Author: Kimberly Silver Dunker, DNP, RN
Title: Assistant Professor of Nursing
Institution: UMASS Graduate School of Nursing Worcester
Upon completion of this activity the students will be able to:
Identify an elderly client in clinical (who is 65 years or older, has poly-pharmacy, dementia or delirium, a fall, or end of life care issues) and create a patient centered plan of care.
Synthesize the needs of their client to identify specific interventions to their elderly and family while at clinical.
Utilize their patient centered elder plan of care to provide specific nursing care, interventions, and teaching to their client while at clinical.
This clinical activity is used to teach students to create an elder centered plan of care.
In preparing to understand more about elders the student will review the following learning modules (Knowledge)
produced by UMMS (University of Massachusetts Medical School) Senior Patient Navigator Program ©.
href=”http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20I.pdf”>Module I: Communicating with Older Adults
href=”http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20II.pdf”>Module II: Geriatric Prescribing
href=”http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20III.pdf”>Module III: Geriatric Specialty-Specific Considerations
Module IV: End-of-Life Care and Considerations
Students will identify an elderly client (see criteria below) while at clinical. They will identify the aged related changes and the body system changes that occur (Knowledge, Skills).
Older than 65 years
Has a recurrent hospitalization due to chronic illness
Poly-pharmacy or medication reconciliation concerns
End of life care
Client information that is gathered will help the student to prepare a case study presentation (Knowledge, Skills).
The students identify the role of the nurse and hospital team in providing elder specific care, valuing what the team identifies as specific and specialized needs for elderly clients within the acute care environment. (Attitudes)
Utilizing a standard concept map format the student will create a geriatric focused plan of care including patient centered interventions and present their case to the clinical group in post conference (Knowledge, Skills).
Patient Centered Care
Students will gain knowledge, understanding, and value their client by learning the preferences and expressed needs of their elder, family, and community. (Knowledge, Skills, Attitudes).
Students will discuss in their presentation and paper how they provided elder specific nursing care, interventions, and goals, which promoted a more patient-centered environment (Knowledge, Skills).
Module 1 “Communicating with Older Adults”
Module 2 “Geriatric Prescribing”
Module 3 “Geriatric Specialty-Specific Experiences & Considerations
Module 4 “End of life Care & Considerations”
Each student presented their elder case study to the clinical group at an assigned date and time during post conference. Presentations were 15-20 minutes, 5 minutes for NCLEX question review, and 5 minutes for questions.
This presentation was a PowerPoint presentation with handouts and references. The students completed a concept map (see example) including: top 3-5 nursing diagnoses, subjective & objective assessment, medications, laboratory and diagnostics, nursing interventions (actions, teaching, collaborative), goals and outcomes for the patient and evaluation of their nursing care.
Above all, the care plan must have an “Elder centered care focus.” The students must focus the aspects of patient centered care of the older. The students need to ask themselves: “Did their care plan and nursing interventions make a difference in their elder patient’s outcome?” (See attached template and examples).
Lastly the students included 3-5 NCLEX questions related to their cases to discuss with the group. The NCLEX questions focused on the elder care plan and nursing interventions specific to elders.
A grading rubric was utilized for evaluating the concept maps. Students had to receive a 95% or greater to successfully pass this assignment.
This assignment was utilized in a graduate level program with pre-licensure nursing students. The assignment is designed for an adult medical-surgical, gerontology course, or chronic care course.
Prior to integrating elderly specific nursing care into the standardized care plan; the students previously developed concept maps, which only addressed standardized acute concerns. However, as many patients in the acute hospital setting have multiple concerns and elder care issues, it is evident the students must create a patient centered care to include the needs of the geriatric population.
Feedback from this assignment has been positive. Students were able to learn about the elder client transforming their care to be more patient centered. This assignment reinforced geriatric concepts taught in the classroom and integrated geriatric assessment into the clinical practice environment. As a result, students reported having an increased knowledge of elder specific concerns, more skill in providing quality patient centered care, and a greater value for the geriatric population.