1. INFUSING YOUR CURRICULUM WITH GEROPSYCH RESOURCES Lois K. Evans, PhD, RN, FAAN van Ameringen Professor in Nursing Excellence University of Pennsylvania Co-Director, Hartford Geropsychiatric Nursing Collaborative with Kathleen C. Buckwalter, PhD, RN, FAAN, & Cornelia Beck, PhD, RN, FAAN Mid-Atlantic Conference to Advance Geriatric Competence in Undergraduate & Graduate Education - December 2011

2. Objectives Discuss importance of educating APRNs in older adult mental health. Describe resources developed by the Geropsychiatric Nursing Collaborative: Competency enhancements Teaching-learning resources Access website resources to enhance teaching-learning re: geropsychiatric nursing concepts and skills in your program.

3. Key Points One in five older Americans needs mental health services. There is a dearth of geriatric providers in any of the core mental health professions, including nursing. APRNs who work with older adults require knowledge and skills in geriatric mental health in order to recognize, assess and treat or refer appropriately. The American Academy of Nursing - Hartford Foundation Geropsychiatric Nursing Collaborative is one initiative aimed at filling this gap.

4. Millie* http://www.nln.org/facultyprograms/facultyresources/ACES/millie.htm

5. Background Mental health services for older adults is a critical public health issue 7.5 mil now have a mental disorder; 15 mil by 2030 Under-recognition and treatment is a critical problem APRNs provide large share of mental health services to older adults; their preparation is uneven & often inadequate

6. Background 2005: National invitational Geropsychiatric Nursing: State of the Future conference in Philadelphia Promoting Mental Health of Older Americans- The Role of Geropsychiatric Nurses to raise awareness White papers & strategic plan for bridging gaps: JAPNA 12 (2,3), 2006 One strategy: Educational preparation of the nursing workforce

7. 2008: Formation of the Geropsychiatric Nursing Collaborative (GPNC) Three Hartford Centers of Geriatric Nursing Excellence with strength in Advanced Practice Geropsychiatric Nursing: Universities of Arkansas for Medical Sciences, Iowa, and Pennsylvania Leadership Team: Lois Evans Kathleen Buckwalter, Cornelia Beck, w/ Pamela Dudzik, Project Coordinator

8. 2008: Formation of the Geropsychiatric Nursing Collaborative (GPNC) Four year project funded by John A. Hartford Foundation Housed at American Academy of Nursing (www.aannet.org/GPNCGeropsych)www.aannet.org/GPNCGeropsych National Advisory Panel

9. Aims and Objectives Overall Aim: To improve the cognitive and mental health of older Americans Two major objectives: Create and infuse core GPN competencies in nursing education programs Develop and disseminate GPN curricula

10. GPNC Strategy Generate enhancements to existing competencies rather than imposing new sets. Focus on three groups: Entry level, Advanced Practice Nurse ‘specialists’ (gerontologic, psychiatric-mental health), Advanced Practice Nurse ‘generalists’ (adult, acute, family, women’s health).

11. Fit with Consensus Model for APRN Regulation Nurse Anesthetist Nurse midwife Clinical Nurse Specialist New Role Nurse Practitioner Adult- gerontology Gender Specific Family/individual Across lifespan NeonatalPediatrics Psych/Mental Health Licensure at levels of role and population foci POPULATION FOCI APRN ROLES APRN Specialties Focus of Practice beyond role and population focus Linked to health care needs Examples include but are not limited to: Oncology, Older Adults, Orthopedics, Nephrology, Palliative care Primary care Acute care

12. Clinical Nurse Specialists Nurse Practitioners

13. Methods: Objective 1 Reviewed all existing competencies & mapped to gerontological competencies. Convened Geropsychiatric Nursing Core Competency Workgroup & National Advisory Panel. Developed definition, competency enhancements & key concepts Enhanced awareness via presentations & publications. Secured endorsements from 12 stakeholder orgs

14. Methods: Objective 2 Collected & reviewed materials from websites & schools with gero/geropsych programs for match to key concepts/competency enhancements. Following focus group with FHNP, ANP, GNP, ACNP, WHNP, PMHNP faculties, developed case studies as a geropsych content infusion method. Developed and disseminated curriculum materials via designated free-access website.

15. Geropsychiatric Nursing Definition Holistic support for and care of older adults and their families as they anticipate and/or experience developmental and cognitive challenges, mental health concerns and psych/substance misuse disorders across a variety of health and mental health care settings. Requires expert knowledge of normal age-related changes and common psychiatric, cognitive and co- morbid medical disorders in later life.

16. Geropsychiatric Nursing Definition cont’d Promotion of mental health and treatment of psychiatric/substance misuse and cognitive disorders emphasize strengths and potentials; integrate biopsychosocial, functional, spiritual, cultural, economic and environmental factors, and address stressors that affect mental health of older adults and their families.

