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

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

Patient Characteristics Outcomes Nurse

Competencies

Patient Characteristic Nurse Competency Course

Stability Clinical Judgement

Level 5 - Highly stable

ConstantResponsive to therapiesLow risk of death

Level 1Collects basic-level dataFollows protocolsQuestions the limits of one's abilityDelegates 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 dataMakes 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

LabileUnstableUnresponsive to therapiesHigh risk of death

Level 5

Synthesizes and interprets multiple sources of data Uses past experiences to anticipate problemsHelps patient and family see the "big picture“Recognizes the limits of clinical judgement Seeks multidisciplinary collaboration

AGACNP III &AGACNP practicum

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)

CDC, 2010CDC, 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

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

Advocacy Moral agency

• 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

Gerontology Day “Unless someone like you cares a whole awful lot,

Nothing is going to get better. It's not.”

An Aging SocietyFor 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

ReferencesCenter for Disease Control(CDC),2010. Older Adult Health,National Hospital Discharge Survey. Accessed http://www.cdc.gov/nchs/fastats/older-american-health.htmCenter for Disease Control(CDC),2013. Older Adult Health,Long term health services overview. Accessed http://www.cdc.gov/nchs/fastats/older-american-health.htmNational 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.pdfNational 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