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Innovative Strategies for Incorporating Gerontology Into BSN Curricula
INNOVATIVE STRATEGIES FOR INCORPORATING GERONTOLOGY INTO BSN CURRICULA KATHLEEN BLAIS, EDD, RN,* EDA MIKOLAJ, PHD, RN, CNAA, CNS,y DIANE JEDLICKA, PHD, RN, CNS,z JUDY STRAYER, PHD, RN, CNS,§ AND SUZANNE STANEK, MS, CFNP, RNt To prepare nurses in providing competent care to older adults, schools of nursing at the Otterbein College and the Florida International University, supported by American Association of Colleges of Nursing/John A. Hartford Foundation, developed innovative strategies for incorporation of gerontological content into their BSN curricula. Both nursing programs integrated these innovative gerontological learning experiences into sophomore-, junior-, and senior-level baccalaureate courses; developed independent gerontology courses, including online courses; supported the development of faculty expertise and sensitivity in elder care; and established new and/or enhanced existing community partnerships. The program objectives, planning, and implementation procedures for each of the two schools evolved similarly. Faculty development strategies and examples of community and international partnerships are presented. Finally, lessons learned from the implementation of these projects and recommendations based on these initiatives are presented. (Index words: Gerontology; Curriculum; Innovation; BSN; Geriatrics) J Prof Nurs 22:98– 102, 2006. A 2006 Published by Elsevier Inc.
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UPPORTED BY THE John A. Hartford Foundation and the American Association of Colleges of Nursing [AACN] (2000), two nursing programs revised their undergraduate curricula to incorporate a greater focus on nursing care of older adult clients. Although faculty from these two schools did not formally collaborate, they designed similar innovative strategies for integrating gerontology throughout their undergraduate baccalaureate nursing curricula. Both schools also developed independent stand-alone gerontology courses that focused on the unique needs of older
*Associate Professor and Director of Academic Programs, College of Health and Urban Affairs, School of Nursing, Florida International University, Miami, FL. yProfessor and Director of Graduate Studies in Nursing, Department of Nursing, Otterbein College, Westerville, OH. zProfessor and Director of Adult Health Program, Department of Nursing, Otterbein College, Westerville, OH. §Professor and Chair, Department of Nursing, Otterbein College, Westerville, OH. tPart-time Faculty, Department of Nursing, Otterbein College, Westerville, OH. Address correspondence and reprint requests to Dr. Blais: Associate Professor and Director of Academic Programs, College of Health and Urban Affairs, School of Nursing, Florida International University, Miami, FL 33199. E-mail: [email protected] 8755-7223/$ - see front matter
98 doi:10.1016/j.profnurs.2006.01.006
adults. With the goal of preparing nurses to provide competent care to our nation’s growing elderly population, both schools also developed similar objectives (Table 1).
Otterbein College Department of Nursing Gerontology Content Integrated Throughout the Curriculum Faculty at the Otterbein College Department of Nursing integrated gerontological curricular changes throughout the baccalaureate curriculum. Toward this end, they incorporated use of their NEED (Nursing Education for Elders Demonstration) Project Curricular Model (Figure 1). The model outlines a curricular process that fosters improved attitudes and behaviors toward the elderly and enables students to provide age-appropriate care to elders. In their first nursing course, sophomore-year students participated in two interactions with older adults, including discussions regarding thoughts about growing older, special experiences associated with aging, and limitations that may occur with aging. In group discussions during clinical conferences, students indicated that these interactions helped them develop positive personal perspectives about the aging experience.
Journal of Professional Nursing, Vol 22, No 2 (March-April), 2006: pp 98– 102 A 2006 Published by Elsevier Inc.
