INFUSING YOUR CURRICULUM WITH GEROPSYCH RESOURCES

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• INFUSING YOUR CURRICULUM WITH GEROPSYCH RESOURCES
• Lois K. Evans, PhD, RN, FAAN
• van Ameringen Professor in Nursing Excellence
• University of Pennsylvania
• Co-Director, Hartford Geropsychiatric Nursing
  Collaborative
• with Kathleen C. Buckwalter, PhD, RN, FAAN,
• Cornelia Beck, PhD, RN, FAAN
• Mid-Atlantic Conference to Advance Geriatric
  Competence in Undergraduate Graduate Education
  - December 2011

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Objectives

• Discuss 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.

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Key Points

• One 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.

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Millie
http//www.nln.org/facultyprograms/facultyresource
s/ACES/millie.htm
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Background

• Mental health services for older adults is a
  critical public health issue
• 7.5 mil now have a mental disorder
  15 mil by 2030
• Under-recognition and treatment is a critical
  problem
• APRNs provide large share of mental health
  services to older adults their preparation is
  uneven often inadequate

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Background

• 2005 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

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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

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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

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Aims and Objectives

• Overall 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

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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,
  womens health).

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Fit with Consensus Model for APRN Regulation
APRN Specialties Focus of Practice beyond role
and population focus Linked to health care
needs Examples include but are not limited to
Oncology, Older Adults, Orthopedics, Nephrology,
Palliative care
POPULATION FOCI
Adult- gerontology
Gender Specific
Neonatal
Pediatrics
Psych/Mental Health
Family/individual Across lifespan
Licensure at levels of role and population
foci
APRN ROLES
Nurse Anesthetist
Nurse midwife
Clinical Nurse Specialist
New Role
Nurse Practitioner
Primary care
Acute care
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Clinical Nurse SpecialistsNurse Practitioners
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Methods Objective 1

• Reviewed all existing competencies mapped to
  gerontological competencies.
• Convened Geropsychiatric Nursing Core Competency
  Workgroup National
• Advisory Panel.
• Developed definition, competency
• enhancements key concepts
• Enhanced awareness via presentations
  publications.
• Secured endorsements from 12 stakeholder orgs

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Methods Objective 2

• Collected 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.

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Geropsychiatric Nursing Definition

• Holistic 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.

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Geropsychiatric Nursing Definition contd

• 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.

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Competency Enhancements

• Successfully infused into revised competencies
  for
• Entry Level nursing
• Adult-Gerontology Primary Care Nurse
  Practitioner and Clinical Nurse Specialist
• Adult-Gerontology Acute Care Nurse Practitioner
  and Clinical Nurse Specialist
• www.aacn.nche.edu/education-resources/competencies
  -older-adults

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

• Psychiatric Mental Health Nurse Practitioner
• Womens Health Nurse Practitioner
• Family Health Nurse Practitioner

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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.

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Enhancements for Psychiatric NPs

• 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.

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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.

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Enhancements for Gerontological NPs

• Based on 2002 NONPF competencies
• Recommended 27 new statements selected
  enhancements to existing statements
• NEW 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.

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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 not
• intended to stand-alone, but rather to enhance
  existing or to-be-developed competencies for
  Gerontological Nurse Practitioners.1 The
  statements are
• organized within the existing Nurse Practitioner
  Primary Care Competencies in Specialty Areas
  Adult, Family, Gerontological, Pediatric, and
  Womens Health
• developed by HRSA in 2002 and National
  Organization of Nurse Practitioner Faculties
  Domains and Core Competencies of Nurse
  Practitioner Practice2 revised by
• NONPF in 2006. The geropsychiatric competency
  enhancements were drafted in Fall 2008 by the
  Geropsychiatric Nursing Collaborative (GPNC), a
  project
• supported by the John A. Hartford Foundation and
  housed at the American Academy of Nursing. They
  were reviewed by representatives of key
  professional
• organizations, revised, and then endorsed by the
  GPNC Core Competency Workgroup and National
  Advisory Panel and disseminated in Winter 2010 to
  all
• relevant 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 is
• helpful to have both of these dimensions
  explicitly stated. Likewise, the term
  psychiatric disorder should be used in
  combination with substance misuse
• disorder to be more inclusive. It is further
  recommended that an expectation for the use of
  valid and reliable clinical assessment tools and
  evidence-based
• practices and processes be clearly stated and
  that gender, sexual orientation, and spirituality
  be made explicit when referring to cultural
  issues.
• __________________________________________________
  ___________________________

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Recommended Geropsychiatric Competency
Enhancements for Gerontological Nurse
Practitioners Example

• Domain I Health Promotion, Protection, Disease
  Prevention, Treatment
• I.A Assessment of Health Status
• 1. 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.

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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.

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Geropsychiatric Nursing Collaborative Materials
Housed in Portal of Geriatric Online Education
(POGOe) A. Definition, Competencies, Key
Concepts, Video
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B. Geropsych Curriculum Materials

• Resources to enhance teaching strategies,
  content, and/or clinical experiences re key
  concepts
• Targets nursing students or clinicians in
  psychiatric mental health, adult/gerontology,
  generalist nursingpractice (acute, family,
  womens health).

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Geropsych Curriculum Materials

• Organized by key concepts in 4 domains
• Assessment
• Management
• Approach to OA
• Role

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Key Concept Assessment

• 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

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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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Accessing POGOe

• If not registered, go to www.POGOe.org, click on
  Register for free in upper right hand corner.
  There you can create a new account.
• Once you create account, you can access documents
  associated with a product for free.

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See POGOe for All Geropsych Materials

• Download 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

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POGOe Report 8,279 views

• Product 20660 Geropsychiatric Nursing
  Collaborative Competency Enhancements
• Top ranked product for the entire POGOe site
• As of November 15, 2011

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Comments from Dr. May Wykle
Wykle.pdflip
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Contribute to Keep Abreast of New Developments

• Join the GPN Listserv contact Lois Evans _at_
  evans_at_nursing.upenn.edu
• Share curriculum materials, websites that work
• Give feedback on the website to make it more user
  friendly
• Give feedback on how you are using the POGOe
  materials

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More Resources

• AACN Webinar, Thursday December 15, 12Noon
• http//www.aacn.nche.edu/webinars/2011/12/15/aprns
  eries4
• APRN case studies in geropsych
• http//hartfordign.org/education/geriatrics_and_
  the_advanced_practice_case_studies/

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Geropsychiatric Nursing Collaborative Promoting
mental health of older Americans www.aannet
.org/GPNCgeropscyh
Funding provided by the John A. Hartford
Foundation
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• Questions?