Expanding Geriatric Nursing Education

The American population is living significantly longer.

As this specific population steadily increases and lives longer by future predictions, there will be a dramatic demand for geriatric nursing specialists at different levels of education.

Accredited nursing programs need to prepare their graduates with the essential skills and leadership to provide appropriate care to the geriatric population.

As people live longer, they will most likely acquire chronic conditions that will make managing their care more complex. Chronic conditions most likely assessed will be cardiovascular disease, hypertension, diabetes mellitus, dementia, arthritis, depression, cancer, chronic kidney disease, stroke and obesity.

Presently, in the United States, there is a critical shortage of geriatric educated nursing professionals at all levels of practice. By 2030, there will be a need of 36,000 geriatric specialists just in America.1

A possible reason for this shortage may be related to many nursing programs having limited or no geriatric experience in the curriculum and lack expertise in meeting demands of the increasing elderly population. Thus, students lack the geriatric experience towards geriatric care and management.

Registered nurses and nursing students are on the cutting edge to attain vital competencies involving skills and knowledge to administer high quality health care to the growing geriatric population. Nursing students need to acquire a well-defined competence level in critical thinking skills to promote positive outcomes in the geriatric population. There is a delicate and intricate balance in managing geriatric patients.

Geriatric principles in curriculum need to be addressed in the classroom, clinical settings and community. American Association of Colleges of Nursing (AACN) states, “Educating nursing students with significant course content and clinical experiences in geriatrics is the key to improving the quality of nursing care, well-being, management and research for the aging population.”2

Perspectives, Demographics & Statistics

In the past 40 years the older population, identified as those individuals 65 years of age and older, has increased twice as fast as compared to the rest of the population. The number of individuals age 85 and older is predicted to triple by 2050.3

This tremendous increase in numbers is partly due to the aging “baby boomers” in our nation. This specific group of individuals actually turned 65 years of age in 2010. Since 2000, the population those 65 years and older, has grown to 18% to over 40 million in 2011. It is predicted that by 2060 this population will double .4

The United States Census Bureau predicts the life expectancy trend to continue to increase for both men and women and the age group that will increase quickly is composed of those 85 years of age and older. The need to manage the individual appropriately in a holistic manner will be a demand and challenge for medical and nursing professionals.

Nurses need to be cognizant of the demographic goal to maximize not only the life span, but the “health span” of the older population. Geriatric specialists now identify that older people are more active and less disabled. Nurses must develop specific plans of care and goals for geriatric patients to maintain their optimal function as long as possible and improve outcomes.

Institute of Medicine

The Institute of Medicine (IOM) has been a pivotal force in responding to the needs in assessing and changing the nursing profession in how universities educate nursing students. Nursing education must be fundamentally improved during their years of higher education as well as when nurses receive their professional license.

In part of its report, The Future of Nursing: Leading change, Advancing Health, the IOM committee faced several challenges, made recommendations and possible solutions for the future of nursing. The committee determined that nurses should achieve higher levels of education and training through an improved educational system that promotes academic progression.5

Nurses need to attain competencies to deliver high quality care. Several of the competencies the IOM recommends include leadership, health policy, system improvement, research and evidence-based practice, teamwork and collaboration, as well as competency in specific content areas such as community and public health and geriatrics. 5

The committee highly recommends nurses to achieve higher levels of education and strongly suggests they be educated in new and innovative ways to better prepare them to meet the different demands of the changing population. Nursing curriculum constantly needs to be reexamined, updated, and adaptive to change with patients’ changing needs and improvements in science and technology.5

The nursing profession needs to be familiar with health policies and how they influence health promotion, disease prevention and influence patient outcomes. Patients frequently admitted to hospitals today are more complex, sicker and frailer. Nurses need to possess a strong knowledge foundation in caring for them.

Academic and laboratory competencies involving geriatrics must change from basic task-based skills to higher level critical thinking that offer a good foundation for knowledge in management and decision making. In addition, students must become proficient in quality improvement, system thinking, health care financing, community health, public health, leadership, delegation, critical thinking and problem solving.

Addressing the Crisis

The American Association of Colleges of Nursing (AACN) is in the forefront in addressing the crisis in meeting the demands of the increasing geriatric population and who will manage them in the future. Gerontology nursing faculty and registered nurses continue to be unprepared to address the complex health care needs of its aging population.

Nurses play an essential role in the provision of acute and chronic care, health education and health promotion for older Americans.6 In their attempt at meeting the vital needs in gerontology, AACN offers five recommendations:

1. Develop Faculty Expertise

Implement gerontology related faculty development. Promote administrative support. Include all faculty members in the gerontology curriculum. Educate the faculty on the need for gerontology knowledge in the curriculum. Develop an advisory board that would provide feedback and recommendations. Conduct gerontology workshops, and presentations.

2. Gerontologize the Curriculum

Develop courses that focus on gerontology and incorporate issues that promote health promotion and disease prevention. The course should be interactive with much class discussion and reflective writing. Other healthcare disciplines should be able to take the gerontology courses to offer and promote a positive learning atmosphere. A recommendation could be that a gerontology course be offered as an elective. Students should have the opportunity to actively participate in research projects that focus on the geriatric individual.

3. Enhance Technology

Promote online teaching. Develop web based gerontology courses that interweave the curriculum. Promote assessment tools and post course requirements online. Develop different teaching strategies.

4. Cultivate Community and Clinical Partnerships

Build on established relationships with organizations and reach out to new establishments. Meet with community leaders and be familiar with the stakeholders surrounding the educational community. Offer diverse settings for geriatric clinical rotations. Offer the long term care rotation as an elective/ mentoring rotation for the senior students interested in geriatrics. Connect with advanced practice nurses and certified nurse practitioners during the educational experience for the students in the clinical setting. This can be quite valuable since the student can learn the independent role of the advanced practice nurse or nurse practitioner. Employ faculty who possess knowledge in geriatrics.

5. Support Student Interest in Gerontology

Supporting a student’s interest in geriatrics is the most important step in geriatric education. Educators can spark an interest and thus improve student attitudes towards the geriatric population. Investigate the students’ perceptions about aging and caring for the geriatric patient. While studying the various degrees of illness within geriatrics, study wellness, autonomy and community living involving the healthy individual. This will cover the illness-wellness continuum.

Nursing Curriculum

Individuals are living longer and there will be an increasing demand in geriatric nursing education, research, critical thinking skills, and outcomes in caring for this population. Nurses at all levels of practice and students need to recognize the unique requirements of the geriatric individual.

There will also be an increase in health care services to assess the effectiveness of different models of training, staffing, and organization of care and their relationship to health outcomes and quality of care of the gerontology individual.7

Nursing faculty, nurses in various settings and nursing students are on the cutting edge in meeting the needs of our changing demographics, conducting research, expanding advanced skills and applying critical thinking in a more unique manner.

Competencies relating general knowledge and clinical skills in geriatrics should be utilized more throughout nursing curriculum. Geriatric competencies will likely improve outcomes of care, initiate additional research, and promote physical functioning and psychosocial interaction in the geriatric patient. The geriatric individual may maintain a better well-being of self and maintain independence.1

The extension of geriatrics within nursing curriculum will assist professional nurses, educators and nursing students in getting involved with health policy and developing leadership roles while implementing health promotion and disease prevention to the aging individuals in our society.

References for this article can be accessed here.

Carlene McAleer is a professor of nursing at Temple University in Philadelphia.

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