INNOVATIVE STRATEGIES FOR INCORPORATING GERONTOLOGY INTO BSN CURRICULA
Table 1. Project Primary Objectives Otterbein College NEED Project ! To integrate innovative gerontological learning experiences within the existing baccalaureate nursing curriculum ! To enhance faculty expertise in gerontology and technology ! To establish community and international partnerships to use available resources in enhancing student learning
FIU Culturally Diverse Adults Project ! To integrate geriatric nursing content throughout the undergraduate curriculum with an emphasis on cultural diversity and interdisciplinary teamwork ! To strengthen faculty understanding and sensitivity in caring for culturally diverse older adults ! To build new partnerships with clinical agencies to provide innovative interdisciplinary clinical experiences for undergraduate nursing students
Faculty who taught the sophomore-level maternity course invited grandparents to participate in a panel discussion. The panelists represented diversity in age, race, and number of grandchildren. Students rated this grandparent panel as bthe best experienceQ in the course. One student commented, bGrandparents rank very highly in my book. I was raised by mine. They are my true parents. From them, I have learned to respect others, be a listener instead of a talker, and always be the best person that I can be.Q Another student commented, bAll of the grandparents that attended the panel were wonderful and I would love to have them as my own grandparents. This experience was a wonderful new perspective that I had never really thought about concerning my own grandparents. Thank you for inviting them.Q The grandparents also viewed their participation on the panel as a positive experience. In groups of three’s and four’s, students in the juniorlevel medical–surgical course participated in a Senior Citizen Health Fair. Each group chose a topic for its health fair booth (i.e., positive aging, osteoporosis, hypertension, or weight management), identified objectives and content for its health promotion session, prepared a poster, and obtained related pamphlets and teaching materials from community agencies. Students collected data—for instance, the small group assigned the topic of hypertension took blood pressure and body mass index readings—and then tabulated and presented results using tables and charts. Students in the senior-level community health care delivery course incorporated elder health issues in two ways, either by creating health promotion projects or by participating in a wellness clinic. Several of the students developed health education materials on fall prevention. They used census data to target elders at high risk for falling and then distributed educational and preventative information to this population. Those who participated in the wellness clinic, a nurse-
99
managed health promotion clinic for medically underserved Somali, Hispanic, and Asian populations, provided educational materials on stroke, exercise, arthritis, fall prevention, and diabetes. Some senior nursing students enrolled in the international section of the community health course participated in a cultural immersion student exchange program in Sweden, Italy, or Northern Ireland. While overseas, they observed older adult clients receiving treatment in hospitals and nursing homes and/or living independently in their homes. Participating students shared their international experiences with their peers and faculty via presentations, poster displays, and reflective journaling. Faculty facilitated access to the gerontological curriculum through a web-based course and teleconferences using interactive video.
Figure 1. NEED Project Curricular Model (A Otterbein College Department of Nursing).
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School-Established Independent Gerontology Course Senior students also had the option of enrolling in one of two modules in a gerontology web-based elective. The first module, Views on Aging Through Literature and Art, developed in collaboration with several English literature and art professors, promotes positive values about aging and examines the question, bWhat is the importance of surviving to old age?Q Activities include analysis of various authors and artists, including the ways they were influenced by their individual aging processes. This course is currently featured on the AACN geriatric nursing education web page under Showcasing Curriculum Innovations for Geriatric Nursing (http://www.aacn.nche.edu/Education/Hartford/ ShowcasingInnovations/Otterbein.htm). The Issues on Aging module, which uses content from the End-of-Life Nursing Education Consortium Curriculum (2000/ 2003), introduces students to topics related to end-oflife care, such as quality of life, and the legal and ethical issues faced by terminally ill patients and their families.
Student Knowledge Assessment To evaluate the integrated curriculum, faculty administered the Palmore Facts on Aging Quiz 1 (FAQ1) to first-quarter junior nursing students who had been previously exposed to the sophomore-level gerontological learning experiences. The quiz identified their knowledge, attitudes, and bias regarding aging. Of the 25 questions on the FAQ1, Palmore (1988) classified 16 as representing negative bias, 5 as indicating positive bias, and 4 as indicating neutrality. For the 41 nursing students taking the FAQ1, the mean score was 18.1 (88.5%) and the standard deviation was 2.61 of a maximum possible score of 25. The correct and incorrect responses were equally weighted. The Kuder–Richardson reliability coefficient 20 was used to test the internal consistency of the instrument. For the 5 questions used to solicit positive bias indications, the calculated coefficient (.36) demonstrated homogeneity of the test questions. Similarly, the Kuder–Richardson reliability coefficient 20 was used to evaluate the 16 questions that solicited negative bias indications and provided a calculated coefficient (.82) that reflected the internal consistency of the test questions. Half of the students incorrectly answered the items that indicated negative bias: old people have incomes below the poverty level (No. 21); the majority of old people say they are seldom irritated or angry (No. 24); and the health and economic status of old people will be about the same or worse by the year 2010 (No. 25). Less than half of the students incorrectly answered the five items that indicated positive bias. These items include that the five senses tend to weaken in old age (No. 2); lung vital capacity tends to decline in old age (No. 4); physical strength tends to decline in old age (No. 6); old people usually take longer to learn something new (No. 12); and older people tend to react slower than younger people (No. 14). The net bias score indicated by the responses of these nursing students to the FAQ1 is
3.03, which is considered a neutral score. Approximately 40% of the students demonstrated a tendency toward a positive bias, whereas 60% had a tendency toward a negative bias (i.e., for every two students with a positive bias, there were three students with a negative bias).
