INFUSING YOUR CURRICULUM WITH
GEROPSYCH RESOURCES
Lois K. Evans, PhD, RN, FAAN
van Ameringen Professor in Nursing Excellence
University of Pennsylvania
Co-Director, Hartford Geropsychiatric Nursing Collaborative
with Kathleen C. Buckwalter, PhD, RN, FAAN,
& Cornelia Beck, PhD, RN, FAAN
Mid-Atlantic Conference to Advance Geriatric Competence in
Undergraduate & Graduate Education - December 2011
Objectives
 Discuss importance of educating APRNs in older
adult mental health.
 Describe resources developed by the
Geropsychiatric Nursing Collaborative:
 Competency enhancements
 Teaching-learning resources
 Access website resources to enhance teaching-learning
re: geropsychiatric nursing concepts and skills in your
program.
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.
 APRNs who work with older adults require
knowledge and skills in geriatric mental health in
order to recognize, assess and treat or refer
appropriately.
 The American Academy of Nursing - Hartford
Foundation Geropsychiatric Nursing Collaborative is
one initiative aimed at filling this gap.
Millie*
http://www.nln.org/facultyprograms/facultyresources/ACES/millie.htm
Background
 Mental health services for older adults is a critical
public health issue
 7.5 mil now have a mental disorder;
15 mil by 2030
 Under-recognition and treatment is a critical
problem
 APRNs provide large share of mental health
services to older adults; their preparation is
uneven & often inadequate
Background
 2005: National invitational
Geropsychiatric Nursing:
State of the Future
conference in Philadelphia
 Promoting Mental Health of
Older Americans- The Role
of Geropsychiatric Nurses to
raise awareness
 White papers & strategic
plan for bridging gaps:
JAPNA 12 (2,3), 2006
 One strategy: Educational
preparation of the nursing
workforce
2008: Formation of the Geropsychiatric
Nursing Collaborative (GPNC)
 Three Hartford Centers of Geriatric Nursing
Excellence with strength in Advanced Practice
Geropsychiatric Nursing: Universities of Arkansas for
Medical Sciences, Iowa, and Pennsylvania
 Leadership Team:
Lois Evans Kathleen Buckwalter, Cornelia Beck, w/ Pamela Dudzik,
Project Coordinator
2008: Formation of the Geropsychiatric
Nursing Collaborative (GPNC)
 Four year project funded by John A. Hartford
Foundation
 Housed at American Academy of Nursing
(www.aannet.org/GPNCGeropsych)
 National Advisory Panel
Aims and Objectives
 Overall Aim: To improve the cognitive and mental
health of older Americans
 Two major objectives:
 Create and infuse core GPN competencies in nursing
education programs
 Develop and disseminate GPN curricula
GPNC Strategy
 Generate enhancements to existing
competencies rather than imposing new sets.
 Focus on three groups: Entry level, Advanced
Practice Nurse ‘specialists’ (gerontologic,
psychiatric-mental health), Advanced Practice
Nurse ‘generalists’ (adult, acute, family, women’s
health).
Fit with Consensus Model for APRN Regulation
APRN Specialties
Licensure at levels of role and
population foci
Focus of Practice beyond role and population focus
Linked to health care needs
Examples include but are not limited to: Oncology, Older Adults,
Orthopedics, Nephrology, Palliative care
POPULATION FOCI
Family/individual
Across lifespan
Adultgerontology
Gender
Specific
Neonatal
Pediatrics
Psych/Mental
Health
APRN ROLES
Nurse
Anesthetist
Nurse
midwife
Clinical Nurse
Specialist
Nurse Practitioner
Primary care Acute care
New Role
Clinical Nurse Specialists
Nurse Practitioners
Methods: Objective 1
 Reviewed all existing competencies & mapped to
gerontological competencies.
 Convened Geropsychiatric Nursing Core Competency
Workgroup & National
Advisory Panel.
 Developed definition, competency
enhancements & key concepts
 Enhanced awareness via presentations &
publications.
 Secured endorsements from 12 stakeholder orgs
Methods: Objective 2
 Collected & reviewed materials from websites &
schools with gero/geropsych programs for match
to key concepts/competency enhancements.
 Following focus group with FHNP, ANP, GNP,
ACNP, WHNP, PMHNP faculties, developed case
studies as a geropsych content infusion method.
 Developed and disseminated curriculum materials
via designated free-access website.
Geropsychiatric Nursing Definition
 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 psych/substance misuse disorders across
a variety of health and mental health care settings.
