2000 Award for Exceptional Baccalaureate Curriculum in Gerontologic Nursing

Winning Abstracts

First Place Award

The Pennsylvania State University School of Nursing
University Park, Pennsylvania
Sarah Hall Gueldner, DSN, FAAN, Director; Carol Smith, DSN, Associate Director; Judy Klinefelter, PhD, Professor in Charge of Undergraduate Programs; Bonnie Ashcroft, MS, RN (Faculty Contact) Phone: (814) 863-9245 Fax: (814) 865-3779 E-mail: bla1@psu.edu

Abstract
Gerontological nursing is woven throughout the baccalaureate curriculum at Penn State's School of Nursing. Within the overall curriculum, health is viewed as a gestalt of wellness and illness that unfolds across the life span. Accordingly, health care of individuals and aggregates, including elders, is approached from a holistic, developmental perspective. One required course and two electives focus specifically on the older adult. Nursing Care of the Elderly, a 4-credit required course, places emphasis on normal aging processes, health promotion, disease prevention, and management of acute and chronic health problems. This course includes 75 hours of clinical experience, with 6 weeks in a skilled nursing facility, 4 weeks in a rehabilitation center, and 3 weeks in a variety of community-based settings. The two elder-specific electives are Medication and the Elderly Client (1 credit) and Independent Study in Gerontological Nursing (variable credit). Additional gerontological options open to students from other majors include Death and Dying, and Bioethical Issues in the Health and Human Development Professions. We are pleased that an increasing number of nursing students in the Honors Program are choosing to do their honors level coursework and thesis research on problems that particularly affect elderly populations. In keeping with our land-grant mission, our gerontological courses are offered at the University Park campus and at two extended locations 100 miles from the main campus. Supported by a grant of $10,000 from the Schreyer Institute for Innovative Learning, the Death and Dying course has been adapted for computer-enhanced learning.

Our baccalaureate students are also encouraged to take fullest advantage of resources and opportunities available through the Gerontology Center housed in our College. For instance, an 18-credit Intercollegiate Undergraduate Minor in Gerontology is offered through the Center. Our Death and Dying course, which attracts up to 200 students from across disciplines each semester, counts toward that minor, and several other nursing courses can be applied to the minor upon request. Students are encouraged to develop interdisciplinary projects, and nursing students and students majoring in Kinesiology sometimes collaborate to promote exercise and strength training in older adults. Several nursing students and faculty also participate each year in an international gerontological exchange program implemented through the College and Gerontology Center.

Innovation
The most important innovation of our gerontological nursing curriculum is its developmental approach and the prominent focus on health as well as illness. Other innovative features are the interdisciplinary enrichment that it enjoys and its delivery to three locations across geographically remote areas of Central Pennsylvania. More than half of our students participate in the weekly clinics operated by the School in an elderly housing unit in one of Pennsylvania's most impoverished and under served rural communities, located in the heart of the Appalachian mountains. It is anticipated that the education of future nurses within rural settings will encourage more graduates to practice with elderly clients in under served areas.

Replicability
Most aspects of the undergraduate gerontological nursing concentration offered at Penn State can be readily replicated in any setting. The key is to think beyond illness and institutional care of elders toward innovative community-based health care that maximizes the potential for health and function even in the presence of considerable illness and disability. The holistic human development approach enables students to develop a personal understanding of the health patterns and needs of all populations, especially the elderly.

Second Place Award

University of Nebraska Medical Center - College of Nursing
Omaha; Lincoln; Kearney; Scottsbluff, Nebraska
Ada M. Lindsey, PhD, Dean; Barbara Wharton McCabe, PhD (faculty contact) Phone: (402) 472-7363 Fax: (402) 472-7345 E-mail: bwmccabe@unmc.edu

Abstract
A common philosophy, program objectives, and course content comprise the baccalaureate program on the four campuses of the UNMC College of Nursing. The baccalaureate program requires three semesters of foundational courses in the arts and sciences prior to admission to the nursing major. Nursing courses focus on age-related issues and populations (infants, children, adults, and older adults) and approach care of the individual within a family structure. The undergraduate curriculum of the UNMC College of Nursing provides an innovative example of how gerontological nursing content can be implemented in a variety of geographical settings. The curriculum is organized into five levels (semesters) and gerontological nursing content is integrated into many undergraduate nursing courses. Course sequencing is planned to lay a foundation for future courses, to increase clinical depth, and to provide simultaneous offerings of courses that complement each other.

