New curricular approach educates undergraduate nursing students in geriatric care

Florida is still in dire need of more nurses and is among the top states in the nation experiencing a shortage. Florida, Texas and California combined account for almost 40 percent of the national nursing shortage. According to the Florida Center for Nursing, more than 40 percent of Florida nurses are approaching retirement age in the next 10 years, leaving the state to face a shortage of registered nurses (RNs) that could cripple the state's health care system and impact medical care for Florida residents. To further complicate matters, by 2030 1 in 5 people will be 65 years or older.

Nurses are at the forefront of caring for older adults in a number of settings including skilled nursing facilities, hospitals, and long-term care facilities, among others. As the population of aging Americans reaches 83.7 million by 2050, RNs will be instrumental in caring for them.

The next generation of nurses need the right tools to ensure that they are poised to deliver age-appropriate care and address the specialized needs of an older population. Teaching undergraduate nursing students clinical care of older adults is complex and challenging given the large number of students, limited clinical sites, and educators who may not be prepared to teach geriatric nursing.

To address these challenges, researchers from Florida Atlantic University's Christine E. Lynn College of Nursing, and Rutgers - The State University of New Jersey, School of Nursing, Blackwood, developed and tested an innovative new curricular approach to educate undergraduate nursing students in geriatric care. Using six types of learning assignments during a seven-week clinical practicum, 124 nursing students were exposed to interactive learning assignments based on competencies in interviewing, performance-based assessment, clinical decision-making, and problem-based learning.

Deanna Gray-Miceli, Ph.D., senior author, an associate professor in FAU's College of Nursing, and a faculty fellow in FAU's Institute for Sensing and Embedded Network Systems Engineering (I-SENSE), one of the university's four research pillars said:

It is essential for undergraduate nursing curricula to ensure that graduates develop competencies for caring for geriatric patients and are equipped to face the challenges of a complex and dynamic health care delivery system. Our program, which specifically focuses on geriatric nursing content, was designed for the purpose of improving students' ability to care for older adults in clinical practice."

The model Gray-Miceli and Catherine Morse, Ed.D., co-author and a clinical assistant professor and program director at Rutgers-The State University of New Jersey, School of Nursing, Blackwood, used for this program taught the nursing students to care for a patient based on his/her ability to perform activities of daily living. The curriculum began with the newborn and ended with the geriatric population, emphasizing patients' ability to provide self-care based on his/her age. Concepts that underscored the cycle of life were integrated throughout the curriculum.

Findings from this approach, published in the journal Nurse Educator, support the use of interactive learning assignments to increase students' understanding, confidence, and competence in performing an assessment of an older adult.

To implement the new program, Gray-Miceli and Morse worked with a premier long-term care facility that allowed the students to rotate through the assisted-living facility to complete their assignments. Students were exposed to direct, hands-on clinical care in a community senior center, dementia care unit or acute care setting as well as simulated clinical experiences that took place in a laboratory. The students were immersed in this intensive seven-week geriatric program with their clinical preceptors.

Three of the six assignments were interactive; one assignment involved a mandatory eight-hour workshop devoted to reviewing an evolving case scenario of an elderly individual who received senior services from a state agency. Students learned about the rules for Medicare and Medicaid beneficiaries, state-funded programs and services, and accessing senior services through community agencies.

The project was well-received by the students and provided them with multiple learning activities to master geriatric content in clinical practice. For example, the interactive assignments such as interviewing older adults were viewed more favorably by the students. Conversely, the least preferred and effective assignment was the eight hours spent learning about services available to senior citizens, which students felt had limited additive value to their overall understanding of the geriatric content.

"Based on these outcomes, we believe that activities are valuable learning experiences to teach nursing students the content and skills necessary to provide safe, competent, and compassionate care to the geriatric patient population," said Gray-Miceli.