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UMass Lowell-D’Youville Transitional Care
Dedicated Education Unit (TC DEU)
FY 2011 – Education Redesign Grant
Nursing and Allied Health, Mass. Department of Higher Education
Final Project Report
November 30, 2012
Karen Devereaux Melillo, PhD, ANP-C, FAANP, FGSA, Principal Investigator
 Executive summary/overview of project accomplishments
Background: Nursing education and healthcare institutions are challenged to meet the needs of
adults 55 and older with multiple chronic illnesses and post-acute care needs as they transition
from shorter hospital stays to long term care facilities. Providing innovative, cost-effective,
patient-centered clinical experiences that include comprehensive education in the care of older
adults for nursing students and LTC staff is one way to meet this need.
Purpose: To evaluate the implementation of a Transitional Care Dedicated Education Unit
(TCDEU) in a long-term care facility.
Specific Aims of the Research Project:
1. To develop the Transitional Care Dedicated Education Unit (TC DEU) program
2. To determine program feasibility and satisfaction with the TC DEU initiative for
students, faculty and staff
3. To evaluate changes in student and staff eldercare cultural self-efficacy and selfassessment of geriatric assessment knowledge for estimation of effect sizes to conduct a
larger study in the future
4. To assess junior-level nursing student, intern, preceptorship, and post-grad residency
interest in LTC as a career option
Methods: A TCDEU was developed using a university-community partnership approach.
Partnership activities included development of preceptor training manuals, conducting joint
training sessions for faculty and staff, implementing student summer internships, arranging
clinical placements for junior nursing students, and hosting a workshop for long-term care
facilities and Massachusetts institutions of higher education to provide hands-on training
materials. A quasi-experimental pre-posttest design was utilized to determine the effectiveness
of the program on baccalaureate nursing students’ eldercare cultural self-efficacy (N=24).
Contextual data were collected from students, partnership members, and clinical teachers via
focus groups and key informant interviews to evaluate program satisfaction and learning
outcomes. Internship, senior preceptorship, and post-graduate residency students’ reflective
journaling will be analyzed using qualitative content analysis.
Results: Paired sample t-tests revealed statistically significant increase in overall ECSES scores
from pre-test (M=3.21,SD=.39) to post-test (M=3.5, SD=.21), t(11)=2.9, p=.05. Contextual data
revealed students, clinical teachers and institutional partners were highly satisfied with the
program.
Discussion/Conclusions: Implementing a TCDEU program using a partnership model
integrates long-term care into nursing education with positive outcomes for students, faculty, and
staff. Implications for gerontological nursing education, practice and patient care offer an
important foundation for replicability and sustainability of this model in other long-term care
settings. Dissemination that has occurred at local, regional, statewide, and international
conference venues through research poster presentations and the anticipated peer-reviewed
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publications will further promote the value of this academic-practice partnership model in longterm care.
 Research findings to date
Evaluation objectives for the project were:
1. To determine student, faculty and staff satisfaction with the Transitional Care Dedicated
Education Unit Initiative.
2. To evaluate changes in students’ eldercare cultural self-efficacy post participation in the
TCDEU clinical experience.
Formative and summative evaluation methods were employed, including focus groups, key
informant interviews, student clinical journals, and the Eldercare Cultural Self-Efficacy Scale
(Shellman, 2006). Data analysis utilized both quantitative descriptive and t-test statistics using
the SPSS 20 software.
Qualitative analysis utilized the immersion/crystallization technique (Borkan, 1999). Emergent
themes from students’ perceptions included: Real Life Nursing, Making Connections, Gaining
Confidence and Skills, and Communication. Narratives that reflected these themes included,
“Watching my patient progress from admission to discharge was a meaningful experience. I was
able to follow the entire process as she recovered. I actually saw how nursing interventions
worked”. For making connections, a student reported, “A patient told my co-RN that she wanted
me to take care of her while I was there because I took the time to get to know her and meant a
lot to me.” Gaining Confidence and Skills was reflected in such statements as, “The rotation
really helped my nursing skills, critical thinking, and understanding of being a work-ready nurse
once I graduate”. Communication theme was clearly reflected in one student’s response, “I felt
that reminiscence allowed me to make deep connections with my patients and gain a better
understanding of who they were. This experience has given me confidence in my ability to
communicate with my patients.”
