Robin E. Remsburg, PhD, GCNS, FNGNA, FGSA, FAAN George Mason University NGNA 2012

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1 Robin E. Remsburg, PhD, GCNS, FNGNA, FGSA, FAAN George Mason University NGNA 2012

2 This project is/was supported by funds from the Department of Health and Human Services (DHHS), Health Resources and Services Administration, the Bureau of Health Professions (BHPr), Division of Public Health and Interdisciplinary Education (DPHIE), under grant number and title for D62HP15118, Comprehensive Geriatric Education Program, $472,897). The information or content, and conclusions are those of the author and should not be construed as an endorsement of or the official position or policy of the U.S. Government, DHHS, BHPR or the DPHIE.

number and title for D62HP15118, Comprehensive Geriatric Education Program, $472,897).

3 PEG faculty Lisa Campo Francine Roberts Deirdre Carolan Dorflinger Terri Ann Guingab Charlene Douglas Advisory Committee Doctoral Students Carla Spinelli Irene Ndege

4 What challenges do we face in preparing the next generation of nurses? What strategies can we use to improve faculty expertise and competencies? How can we increase geriatrics and gerontological nursing content and experiences in undergraduate nursing education?

5 Everyone!

6 January 1, 2011, baby boomers celebrate 65th birthdays 8,000-10,000 people turn 65 every day Continues for 20 years Fastest growing segment = 85+ y/o 400% Percent in Nursing Homes: 1% of y/o 5% of y/o 15% of 85+ % OLDER ADULTS Florida 16.8% West Virginia 15.3% Pennsylvania 15.2% Iowa 14.6% North Dakota 14.6% Maine 14.6% South Dakota 14.2% Hawaii 14.0% New Hampshire13.5%

65-74 y/o 5% of 75-84 y/o 15% of 85+ % OLDER ADULTS Florida 16.8% West Virginia 15.

7 Global Aging million older adults billion older adults (1 in 8)

8 1900 Rare , , , , over 700,000 ***30% of Centenarians today live Independently*** US Census, 2002

9 Older adults (12% of the population) 26% of all physician visits 38% of all hospital patients 34% of prescriptions 70% of home care visits 43% of all hospital days Longer LoS (5.6 days) Higher rates of readmission within 30 days Higher rates of functional decline and medical errors In 2003, used 44% of total healthcare resources

10 To be conscious of the stereotypes applied to aging individuals Assist our colleagues, students, older adults, & their families to move beyond these stereotypes Doing with / not doing for

13 Younger Adults: Over estimate the problem-reality of old people Worry about losing their good health and independence in old age Impose middle-aged values on older adults Define aging as withdrawal and decline Feel they need to make decisions for their parents

Impose middle-aged values on older adults Define aging as

16 Older Adults: Don t perceive their problems as negatively Seek autonomy and participation in decision making Report that the reality of aging isn t so bad Do not perceive themselves as clients or patients Are not willing to abandon their judgment for the judgment of others Want to maintain control of their own destiny Love, 1998

not perceive themselves as clients or patients Are not willing to abandon their

19 Faculty with knowledge and expertise Minimal content in basic and advance practice education LACK OF TIME, regardless of opportunities for faculty development and available resources Daily demands Life happens Aging out / retirement Curricula in nursing schools are often additive; there s no room for more and it is difficult to decide what to eliminate

available resources Daily demands Life happens Aging out / retirement Curricula in

20 ANCC certified gerontological nursing <1% of RNs and 2.6% of APRNs (IOM) BSN Programs (in 2003) 76% have at least one full time expert, but only 30% have a certified faculty member (42% in 1997) Faculty with certification dropped from 161 programs in 1997 to 150 programs in 2003 (Berman et al, 2005; Rosenfeld et al, 1999) ADN programs 60% unfamiliar with geriatrics resources Among 25% familiar, rarely used (Ironside et al, 2010)

certified faculty member (42% in 1997) Faculty with certification dropped from 161 programs in 1997 to 150

21 BSN Programs AD Programs Integrated 92% (63% in 1997) Integrated 80% Stand-alone 5% Combined 15% Stand alone 34% (37% in 1997) Required** BSN 78% (69% in 1997) RN-BSN 51% (41% in 1997) Clinical courses offered in: Nursing Homes / LTC 81% Hospitals 83% Other Mental Health 60% Home Health <50%