Student Attitudes Examined Ninety-five percent of the students indicated that their attitudes had become more positive since the completion of their sophomore-year clinical courses. Juniorlevel students reported that the diverse grandparent panel discussion they observed helped them learn how to interact more positively with well elders. However, FAQ1 responses indicate an inherent tendency among these young nursing students toward older adult negative bias. Developing positive bias toward elders will require more targeted learning exercises, along with strong faculty commitment to integrate additional gerontological content and learning experiences throughout the curriculum.
Florida International University Gerontology Content Integrated Throughout the Curriculum In response to current trends and technologies in nursing and health care, faculty at the Florida International University (FIU) School of Nursing designed a full curriculum revision that included the integration of geriatric nursing content. The revised curriculum addresses the rapid growth in the older adult population, community-based health care, and the use of new technologies as they apply to nursing care. Faculty reviewed the courses in their specialty areas and identified ways to incorporate and emphasize geriatric nursing. Faculty integrated gerontological content throughout the curriculum, from sophomorelevel nursing courses to senior-level courses, and added an independent capstone course in geriatric nursing, Nursing Care of Older Adults. Students enrolled in the sophomore-level Client Assessment course are required to select an older adult (preferably a grandparent or older family member) from whom to obtain a history. This interview process (including questions regarding biographical data, past medical history, family health history, current health status, medications, etc.) reveals for a student the complexity of older adult health care needs. Students who interview their own grandparents tend to learn more about their own family histories as well. To date, students report their grandparents to be enthusiastic about participating in this assignment. This course also addresses the differences between assessments of older adults and those of clients in other age groups. Faculty who teach the pharmacology course include content about the pharmacodynamics of drugs in the elderly, polypharmacy issues, and contraindications of specific drugs or drug groups in the elderly population. In Foundations of Nursing, the faculty discuss nursing care as it relates to a client’s developmental needs. Here,
INNOVATIVE STRATEGIES FOR INCORPORATING GERONTOLOGY INTO BSN CURRICULA
again, the unique nursing needs of older adults are discussed in relation to the physiological changes of aging. This gerontological nursing theme extends through the curriculum in several more courses. In Pathophysiology and Adult Physiological Nursing, students learn about the biologic theories of aging and physiological changes of aging and how they relate to the development of age-related health problems. In Psychiatric Mental Health Nursing, students learn about the dementias that occur with aging and how to differentiate between those that are reversible and those that are not. Opportunities to care for older clients with age-related health problems are provided in the clinical sites, including both illness and wellness settings, where students observe older adults living productive lives in spite of their chronic illnesses. Senior-year students enrolled in Childbearing and Childrearing Nursing are exposed to gerontology content by examination of intergenerational roles (i.e., grandparents as primary care providers and mothers serving as labor coaches).
School-Established Independent Gerontology Course Students are required to take Nursing Care of Older Adults, a last-semester senior-year synthesis course. The development of a capstone senior course was not originally included as a project goal. However, faculty soon recognized the wisdom in complementing the integration of gerontological content with the creation of a stand-alone gerontology course. In an eureka moment, faculty understood that if the curriculum includes specific courses for childbearing and childrearing (courses in which the time span ranges from 9 months to 18 years), then it must also include a specific course regarding the elderly (incorporating a time span of 40+ years). The revised curriculum has not yet been fully implemented; however, faculty have adjusted their current courses to include more content on care of older adults during the new curriculum’s phasing-in process. The independent course, Nursing Care of Older Adults, remains a highly recommended elective, given that students cannot be required to switch to a curriculum that was not published at their time of admission. Pairing students with older adult senior mentors provides an invaluable one-on-one student learning experience; feedback from student evaluations include bthis course should be required for everyoneQ and bthis is one of the best courses I’ve taken.Q
Similar Program Characteristics Faculty Development At both institutions, the programs included faculty development activities. At an Otterbein College faculty retreat, faculty created a curriculum grid of baccalaureate gerontology content and identified strategies for incorporating gerontological learning activities. At a second retreat, faculty explored techniques for delivering culturally competent care to elderly members of the Appalachian culture.