17. Competency Enhancements Successfully infused into revised competencies for: Entry Level nursing Adult-Gerontology Primary Care Nurse Practitioner and Clinical Nurse Specialist Adult-Gerontology Acute Care Nurse Practitioner and Clinical Nurse Specialist www.aacn.nche.edu/education-resources/competencies- older-adults

18. Infusion Currently Underway with National Organization of Nurse Practitioner Faculties (NONPF) Psychiatric Mental Health Nurse Practitioner Women’s Health Nurse Practitioner Family Health Nurse Practitioner

19. General Recommendations ‘Health,’ ‘illness,’ ‘frailty,’ ‘care’ or ‘disease’ should be broadly defined to include both ‘physical and mental.’ None of the new statements are intended to ‘stand alone’ but rather to enhance existing or to-be-developed competencies for the particular level of nurse. The recommendations are presented in the context of the existing documents so that the reader/reviewer can more readily understand the intent.

20. Based on existing PMH NP Competencies developed by NONPF in 2003 Recommended 21 new statements and selected enhancements to existing statements NEW: ‘Conducts a comprehensive assessment that includes the differentiation of normal age changes from acute and chronic medical and psychiatric/substance misuse disease processes, with attention to commonly occurring atypical presentations & co-occurring health problems including cognitive impairment.’ Enhancements for Psychiatric NPs

21. Enhancements for ‘Other’ NPs Based on the forty-seven competencies developed in 2004 by AACN & HGNI Recommended 29 additional statements & selected enhancements to existing statements NEW: ‘Differentiate psychiatric presentations of medical conditions, including psychiatric symptoms at the end of life, from psychiatric/ substance misuse disorders and arrange appropriate evaluation and follow up.’

22. Based on 2002 NONPF competencies Recommended 27 new statements & selected enhancements to existing statements NEW: ‘Assess the interaction between aging and disease processes and acute and chronic health problems with attention to co-occurring psychiatric/substance misuse disorders, including cognitive impairment.’ Enhancements for Gerontological NPs

23. Recommended Geropsychiatric Competency Enhancements for Gerontological Nurse Practitioners March 2010 Recommended Geropsychiatric Competency Enhancements for Gerontological Nurse Practitioners These recommended competency enhancement statements draw attention to the special needs of older adults with mental health concerns. They are not intended to ‘stand-alone,’ but rather to enhance existing or to-be-developed competencies for Gerontological Nurse Practitioners.1 The statements are organized within the existing Nurse Practitioner Primary Care Competencies in Specialty Areas: Adult, Family, Gerontological, Pediatric, and Women’s Health developed by HRSA in 2002 and National Organization of Nurse Practitioner Faculties Domains and Core Competencies of Nurse Practitioner Practice2 revised by NONPF in 2006. The geropsychiatric competency enhancements were drafted in Fall 2008 by the Geropsychiatric Nursing Collaborative (GPNC), a project supported by the John A. Hartford Foundation and housed at the American Academy of Nursing. They were reviewed by representatives of key professional organizations, revised, and then endorsed by the GPNC Core Competency Workgroup and National Advisory Panel and disseminated in Winter 2010 to all relevant professional organizations and schools of nursing for endorsement and utilization. New competency enhancement statements and modifications to existing competencies are highlighted in yellow for ease in identification. As revisions are made to existing competency documents,3 we recommend that the intent of these recommended enhancements be included and that the terms ‘health,’ ‘illness,’ ‘frailty,’ ‘care’ or ‘disease’ be broadly defined as both ‘physical and mental.’ Although physical and mental may be assumed, we believe that it is helpful to have both of these dimensions explicitly stated. Likewise, the term ‘psychiatric disorder’ should be used in combination with ‘substance misuse disorder’ to be more inclusive. It is further recommended that an expectation for the use of valid and reliable clinical assessment tools and evidence-based practices and processes be clearly stated and that gender, sexual orientation, and spirituality be made explicit when referring to cultural issues. _____________________________________________________________________________ 1 This competency enhancement document is one of seven developed and recommended by the Geropsychiatric Nursing Collaborative. The seven enhancement documents are aimed at the entry level nurse and the following groups of advanced practice nurses: gerontological NP and CNS, psychiatric NP and CNS, and other APRNs (NP and CNS) who care for older adults but are not prepared as gerontological experts, e.g., women’s health, adult, family and acute care. A link to the entire set of enhancement documents can be found at www.aannet.org/GPNCresources. For more information, see www.aannet.org/GPNCgeropsych.www.aannet.org/GPNCresourceswww.aannet.org/GPNCgeropsych 2 HRSA (2002). Nurse practitioner primary care competencies in specialty areas: Adult, Family, Gerontological, Pediatric, and Women’s Health, pp. 26-29 available at www.eric.ed.gov/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/1a/9d/20.pdfwww.eric.ed.gov/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/1a/9d/20.pdf and NONPF (2006). National Organization of Nurse Practitioner Faculties Domains and Core Competencies of Nurse Practitioner Practice available at www.nonpf.com/associations/10789/files/DomainsandCoreComps2006.pdfwww.nonpf.com/associations/10789/files/DomainsandCoreComps2006.pdf 3 We recognize that work is in process by the American Association of Colleges of Nursing (AACN) and the Hartford Institute for Geriatric Nursing (HIGN) to combine competencies for the Adult and Gerontological Nurse Practitioner Specialties in accordance with the new Consensus Model. The GPNC enhancements were used to inform the work of the AACN and HIGN expert panels, however, the final AACN and HIGN documents are still in refinement at this time.

