Creative strategies for a stand-alone gerontology course for the nursing curriculum.

TODAY, ONLY 2 PERCENT OF NEW NURSE GRADUATES REPORT THAT THEY WILL SPECIALIZE IN GERONTOLOGY (AUD, BOSTICK, MAREK, & McDANIEL, 2006). Among the reasons students do not choose this specialty are a lack of effective preparation, too few faculty with certification in gerontology, and inadequate clinical experience focused on older adults (Abbey et al., 2006). The pay in long-term care, uninspiring clinical settings, and a shortage of role models are other reasons students avoid this specialty area (Abbey et al.).

Adequate preparation of nursing students to care for older adults in a knowledgeable, skillful, and caring manner benefits students, clients, and society. Nursing programs are needed that help students develop more positive attitudes and a greater willingness to work with the older adult population. Students with more positive attitudes will be more understanding and accommodating when working with older adults (Kirkpatrick & Brown, 2006).

Nursing curricula that offer inspiring and challenging interactions with older adults can bring about attitudinal change in students (Burbank, Dowling-Castronovo, Crowther, & Capezuti, 2006). For example, the opportunity for students to be mentored by older adult community volunteers (MacDonald & Gallant, 2007) led to students who were more empathetic, aware of ageism, and respectful of older people. The focus of gerontology courses should be on improving client function, rather than curing disease (Scott-Tilley, Marshall-Gray, Valadez, & Green, 2005), and medical model of cure must be replaced with a model of care (Quinn et al., 2004). Scott-Tilley et al. wrote about the importance of focusing on successful aging, health promotion, holistic assessments, and models of health care.

The focus of this article is the development and evaluation of a two-credit, elective senior nursing course for a baccalaureate program. The course was offered for the first time in the fall of 2008 and was envisioned as an efficient method for quickly incorporating gerontology information into the curriculum. About half of the program's 48 seniors completed the course.

Stand-alone courses described in the literature were examined as models for the course. Blais, Mikolay, Jedlicka, Strayer, and Stanek (2006) recommend using the literature and arts to explore how aging is discussed in those mediums. Kirkpatrick and Brown (2006) used movies to help raise issues about aging for class discussions. Burbank et al. (2006) used debates to explore issues surrounding aging and ageism. Plowfield, Raymond, and Hayes (2006) required attendance at a national gerontological conference as part of the didactic component of the course. Blais et al. recommended using Palmore's (1977) Facts on Aging Quiz as a pretest/postest to assess changes in students knowledge, attitudes, and biases. Using this assessment at the beginning of the course helps faculty address negative attitudes early on (Burbank et al., 2006).

Creative Strategies for a Stand-Alone Course For the author's course, careful consideration was given to selecting a text. Mauk's Gerontological Nursing: Competencies for Care (2006), which focuses on American Association of Colleges of Nursing (AACN) and Hartford Institute for Geriatric Nursing (HIGN) competencies (2006), was selected, with journal articles used to augment the text. The HIGN Try This[R] series of assessments supplemented the readings.

Assignments included teaching an older adult about a health promotion topic and having a conversation with an older adult. This involved writing a process recording of the conversation and analyzing communication techniques. After touring a community senior center, students spent three additional hours at the center, observing and interacting with the older adults and exercising with them. They then wrote a two-page reflective journal about their experience.

The course focused on affective, cognitive, and psychomotor activities and assignments. Class time included discussions of the readings, developing holistic care plans from case studies, and watching films including "The Bucket List," "The Notebook," and "Up." These films were selected because the issues they raise lead easily to class discussion: friendship and coping with terminal disease, coping with Alzheimer's disease, and coping with loss.

Students worked in groups of three for two required 15-minute presentations--the first on a common health concern of older adults with an individualized, creative treatment plan, and the second on a proposed improvement for a community or health care setting that would enable older adults to navigate more easily and safely. Groups were required to submit a typed outline of their work and use three to four references. Some of the settings selected for improvement were a barber/beauty shop with chairs that were easy to maneuver, a community garden with raised planting beds, and a well-lit casino that served food that was appealing to the targeted population.