For the partnership perceptions, emergent themes centered on: Melding of education and
practice, Excitement and energy, Communication and Challenges. As noted by one partner
participant, “The goals of both entities are truly the same in that we want to make long term care
a very attractive option for new nurses and improve care for older adults”. Communication was
vital to the successful partnership. As noted, “Communication between the team members was a
strength. We communicated very regularly on all important decisions”. Excitement and energy
was exemplified by this comment, “The team members really helped spark the energy. The team
dynamic was good and that helped the energy to infiltrate to the clinical teachers and to the
students”. Challenges were noted as well, “By far the greatest challenge is finding BSN
prepared nurses to be clinical teachers and then keeping them”.
Clinical teachers identified the importance of frequent communication with the UMass Lowell
faculty member to ensure course objectives were met. They valued the ability to contact the
faculty member with any questions/concerns regarding student performance and to subsequently
work collaboratively with that faculty member to develop an action plan for at risk students. The
collaborative approach to grading clinical performance and assignments was noted as a strength,
and the opportunity to provide weekly communication and feedback by the Clinical Teacher was
highly effective in recognizing the value of the Clinical Teacher input. Challenges identified by
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the Clinical Teachers including being able to identify individual student needs, while
incorporating student learning experiences in addition to carrying a full patient assignment.
Ensuring a quality clinical experience for the students was perceived to be a challenge at times.
Working as a role model and mentor future nurses and colleagues was considered a benefit,
while enabling the Clinical Teacher to keep up their own nursing skills and encouraging
continued learning and academic degree attainment.
The Eldercare Cultural Self-Efficacy Scale (Shellman, 2006) measures nursing students’
perceptions of confidence in caring for diverse older adults. This 28-item, 40-factor structure
scale addresses: assessing lifestyle and social patterns, determining cultural health practices,
determining cultural beliefs, and dealing with grief and losses associated with aging. Alpha
scores range .82-.95. Pre-/post-test responses indicated no significant findings for the control
group of non-LTC DEU junior-level nursing student participants, while there was a statistically
significant difference for the LTC DEU intervention group with an increase in overall EES score
from pre-test (M=3.21, SD=.39) to post-test (M=3.5, SD=.21), t(11) = 2.9, p. = .05 (Eta squared
= .19). There was also a statistically significant increase in caring for White older adults scores
from pre-test (M=3.6, SD=.57) to post-test (M=4.02, SD=.29), t (11) – 3.9, p<.05 (Eta squared =
.26). However, there were no significant findings in caring for other ethnic groups.
Confidence in Caring for Diverse
Older Adults
AA
Pre
AA Post
LH Pre
LH2
Post
AS Pre
AS
Post
W Pre
W Post
Intervention
(n=12)
3.2 (.48)
3.3 (.22)
2.9 (.45)
3.2(.21)
2.9 (.62)
3.1 (.48)
3.6(.57)
4.0(.29)
Control
(n=12)
3.2 (.39)
3.1 (.28)
3.1 (.43)
3.2(.21)
3.0 (.45)
3.0 (.37)
3.2(.47)
3.1(.28)
*AA=African-American
LH=Latino/Hispanic
AS=Asian
W=White
In summary, the TCDEU students gained confidence in caring for older adults. Students
reported high satisfaction with the clinical experience. Students rated themselves as less
confident with skills associated with death and dying and end-of-life care. Reminiscence
assisted students with communication and making connections with patients. As one student
stated, “This was the best clinical experience I could have asked for. Having had this
opportunity was amazing!”

