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Virtual Friday Presentation


1. Describe an example of an innovative workforce training program that ... Paucity of innovative care models. Wealth of geriatric information on the web ... – PowerPoint PPT presentation

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Title: Virtual Friday Presentation

  • Virtual Friday Presentation
  • Purposes
  • 1. Describe an example of an innovative workforce
    training program that addresses the critical need
    to build hospital geriatric nursing capacity, and
  • 2. Search if there are other people in the ILN
    who are interested in this issue and would like
    to network

RN Residency Transitioning to Geriatrics and
Palliative CareEdward Coakley, RN, Project
DirectorSusan Lee, RN, Senior Faculty and
EvaluatorPenny Ford-Carleton, RN, FacultyConnie
Dahlin, RN, Faculty
Funded by the U.S. Department of Health and Human
Services, Health Resources and Services
Administration, Bureau of Health Professions,
Division of Nursing, Grant No. D11HP08359
  • HRSA Purposes
  • Develop and implement internship and residency
  • Encourage mentoring and the development of
  • Assure the quality of health care Improve the
    knowledge, skills, competencies and outcomes of
    the health professions workforce.

  • Background
  • In 2008, the first of the baby boom generation
    reaches age 62. Over the next 30 years, the U.S.
    population over age 62 is projected to double
    (from about 40 million to about 80 million
    people), while the working age population
    increases by just 13 percent. The implications
    for individuals, labor markets, government and
    employer provided retirement and health insurance
    programs, and the overall economy are profound.

  • Background
  • Older adults in the U.S.
  • National nursing shortage
  • Lack of geriatric experts
  • Palliative care trends
  • Paucity of innovative care models
  • Wealth of geriatric information on the web
  • Need to develop networks of innovators
  • Increasing inequalities in health care

  • Older Adults in the US
  • Geriatrics is the core business of US hospitals,
    comprising about 50 of hospital visits
  • By 2030, the population of older adults in the US
    will nearly double (37 million to over 70
  • Older adults have a longer average LOS (6.6 days)
    than adults below age 65 (5.5 LOS)
  • Older adults are at higher risk for adverse
    events in hospitals
  • Older adults

  • Background Registered Nurses in the US
  • National nursing shortage.
  • Nurses are aging (average age 46)
  • It is important to retain our nurses.
  • Our highest turnover exists among nurses lt 5
    years at MGH.
  • We want to retain older nurses who possess
    invaluable clinical knowledge by creating new
    roles close to the bedside.
  • Residency programs are effective ways of engaging
    nurses in new learning and developing new skills.


  • Executive Challenges
  • Increase workforce flexibility
  • Extend workforce longevity
  • Recruit and retain a multi-generational workforce
  • Ensure transfer of clinical knowledge through out
    the generations
  • Develop multi-generational workforce that
    delivers innovative patient care

  • MGH a NICHE Hospital
  • Started in 1992, NICHE has evolved into a
    national geriatric nursing program comprising
    more than 200 hospitals in more than 40 states as
    well as parts of Canada. A program of the
    Hartford Institute for Geriatric Nursing at New
    York University College of Nursing, the goal of
    NICHE is to achieve systematic nursing change
    that will benefit hospitalized older patients.
    The vision of NICHE is for all patients 65 and
    over to be given sensitive and exemplary care.
    The mission of NICHE is to import principles and
    tools to stimulate a change in the culture of
    healthcare facilities to achieve patient-centered
    care for older adults.

  • Evaluation of Geriatric Capacity at MGH
  • In 2004, MGH became a NICHE hospital. NICHE goals
  • to improve health outcomes for hospitalized older
  • to support clinicians in providing a positive
    experience for older adults their families
  • to improve knowledge, attitudes, and practices
    regarding care of older adults
  • Geriatric Institutional Assessment Profile (GIAP)
  • Findings suggested that although nurses perceived
    themselves to be knowledgeable in the care of
    older adults, scores fell short in some areas.
  • MGH Senior Health, psychiatric CNSs
  • One staff nurse with geriatric certification

  • Goals of RNResidency Program
  • to strengthen the nursing workforce by increasing
    knowledge, skills, and competencies in the
    specialties of geriatrics and palliative care
  • to improve retention of the RN workforce at MGH
    by providing career pathways and transitioning to
  • to improve the quality of nursing care to elderly
    patients and their families