101
FIU recruited an expert in geriatric nursing and curriculum development to lead a faculty development workshop on baccalaureate curriculum revision and the need for a concentrated geriatric nursing focus. Experts in geriatric nursing were invited to speak at the School of Nursing Annual Research Day, attended by both faculty and students. Two faculty members were sponsored to attend the University of Arkansas Southern Gerontological Nursing Certificate Program. The University of Arkansas program is designed to strengthen faculty knowledge and experience in older adult care, thus enabling them to become more effective teachers of geriatric nursing. The program also provides faculty instruction regarding development of geriatric nursing web-based modules.
Partnerships Both projects aimed to create new and enhanced partnerships with community sites. The Otterbein College established community and international partnerships to provide students with experiences in end-oflife care, to expose them to medically underserved ethnic older adult populations, and to acquaint them with international gerontological issues. FIU strengthened existing partnerships internally with the university-based Center on Aging and externally with the Miami Jewish Home and Hospital for the Aged, a facility that provides a continuum of care from independent living to assisted living to skilled nursing. It includes an onsite apartment tower where older adults live independently and participate in campus services such as meal programs and recreational programs. Older adults who participate in the university-based Elder Institute are recruited to serve as senior mentors for students enrolled in Nursing Care of Older Adults.
Sustainability At Otterbein College, prior to implementation, the curriculum initiatives were approved by the entire faculty, an essential step toward successful implementation and maintenance of the curriculum changes. Full implementation has taken place over the last 2 years and includes ongoing evaluations that provide data used for curriculum refinement. Course evaluations have been extremely positive, and the independent gerontological course continues to receive rave reviews. At FIU, the revised curriculum received approvals from all levels of the university curricular process. Full implementation of the new curriculum will begin in the summer semester of 2006. Faculty had already begun to increase the gerontology content in all of their courses and are prepared for full gerontological curricular implementation.
Lessons Learned Both schools acknowledge the vital importance of faculty development as a prerequisite to gerontological curricular change and the need to allow for time to cultivate faculty buy in. Both schools organized faculty retreats and/or extended faculty meetings. During the
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retreats/meetings, faculty brainstormed creative strategies to integrate gerontology learning opportunities throughout the undergraduate curriculum. The nursing curriculum committees of each institution supported the project by reviewing and approving the curricular changes. Both schools recognized the need for recruiting additional personnel, including an instructional designer to assist with online gerontology course development. Library resources relative to older adults were also expanded. Both schools acknowledged the importance of complementing full gerontological curricular integration with the creation of an independent course. Finally, both schools identified faculty champions to help their colleagues recognize the importance of addressing the unique needs of older adults. Faculty champions make learning about the care of older adults exciting for students and faculty.
Recommendations The following recommendations are presented to assist other schools that may attempt a gerontological curricular integration: 1. A focus on the positive aspects of aging, such as grandparenting or older adults working as volunteers in the community, helps promote positive attitudes toward aging. 2. Students must be prepared to work with older adults from diverse cultural populations and be able to provide culturally competent care for underserved and vulnerable populations, such as minorities, immigrants, and refugees. 3. Experiences with community-based elderly should be incorporated in all nursing curricula. Most older adults are not institutionalized and remain in the community as active and productive members of society. 4. International experiences with aging may contribute to the development of a global perspective toward issues associated with aging and may promote increased sensitivity toward the cultural implications of nursing care.
Conclusion These funded projects support the improvement of nurse preparation regarding older adult care. They demonstrate the need for focusing on both full integration of gerontological content across nursing curricula and creation of stand-alone courses relative to the unique needs of older adults (American Nurses Association, 1995). Student interaction with culturally diverse older adults across the wellness–illness continuum fosters positive attitudes about aging among students and faculty (Federal Interagency Forum on Aging, n.d.). In addition, interdisciplinary experiences help nursing students appreciate the varied contributions of health care team members. The implementation of these creative and innovative learning experiences expands participant knowledge about the aging process. The experiences of these two schools reinforce the need for nursing faculty across the country to critically review their curricula, toward the provision of optimal gerontological nursing care from their graduates.