Lessons Learned with Recommendations Student evaluations of the course were positive. Students rated the class 4.7 on a scale of one to five. They especially enjoyed their time at the senior center; commenting on how energetic and spirited people were, some students stated that they would like to return to the center, and some said they would like to work with older adults.

Faculty found that students engaged readily with the course material. Discussions were active, and students reacted emotionally to the films. They embraced the presentations, creating holistic care plans and showing how to recreate spaces that were user-friendly and safe for older adults.

Incorporating a stand-alone gerontology course as a nursing elective allowed at least some students to consider issues faced by older adults. Creating an elective course, which satisfied most of the 30 competencies recommended by the AACN and HIGN (2006), will help the transition to a mandatory course. By encouraging students to assess their attitudes, interact with elders, and think creatively about how they would make venues responsive to older adults, this course prepared students to be better practitioners.

After implementing this course as an elective, the author recommends that a required gerontology course be added to the nursing curriculum. This would necessitate an assessment of the entire curriculum and a determination of how credits should be assigned; the issue of whether credits should be added to the required curriculum or transferred from another course is still under review. However, juniors may now enroll in the course and seniors are encouraged to do so.

It is also important that the course have a clinical component that gives students the opportunity to apply their learning to real-fife situations. It is especially important to remember that gerontology encompasses a broad range of ages and lifestyles. Students need to interact with older adults who face a range of issues and circumstances, with many still working and using technology. It would be advantageous for students to see older adults who are independent, have a few social needs, need skilled care, and need acute care.

References

Abbey, J., Abbey, B., Bridges, P., Elder, R., Lemcke, P., Liddle, J., & Thornton, R. (2006). Clinical placements in residential aged care facilities: The impact on nursing students' perception of aged care and the effect on career plans. Australian Journal of Advanced Nursing, 23(4), 14-19.

American Association of Colleges of Nursing and Hartford Institute for for Geriatric Nursing. (2006). Caring for an aging America: A guide for nursing faculty. Retrieved from www.aacn.nche.edu/ geriatric-nursing/monograph.pdf

Blais, K., Mikolay, E., Jedlicka, D., Strayer, J., & Stanek, S. (2006). Innovative strategies for incorporating gerontology into BSN curricula. Journal of Professional Nursing, 22(2), 98-102. doi: 10.1016/j.profnurs.2006.01.006

Burbank, P. M., Dowling-Castronovo, A. D., Crowther, M. R., & Capezuti, E. A. (2006). Improving knowledge and attitudes toward older adults through innovative educational strategies. Journal of Professional Nursing, 22(2), 91-97. doi: 10.1016/j.profnurs.2006.01.007

Kirkpatrick, M. K., & Brown, S. T. (2006). Leadership development in geriatric care through the integration of the Make a Difference Project. Nursing Education Perspectives, 27(2), 89-92.

MacDonald, J., & Gallant, M. (2007). Elders as mentors of nursing students. Nurse Educator, 32(2), 58-60. doi: 10.1097/01.NNE.O000264332.48415cl

Mauk, K. L. (2006). Gerontological nursing: Competencies for care. Sudbury, MA: Jones and Bartlett.

Palmore, E. (1977). Facts on aging: A short quiz. Gerontologist, 17. 315-320.

Plowfield, L. A., Raymond, J. E., & Hayes, E. R. (2006). An educational framework to support gerontological nursing education at the baccalaureate level. Journal of Professional Nursing, 22(2), 103-106. doi: 10.1016/jprofnurs.2006.01.014

Quinn, M. E., Berding, C., Daniels, E., Gerlach, M. J., Harris, K., Nugent, K. et al., (2004). Shifting paradigms: Teaching gerontological nursing from a new perspective. Journal of Gerontological Nursing, 30(1), 21-27.

Scott-Tilley, D., Marshall-Gray, Valadez, A., & Green, A. (2005). Integrating long-term care concepts into baccalaureate nursing education: The road to quality geriatric healthcare. Journal of Nursing Education, 44, 286-290.

Joyce B. Azzaline, DHSc, APRN-BC, is an associate professor in the Department of Nursing at Trinity Christian College, Palos Heights, Illinois. For more information, contact her at joyce.azzaline @trnty. edu.