  • RN Preceptors
  • Age 45
  • 6 days of class (48 hrs)
  • 3 days/clinical placement
  • participates in online learning
  • willing to serve as preceptor to RN resident
  • Sep-Dec 2008 2009
  • RN Residents
  • Out of school 2 to 5 yrs.
  • 12 days of class (144 hrs)
  • 3 days clinical placement
  • participates in online learning
  • willing to work with preceptor on unit projects
  • Jan-Sep 2009, 2010

  • Geriatrics
  • National curricula John A. Hartford Foundation
  • Use expert faculty from MGH clinical staff
  • Sit for ANCC Geriatric Certification exam
  • Palliative Care
  • National curricula ELNEC curricula
  • Use expert faculty from MGH clinical staff
  • ELNEC Trained
  • Sit for Palliative Care Certification exam

  • National Curricula John A. Hartford Foundation
  • http//
  • Hartford Institute for Geriatric Nursing
  • End-of-Life Nursing Curriculum (ELNEC)
  • National Quality Forum and National Consensus

  • Examples of Modules
  • Assessing Cognitive Functioning
  • Depression
  • Delirium
  • Dementia
  • Preventing Falls
  • Assessment of Function
  • Urinary Incontinence
  • Physical Restraints

  • Excessive sleepiness
  • Pressure ulcers and skin tears
  • Critically ill elders
  • Age-related changes in health
  • Reducing adverse drug events
  • Family care-giving
  • Mealtime difficulties

  • Geriatric Syndromes
  • Term used to capture those clinical conditions in
    older persons that do not fit into discrete
    disease categories.
  • Have multiple risk factors.
  • Examples delirium, falls, urinary incontinence,
    pressure ulcers, mealtime difficulties.
  • Associated with longer LOS, morbidity, mortality.
  • Predictable and many can be prevented.
  • For nurses who have not been trained in
    geriatrics, it is crucial to gain knowledge of
    geriatric syndromes and
  • EBP.

  • Palliative Care
  • Prevailing paradigm reserves palliative care for
    end-of-life and disregards the needs of the
    elderly who suffer from chronic illness on a
    longer, slower trajectory
  • Building on existing palliative care program
  • Merging Critical Care and Palliative Care
    Cultures in the MICU (RWJF grant)
  • Need more nurses trained in palliative care

  • Nursing Care at the End of Life Overview of
    death and dying in America, principles and goals
    of hospice and palliative care, dimensions of and
    barriers to quality care at EOL, concepts of
    suffering and healing, role of the nurse in EOL
  • Pain Management Definitions of pain, current
    status of and barriers to pain relief, components
    of pain assessment, specific pharmacological, and
    non-pharmacological therapies including concerns
    for special populations.
  • Symptom Management Detailed overview of symptoms
    commonly experienced at the EOL, and for each,
    the cause, impact on quality of life, assessment,
    and pharmacological/non-pharmacological
  • Ethical/Legal Issues Recognizing and responding
    to ethical dilemmas in EOL care including issues
    of comfort, consent, prolonging life, withholding
    treatment euthanasia, and allocation of
    resources and legal issues including advance
    care planning, advance directives, and decision
    making at EOL.
  • Cultural Considerations in EOL Care Multiple
    aspects of culture and belief systems, components
    of cultural assessment with emphasis on
    patient/family beliefs about roles, death and
    dying, afterlife, and bereavement.
  • Communication Essentials of communication at
    EOL, attentive listening, barriers to
    communication, breaking bad news, and
    interdisciplinary collaboration.
  • Grief, Loss, Bereavement Stages and types of
    grief, grief assessment and intervention, and the
    nurse's experience with loss/grief and need for
  • Achieving Quality Care at the End of Life
    Challenge for nursing in EOL care, availability
    and cost of EOL care, the nurses' role in
    improving care systems, opportunities for growth
    at EOL, concepts of peaceful or "good death",
    "dying well", and dignity.
  • Preparation and Care for the Time of Death
    Nursing care at the time of death including
    physical, psychological, and spiritual care of
    the patient, support of family members, the death
    vigil, recognizing death, and care after death.

  • End of Year 1
  • 14 RN Preceptors
  • 12 RN Residents
  • Revising curricula, program, competencies
  • Web-based Learning site
  • Placement Sites
  • Focus Groups
  • Certification Exams

  • Retooling for an Aging America Building the
    Health Care Workforce http///
  • Institute of Medicine (IOM), Committee on the
    Future of Health Care Workforce for Older
    Americans in Jan, 2007
  • To determine the best use of the health care
    workforce to meet the needs of the growing number
    of adults 65 and older