Acknowledgments The nursing faculty from Otterbein College and the FIU greatly appreciate the support provided by the AACN/ John A. Hartford Foundation that enabled both schools to participate in these innovative projects.
References American Association of Colleges of Nursing. (2000). Older adults: Recommended baccalaureate competencies and curricular guidelines for geriatric nursing care. Washington, DC: Author. End-of-Life Nursing Education Consortium (ELNEC) Curriculum. (2000, Revised, 2003). Washington, DC: American Association of Colleges of Nursing (AACN). Los Angeles: City of Hope (COH) National Medical Center. American Nurses Association. (1995). Scope and standards of gerontological nursing practice. Washington, DC: American Nurses Association. Federal Interagency Forum on Aging. (1998). Older Americans 2004: Key indicators of well-being. Retrieved June 17, 2005, from http://www.agingstats.gov/chartbook2004/population. html. Palmore, E. B. (1998). The facts on aging quiz. 2nd ed. New York: Springer.
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UPPORTED BY THE John A. Hartford Foundation and the American Association of Colleges of Nursing [AACN] (2000), two nursing programs revised their undergraduate curricula to incorporate a greater focus on nursing care of older adult clients. Although faculty from these two schools did not formally collaborate, they designed similar innovative strategies for integrating gerontology throughout their undergraduate baccalaureate nursing curricula. Both schools also developed independent stand-alone gerontology courses that focused on the unique needs of older
*Associate Professor and Director of Academic Programs, College of Health and Urban Affairs, School of Nursing, Florida International University, Miami, FL. yProfessor and Director of Graduate Studies in Nursing, Department of Nursing, Otterbein College, Westerville, OH. zProfessor and Director of Adult Health Program, Department of Nursing, Otterbein College, Westerville, OH. §Professor and Chair, Department of Nursing, Otterbein College, Westerville, OH. tPart-time Faculty, Department of Nursing, Otterbein College, Westerville, OH. Address correspondence and reprint requests to Dr. Blais: Associate Professor and Director of Academic Programs, College of Health and Urban Affairs, School of Nursing, Florida International University, Miami, FL 33199. E-mail: [email protected] 8755-7223/$ - see front matter
98 doi:10.1016/j.profnurs.2006.01.006
adults. With the goal of preparing nurses to provide competent care to our nation’s growing elderly population, both schools also developed similar objectives (Table 1).
Otterbein College Department of Nursing Gerontology Content Integrated Throughout the Curriculum Faculty at the Otterbein College Department of Nursing integrated gerontological curricular changes throughout the baccalaureate curriculum. Toward this end, they incorporated use of their NEED (Nursing Education for Elders Demonstration) Project Curricular Model (Figure 1). The model outlines a curricular process that fosters improved attitudes and behaviors toward the elderly and enables students to provide age-appropriate care to elders. In their first nursing course, sophomore-year students participated in two interactions with older adults, including discussions regarding thoughts about growing older, special experiences associated with aging, and limitations that may occur with aging. In group discussions during clinical conferences, students indicated that these interactions helped them develop positive personal perspectives about the aging experience.
Journal of Professional Nursing, Vol 22, No 2 (March-April), 2006: pp 98– 102 A 2006 Published by Elsevier Inc.