Changes implemented and plan for sustainability
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As a result of this successful academic-practice partnership and the overall satisfaction with the
TCDEU, this model has been extended to include two different clinical groups in each of the 7
week rotations provided to junior students, which totals 4 practica of 12 students each. Thus, by
the end of the academic year 2012-2013, it is anticipated that the DEU will enable a total of 48
students to participate in this clinical innovative model of nursing education. Additional clinical
teachers have continued to be recruited and trained by the UMass Lowell Nursing
Faculty/project investigators, and these Clinical Teachers have expressed interest in serving in
this role knowing that the stipend was being discontinued at the end of the project funding in
early Fall 2012.
Additionally, exploratory plans are underway to discuss DEU establishment in an acute care
setting at a local community hospital as well as a DEU in psychiatric mental health facility in the
Merrimack Valley region. Clinical Assistant Professors from UMass Lowell who have or will
undertake this dialogue and development of a DEU are being afforded ‘service leadership hours’
toward their direct teaching roles and responsibilities as part of their faculty role.

Barriers encountered, addressed/worked around
As noted in the research summary, the major barriers surrounded the recruitment and retention of
qualified LTC staff nurses who could serve in the Clinical Teacher role. When the appropriate
credential was not earned by the potential candidate, a facility nurse administrator/manager
served as the credentialed professional overseeing the Clinical Teacher role. As a result, the
proposed budget for the stipends per Clinical Teacher was less than planned for resulting in an
anticipated return of some funding to the MDHE.
The sophomore LTC/gerontological intern, junior student summer CNA intern, and senior
preceptorship students were all able to identify the value of this experience for their future
nursing roles; unfortunately, the senior preceptorship student was not successful on the first testtaking of the NCLEX-RN examination. Therefore, this graduate was not eligible for the postgraduate residency. The opportunity was afforded to a qualified student selected by the research
team based on this graduate’s expressed interest in writing for working in LTC.
Also, the development of a Wiki site to enable uploading of training and resource materials for
D’Youville Clinical Teachers and Nursing Staff was never fully realized; Dr. Ruth Remington
was taking leadership on this activity. Unfortunately, Dr. Ruth Remington resigned from the
University of Massachusetts Lowell in May 2012. Thus, the Wiki site was never fully
implemented, although our LTC DEU Website link from the UMass Lowell Nursing home page
was and is operational (See http://ww.uml.edu/SHE/Nursing?LTC-Dedicated-Ed-Unit.aspx).

Ongoing project dissemination
On August 16, 2012, a state-wide Seminar/Conference on Dissemination/Replicability of the
LTC DEU Program was held at the UMass Lowell Inn and Conference Center. This was also
scheduled in conjunction with Mass. Senior Care Foundation/UMass Lowell co-sponsored
“Faculty Institute in Gerontological Nursing” to allow attendance of the 10 selected nurse faculty
from across the state. Positive evaluations by n=60 attendees (See Appendix) representing
Nursing Faculty, LTC Administrators, and other health professionals from 4 states (New
Hampshire, Massachusetts, Connecticut, and Rhode Island) were received.
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Additional individuals have approached the UMass Lowell research project investigators about
replication in their settings/sites. A planned meeting is scheduled on campus with a lead
Administrator of Genesis Healthcare Facilities who wishes to explore options for establishing
DEUs in one of their premier LTC sites. At the Gerontological Society of America meeting held
in San Diego, CA, November 14-18, 2012, in which a poster presentation describing the LTC
DEU project, a nurse faculty from Radford University, VA, approached me about lessons learned
for establishing a LTC DEU at a facility in which she has a practicum site. She actually intended
on coming to the August 16th, 2012 Conference but was unable to secure travel funding from her
institution to attend.
