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Integrating Geropsychiatric Nursing in Nurse Practitioner Education

Integrating Geropsychiatric Nursing in Nurse Practitioner Education. Lois K. Evans, PhD, RN, FAAN Cornelia Beck, PhD, RN, FAAN Kathleen C. Buckwalter, PhD, RN, FAAN NONPF 36 th Annual Meeting, April 17, 2010 Washington, D.C. Key Points.

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Integrating Geropsychiatric Nursing in Nurse Practitioner Education

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  1. Integrating Geropsychiatric Nursing in Nurse Practitioner Education Lois K. Evans, PhD, RN, FAAN Cornelia Beck, PhD, RN, FAAN Kathleen C. Buckwalter, PhD, RN, FAAN NONPF 36th Annual Meeting, April 17, 2010 Washington, D.C.

  2. Key Points • One in five older Americans needs mental health services. • There is a dearth of geriatric providers in any of the core mental health professions, including nursing. • The AAN-Hartford Geropsychiatric Nursing Collaborative is one initiative aimed at filling this gap. • Enhancing the GPN preparation of nurse practitioners is an important strategy for the near term.

  3. Background • Geriatric mental health is a critical public health issue: 7.5 mil older adults have a diagnosable mental disorder; <15 mil by 2030. • These problems are currently under-recognized and/or treated. • APRNs provide a large share of mental health services to older adults; their preparation for geriatric mental health care is unknown. • 2004: A national survey of GPN classroom & clinical education in graduate programs revealed few programs & little integration.

  4. Background cont’d • 2005: National invitational Geropsychiatric Nursing: State of the Future conference in Philadelphia • White Papers on education, science, and practice and a strategic plan for bridging the gaps published in JAPNA 12 (2,3), 2006.

  5. Background cont’d • Produced and distributed broadly: Promoting MH of OA: The Work of Geropsychiatric Nurses • Recommended strategies included infusion in nursing education

  6. Formation of the Collaboration • Three HCGNEs with strength in AP GPN: University of Arkansas for Medical Sciences, Iowa, and Pennsylvania • Leadership Team: Cornelia Beck, Kathleen Buckwalter, Lois Evans • Four year project funded by John A. Hartford Foundation • Housed at American Academy of Nursing; Project Coordinator: Pamela Dudzik (202-777-1171 or pdudzik@aannet.org) • National Advisory Panel

  7. Aims and Objectives • Overall Aim: To improve the cognitive and mental health of older Americans Major Objectives: • Create and include core GPN competencies in all levels of nursing education programs • Adapt, develop and disseminate GPN curricula for inclusion in entry level, advanced practice, and continuing education programs

  8. Process • Retrieved, reviewed & mapped all existing competencies, essentials, scope of practice documents with relevance to GPN practice • Convened GPN Core Competency Workgroup to develop competency enhancements • Sent edited draft enhancements for review by designees from key stakeholder nursing organizations and groups • Revised, reviewed & endorsed by Core Competency Workgroup & National Advisory Panel • Distributed broadly for endorsement and dissemination • Participated in AACN/HGNI task force to redevelop competencies for combined A/GNP

  9. GPN Core Competency WorkgroupB. Puentes, C. Beck, L. Macera, S. Demaris, L. Evans, D. Morris, C. Blair, G. McKenzie, K. Buckwalter, K. Melillo, R. Watman

  10. General points • Recommended that the words ‘health,’ illness,’ ‘frailty,’ ‘care’ or ‘disease’ in existing competency documents be broadly defined to include both ‘physical and mental.’ • Chose not to develop a set of GPN competencies, but rather to enhance existing or to-be-developed competencies for the particular specialty or level. • Presented enhancement statements in the context of the existing documents so that the reader/reviewer could more readily understand the intent.