A 4-hour required course Gerontological Nursing is an integral part of the students' theoretical and clinical learning in Level IV, and allows students to focus on the essence of the art and science of gerontological nursing. Prior learning about the health care needs of the older client are expanded and synthesized through an exclusive focus on gerontological nursing. Faculty on each of the four campuses provide clinical experiences throughout the semester that require the students to draw upon previous learning and become intimately involved with concepts and best practices relevant to the care of the older adult. In the clinical area, students care for clients in acute, sub-acute, rehabilitation units, adult day care, assisted living units, nursing homes, Alzheimer's Special Care Units, and specialty senior clinics. Community senior fairs and festivals provide yet another venue for students to develop and refine health assessment and intervention techniques with older clients. Student learning experiences are in concert with the generalist levels described in Standards of Gerontological Nursing Practice. In the classroom and clinical setting a broad array of instructional techniques are used to engage the student in active learning about the role of the professional nurse in a variety of settings.

Innovation
College wide commitment to quality educational experiences give nursing students the opportunity to focus on the health care needs of older adults throughout all levels of the curriculum. Faculty representing specialty areas are available to consult with each other and students regarding concepts from their specialty domain, thus demonstrating the importance of collaboration and consultation in professional practice. The dialogue between faculty illustrates a culture that respects and values contributions each specialty area can make in improving nursing care of the older client. The 4-hour course in gerontological nursing, taught by faculty in the specialty who work with students in both the classroom and the clinical setting, is a mark of commitment to excellence in learning about the needs of the older client. Collaboration by Level IV specialty faculty (gerontological, psychiatric mental health and community health nursing) on the Lincoln campus, has led to the development of a Senior Nursing Clinic. The Clinic, staffed by the Level IV students and faculty, offers a variety of age specific services. Students have a firsthand experience of developing a partnership in health promotion and disease prevention with older adults. Cross-course faculty collaboration results in creating an integrated learning experience in gerontological, mental health, and community health nursing.

Replication
The gerontological learning experiences were developed by faculty from four campus sites across the state, and are appropriate for use in urban and rural settings. The learning experiences developed and the insights gained by UNMC College of Nursing faculty who have implemented the undergraduate curriculum in gerontological nursing can be replicated by other nursing faculties as they fulfill the responsibility of the nursing profession to address the changing demographics in our nation.

Honroable Mentions

Sacred Heart University - Nursing Programs and Physical Therapy Program
Fairfield, Connecticut
Patricia W. Walker, EdD, Dean, Dori Taylor Sullivan, PhD, RN, Nursing Program Director, Linda L. Strong, EdD,RN and Michelle M. Lusardi, PhD, PT (faculty contacts) Phone: (203) 371-7719 Fax: (203) 365-7662 E-mail: strongl@sacredheart.edu, lusardim@sacredheart.edu

Abstract
The baccalaureate curriculum in the College of Education and Health Professions, Nursing Programs includes an 18 credit Interdisciplinary Minor in Geriatric Health and Wellness. This minor consists of two required courses, Health and Wellness in Later Life and Chronic Illness and Frailty in Later Life and four elective courses that may be chosen from at least two additional disciplines. As an interdisciplinary minor, faculty from nursing, physical therapy and occupational therapy jointly teach the two required courses. These courses explore the physical, psychosocial, spiritual, and socio-cultural aspects of aging and the impact of ageism on health care, while stimulating student reflection into their own attitudes and perceptions towards older adults. Both required courses use the conceptual models of health promotion (Pender, 1996) and disablement (Nagi,1994) to explore, understand and analyze normal and expected phenomena of aging, chronicity, and frailty. Health and Wellness in Later Life focuses on primary prevention, health promotion, and disablement, comparing and contrasting the two models, identifying their complimentary and divergent aspects and explores methods for application of these models. Chronic Illness and Frailty in Older Life continues the exploration and use of these models, but focuses on aspects of secondary and tertiary prevention with minimally to moderately impaired older adults. Service learning is a required component of both courses, and consist of health fairs conducted in community based independent living environments, and of "friendly visitors / adopted grandparents" with older adults living in assisted living and extended care facilities.