22 Student outcomes Despite evidence-based curricula for faculty development and some support for effectiveness among faculty Paucity of evidence for students Knowledge Attitudes Evidence of impact: mixed results

24 Student-centered, interactive, innovative programs and curricula Evidence-based programs & teaching / evaluation methods Well-prepared faculty Recognition of expertise (certification) Well-prepared administrators Quality & adequate resources Clear program standards & hallmarks that raise expectations

25 Visual Aural Reading / writing Thinking / watching Hands on

26 PEG

27 1. Improve faculty participant attitudes toward the elderly; 2. Increase faculty participant knowledge; 3. Increase course content on gerontological nursing and care for the older adults; 4. Increase the number of faculty certified in gerontology; 5. Determine if a distance education delivery mode is as effective as an in-seat mode in attaining program objectives

28 Audience: Nursing faculty members teaching in undergraduate nursing programs Goals: Increase faculty competence in care for older adults, including those living with disabilities Increase faculty competence in teaching students who to care for older adults, including those living with disabilities Participants: 48 nursing instructors Time Frame: 3 years Program Components: Two semesters of in-seat/online seminar courses in year 1 (30 hours) summer field observation experience at the end of year 1 (60 hours) Certification review course (24 hours) Follow-up online booster sessions in year 2 (two 3-hour) One-stop website

29 Seminar 1 Seminar 2 Interdisciplinary Team Case Study 3 Ds (Dementia, Delirium, & Depression) Community partners Polypharmacy Palmore s Facts on Aging Quiz Health Literacy Myths and Realities of Aging Cultural Competence Healthcare Resources Functional Assessment Tools Communication Palliative & End of Life Care Caregivers Incontinence Funding and Reimbursement Falls Global Aging and Theories on Aging Nutrition Social Function Skin & Wound Issues The Informed Consumer: Health Information AACN Gerontological Certification and the Internet Prevalence of disease in VA* Cognitive, Psychological and Physical Healthy People* Function Keys to Healthy Aging

30 ortal/frameset.jsp

38 INOVA Commonwealth Care Center INOVA Fairfax Hospital INOVA Home Health Hospital Elder Life Program (HELP) Loudoun Adult Medical Psychiatric Services (LAMPS) Hospice and Palliative Care

39 2 cohorts PEG 1 PEG 2 Baseline Assessments 17 educators from NoVA schools 31 educators from 16 states Average (SD) Knowledge (Towner) / 50 (4.98) Attitudes (Palmore) / 25 (2.83) Strengths Knowledge: gait / balance, delirium, falls, caregiver behaviors Attitudes: sexual activity, employment, temperament

40 Weaknesses Knowledge: smoking, normal age related changes, cancer Attitudes: memory, poverty, economic status In-seat vs. online In-seat 20 applications 47% completion 5 completed certification review course Online 42 applications 35% completion 1 completed certification

41 Post program survey (n=27; 9 in-seat, 18 online) Taught 1-10 courses in the past year 96% used PEG content 86% didactic 75% clinical 50% lab 20% taught gerontology / geriatrics course 2,796 students enrolled in courses with PEG content 75% plan to use PEG content in future courses 7 (27% ) plan to take ANCC certification in next year

42 Falls Polypharmacy Healthy People 2020 Communication Myths and realities of aging Nutrition Cogniton Psychological & physical functioning Incontinence Skin and wound Caregivers 3 Ds (delirium, dementia, depression)

43 Nurse educators are hungry for content and teaching strategies Program evaluation: overwhelmingly positive Online faculty development program is popular and increases access In-seat requires more investment, i.e., time, travel; but increases socialization and contact with likeminded individuals and may result in better attendance and completion Lack of time is a major obstacle to program completion and mirrors other programs cited in the literature Shorter courses and evaluation periods may improve completion and evaluation of learning

46 e_education/ ies/ Portal of Geriatric Online Education

NGNA: Position Paper on Essential Gerontological Nursing Education in Registered Nursing and Continuing Education Programs

NGNA: Position Paper on Essential Gerontological Nursing Education in Registered Nursing and Continuing Education Programs Introduction/Problem Statement The intent of this position statement is to affirm