 Requires expert knowledge of normal age-related
changes and common psychiatric, cognitive and comorbid medical disorders in later life.
Geropsychiatric Nursing Definition cont’d
 Promotion of mental health and treatment of
psychiatric/substance misuse and cognitive disorders
emphasize strengths and potentials; integrate
biopsychosocial, functional, spiritual, cultural, economic
and environmental factors, and address stressors that
affect mental health of older adults and their families.
Competency Enhancements
 Successfully infused into revised competencies
for:
 Entry Level nursing
 Adult-Gerontology Primary Care Nurse
Practitioner and Clinical Nurse Specialist
 Adult-Gerontology Acute Care Nurse
Practitioner and Clinical Nurse Specialist
www.aacn.nche.edu/education-resources/competenciesolder-adults
Infusion Currently Underway with
National Organization of Nurse
Practitioner Faculties (NONPF)
 Psychiatric Mental Health Nurse Practitioner
 Women’s Health Nurse Practitioner
 Family Health Nurse Practitioner
General Recommendations
 ‘Health,’ ‘illness,’ ‘frailty,’ ‘care’ or ‘disease’
should be broadly defined to include both
‘physical and mental.’
 None of the new statements are intended to
‘stand alone’ but rather to enhance existing or
to-be-developed competencies for the
particular level of nurse.
 The recommendations are presented in the
context of the existing documents so that the
reader/reviewer can more readily understand
the intent.
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.’
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.’
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.’
Recommended Geropsychiatric Competency Enhancements for
Gerontological Nurse Practitioners
March 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.
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, cohortspecific 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.
Sample Enhancement for Gerontological
Nurse Practitioners & A/GNP Infusion
Results
Health Promotion, Health Protection, Disease Prevention, & Treatment:
Assessment of Health Status
NEW REC: 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.
REVISION: Assesses for syndromes and constellations of symptoms that may be
manifestations of other common health problems, e.g., risk-taking behaviors, selfinjury, stress, incontinence, falls, delirium or depression.
B. Geropsych Curriculum Materials
 Resources to enhance teaching strategies, content,
and/or clinical experiences re: key concepts
 Targets nursing students or clinicians in psychiatric
mental health, adult/gerontology, & generalist
nursingpractice (acute, family, women’s health).
Geropsych Curriculum Materials
 Organized by key concepts in 4 domains:
 Assessment
 Management
 Approach to OA
 Role
Key Concept: Assessment
I.
Assessment
I.
Normal aging: biopsychosocial theories
II. Appropriate instruments/clinical evaluation tools
III. Adapting assessment procedures
IV. Atypical presentations; Co-occurring illness; Psychiatric
manifestations: medical conditions
V. Common disorders
VI. Comprehensive
VII. Stressors affecting mental health
Types of resources
 Websites that include geropsychiatric nursing
concepts/educational components
 Curriculum materials/teaching strategies that
relate to geropsychiatric nursing key
concepts
Accessing POGOe
 If not registered, go to www.POGOe.org, click on
Register for free in upper right hand corner. There
you can create a new account.
 Once you create account, you can access
documents associated with a product for free.
See POGOe for All Geropsych Materials
Download complete set of competency
Enhancements at :
www.POGOe.org/productid/20660
Explore Curriculum Products and Resources at:
www.POGOe.org/producted/20947-54
View short video at:
Discover Mental Health: The Forgotten Piece in Elder Care
www.POGOe.org/productid/20893
POGOe Report: 8,279 views*
 Product 20660: Geropsychiatric
Nursing Collaborative Competency
Enhancements
 Top ranked product for the entire
POGOe site
 *As of November 15, 2011
Comments from
Dr. May Wykle
Wykle.pdflip
Contribute to & Keep Abreast
of New Developments
 Join the GPN Listserv contact Lois Evans @
evans@nursing.upenn.edu
 Share curriculum materials, websites that work
 Give feedback on the website to make it more
user friendly
 Give feedback on how you are using the POGOe
materials
More Resources
 AACN Webinar, Thursday December 15, 12Noon
http://www.aacn.nche.edu/webinars/2011/12/15/aprnse
ries4
 APRN case studies in geropsych
http://hartfordign.org/education/geriatrics_and_
the_advanced_practice:_case_studies/
Geropsychiatric Nursing Collaborative
Promoting mental health of older Americans
Funding provided by
the John A. Hartford
Foundation
www.aannet.org/GPNCgeropscyh
Questions?