INNOVATIVE STRATEGIES FOR INCORPORATING GERONTOLOGY INTO BSN CURRICULA
Table 1. Project Primary Objectives Otterbein College NEED Project ! To integrate innovative gerontological learning experiences within the existing baccalaureate nursing curriculum ! To enhance faculty expertise in gerontology and technology ! To establish community and international partnerships to use available resources in enhancing student learning
FIU Culturally Diverse Adults Project ! To integrate geriatric nursing content throughout the undergraduate curriculum with an emphasis on cultural diversity and interdisciplinary teamwork ! To strengthen faculty understanding and sensitivity in caring for culturally diverse older adults ! To build new partnerships with clinical agencies to provide innovative interdisciplinary clinical experiences for undergraduate nursing students
Faculty who taught the sophomore-level maternity course invited grandparents to participate in a panel discussion. The panelists represented diversity in age, race, and number of grandchildren. Students rated this grandparent panel as bthe best experienceQ in the course. One student commented, bGrandparents rank very highly in my book. I was raised by mine. They are my true parents. From them, I have learned to respect others, be a listener instead of a talker, and always be the best person that I can be.Q Another student commented, bAll of the grandparents that attended the panel were wonderful and I would love to have them as my own grandparents. This experience was a wonderful new perspective that I had never really thought about concerning my own grandparents. Thank you for inviting them.Q The grandparents also viewed their participation on the panel as a positive experience. In groups of three’s and four’s, students in the juniorlevel medical–surgical course participated in a Senior Citizen Health Fair. Each group chose a topic for its health fair booth (i.e., positive aging, osteoporosis, hypertension, or weight management), identified objectives and content for its health promotion session, prepared a poster, and obtained related pamphlets and teaching materials from community agencies. Students collected data—for instance, the small group assigned the topic of hypertension took blood pressure and body mass index readings—and then tabulated and presented results using tables and charts. Students in the senior-level community health care delivery course incorporated elder health issues in two ways, either by creating health promotion projects or by participating in a wellness clinic. Several of the students developed health education materials on fall prevention. They used census data to target elders at high risk for falling and then distributed educational and preventative information to this population. Those who participated in the wellness clinic, a nurse-
99
managed health promotion clinic for medically underserved Somali, Hispanic, and Asian populations, provided educational materials on stroke, exercise, arthritis, fall prevention, and diabetes. Some senior nursing students enrolled in the international section of the community health course participated in a cultural immersion student exchange program in Sweden, Italy, or Northern Ireland. While overseas, they observed older adult clients receiving treatment in hospitals and nursing homes and/or living independently in their homes. Participating students shared their international experiences with their peers and faculty via presentations, poster displays, and reflective journaling. Faculty facilitated access to the gerontological curriculum through a web-based course and teleconferences using interactive video.
Figure 1. NEED Project Curricular Model (A Otterbein College Department of Nursing).
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School-Established Independent Gerontology Course Senior students also had the option of enrolling in one of two modules in a gerontology web-based elective. The first module, Views on Aging Through Literature and Art, developed in collaboration with several English literature and art professors, promotes positive values about aging and examines the question, bWhat is the importance of surviving to old age?Q Activities include analysis of various authors and artists, including the ways they were influenced by their individual aging processes. This course is currently featured on the AACN geriatric nursing education web page under Showcasing Curriculum Innovations for Geriatric Nursing (http://www.aacn.nche.edu/Education/Hartford/ ShowcasingInnovations/Otterbein.htm). The Issues on Aging module, which uses content from the End-of-Life Nursing Education Consortium Curriculum (2000/ 2003), introduces students to topics related to end-oflife care, such as quality of life, and the legal and ethical issues faced by terminally ill patients and their families.
Student Knowledge Assessment To evaluate the integrated curriculum, faculty administered the Palmore Facts on Aging Quiz 1 (FAQ1) to first-quarter junior nursing students who had been previously exposed to the sophomore-level gerontological learning experiences. The quiz identified their knowledge, attitudes, and bias regarding aging. Of the 25 questions on the FAQ1, Palmore (1988) classified 16 as representing negative bias, 5 as indicating positive bias, and 4 as indicating neutrality. For the 41 nursing students taking the FAQ1, the mean score was 18.1 (88.5%) and the standard deviation was 2.61 of a maximum possible score of 25. The correct and incorrect responses were equally weighted. The Kuder–Richardson reliability coefficient 20 was used to test the internal consistency of the instrument. For the 5 questions used to solicit positive bias indications, the calculated coefficient (.36) demonstrated homogeneity of the test questions. Similarly, the Kuder–Richardson reliability coefficient 20 was used to evaluate the 16 questions that solicited negative bias indications and provided a calculated coefficient (.82) that reflected the internal consistency of the test questions. Half of the students incorrectly answered the items that indicated negative bias: old people have incomes below the poverty level (No. 21); the majority of old people say they are seldom irritated or angry (No. 24); and the health and economic status of old people will be about the same or worse by the year 2010 (No. 25). Less than half of the students incorrectly answered the five items that indicated positive bias. These items include that the five senses tend to weaken in old age (No. 2); lung vital capacity tends to decline in old age (No. 4); physical strength tends to decline in old age (No. 6); old people usually take longer to learn something new (No. 12); and older people tend to react slower than younger people (No. 14). The net bias score indicated by the responses of these nursing students to the FAQ1 is
3.03, which is considered a neutral score. Approximately 40% of the students demonstrated a tendency toward a positive bias, whereas 60% had a tendency toward a negative bias (i.e., for every two students with a positive bias, there were three students with a negative bias).