24. Domain I : Health Promotion, Protection, Disease Prevention, & Treatment I.A Assessment of Health Status 1. Analyzes the relationship between normal physiology and specific system alterations produced by aging and disease processes. NEW: Adapts assessment processes for persons with cognitive impairment and psychiatric /substance misuse disorders. NEW: Conducts a comprehensive assessment that includes the differentiation of normal age changes from acute and chronic medical and psychiatric/substance misuse disease processes, with attention to commonly occurring atypical presentations and co-occurring health problems including cognitive impairment. NEW: Identifies and assesses factors that affect mental health including stressors that may be more common among older adults such as caregiving, multiple chronic illnesses, pain, relocation, trauma, cohort- specific stressors, and losses such as financial (retirement), functional (Instrumental Activities of Daily Living /Activities of Daily Living), social network (death of family members and friends), and role (status changes). 2. Assesses the developmental status regarding maintenance of self-identity through later and final stages of life. 3. Assesses the dynamic interaction between acute illness and known chronic health problems in older adults.

25. Sample Enhancement for Gerontological Nurse Practitioners & A/GNP Infusion Results Health Promotion, Health Protection, Disease Prevention, & Treatment: Assessment of Health Status NEW REC: Conducts a comprehensive assessment that includes the differentiation of normal age changes from acute and chronic medical and psychiatric/substance misuse disease processes, with attention to commonly occurring atypical presentations and co-occurring health problems including cognitive impairment. REVISION: Assesses for syndromes and constellations of symptoms that may be manifestations of other common health problems, e.g., risk-taking behaviors, self- injury, stress, incontinence, falls, delirium or depression.

31. B. Geropsych Curriculum Materials Resources to enhance teaching strategies, content, and/or clinical experiences re: key concepts Targets nursing students or clinicians in psychiatric mental health, adult/gerontology, & generalist nursingpractice (acute, family, women’s health).

32. Geropsych Curriculum Materials Organized by key concepts in 4 domains: Assessment Management Approach to OA Role

33. Key Concept: Assessment I. Assessment I. Normal aging: biopsychosocial theories II. Appropriate instruments/clinical evaluation tools III. Adapting assessment procedures IV. Atypical presentations; Co-occurring illness; Psychiatric manifestations: medical conditions V. Common disorders VI. Comprehensive VII. Stressors affecting mental health

34. Types of resources Websites that include geropsychiatric nursing concepts/educational components Curriculum materials/teaching strategies that relate to geropsychiatric nursing key concepts

42. Accessing POGOe If not registered, go to www.POGOe.org, click on Register for free in upper right hand corner. There you can create a new account.www.POGOe.org Once you create account, you can access documents associated with a product for free.

43. See POGOe for All Geropsych Materials Download complete set of competency Enhancements at : www.POGOe.org/productid/20660 Explore Curriculum Products and Resources at: www.POGOe.org/producted/20947-54 View short video at: Discover Mental Health: The Forgotten Piece in Elder Care www.POGOe.org/productid/20893

44. POGOe Report: 8,279 views* Product 20660: Geropsychiatric Nursing Collaborative Competency Enhancements Top ranked product for the entire POGOe site *As of November 15, 2011

45. Comments from Dr. May Wykle Wykle.pdflip

46. Contribute to & Keep Abreast of New Developments Join the GPN Listserv contact Lois Evans @ evans@nursing.upenn.edu evans@nursing.upenn.edu Share curriculum materials, websites that work Give feedback on the website to make it more user friendly Give feedback on how you are using the POGOe materials

47. More Resources AACN Webinar, Thursday December 15, 12Noon http://www.aacn.nche.edu/webinars/2011/12/15/aprnse ries4 APRN case studies in geropsych http://hartfordign.org/education/geriatrics_and_ the_advanced_practice:_case_studies/

48. Geropsychiatric Nursing Collaborative Promoting mental health of older Americans www.aannet.org/GPNCgeropscyh Funding provided by the John A. Hartford Foundation

49. Questions?