  11. Definition: Geropsychiatric Nursing Geropsychiatric nursing (GPN) practice includes holistic support for and care of older adults and their families as they anticipate and/or experience developmental and cognitive challenges, mental health concerns and psychiatric/substance misuse disorders across a variety of health and mental health care settings. GPN practice is based on expert knowledge of normal age-related changes and common psychiatric, cognitive and co-morbid medical disorders in later life. Promotion of mental health and treatment of psychiatric/substance misuse and cognitive disorders emphasize strengths and potentials and integrate biopsychosocial, functional, spiritual, cultural, economic and environmental factors and address stressors that affect mental health of older adults and their families.

  12. Recommended Geropsychiatric Competency Enhancements for Gerontological Nurse PractitionersMarch 2010 Recommended Geropsychiatric Competency Enhancements for Gerontological Nurse Practitioners These recommended competency enhancement statements draw attention to the special needs of older adults with mental health concerns. They are not intended to ‘stand-alone,’ but rather to enhance existing or to-be-developed competencies for Gerontological Nurse Practitioners.1 The statements are organized within the existing Nurse Practitioner Primary Care Competencies in Specialty Areas: Adult, Family, Gerontological, Pediatric, and Women’s Health developed by HRSA in 2002 and National Organization of Nurse Practitioner Faculties Domains and Core Competencies of Nurse Practitioner Practice2 revised by NONPF in 2006. The geropsychiatric competency enhancements were drafted in Fall 2008 by the Geropsychiatric Nursing Collaborative (GPNC), a project supported by the John A. Hartford Foundation and housed at the American Academy of Nursing. They were reviewed by representatives of key professional organizations, revised, and then endorsed by the GPNC Core Competency Workgroup and National Advisory Panel and disseminated in Winter 2010 to all relevant professional organizations and schools of nursing for endorsement and utilization. New competency enhancement statements and modifications to existing competencies are highlighted in yellow for ease in identification. As revisions are made to existing competency documents,3 we recommend that the intent of these recommended enhancements be included and that the terms ‘health,’ ‘illness,’ ‘frailty,’ ‘care’ or ‘disease’ be broadly defined as both ‘physical and mental.’ Although physical and mental may be assumed, we believe that it is helpful to have both of these dimensions explicitly stated. Likewise, the term ‘psychiatric disorder’ should be used in combination with ‘substance misuse disorder’ to be more inclusive. It is further recommended that an expectation for the use of valid and reliable clinical assessment tools and evidence-based practices and processes be clearly stated and that gender, sexual orientation, and spirituality be made explicit when referring to cultural issues. _____________________________________________________________________________ 1 This competency enhancement document is one of seven developed and recommended by the Geropsychiatric Nursing Collaborative. The seven enhancement documents are aimed at the entry level nurse and the following groups of advanced practice nurses: gerontological NP and CNS, psychiatric NP and CNS, and other APRNs (NP and CNS) who care for older adults but are not prepared as gerontological experts, e.g., women’s health, adult, family and acute care. A link to the entire set of enhancement documents can be found at www.aannet.org/GPNCresources . For more information, see www.aannet.org/GPNCgeropsych. 2 HRSA (2002). Nurse practitioner primary care competencies in specialty areas: Adult, Family, Gerontological, Pediatric, and Women’s Health, pp. 26-29 available at www.eric.ed.gov/ERICDocs/data/ericdocs2sql/content_storage_01/0000019b/80/1a/9d/20.pdf and NONPF (2006). National Organization of Nurse Practitioner Faculties Domains and Core Competencies of Nurse Practitioner Practice available at www.nonpf.com/associations/10789/files/DomainsandCoreComps2006.pdf 3 We recognize that work is in process by the American Association of Colleges of Nursing (AACN) and the Hartford Institute for Geriatric Nursing (HIGN) to combine competencies for the Adult and Gerontological Nurse Practitioner Specialties in accordance with the new Consensus Model. The GPNC enhancements were used to inform the work of the AACN and HIGN expert panels, however, the final AACN and HIGN documents are still in refinement at this time.

