Learning to provide comprehensive care for senior adults is an essential element in baccalaureate nursing education (American Association of Colleges of Nursing, 1998; National League for Nursing, 2011). The Washington State University College of Nursing undergraduate curriculum includes learning outcomes in geriatric nursing presented in the first semester and reinforced throughout the program (Washington State University, 2016). Students have opportunities to care for senior adults in a variety of settings including acute care, outpatient clinics, skilled nursing, and community health. The Meals on Wheels (MOW) partnership, which began in 2013, expanded the opportunities to work with homebound senior adults receiving volunteer-delivered meals.
BACKGROUND
Senior adults, defined as 65 years and older, comprise 14.9 percent of the national population (US Census Bureau, 2016). National census data for the period 2010-2014 indicated that 10 percent of senior adults were living in poverty (US Census Bureau, 2016). Meals on Wheels of America (2016) is a national organization that empowers communities to address the nutrition and socialization needs of seniors. The need for nutritional support in local senior populations is evident in the utilization of home-delivered meals. In 2015, 29 percent of home delivery clients residing in the Benton and Franklin County service area were at or below the federal poverty level.
With nursing education programs required to meet clinical practice hours, even taking into account simulation, there remains a continual need to explore new opportunities for real-world experiences through partnerships with clinical agencies. Changes in health care delivery give faculty greater options for clinical learning opportunities outside of acute care. The MOW program is an example of a community-based, non-health-care partnership that provides opportunities for students to meet curricular outcomes in a nontraditional way.
THE PROCESS
In 2013, local MOW staff were looking for opportunities to involve nursing students in nutrition and health outcome assessments for seniors receiving home-delivered meals. At the same time, the College of Nursing wanted to expand options to connect students with senior adults living outside of skilled nursing facilities. A collaboration was designed to meet both needs.
Senior adult participants are screened by MOW staff for appropriateness in meeting student objectives, agreement to participate, and having a safe environment for students. The initial nutritional assessment, completed by MOW staff, evaluates nutritional risk, weight, body mass index, blood pressure, history of recent hospital visits, medications, and self-perception of health. Participants are asked about food security, financial security, and socialization.
Nurse faculty and MOW staff provide a joint orientation for the 24 students who comprise the first-semester cohort. Faculty and MOW staff help students explore the potential risks for vulnerable senior adults living alone and coach students on the need to maintain strict standards of confidentiality with regard to client names and addresses. Students sign a confidentiality agreement specific for this assignment. The nurse's responsibility as a mandatory reporter of senior abuse and neglect is also presented.
Working in pairs, students receive the name, brief biography, and home address of an assigned client along with a photograph. They visit the client weekly for a total of five visits. Utilizing the initial assessment completed by MOW, the nursing students assess the senior adult's health, safety, and resource needs (see Table 1 for weekly assignments).
OUTCOMES
To date, more than 120 students have participated in this collaboration, and the outcomes have been seen as successful from all perspectives. The assignment accounts for 18 hours of a total of 180 clinical hours required in the first semester of the nursing program. As the semester also includes didactic and other clinical courses for gerontological nursing, students have the opportunity to apply concepts from theory to practice.
Formative and summative evaluations are used to assess student progress. Weekly communication with faculty and a mid-semester meeting with MOW representatives provide the formative evaluation. Students complete a summative written assignment reflecting on their weekly visits. Often, during convocation, students highlight this assignment as one of the most life-impacting experiences in the nursing program. Many students are emotionally moved by their encounters with senior adults living in poverty and isolation. Course evaluations often reflect on this experience as an effective way to practice professionalism and apply concepts of therapeutic communication.
The impact on the seniors participating with students has also been positive. MOW developed satisfaction surveys for clients that show a decrease in feelings of isolation, improved understanding of medication regimens, increased activity, and the identification of personal health goals. The authors anticipate expanding collaboration with other disciplines in the future. The impact of interdisciplinary home visits on fall rates and hospitalizations are areas of interest for further study.
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