Integration of Geriatric Curriculum Content into a Synergy Model Driven Acute Care NP Program BMcLear, DNP, FNP-C, ACNP-BC Georgia Regents University College of Nursing

GRU Acute Care Nurse Practitioner Program History 2010-HRSA grant awarded First DNP ACNP program in the Southeast 2011 Program for Accelerated Certification Education (PACE-ACNP) Mastering Essentials by Gaining Awareness during immersion days (MEGA i days)

The APRN Consensus Model Licensure -granting of authority to practice. Accreditation -formal review and approval by a recognized agency of educational degree or certification programs in nursing or nursing- related programs. Certification - formal recognition of the knowledge, skills, and experience demonstrated by the achievement of standards identified by the profession. Education -formal preparation of APRNs in graduate degree-granting or post-graduate certificate programs The consensus model was designed to align the inter-relationships among licensure, accreditation, certification, and education to create a more uniform practice across the country. We anticipate that the consistency – and clarity – that results from the new model will take advanced practice nursing to the next level, benefiting individual nurses and enhancing patient care. The consensus model is the product of a collaborative effort among more than 40 organizations (including ANCC) that have an interest in making the practice more uniform. ANCC is leading the way to ensure that this transformative model will enhance the certification process. APRNs, educators, and collaborative organizations should turn to ANCC for the most up-to-date information regarding the consensus model's effects on certification. Full implementation of the consensus model will require coordination groups that represent licensure, accreditation, certification, and education. We expect full implementation of the consensus model to be complete by 2015. Impact of the Consensus Model on Certification As implementation of the new consensus model progresses, ANCC's certification programs may change to more closely reflect the roles and populations required in the model. To help APRNs make the transition as smoothly as possible, ANCC will provide advance notice and information on the effects of any required changes. In the Consensus Model for APRN Regulation1, patient safety is a key uniting link among the components of advanced practice registered nursing (APRN) regulation – licensure, accreditation, certification, and education (LACE). Nurse practitioners (NPs), as the largest group of APRNs, have a prominent role in addressing patient health care needs in the current and evolving US health system. The alignment of the LACE components defines the NP scope of practice with a goal of public protection. 2 As described by the Pew Health Professions Commission, scope of practice is the “definition of the rules, the regulations, and the boundaries within which a fully qualified practitioner with substantial and appropriate training, knowledge, and experience may practice.”3 As part of an ongoing commitment to advance patient safety and clarify scope of practice, this paper elaborates on a significant issue for NP practice: The distinctions and overlap in practice by acute and primary care NPs. NCSBN, 2008

Primary Care NP roles Primary Care Education: Focus on comprehensive chronic, continuous care characterized by a long term relationship between the patient and NP. Cares for patients with a focus on disease prevention, assessment and management of common acute and chronic illnesses. Populations: Pediatric Adult Gerontological Family NONPF, 2011

Acute Care NP roles Acute Care Education: Focus on restorative care that is characterized by rapidly changing clinical conditions. Care for patients with unstable chronic conditions, complex acute illnesses, and critical illnesses Populations: Pediatric Adult Gerontological NONPF, 2011

AACN Synergy Model AACN,2015 The core concept of the reconceptualized model of certified practice — the AACN Synergy Model for Patient Care — is that the needs or characteristics of patients and families influence and drive the characteristics or competencies of nurses. Synergy results when the needs and characteristics of a patient, clinical unit or system are matched with a nurse's competencies. AACN,2015

Patient Characteristics Outcomes Nurse Competencies Patient Characteristics Resiliency Vulnerability Stability Complexity Resources Participation in care Participation in decision making Predictability Nurse Competencies Clinical Judgement Advocacy and Moral Agency Caring Practices Collaboration Systems Thinking Response to Diversity Facilitation of Learning Clinical Inquiry