  13. Recommended Geropsychiatric Competency Enhancements for Gerontological Nurse Practitioners March 2010 Example Domain I : Health Promotion, Protection, Disease Prevention, & Treatment I.A Assessment of Health Status 1. Analyzes the relationship between normal physiology and specific system alterations produced by aging and disease processes. NEW: Adapts assessment processes for persons with cognitive impairment and psychiatric /substance misuse disorders. NEW: Conducts a comprehensive assessment that includes the differentiation of normal age changes from acute and chronic medical and psychiatric/substance misuse disease processes, with attention to commonly occurring atypical presentations and co- occurring health problems including cognitive impairment. NEW: Identifies and assesses factors that affect mental health including stressors that may be more common among older adults such as caregiving, multiple chronic illnesses, pain, relocation, trauma, cohort-specific stressors, and losses such as financial (retirement), functional (Instrumental Activities of Daily Living /Activities of Daily Living), social network (death of family members and friends), and role (status changes). 2. Assesses the developmental status regarding maintenance of self-identity through later and final stages of life. 3. Assesses the dynamic interaction between acute illness and known chronic health problems in older adults. 4. Assesses elders and caregivers for abuse and/or neglect. 5. Assesses for addictive behavior. 6. Assesses health/illness by conducting a complete health history in light of physiologic and psychosocial changes of aging. NEW: Uses valid and reliable clinical evaluation tools to conduct a comprehensive mental health assessment across a range of psychiatric/substance misuse disorders that includes assessment of strengths and potential for improvement. 7. Performs a comprehensive physical exam considering physiologic changes of aging. 8. Performs a comprehensive functional assessment, including mental status, social support, and nutrition. 9. Assesses special risks of institutionalized older adults for common patterns of illness and communicable disease. 10. Assesses sexual function and sexual well-being in older adults. 11. Assesses roles, tasks, and stressors of informal system/family caregivers for older adults, especially the frail.

  14. Enhancements for Gerontological NPs • Based on 2002 NONPF competencies • Recommended 27 new statements & selected enhancements to existing statements • NEW: ‘Assess the interaction between aging and disease processes and acute and chronic health problems with attention to co-occurring psychiatric/substance misuse disorders, including cognitive impairment.’

  15. Enhancements for Psychiatric NPs • Based on existing PMH NP Competencies developed by NONPF in 2003 • Recommended 21 new statements and selected enhancements to existing statements • NEW: ‘Conducts a comprehensive assessment that includes the differentiation of normal age changes from acute and chronic medical and psychiatric/substance misuse disease processes, with attention to commonly occurring atypical presentations & co-occurring health problems including cognitive impairment.’

  16. Enhancements for ‘Other’ NPs • Based on the forty-seven competencies • developed in 2004 by AACN & HGNI • Recommended 29 additional statements • & selected enhancements to existing • statements • NEW: ‘Differentiate psychiatric presentations • of medical conditions, including psychiatric symptoms at the end of life, from psychiatric/ substance misuse disorders and arrange • appropriate evaluation and follow up.’

  17. Update Objective 2 in process* • Reviewing & mapping to key GPN concepts curriculum materials from NP programs and from relevant websites • Posting definition, key concepts, and 7 competency enhancement documents on POGOe website @ http://www.pogoe.org/front2 • Planning to provide via POGOe links to existing curriculum materials mapped to key concepts/enhancements • Planning for enhancing existing geriatric case studies with GPN concepts • Partnering with key stakeholder organizations to plan for additional dissemination strategies, e.g. AACN webinar, presentations at national meetings * Primary focus of Project Years 3 & 4

  18. Collaborative Opportunities • Share curriculum materials, websites that work • Suggest approaches for dissemination and uptake • Identify possible linkages with new/existing projects, competency revisions, etc. • Join the GPN Listserv contact Lois Evans @ evans@nursing.upenn.edu

  19. Geropsychiatric Nursing Collaborative Promoting mental health of older Americans www.aannet.org/GPNCgeropscyh Funding provided by the John A. Hartford Foundation

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