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Structuring Student Placements in the Nursing Home

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Structuring Student Placements in the Nursing Home Mathy Mezey, EdD, RN, FAAN, Sarah Greene Burger, RN-C, MPH, FAAN Ethel Mitty, EdD, RN Hartford Institute for ... – PowerPoint PPT presentation

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Title: Structuring Student Placements in the Nursing Home


1
Structuring Student Placements in the Nursing
Home
Mathy Mezey, EdD, RN, FAAN, Sarah Greene
Burger, RN-C, MPH, FAAN Ethel Mitty, EdD, RN
Hartford Institute for Geriatric Nursing, New
York University College of Nursing
Module 4 of Nursing Homes as Clinical Placement
Sites for Nursing Students Series
2
Acknowledgments
This is a joint project of
With support from
Grant to the University of Minnesota School of
Nursing
3
This project is endorsed by
  • Project Steering Committee
  • View List of Members

4
About Module 4 Structuring Student Placements in
the Nursing Home
  • Select a nursing home as a clinical placements
    for nursing students
  • Design student placements in nursing homes in
    light of student learning goals
  • Organize student exposure to resident-directed
    care and culture change
  • Analyze resources that can inform student
    placement in nursing homes
  • Resources to enhance clinical teaching in nursing
    homes generally
  • Resources specific to clinical teaching of
    resident-directed care and culture change
  • General geriatric nursing resources

Objectives/Purpose At the end of this module
you will be able to
Please note that Module 4 refers to nursing
practice in typical nursing homes. For
information on nurse practice in nursing homes
implementing resident directed care and culture
change, see Modules 3 and 5.
5
Selecting a Nursing Home as a Clinical Placement
General Recommendation 1
  • Faculty should preferentially choose nursing
    homes for clinical
  • placements that meet nationally recognized
    standards of high
  • quality care
  • Nursing homes with a CMS 5 or 4 Star Quality
    Rating
  • These nursing homes will be in the top 10 of
    nursing homes nationally and represent the
    highest quality of care
  • These nursing homes are more likely than others
    to have higher RN / resident staffing ratios
  • Nursing homes with Joint Commission accreditation
  • Joint Commission accreditation is voluntary
    related to nursing homes managed care
    relationship and healthcare network requirements

Click to view more information on MDS - Module 1
An overview of nursing homes generally and on
Nursing Staffing, Module 2 An overview of
nursing in nursing homes
6
Selecting a Nursing Home as a Clinical Placement
General Recommendation 2
  • Nursing homes with a CMS 1 Star Rating in all
    likelihood have
  • serious deficiencies in quality of care
  • Avoid homes with one yellow star, indicating
    chronic poor care,
  • irrespective of student learning objectives
  • Nursing homes with CMS 2 and 3 Star Ratings are
    likely to have
  • deficiencies in important aspects of care and/or
    staffing
  • Nursing homes with many and persistent
    deficiencies should be
  • Avoided
  • Consider the number and type of deficiencies in
    relationship to the student learning objectives

7
Options for Student Placement When Nursing Homes
with High Quality Ratings are Not Geographically
Accessible
Collaborate with nursing homes Workshops for
faculty and students
Seek CMS 3 4 star nursing homes interested in
opportunities to improve care
Assisted Living
Senior Center
Continuing Care Retirement Community
Naturally Occurring Retirement Community
8
Nursing Faculty Concerns Nursing Homes as a
Clinical Placement
  • The Director of Nursing (DON) does not have a
    minimum of a baccalaureate degree in nursing
  • RNs are not on site during student placement
  • There is instability in nurse leadership, and
    nursing staff (RN LPN CNA) turnover is very high

Click here to learn more Module 2 An overview
of nursing in nursing homes
9
Options for Student Placements When a Nursing
Home with Strong RN Presence is Not Available
  • Select placements other than nursing homes
  • Tailor student assignment to nursing homes
    staffing strengths and students level in the
    program
  • Use nursing home for task-oriented assignments
    (e.g., manual skill acquisition).
  • Assign student to nursing home nursing staff with
    at least BSN.
  • Assign students to shadow an APN who cares for
    residents in the nursing home.