To complete the curriculum students may choose courses from several disciplines, including a course from the Department of Modern Foreign Languages, Spanish Language and Culture for the Health Professional. This course combines weekly grammatical objectives such as, greetings and methods of expressing age and time with weekly cultural objectives such cultural notion of personal space, cultural views of aging, health, illness, and disability. This is a service learning course, and requires students to periodically meet with Hispanic elders who act as language and cultural guides and conversational partners. Course outcomes include the development of a cultural interview, and the preparation of two fiestas that showcase favored foods of conversational and cultural partners. Additional elective courses can be chosen from the disciplines of Nursing, Psychology, and Religious Studies.

Innovation
This curriculum is unique in that it promotes interdisciplinary collaboration among Nursing, Physical Therapy, and Occupational Therapy students as they investigate, analyze, and understand the health and wellness needs of older individuals. The interdisciplinary design uses two conceptual frameworks that are commonly associated with either primary care, health promotion, or rehabilitation sciences disablement model and demonstrates the appropriateness and applicability of these models in the promotion of wellbeing for older adults. Using these models promotes increased awareness of collaborative methods and valuing of the contributions of other disciplines. Service learning allows students to apply their knowledge of their own discipline in an activity that requires common skills and knowledge, namely education, health care advisement, and evaluation. Elective courses provide a different lens through which to view the aging process and the phenomena associated with normal aging and frailty.

Replication
While the disciplines involved are Nursing, Physical Therapy and Occupational Therapy, the focus on health promotion and secondary prevention within the context of physiologic, psychosocial, socio-cultural and spiritual factors form a common language that transcends health care disciplines. This model can be easily replicated with many of the health care disciplines.

Winston-Salem State University - School of Health Sciences - Department of Nursing
Winston-Salem, North Carolina
Sylvia A. Flack, EdD, Interim Dean; Kim Hutchinson, EdD, Associate Professor; Bobbie Reddick, EdD, Associate Professor; Carol Boles, RN, MSN Contact: Sylvia A. Flack Phone: (336)750-2567 Fax: (336)750-2568 E-mail: flacks@wssu.edu

Abstract
In an era where advanced aging trends are evident, Winston-Salem State University (WSSU) formally initiated Gerontological Nursing in Fall 1992 as a requirement for all BSN students. From that point forward, students began to gain an appreciation for concepts of health promotion and disease prevention as they relate to longevity and healthy aging.

The WSSU nursing curriculum offers a course that is formally devoted to gerontological nursing concepts. These concepts however are integrated through the curriculum beginning with the first clinical course. The course builds upon biological, sociological, psychological and spiritual aspects of the person. The clinical practice environment is in long-term care facilities, and the WSSU University/Community Wellness Center an academic primary care facility.

Gerontological Nursing is a semester-long didactic course that builds upon concepts presented in prerequisite courses. The course focus is on the study of elders over the age of 65. Emphases are on roles and functions of the nurse in meeting the needs of elder clients who are well and those with functional pathological health alterations. Social, economic, legal and ethical issues in maintaining and promoting wellness and safety are examined. Special permission for enrollment may be granted for elective credit to students who are majoring in other programs.

Innovation
In Spring 2000 faculty investigated a unique approach to augment student-learning experiences. Using the book, Teaching in the Neighborhood (1995) as a framework, the Gerontological Nursing course was held in one of the low income community housing units (Crystal Towers). Early in the course emphases were placed on debunking negative attitudinal perspectives and myths about the aged and the aging process. The expectation was for students to purposefully interact with elders on their home turf with the primary rationale being the promotion of positive attitudes toward aging individuals.

Because class meetings were held in the independent living complex, students had the opportunity to engage in "reality-based", "hands-on" experiential learning situations with unlikely dyads. Intergenerational cohorts convened in a round table format. Content mastery was accomplished by instructor-and student-led presentations, derived from assigned readings and case studies, dialogue, values clarification exercises, audio-visuals, guest lecturers, role-playing activities, and simulations. Resident-participants engaged in discussion with students and worked side-by-side with them to construct health-related posters. The posters remained in the vicinity of the auditorium for 24-hour visibility until the end of the semester. By course end, both students and elders had fruitful opportunity to demystify confusions and to challenge myths and stigma through shoulder-to-shoulder experiences.

Replication
All content, learning methodologies, and strategies are outlined in nursing course syllabi. This road mapping schemata, therefore, makes content replication easy. The innovation described above involved a change in the learning environment from the classroom to the "real world". To create this type of scenario, collaborative partnerships should be established. In order that dialogue with official and unofficial constituents, such as resident organizations, housing authority personnel, and health care managers. Quality-of-life enhancing interventions are of benefit to all strata.

For information and an application for the 2001 competition, click here.