Strategies for implementing best practices
Learning objectives: After reading this article, you will be able to
1. Discuss the importance of geriatric care education within the clinical nursing environment
2. Describe the role of a geriatrician
3. Describe how to implement a geriatric education program at your facility
The need for geriatric knowledge development is a real one in today's nursing world. According to the U.S. Census Bureau, an elderly population explosion between 2010 and 2030 is inevitable as the baby boomer generation reaches the age of 65. Much of healthcare is devoted to the care of older adults; patients over 65 reportedly make up 57% of all visits to a generalist physician, as well as 80% of all homecare visits. However, despite this fast-growing patient population, many nursing schools are not focusing on geriatric education.
"There really hasn't been much attention given to geriatrics in nursing school," says Jann Pfaff, MSN, RN, CNS, preceptor at the University of Wisconsin in Milwaukee. "Sometimes, it's just that there isn't enough time. There are so many other things to get to and so many other specialties."
This leaves much of the development of a geriatric knowledge base in the hands of nurse educators at healthcare facilities, says Geri Heppe, MS, coinstructor of nursing at Waukesha Memorial Hospital in Madison, WI.
"We have to do it with our nurses," says Heppe. "That's how we are going to handle the geriatric population. Medicine has always changed historically through nursing care, so this is the right way to do it: hands-on with our nurses."
Finding instructors who are able to teach about geriatrics in the clinical environment can often be difficult. According to The American Geriatrics Society, there are presently only 9,000 geriatricians in the country; the researchers claim about 20,000 will be needed by the year 2020.
To learn more about geriatricians, click here.
"How can we see this coming and not do something about it?" says Heppe.
Geriatric care: What to teach your nurses
According to a recent article in the Journal of Professional Nursing, "knowledge of special characteristics of older persons, as well as demographics of the aging population, resources, and principles of care are important in the provision of effective, professional primary healthcare." Thus, it remains crucial that you help your nurses recognize the differences in care regarding the geriatric patient population, including issues related to physical and social conditions.
Nurses need to be taught that the older population must be defined in a narrower scope, says Heppe.
"When you look at the body of a 50-year-old and the body of an 80-year-old, there is so much difference," she says. "You can't possibly treat them the same way."
It's also important to keep in mind that hospitals are now dealing with a much greater amount of chronic illness, and older adults are more commonly living with these conditions rather than viewing them as terminal. Focusing on training nurses about chronic disease management is therefore essential, says Heppe.
"In terms of what's killing us, things are changing," she says. "We used to get a cancer diagnoses, and that did us in; we died of that. It was a death sentence. Today, we live with those. But we have to learn to live with those."
Additionally, teaching your staff members to look at the bigger picture and think critically plays a major role in geriatric care, says Heppe. "We need to have a better idea overall of what's going on [with] the patients today," she says. "For example, are they going home alone? Can they succeed once they're home, or are we setting them up to fail?"
It's also crucial to change staff members' attitudes regarding learning about geriatric care. "Not everyone gets into nursing care for older adults," says Heppe. "It's not always looked at as a desirable nursing position. I think that's challenging, but it's a hurdle trying to get people to not see that as a negative aspect of nursing."
To fight that battle, teach nurses to dismiss social stereotypes in aging. For example, some nurses may believe that all elderly patients are confused, rather than recognize that this is not the case and that confusion may indicate a medical condition, particularly if it's a new development.
Overall, it's about embracing a culture change, says Pfaff. "It's about getting people to start to think differently about older-adult care," she says. "It's more about their attitudes, and about instituting new ways of doing things that bring about change and better outcomes for adults. We can give them a better hospital environment, and we can get them back home."
By educating your nurses on the subtleties of geriatric care, you are also giving them a substantial boost of confidence and thus giving your facility an important retention tool.
"They have a knowledge base that most nurses don't have," says Heppe. "They know medications that geriatric patients are not supposed to have. And that gives them pride in what they do and makes them feel ownership." With program training about this patient population, nurses can learn, for example, how geriatric patients may be more susceptible to the toxic effects of salicylates.
This knowledge can go beyond nurse-to-patient care, because nurses can inform physicians how certain medications will interact. "In most cases, doctors appreciate that," says Heppe. "The nurses will know how to settle down agitated patients and patients with dementia. That's an incredible gift."
Program elements for your facility
When developing a geriatric education program for your nurses, assessment should be the first step.
"We need to give the staff assessment tools first," says Heppe. "They need to be able to look at that patient and figure out what's wrong. No patient is coming in with just one thing wrong."
Questions that a nurse should consider during geriatric patient assessment include:
- Is the patient a fall risk?
- Is there dementia?
- Is there memory loss or confusion?
- How is the patient's sensory perception?
- Is there urinary incontinence?
- Are there signs of depression?
Click here for more information on geriatric assessment.
Another element of any program, says Heppe, should be support from upper management.
"You need to have someone who's going to be your cheerleader," she says. "That's crucial. Unless a manager understands the benefits of geriatrics, it can be challenging. You need that champion effect."
"Dedicate resources to run the program," adds Pfaff. "Be the advocate, and have a group of advocates."
Jumping the hurdles in geriatrics
The importance of educating nurses in the subject of geriatric care is clear cut. However, bringing this knowledge base into your facility may present some challenges for which educators must prepare. Keep the following strategies in mind when instituting a geriatric knowledge program at your facility:
Get time off for the nurses to participate in educational programs. "You must include that in the budget," says Heppe.
Convince your peers of the importance of geriatric education. It is essential to enforce the magnitude of this educational need. "Our hospital knows and values aging, and I think this lays the framework," says Heppe. "People will begin to realize that there is a huge difference in terms of competencies and patient care."
Reach out to nursing schools. "Helping them improve their curriculum is an important step," says Pfaff. "The clinical educator can say to the school, 'Let's help you do this.' "
For more helpful tips and facts about geriatric care, click here.
Towner, E. (2006). "Assessment of geriatric knowledge: An online tool for appraising entering APN students," Journal of Professional Nursing 22 (2): 112-115.
1. "Frequently Asked Questions About Geriatricians and the Shortage of Geriatrics Healthcare Providers" http://www.americangeriatrics.org/news/geria_faqs.shtml#1
2. "The Merck Manual of Geriatrics: Comprehensive Geriatric Assessment"
3. "Fast Facts: Geriatric Care Principles"