Patient Characteristic Nurse Competency Course Stability Clinical Judgement Level 5 - Highly stable Constant Responsive to therapies Low risk of death Level 1 Collects basic-level data Follows protocols Questions the limits of one's ability Delegates the decision-making AGACNP I Level 3 - Moderately stable Maintains steady state for limited time Some responsiveness to therapies Level 3 Collects and interprets complex patient data Makes clinical judgments based on an immediate grasp of the whole picture Recognizes patterns and trends Recognizes limits and seeks appropriate help AGACNP II Level 1 - Minimally stable Labile Unstable Unresponsive to therapies High risk of death Level 5 Synthesizes and interprets multiple sources of data Uses past experiences to anticipate problems Helps patient and family see the "big picture“ Recognizes the limits of clinical judgement Seeks multidisciplinary collaboration AGACNP III & AGACNP practicum Assesses individuals with complex health issues and co-morbidities, including the interaction with aging and acute and chronic physical and mental health problems

Why a geriatric focus? Inpatients over the age of 65 years of age 38.7%(2010) Average length of stay 5.5-5.7 days Percent of adult day services center participants: 63.5% (2012) Percent of home health agency patients: 82.4% (2011) Percent of hospice patients: 94.5% (2011) Percent of nursing home residents : 85.1% (2012) Percent of residential care community residents: 93.3% (2012) Avg length of stay 3.2-5.0 younger age groups CDC, 2010 CDC, 2013

UAB Faculty Scholars Program Offered by UAB Geriatric Education Center 1) advanced illness and palliative care 2) transitions in care 3) family systems and self/caregiver management 4) communication skills addressing the cultural aspects of aging and health literacy

UAB Faculty Scholars Program 160 hours of training 5 in person sessions 2 day Interdisciplinary geriatric education conference 12 Continuing education modules 1 Scholarly activity-publishable article or grant 1 Curriculum enhancement activity

Resource Availability Vulnerability Overview of Aging Low vision and aging: an interdisciplinary approach Incontinence Resource Availability SNF, ALF, SCALF, IL, LTC – What Does It All Mean Preventing Elder Investment Fraud Medicare Overview Complexity Complex Decision Making Advanced Care Planning Family systems Medication Management ResiliencyThe capacity to return to a restorative level of functioning using compensatory/coping mechanisms; the ability to bounce back quickly after an insult VulnerabilitySusceptibility to actual or potential stressors that may adversely affect patient outcomes ComplexityThe intricate entanglement of two or more systems (e.g., body, family, therapies) Resource availabilityExtent of resources (e.g., technical, fiscal, personal, psychological and social) the patient/family/community bring to the situation Participation in careExtent to which patient/family engages in aspects of care Participation in decision-makingExtent to which patient/family engages in decision-making

Advocacy Moral agency Caring Practices Collaboration Health Disparities and Aging Ethics and Aging Caring Practices Developing Empathy Geriatrics for Hospice and Palliative Care Workers Collaboration Geriatric Interdisciplinary Team Training Inter-professional Competencies Advocacy and Moral AgencyWorking on another's behalf and representing the concerns of the patient/family and nursing staff; serving as a moral agent in identifying and helping to resolve ethical and clinical concerns within and outside the clinical setting

Gerontology Day “Unless someone like you cares a whole awful lot, Nothing is going to get better. It's not.”

An Aging Society For the first time in history, people aged 65 and over will soon outnumber children under the age of 5. Throughout the world today, there are more people aged 65 and older than the entire populations of Russia, Japan, France, Germany and Australia— combined. By 2050, the U.N. estimates that the proportion of the world's population age 65 and over will more than double, from 7.6% today to 16.2%. The United States contains more people age 65 and older than the total population of Canada. Americans aged 65 and older outnumber the combined populations of New York, London, and Moscow. http://transgenerational.org/aging/demographics.htm#ixzz2YBlYejb0

Objective Structured Clinical Exam (OSCE) Focus on: Uncommon presentations of common illness Polypharmacy Mobility

Geriatric Immersion Experience

References Center for Disease Control(CDC),2010. Older Adult Health,National Hospital Discharge Survey. Accessed http://www.cdc.gov/nchs/fastats/older-american-health.htm Center for Disease Control(CDC),2013. Older Adult Health,Long term health services overview. Accessed http://www.cdc.gov/nchs/fastats/older-american-health.htm National Council for State Boards of Nursing(NCSBN),2008.Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education. Accessed http://www.aacn.nche.edu/education- resources/APRNReport.pdf National Organization of Nurse Practitioner Faculties(NONPF), 2011. Statement on Acute Care and Primary Care Nurse Practitioner Practice. Accessed http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/imported/NPPrimaryCareAcuteCarePracticeFINAL.pdf