The University of Alabama in Huntsville College of Nursing (CON) undergraduate program has responded to the call to increase geriatric nursing content in the undergraduate nursing curricula with a new approach to clinical education instituted in 2016. Faculty well qualified in didactic content partnered with a clinical champion, a certified registered nurse practitioner (CRNP), and worked together to structure and facilitate this innovation in geriatric clinical education.
The CRNP maintained regular practice hours with a local geriatric expert, Dr. Zaheer Khan, the primary care physician for the Center for Elder Care. The Center for Elder Care is a specialty practice for persons over the age of 65 that has been recognized as a level three patient-centered medical home. The practice has been recognized as providing exceptional comprehensive, collaborative care for senior adults. Khan is also founder of the nonprofit Center for Aging and a key stakeholder in a community program known as Balance for Life.
The Balance for Life program, free to community-dwelling senior adults, focuses on balance and strength training at various levels and is designed to improve gait and balance and ultimately prevent falls. The collaborative partnership that formed between the CON faculty and Khan is the foundation for a unique, innovative approach to teaching gerontology to undergraduate nursing students.
DEVELOPING CLINICAL EXPERIENCES
As the gerontology course was taking shape in didactic form, faculty began to think about possible clinical experiences for students. According to the National League for Nursing (2011) vision statement "Caring for Older Adults," it is imperative to design intentional encounters with older adults in a variety of health care settings. The challenge was to develop measurable nursing outcomes aligned with the needs of older adults while changing stereotypical attitudes toward the older adult population (Lane, 2016). This was accomplished by designing experiences that focus on wellness and independence and progress to hospital care under a specialty model for geriatrics.
The initial clinical experiences include a community rotation at local area churches participating in the Balance for Life program. This successful program has expanded to 14 churches in the Huntsville and surrounding Madison County areas. Balance for Life activities progress along a range from mild to difficult to accommodate all those who wish to participate. The instructors teaching balance classes are certified and trained in gait and balance training for older adults.
Next, students are afforded the opportunity to do a clinical rotation under the supervision of the CRNP in the medical office of the geriatrician. The objective of this clinical is to perform annual wellness visits required by Medicare for assigned consenting patients. This valuable experience encompasses screening exams, such as cognitive evaluation, geriatric depression scale, functional assessment status, the Timed Up and Go Test, and a review of age-appropriate recommendations for health maintenance and vaccinations.
Students then do a clinical rotation at Crestwood Hospital in the Huntsville community where Khan was responsible for pioneering the ACE (Acute Care for the Elderly) in 2009 and has been medical director since that time. The ACE unit, which is also NICHE (Nurses Improving Care for Health System Elders) certified, specializes in multidisciplinary care for older adults by building on concepts put forth by the Hartford Institute for Geriatric Nursing. Crestwood's ACE unit is one of only three NICHE-trained and -certified units in the state of Alabama. It provides an evidence-based practice site where students and instructors can critique and evaluate the appropriate use of knowledge areas in specific situations when caring for older adults.
This particular rotation provides a unique and personal experience for nursing students. Students have already become acquainted with many of the hospitalized patients during their clinical experience at the Center for Elder Care. Because of the well-established and trusting relationship that has already formed with patients, a positive learning environment is created for students. Students make rounds with the geriatrician during clinical and discuss the phenomenon of geriatric syndromes that happen during hospitalization. This unique collaborative experience eases students' fear of talking with physicians.
IMPLICATIONS FOR NURSING EDUCATION
The design of the clinical model for this gerontology course is a unique and innovative approach to clinical experiences with older adults. According to Lane (2016), undergraduate students typically do not choose to work with older adults. By incorporating an independent course focusing on older adults and selecting passionate and qualified faculty, our hope is that student perceptions can be changed. Our mission is to better prepare our graduates for gerontological nursing and encourage a passion for this segment of our population. Students come away from the University of Alabama in Huntsville CON experience with a positive outlook toward caring for the elderly population, and many express a desire to work with this population after graduation.
Our CON has been selected as a member of the National Hartford Center of Gerontological Nursing Excellence, an international collaboration between schools of nursing and Sigma Theta Tau International Honor Society of Nursing, whose goal is to support research, education, and practice to provide better nursing care for our aging society (Harden & Watman, 2015). The strong collaboration with a geriatric expert and a CRNP provides nursing students with excellent clinical opportunities, working with populations ranging from healthy, independently functioning older adults to elderly patients requiring hospitalization.
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