Click to view more information on MDS Module 1
An overview of nursing homes generally
Click to view more information on Nursing
Staffing Module 2 An overview of nursing in
nursing homes
10
Resident-Directed Care and Culture Change Nursing
Homes
  • Nursing homes engaged in culture change should be
    preferentially selected as clinical placement
    sites
  • Identifying culture change nursing homes
  • Self-identified
  • Member of
  • Pioneer Network (http//www.pioneernetwork.net)
  • Eden Alternative (http//www.edenalt.org)
  • Greenhouse (http//www.thegreenhouseproject.org)
  • Wellspring (http//www.wellspringis.org)
  • Nursing homes can be practicing resident-directed
    care
  • but not self-identify as a culture change nursing
    home.

Click here to view content on resident directed
care and culture change Module 3 Content
on resident directed care and culture change
Click here to view a case-study on culture
change and options for introducing culture change
concepts when no culture change facilities are
geographically available Module 5 A case study
to help faculty introduce resident-directed care
and culture change
11
Opportunities for Student Learning in Culture
Change Nursing Homes
  • Observe and understand
  • Resident choices and autonomy
  • Issues of resident risk versus safety
  • Licensed nursing role in staff and resident
    empowerment
  • Leadership style
  • Meet with a primary CNA to learn about resident
    preferences, how CNAs prioritize and help the
    resident make decisions
  • Senior/APN student activity/assignment modify
    and adapt residents care plan based on the
    residents perception of risk taking and safety
    needs
  • In absence of a culture change nursing home see
    module 5

Click here to learn more about Resident directed
care and culture change Module 3 Content
on resident directed care and culture change
Click here to view a case-study on culture
change Module 5 A case study to help faculty
introduce resident-directed care and culture
change
12
Nursing Student Learning Objectives
  • Types of learning objectives
  • Learning objectives related to type of course
  • Learning objectives related to specific content
    or skills 1, 2
  • Health systems Nursing Home Quality
  • Resident attributes/assessment
  • Diagnosis and management
  • Leadership, staffing and organizational
    assessment
  • Interdisciplinary team
  • Resident directed care and culture change
  • Ethical decision making
  • Policy and reimbursement

13
Learning Objective Health systems NH Quality
Sample Student Assignments
  • Assign student to evaluate overall quality of the
    nursing home to which they are assigned by
    comparing with other nursing homes. See
    websites
  • www.medicare.gov/NHCompare
  • www.nhqualitycampaign.org
  • Assign student to compare state regulatory
    variations among states
  • http//www.hpm.umn.edu/nhregsplus/
  • Intensify the depth of assignment based on
    students level in the program (i.e. generic
    juniors, seniors, graduate)
  • Assign students to look at web site Nursing Home
    Compare
  • http//www.medicare.gov/NHCompare
  • http//pioneernetwork.org

14
Learning Objective Health systems Nursing Home
Quality Sample Student Assignments (Contd)
  • Create assignments to meet student learning
    goals, e.g. communication, policy,
    interdisciplinary
  • Assign student to participate in family/resident
    care plan meeting
  • Adopt a resident interview resident, family,
    interdisciplinary team members, staff to create a
    collage of the resident history, etc.
    reminiscence-type therapy
  • After soliciting input from nursing staff, have
    student prepare and present an evidence-based
    in-service program (e.g., culture change,
    geriatric syndromes, geriatric resources)
  • Discussion why did the facility get a low
    star rating? What were the deficiencies? How were
    they related to nursing care? How can nursing
    leadership/management change in order to achieve
    better outcomes?

15
Learning Objective Resident Attributes/
Assessment Sample Student Assignments
  • Student assignments can consist of the following
  • Dementia unit meet learning objectives related
    to communication
  • Sub-acute care unit meet learning objectives
    related to acquiring manual/technical skills
    (ventilators tracheostomy care)
  • Interdisciplinary team meetings meet learning
    objectives related to understanding team roles
  • Short-stay residents meet learning objectives
    for synthesis of patient care management

For a description of resident attributes, special
care units etc. see
Module 1 An overview of nursing homes generally
Module 2 An overview of nursing in nursing homes
16
Learning Objective Leadership, Staffing and
Organizational Assessment Sample Student
Assignments
  • Assign students to compare the job descriptions
    of the chief nursing officer in the nursing home,
    the hospital, in assisted living and in home care
  • Assign students to compare nurse staffing (RN
    LPN CNA) in their nursing home placement with
    nursing home staffing nationally and in their
    state (content related to policy) View
    the Nursing Home Compare Website
  • Assign students to observe the role of the DON,
    the nurse manager, the CNA (content related to
    leadership)
  • Assign students to assess the program offered in
    a nursing home rehabilitation unit verses the
    rehabilitation program in home care or in a
    hospital rehab unit
  • Assign student to observe examples of
    communication within and between different
    categories/strata of staff (i.e. direction and
    type of communication)

17
The Interdisciplinary Team in Nursing Homes
  • Nursing homes are ideal clinical placements to
    expose nursing students
  • to an inter-disciplinary team. 1,2
  • Students should have the opportunity to observe
    the process and
  • outcomes of an interdisciplinary team meeting.

