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Celebrating Ten Years of Improving Health Care for Older Adults
Making Best Geriatric Practice
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Strategy No. 1: Increasing Individual Nurse Competence

Infusing Geriatrics into Nursing School Curricula

Before the Hartford Institute was founded, few nursing schools incorporated geriatrics into their curricula. Some schools offered geriatric content, but this was often dependent on the interests and efforts of individual faculty members. There was no required curriculum or national standards focused on transmitting competencies in geriatric nursing. In 1997, a Hartford Institute survey of baccalaureate nursing programs found that 60 percent of programs felt they needed to strengthen their curricula and faculty development in geriatrics.5 To correct this deficiency and infuse geriatrics into nursing school curricula on a large scale, the Hartford Institute collaborated with the American Association of Colleges of Nursing (AACN), which establishes quality standards for bachelor's-and graduate-degree nursing education and accredits baccalaureate and graduate nursing education programs.

Partnering with this influential organization, the Hartford Institute developed guidelines that define a set of core competencies for geriatric nursing to be incorporated into baccalaureate education. These guidelines reflect the view that nurses who graduate from bachelor's-degree programs should have the skills to recognize the complex interactions of acute and chronic conditions common in the elderly, use technology to enhance older adults' independence and safety, and assess older adults' physical, cognitive, psychological, social, and spiritual status.

The July 2000 document—"Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Gerontological Nursing Care"—defines 30 clinical competencies necessary for nurses to provide high-quality care to older adults and their families. "The expectation," says Dr. Mezey, "is that every nursing student will have a baseline competence in care of older adults." The implication for nursing programs is that they need to include geriatrics content in their curricula.

The Hartford Institute also provides resources to help faculty shape their curricula to meet the core competencies. This technical assistance material is in the publication "Best Nursing Practices in Care for Older Adults: Incorporating Essential Gerontological Content into Baccalaureate Nursing and Staff Development: A Curriculum Guide," and includes presentation materials for professors that were updated in 2005.

"The idea," says Dr. Capezuti, "is to teach geriatric content, but not necessarily in the form of typical geriatric nursing topics." In fact, the core competency document does not require that a separate course in geriatrics be added to the curriculum. Instead, it encourages faculty to teach care of older adult patients in the context of general nursing topics. "For example, when teaching about cardiac disease, instead of using the textbook 45-year-old man as a case study, talk about the more typical case of an 85-year-old woman with congestive heart failure," says Dr. Capezuti.

Dr. Capezuti also emphasizes that the Hartford Institute creates materials in a way that allows institutions to adapt them to their particular needs and style. Curricular materials are readily available on and downloadable from the Hartford Institute's Web site (www.hartfordign.org). "We make it easy for a faculty member who wants to teach a class with geriatrics content," says Dr. Capezuti. "We provide everything they need, including learning objectives, lecture content, exercises, and case studies in an accessible, but not lengthy, format. We provide all of the research to allow the faculty member to teach the most up-to-date evidence-based practice. This is all in a form that can be used as is or adapted to fit the particular needs of the faculty member."

The Institute's strategy has produced concrete results. A 2003 survey found that 92 percent of baccalaureate nursing programs reported that gerontological content was integrated in one or more courses in the curriculum, a remarkable increase from the 63 percent of schools reporting integration of gerontological content in 1997.6 The authors also found that many schools that had stand-alone classes in gerontological nursing made them required courses, instead of electives. And, of the schools with a stand-alone course, "78 percent also offered integration of gerontological content, suggesting that offering a stand-alone course serves as a catalyst for integration of gerontological content."

Overall, the authors reported that "there has been a fundamental shift in baccalaureate curricula toward incorporation of a greater amount of gerontological content, integration of gerontological content in a greater number of nursing courses, and more diversity of clinical sites used for gerontological clinical experiences." 5- Rosenfeld, P., Bottrell, M., Fulmer, T., Mezey. M. "Gerontological Nursing Content in Baccalaureate Nursing Programs," The Journal of Professional Nursing, 15.2, 1999, pp. 84-94.

6- Berman A, Mezey M, Kobayashi M, et al. "Gerontological Nursing Content in Baccalaureate Nursing Programs: Comparison of Findings from 1997 and 2003." Journal of Professional Nursing. 2005. Vol. 21, Number 5, pp. 268-275.
Visit the Hartford Institute for Geriatric Nursing Web site: www.hartfordign.org