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Geropsychiatric Nursing Collaborative: Update on Competency Work

Geropsychiatric Nursing Collaborative: Update on Competency Work. Lois K. Evans, PhD, RN, FAAN vanAmeringen Professor in Nursing Excellence University of Pennsylvania May 27, 2009 Upper Midwest Geriatric Nursing Education Alliance. Key Points.

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Geropsychiatric Nursing Collaborative: Update on Competency Work

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  1. Geropsychiatric Nursing Collaborative: Update onCompetency Work Lois K. Evans, PhD, RN, FAAN vanAmeringen Professor in Nursing Excellence University of Pennsylvania May 27, 2009 Upper Midwest Geriatric Nursing Education Alliance

  2. Key Points • One in five older Americans needs mental health services • There is a dearth of 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 nurses at all levels is an important strategy for the near term

  3. Background • 7.5 mil OA have a diagnosable mental disorder; 15 mil by 2030: A critical public health issue • Current under-recognition and treatment • APNs provide large share of MH services to OA; MH preparation not known

  4. Geropsychiatric Nursing History • 1970s: Blended subspecialty—Geropsychiatric Nursing—emerged from PMHN and Gerontological Nursing • 2004: National survey of GPN content & clinical in graduate programs revealed few programs & little integration

  5. History cont’d • 2005: National Geropsychiatric Nursing: State of the Future conference in Philadelphia-- white papers on education, science, and practice and a strategic plan for bridging the gaps; • Conference Papers published in JAPNA 12 (2,3), 2006. • Brochure produced: Promoting MH of OA: The Work of Geropsychiatric Nurses • AAN: Mental Health and Aging Study Group • National meeting presentations • Participation in GNEC: AACN BSN geriatric curriculum project [2 mental health modules] • HCGNE collaboration & BAGNC support

  6. Stage Set for Implementation of Selected Conference Strategies • Provide models for graduate programs in PMHN and adult, gerontological and family nurse practitioner programs to include core GPN content and clinical learning experiences. • Develop innovative programs to prepare practicing nurses for providing mental health services to culturally diverse older adults. • Encourage specialty organizations in nursing to incorporate geropsychiatric competencies in their scopes and standards of practice.

  7. 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

  8. 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 • Develop and disseminate GPN curricula for inclusion in entry level, advanced practice, and continuing education programs

  9. Methods: Objective 1* • Complete scan and review of literature/existing competencies • Convene GPN Core Competency Workgroup • Convene National Advisory Panel • Keep level of project awareness high via national presentations, reports, AAN Mental Health & Aging Workgroup efforts • Seek review and final endorsement, dissemination, and utilization of enhancements by relevant professional groups • *primary focus of years 1-2

  10. Methods: Objective 2* • Find, review, adapt, develop curriculum materials for all levels of nursing education • Collaborate with existing projects; Partner w/organizations to infuse content • Develop, make available GPN champion video clips • Hold regional workshops for graduate faculty; provide consultation for infusion • House materials/links on GPN Collaborative website [Hartford] • *Primary focus of years 2-4

  11. Update Objective 1 • Searched, collated, synthesized background materials: • All existing competency statements from general and specialty organizations • Published definitions • Practice guidelines • CE offerings • Mapped to relevant competencies or essentials • Strategic Decision: • Generate enhancements to existing competencies rather than imposing new sets • Focus on three groups: Entry level, APN generalists, APN specialists [gero, PMH] • Core Competency Workgroup met in October & drafted competency enhancement statements for each of the four groups

  12. GPN Core Competency Workgroup Members • Charles Blair, University of Texas-Tyler • Susan Demaris, Evercare • Liz Macera, UCSF • Glenise McKenzie, OHSU • Karen Melillo, University of Massachusetts – Lowell • Diana Morris, CWRU • William Puentes, UMDNJ

  13. Draft definition developed by GCW • Geropsychiatric nursing practice includes care of persons and their families approaching and/or experiencing developmental tasks and mental health concerns of later life.  • This care addresses the integration of biopsychosocial, functional, spiritual, cultural, economic, and environmental assessment in the mental health promotion and psychiatric treatment plans which are established, and emphasizes strengths-based assessment to support older adults and their families.

  14. General Recommendations • The words ‘health,’ illness,’ ‘frailty,’ ‘care’ or ‘disease’ in existing competency documents should be broadly defined to include both ‘physical and mental.’ • None of the new statements were intended to ‘stand alone but rather to enhance existing or to-be-developed competencies for the particular level of nurse. • The recommendations were presented in the context of the existing documents so that the reader/reviewer could more readily understand the intent.

  15. Examples of GPN enhancements: Entry Level • Based on the thirty gerontologic nursing competencies developed by AACN and HGNI in 2000 • 5 new statements were suggested along with several enhancements to existing statements. • Ex. NEW: ‘Support and advocate for older adults with cognitive, affective or behavioral symptoms and their families in decision-making for everyday, advance directive, end of life and informed treatment issues. ‘

  16. Examples of Enhancements for ‘Generalist’ APNs • Based on the forty-seven competencies developed in 2004 by AACN & HGNI • Fourteen additional statements were recommended as well as a few enhancements to existing statements • Ex. NEW: ‘Differentiate psychiatric presentations of medical conditions, including psychiatric symptoms at the end of life, from psychiatric disorders and arranges appropriate evaluation and follow up.’

  17. Examples of PMHN Enhancements • Reviewed both 2003 NONPF and newest NACNS competencies • Suggested 6 new statements and few enhancements to existing statements • Ex. NEW: ‘Assesses interaction between aging and disease processes and acute and chronic health problems including attention to co-occurring psychiatric symptoms and disorders.’

  18. Examples of Gerontological APN Enhancements • Based on 2002 NONPF and newest NACNS competencies • Recommended 11 new statements and few enhancements to existing statements • Ex. NEW: ‘Evaluates common psychiatric disorders among older adults-- such as depression, anxiety and delirium-- as part of a complete health assessment.’

  19. Update Objective 1 continued • Formed & convened National Advisory Panel • Edited, reviewed, affirmed draft competency enhancements with Leadership Team and CDW • Requested/ received opportunity to send reps to AACN expert panels [CNS, NP] meeting for developing competencies for newly combined Adult-Gero population APNS; positive reception to GPN work • Developed electronic competency enhancement validation survey; sent to designees from relevant nursing organizations: AACN, NLN, NONPF, APNA, ISPN, NGNA, GAPNA, AAN Expert Panel on Aging, AAN Expert Panel on MH & Substance Abuse; due in June.

  20. Next Steps for Competencies • Make final edits based on survey feedback • Seek endorsement for competency enhancements from all relevant nursing organizations • Request they post link to competencies on their websites • Solicit invitation to participate, or at least utilize enhancement statements, in next revision work [scope & standards, competencies].

  21. Next Steps & Opportunities • Facilitate organizational partnerships • Suggest dissemination approaches • Identify possible linkages with new/existing projects • Identify schools to query re: GPN curriculum infusion • Share curriculum materials with project team for review/adaptation • Identify potential technical assistance consultants

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