For more information, click to view Module 1 An
overview of nursing homes generally
Click here to view the GNEC Module on the
interdisciplinary team
18
Learning Objective Interdisciplinary
teams Sample Student Assignments
  • Observe the role of nurses on the
    interdisciplinary team
  • Present a resident issue at team meetings
  • Speak with and shadow key members of the
    interdisciplinary team
  • Meet with resident/family prior to team meeting
    to learn their wishes or concerns
  • Meet with the residents CNA to get their view on
    care needs and/or solutions to problems

For more information, click on the following
links
AGS Geriatric Competences for Inter-disciplinary
practice
Module 1 An overview of nursing homes generally
Module 2 An overview of nursing in nursing homes
19
Learning Objective Ethics and Decision Making
Sample Student Assignments
  • Determine a residents capacity to execute an
    advance directive
  • Evaluate the extent of resident involvement in
    their everyday decisions (e.g., bathing
    eating)
  • Understand how decisions are made to transfer a
    resident to the hospital
  • Senior level student In discussion with the
    resident, evaluate the benefit and burden of
    potential treatments/interventions1

For more information click to view Module 2 An
overview of nursing in nursing homes
20
Learning Objective Policy and Reimbursement Sampl
e Student Assignments
  • Speak with social workers regarding criteria for
    nursing home admission and discharge
  • Meet with the MDS coordinator to understand how
    assessment drives reimbursement
  • Evaluate the quality improvement data collected
    and distributed to the interdisciplinary team
  • Read and evaluate the NH current quality
    improvement plan and/or study
  • APN Student Assignment Evaluate/describe how
    advocacy groups like NCCNHR and Pioneer Network
    work to change policy to improve care and quality
    of life

For more information click on the following links
Module 1 An overview of nursing homes generally
Module 2 An overview of nursing in nursing homes
21
Enhancing Communication with the Nursing Homes to
Strengthen the Student Learning Environment
  • Faculty should
  • Learn/understand the mission of the nursing home
  • Seek unit staff buy-in
  • to the goal and purpose of the placement
  • to assure their awareness of students level of
    knowledge and skills
  • Learn how nursing staff organize their time to
    provide resident care
  • Identify opportunities for electronic
    communication
  • Recognize staff and students through established
    joint rituals (e.g. graduations awards end
    of semester luncheons nurses week celebrations)
  • If possible, spend several hours at the nursing
    home to
  • Identify professional roles in the nursing home
  • Understand decision-making practices regarding
    resident care
  • Understand the culture and routine(s) of the
    nursing home, including time and location of
    interdisciplinary team conferences
  • Learn the EMR system/ process with which the
    students will be interacting/involved
  • Adapted with permission of CS Aron., Illinois
    State University, Mennonite College of Nursing

22
Related Resources for Clinical Teaching in
Nursing Homes
Weekly Reflection Questions UNC Charlotte School
of Nursing http//nursing.uncc.edu
Elder Project Fairfield University School of
Nursing http//www.fairfield.edu/son
ECLEPs Project College of Nursing, Oregon Health
Sciences University http//www.ecleps.org
View General Geriatric Nursing Resources
23
Recap Key Points about Structuring Student
Placement in the Nursing Home
  • All nursing homes are not alike
  • Use objective criteria as to quality and staffing
    to help you select a nursing home for student
    placement
  • Choose programs within a nursing home to meet
    specific learning objectives

We present the following key points to consider
24
Please Proceed to the following modules of the
Series Nursing Homes as Clinical Placement Sites
for Nursing Students
  • Overview of the Project
  • Module 1 An overview of nursing homes generally
  • Module 2 An overview of nursing in nursing homes
  • Module 3 Content on resident directed care and
    culture change
  • Module 4 Selecting and structuring clinical
    placements in nursing homes
  • Module 5 A case study to help faculty introduce
    resident directed care and culture change
  • Module 6 Strategies to help nursing homes
    position themselves as clinical placement
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