Student Attitudes Examined Ninety-five percent of the students indicated that their attitudes had become more positive since the completion of their sophomore-year clinical courses. Juniorlevel students reported that the diverse grandparent panel discussion they observed helped them learn how to interact more positively with well elders. However, FAQ1 responses indicate an inherent tendency among these young nursing students toward older adult negative bias. Developing positive bias toward elders will require more targeted learning exercises, along with strong faculty commitment to integrate additional gerontological content and learning experiences throughout the curriculum.
Florida International University Gerontology Content Integrated Throughout the Curriculum In response to current trends and technologies in nursing and health care, faculty at the Florida International University (FIU) School of Nursing designed a full curriculum revision that included the integration of geriatric nursing content. The revised curriculum addresses the rapid growth in the older adult population, community-based health care, and the use of new technologies as they apply to nursing care. Faculty reviewed the courses in their specialty areas and identified ways to incorporate and emphasize geriatric nursing. Faculty integrated gerontological content throughout the curriculum, from sophomorelevel nursing courses to senior-level courses, and added an independent capstone course in geriatric nursing, Nursing Care of Older Adults. Students enrolled in the sophomore-level Client Assessment course are required to select an older adult (preferably a grandparent or older family member) from whom to obtain a history. This interview process (including questions regarding biographical data, past medical history, family health history, current health status, medications, etc.) reveals for a student the complexity of older adult health care needs. Students who interview their own grandparents tend to learn more about their own family histories as well. To date, students report their grandparents to be enthusiastic about participating in this assignment. This course also addresses the differences between assessments of older adults and those of clients in other age groups. Faculty who teach the pharmacology course include content about the pharmacodynamics of drugs in the elderly, polypharmacy issues, and contraindications of specific drugs or drug groups in the elderly population. In Foundations of Nursing, the faculty discuss nursing care as it relates to a client’s developmental needs. Here,
INNOVATIVE STRATEGIES FOR INCORPORATING GERONTOLOGY INTO BSN CURRICULA
again, the unique nursing needs of older adults are discussed in relation to the physiological changes of aging. This gerontological nursing theme extends through the curriculum in several more courses. In Pathophysiology and Adult Physiological Nursing, students learn about the biologic theories of aging and physiological changes of aging and how they relate to the development of age-related health problems. In Psychiatric Mental Health Nursing, students learn about the dementias that occur with aging and how to differentiate between those that are reversible and those that are not. Opportunities to care for older clients with age-related health problems are provided in the clinical sites, including both illness and wellness settings, where students observe older adults living productive lives in spite of their chronic illnesses. Senior-year students enrolled in Childbearing and Childrearing Nursing are exposed to gerontology content by examination of intergenerational roles (i.e., grandparents as primary care providers and mothers serving as labor coaches).
School-Established Independent Gerontology Course Students are required to take Nursing Care of Older Adults, a last-semester senior-year synthesis course. The development of a capstone senior course was not originally included as a project goal. However, faculty soon recognized the wisdom in complementing the integration of gerontological content with the creation of a stand-alone gerontology course. In an eureka moment, faculty understood that if the curriculum includes specific courses for childbearing and childrearing (courses in which the time span ranges from 9 months to 18 years), then it must also include a specific course regarding the elderly (incorporating a time span of 40+ years). The revised curriculum has not yet been fully implemented; however, faculty have adjusted their current courses to include more content on care of older adults during the new curriculum’s phasing-in process. The independent course, Nursing Care of Older Adults, remains a highly recommended elective, given that students cannot be required to switch to a curriculum that was not published at their time of admission. Pairing students with older adult senior mentors provides an invaluable one-on-one student learning experience; feedback from student evaluations include bthis course should be required for everyoneQ and bthis is one of the best courses I’ve taken.Q
Similar Program Characteristics Faculty Development At both institutions, the programs included faculty development activities. At an Otterbein College faculty retreat, faculty created a curriculum grid of baccalaureate gerontology content and identified strategies for incorporating gerontological learning activities. At a second retreat, faculty explored techniques for delivering culturally competent care to elderly members of the Appalachian culture.
