INFUSING YOUR CURRICULUM WITH GEROPSYCH RESOURCES Lois K. Evans, PhD, RN, FAAN van Ameringen Professor in Nursing Excellence University of Pennsylvania.

INFUSING YOUR CURRICULUM WITH GEROPSYCH RESOURCES

Lois K. Evans, PhD, RN, FAAN Lois K. Evans, PhD, RN, FAAN van Ameringen Professor in Nursing Excellencevan Ameringen Professor in Nursing Excellence

University of PennsylvaniaUniversity of PennsylvaniaCo-Director, Hartford Geropsychiatric Nursing CollaborativeCo-Director, Hartford Geropsychiatric Nursing Collaborative

with Kathleen C. Buckwalter, PhD, RN, FAAN, with Kathleen C. Buckwalter, PhD, RN, FAAN, & Cornelia Beck, PhD, RN, FAAN& Cornelia Beck, PhD, RN, FAAN

Mid-Atlantic Conference to Advance Geriatric Competence in Mid-Atlantic Conference to Advance Geriatric Competence in Undergraduate & Graduate Education - December 2011Undergraduate & Graduate Education - December 2011

ObjectivesDiscuss 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.

Key PointsOne 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.

Millie*

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

BackgroundMental health services for older adults is a

critical public health issue7.5 mil now have a mental disorder;

15 mil by 2030Under-recognition and treatment is a critical

problemAPRNs provide large share of mental health

services to older adults; their preparation is uneven & often inadequate

Background2005: 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

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

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)

National Advisory Panel

Aims and ObjectivesOverall 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

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).

NurseAnesthetist

Nursemidwife

Clinical NurseSpecialist

New Role Nurse Practitioner

Adult-gerontology

GenderSpecific

Family/individualAcross lifespan

Neonatal PediatricsPsych/Mental

Health

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POPULATION FOCI

APRN ROLES

APRN SpecialtiesFocus of Practice beyond role and population focus

Linked to health care needsExamples include but are not limited to: Oncology, Older Adults,

Orthopedics, Nephrology, Palliative care

Primary care Acute care

Clinical Nurse SpecialistsNurse Practitioners

Methods: Objective 1Reviewed all existing competencies & mapped to

gerontological competencies.Convened Geropsychiatric Nursing Core

Competency Workgroup & National Advisory Panel.Developed definition, competency enhancements & key conceptsEnhanced awareness via presentations &

publications.Secured endorsements from 12 stakeholder orgs

Methods: Objective 2Collected & 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.

Geropsychiatric Nursing DefinitionHolistic 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.

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.

Competency Enhancements Successfully infused into revised competencies

for:Entry Level nursingAdult-Gerontology Primary Care Nurse

Practitioner and Clinical Nurse SpecialistAdult-Gerontology Acute Care Nurse

Practitioner and Clinical Nurse Specialist

www.aacn.nche.edu/education-resources/competencies-older-adults

Infusion Currently Underway with National Organization of Nurse Practitioner Faculties (NONPF)

Psychiatric Mental Health Nurse PractitionerWomen’s Health Nurse PractitionerFamily Health Nurse Practitioner

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.

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

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.’

Based on 2002 NONPF competenciesRecommended 27 new statements & selected

enhancements to existing statementsNEW: ‘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

Recommended Geropsychiatric Competency Enhancements for Gerontological Nurse PractitionersMarch 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 notintended to ‘stand-alone,’ but rather to enhance existing or to-be-developed competencies for Gerontological Nurse Practitioners.1 The statements areorganized within the existing Nurse Practitioner Primary Care Competencies in Specialty Areas: Adult, Family, Gerontological, Pediatric, and Women’s Healthdeveloped by HRSA in 2002 and National Organization of Nurse Practitioner Faculties Domains and Core Competencies of Nurse Practitioner Practice2 revised byNONPF in 2006. The geropsychiatric competency enhancements were drafted in Fall 2008 by the Geropsychiatric Nursing Collaborative (GPNC), a projectsupported by the John A. Hartford Foundation and housed at the American Academy of Nursing. They were reviewed by representatives of key professionalorganizations, revised, and then endorsed by the GPNC Core Competency Workgroup and National Advisory Panel and disseminated in Winter 2010 to allrelevant 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 ishelpful to have both of these dimensions explicitly stated. Likewise, the term ‘psychiatric disorder’ should be used in combination with ‘substance misusedisorder’ to be more inclusive. It is further recommended that an expectation for the use of valid and reliable clinical assessment tools and evidence-basedpractices 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 areaimed 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) whocare 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 canbe found at www.aannet.org/GPNCresources . For more information, see www.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 atwww.eric.ed.gov/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/1a/9d/20.pdf and NONPF (2006). National Organization of Nurse Practitioner FacultiesDomains and Core Competencies of Nurse Practitioner Practice available at www.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 combinecompetencies for the Adult and Gerontological Nurse Practitioner Specialties in accordance with the new Consensus Model. The GPNC enhancements were used to inform thework of the AACN and HIGN expert panels, however, the final AACN and HIGN documents are still in refinement at this time.

Domain I : Health Promotion, Protection, Disease Prevention, & TreatmentI.A Assessment of Health Status1. 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.

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.

B. Geropsych Curriculum Materials Resources to enhance teaching strategies, content,

and/or clinical experiences re: key conceptsTargets nursing students or clinicians in psychiatric

mental health, adult/gerontology, & generalist nursingpractice (acute, family, women’s health).

Geropsych Curriculum Materials

Organized by key concepts in 4 domains:AssessmentManagementApproach to OARole

Key Concept: Assessment

I. Assessment Normal aging: biopsychosocial theories Appropriate instruments/clinical evaluation tools Adapting assessment procedures Atypical presentations; Co-occurring illness; Psychiatric

manifestations: medical conditions Common disorders Comprehensive Stressors affecting mental health

Types of resources

Websites that include geropsychiatric nursing concepts/educational components

Curriculum materials/teaching strategies that relate to geropsychiatric nursing key concepts

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See POGOe for All Geropsych MaterialsDownload 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

POGOe Report: 8,279 views*Product 20660: Geropsychiatric

Nursing Collaborative Competency EnhancementsTop ranked product for the entire POGOe site

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Contribute to & Keep Abreast of New DevelopmentsJoin the GPN Listserv contact Lois Evans @

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POGOe materials

More ResourcesAACN Webinar, Thursday December 15, 12Noon

http://www.aacn.nche.edu/webinars/2011/12/15/aprnseries4

APRN case studies in geropsychhttp://hartfordign.org/education/geriatrics_and_

the_advanced_practice:_case_studies/

Geropsychiatric Nursing Collaborative

Promoting mental health of older Americans

www.aannet.org/GPNCgeropscyh

Funding provided by the John A. Hartford Foundation

Questions?