging workforce. Increased longevity and decreased birth rate which will result in over two billion people over age 60 by NLN-ACES & AACN The Center for Medicaid and Medicare services (CMS) is the agency with the largest impact.

Goals And Objectives Understand the barriers to older adults understanding and receiving information. Use resources (patient, family, online tools, and textbooks) to assess the older adults’ sensory, behavioral and cognitive ability. Identify and manage geriatric syndromes. Describe geriatric syndromes and interventions to manage these syndromes. Plan patient centered care with consideration of the special needs of older adults. Create a plan of care which identifies the older adult’s physical, emotional, and cognitive needs Identify home teaching needs to facilitate safe transitions. Evaluate patient’s home needs with consideration of functional, physical, cognitive, psychological, and social needs.

Achieving Success Goal 1: Students need to understand the impact of sensory, affective, behavioral, and cognitive symptoms on expressive and receptive communication patterns with older adults. Sensory Assessment- The student will demonstrate the Rinne and Weber tuning fork test and the whisper test in the simulation lab. The student will also verbalize to the clinical faculty the interventions that can be used to communicate with an older adult with hearing loss.

Achieving Success Behavioral Assessment- The student will demonstrate knowledge of the Geriatric Depression Scale (GDS). The student will be given a sample of a completed GDS and will interpret the results. Cognitive Assessment- The student will demonstrate understanding of the Mental Status Assessment of Older Adults: The Mini-Cog. In the clinical setting, the student will assess an older adult using the Mini-Cog test and interpret the results with the clinical instructor.

Achieving Success Goal 2: Identify and manage geriatric syndromes. The students understand the health status of older adults can be rapidly changing. Students will write a short paper on one geriatric syndrome of their choice. Geriatric Syndromes are common clinical conditions that don’t fit into specific disease categories but have an impact on function and life satisfaction: Pressure Ulcers Incontinence Falls Functional Decline Delirium

Achieving Success Goal 3: Plan patient centered care with consideration of the special needs of older adults. Students recognize the complex interaction of acute and chronic co-morbid physical and mental conditions and associated treatments of older adults. Create a concept map based on a patient they have cared in the clinical setting. The student must chose a patient over the age of 65 with two or more co-morbidities. The concept map must contain chief complaint, assessment data, labs, medications, nursing problem, goals, interventions and evaluation. A 4-point scale will be used ranging from poor (1-point) to excellent (4-points).

Achieving Success Goal 4: Identify home teaching needs to facilitate safe transitions. Students will be able to facilitate safe transitions to the home setting. Students will be presented with a scenario related to discharging a patient to home. The students will verbalize the safety concerns for the patient and offer ideas to maintain safety. Student will be graded as pass/fail.

Curriculum Map

Conclusion In order to increase undergraduate nursing students’ knowledge of geriatrics, educational opportunities need to be integrated into the curriculum throughout the 4-years. The focus of the education must address core geriatric competencies including but not limited to physiological, psychological and cognitive changes and spiritual needs of older adults. Providing student nurses with opportunities to learn about the older adult over the course of the nursing curriculum will enable student nurses to realize that the field of geriatrics is as complex as other specialties and will increase the knowledge base necessary to deliver quality of care to older adults.

References American Association of Colleges of Nursing (2010). Recommended baccalaureate competencies and curricular guidelines for the nursing care of older adults. Retrieved from nursing/aacn_gerocompetencies.pdf nursing/aacn_gerocompetencies.pdf Aud, M. A., Bostick, J. E., Marek, K. D. & McDaniel, R. W. (2006). Introducing baccalaureate student nurses to gerontological nursing. Journal of Professional Nursing, 22(2), doi: /j.profnurs Burbank, P. M., Dowling-Castronovo, A., Crowther, M. R. & Capezuti, E. A. (2006). Improving knowledge and attitudes toward older adults through innovative educational strategies. Journal of Professional Nursing, 22(2), doi: /j.profnurs Clendon, J. (2011). Enhancing preparation of undergraduate students for practice in older adults settings. Contemporary Nurse, 38(1-2),

References Jeffers, B. R. & Campbell, S. L. (2005). Preparing to care for older adults: engaging college constituents. Journal of Nursing Education, 44(6), Latimer, D. G. & Thornlow, D. K. (2006). Incorporation geriatrics into baccalaureate nursing curricula: laying the groundwork with faculty development. Journal of Professional Nursing, 22(2), doi: /j.profnurs National League for Nursing (2011). ACES: Advancing care excellence for seniors. Retrieved from Ryan, M. & McCauley, D. (2004/2005). We built it and they did not come: knowledge and attitudes of baccalaureate nursing students toward the elderly. Journal of the New York State Nurses Association, 5-9. Scott-Tilley, D., Marshall-Gray, P., Valadez, A. & Green, A. (2005). Integrating long-term care concepts into baccalaureate nursing education: the road to quality geriatric health care. Journal of Nursing Education, 44(6), Wallace, M. Greiner, P., Grossman, S., Lange, J. & Lippman, D. T. (2006). Development, implementation, and evaluation of a geriatric nurse education program. The Journal of Continuing Education in Nursing, 37(5), Wallace, M., Lange, J. & Grossman, S. (2005). Isolation followed by integration: A model for development of a separate geriatric course. Journal of Nursing Education, 44(6),

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