101
FIU recruited an expert in geriatric nursing and curriculum development to lead a faculty development workshop on baccalaureate curriculum revision and the need for a concentrated geriatric nursing focus. Experts in geriatric nursing were invited to speak at the School of Nursing Annual Research Day, attended by both faculty and students. Two faculty members were sponsored to attend the University of Arkansas Southern Gerontological Nursing Certificate Program. The University of Arkansas program is designed to strengthen faculty knowledge and experience in older adult care, thus enabling them to become more effective teachers of geriatric nursing. The program also provides faculty instruction regarding development of geriatric nursing web-based modules.
Partnerships Both projects aimed to create new and enhanced partnerships with community sites. The Otterbein College established community and international partnerships to provide students with experiences in end-oflife care, to expose them to medically underserved ethnic older adult populations, and to acquaint them with international gerontological issues. FIU strengthened existing partnerships internally with the university-based Center on Aging and externally with the Miami Jewish Home and Hospital for the Aged, a facility that provides a continuum of care from independent living to assisted living to skilled nursing. It includes an onsite apartment tower where older adults live independently and participate in campus services such as meal programs and recreational programs. Older adults who participate in the university-based Elder Institute are recruited to serve as senior mentors for students enrolled in Nursing Care of Older Adults.
Sustainability At Otterbein College, prior to implementation, the curriculum initiatives were approved by the entire faculty, an essential step toward successful implementation and maintenance of the curriculum changes. Full implementation has taken place over the last 2 years and includes ongoing evaluations that provide data used for curriculum refinement. Course evaluations have been extremely positive, and the independent gerontological course continues to receive rave reviews. At FIU, the revised curriculum received approvals from all levels of the university curricular process. Full implementation of the new curriculum will begin in the summer semester of 2006. Faculty had already begun to increase the gerontology content in all of their courses and are prepared for full gerontological curricular implementation.
Lessons Learned Both schools acknowledge the vital importance of faculty development as a prerequisite to gerontological curricular change and the need to allow for time to cultivate faculty buy in. Both schools organized faculty retreats and/or extended faculty meetings. During the
102
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retreats/meetings, faculty brainstormed creative strategies to integrate gerontology learning opportunities throughout the undergraduate curriculum. The nursing curriculum committees of each institution supported the project by reviewing and approving the curricular changes. Both schools recognized the need for recruiting additional personnel, including an instructional designer to assist with online gerontology course development. Library resources relative to older adults were also expanded. Both schools acknowledged the importance of complementing full gerontological curricular integration with the creation of an independent course. Finally, both schools identified faculty champions to help their colleagues recognize the importance of addressing the unique needs of older adults. Faculty champions make learning about the care of older adults exciting for students and faculty.
Recommendations The following recommendations are presented to assist other schools that may attempt a gerontological curricular integration: 1. A focus on the positive aspects of aging, such as grandparenting or older adults working as volunteers in the community, helps promote positive attitudes toward aging. 2. Students must be prepared to work with older adults from diverse cultural populations and be able to provide culturally competent care for underserved and vulnerable populations, such as minorities, immigrants, and refugees. 3. Experiences with community-based elderly should be incorporated in all nursing curricula. Most older adults are not institutionalized and remain in the community as active and productive members of society. 4. International experiences with aging may contribute to the development of a global perspective toward issues associated with aging and may promote increased sensitivity toward the cultural implications of nursing care.
Conclusion These funded projects support the improvement of nurse preparation regarding older adult care. They demonstrate the need for focusing on both full integration of gerontological content across nursing curricula and creation of stand-alone courses relative to the unique needs of older adults (American Nurses Association, 1995). Student interaction with culturally diverse older adults across the wellness–illness continuum fosters positive attitudes about aging among students and faculty (Federal Interagency Forum on Aging, n.d.). In addition, interdisciplinary experiences help nursing students appreciate the varied contributions of health care team members. The implementation of these creative and innovative learning experiences expands participant knowledge about the aging process. The experiences of these two schools reinforce the need for nursing faculty across the country to critically review their curricula, toward the provision of optimal gerontological nursing care from their graduates.
Acknowledgments The nursing faculty from Otterbein College and the FIU greatly appreciate the support provided by the AACN/ John A. Hartford Foundation that enabled both schools to participate in these innovative projects.
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