Contact was made with Dr. Paul Katz, MD, Baycrest Geriatric Center, Toronto, Ontario, Canada,
regarding LTC DEU grant received by their Ministry of Health to develop and implement an
interprofessional DEU – initial email/phone contact held 9-5-2011, with plans to confer further;
Dr. Katz approached Dr. Alice Bonner at CMS, who put him in touch with Mass. Senior Care
Foundation’s Laurie Herndon, MS, GNP-BC, who contacted us at UMass Lowell. The
following dissemination activities are planned:
o Spring 2013 – Ontario Long-term Care Association-sponsored LTC Applied
Research Education Day, February 13, 2013 – Abstract submission on Evaluation
of DEU in LTC (poster presentation); notification of acceptance received
November 30, 2012
o December 3, 2012 – Webinar on UMass Lowell/D’Youville Center for Advanced
Therapy DEU in LTC to be presented by Karen Devereaux Melillo from 4:305:30 to Baycrest Geriatric Services, Toronto, Ontario, CA, Raquel Meyer, PhD,
Program Director, Centre for Learning, Research & Innovation (Interprofessional
Learning Unit, ILU); purpose is to provide an overview of the UMass LowellD’Youville work and lessons learned from our experience in implementing a
Nursing DEU.
o Spring 2013 – Baycrest Geriatric Services, Toronto, Ontario, Canada; February
13, 2013, Inaugural conference of the Ontario Centres for Learning, Research and
Innovation hosted by Baycrest – focus on transforming practice in LTC through
educational innovation.
Poster Presentations:
2013
Shellman, J., Melillo, K.D., Abdallah, L., Dodge, L., Dowling, J.,
Prendergast, N., Remington, R., Rathbone, A., & Thornton, C.,
Evaluation of a DEU in LTC (poster presentation). Ontario Long-term
Care Association-sponsored LTC Applied Research Education Day,
February 13, 2013 – Abstract notification of acceptance received
November 30, 2012.
2012
Abdallah, L., Dodge, l., Dowling, J., Prendergast, N., Rathbone, A.,
Remington, R., Shellman, J., Thornton, C., & Melillo, K.D., LTC
Dedicated Education Unit: Evaluation of an Innovative Clinical
Education Model. Annual Scientific Meeting of the Gerontological
Society of America, Charting New Frontiers in Aging, San Diego, CA,
November 14-18, 2012.
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2012
Abdallah, L., Dodge, L., Dowling, J., Prendergast, N., Rathbone, A.,
Remington, R., Shellman, J., Thornton, C. & Melillo, K.D., Dedicated
Education Unit in Long-term Care: UMass Lowell and D’Youville Center
for Advanced Therapy Partnership for Transitional Care – Development,
Implementation and Evaluation of an Innovative Clinical Education
Model. St. Anselm College 20th Annual Conference for Nurse Educators
and Clinicians: Partners in Developing Tomorrow’s Nurse; Resort and
Conference Center, Hyannis, MA, May 30-June 1, 2012.
Other Poster Development for Dissemination:
o At D’Youville partner/recruitment of nursing staff Clinical Teachers meeting,
October 20, 2011
o At MDHE Grantees’ Meeting, October 21, 2011
o In class for 33:313 Nursing Health Assessment for all 107 junior-level nursing
students
o At Training Session for Clinical Teachers at D’Youville, November 29, 2011,
January and March 2012
o Nursing and Allied Health Initiative Advisory Board Meeting, September 26,
2012, Mass. Hospital Association, Burlington, MA (Oral/PowerPoint
presentation)
Peer-Reviewed Manuscript Preparation Plans Underway:

a. Naomi Prendergast, CEO/President, D’Youville to take the lead drafting a
manuscript for the trade journal Provider magazine that speaks to the host
facility’s experience. Draft to be completed by end of year (12/31/12)
b. Dr. Karen Devereaux Melillo, PI, UMass Lowell to take the lead on the overall
project manuscript with a draft completed by end of January
c. Dr. Lisa Abdalla and Lea Dodge, Faculty of Record in the LTC DEU, will take
the lead on the students’ lived experience on the DEU as well as Clinical Teacher
(based on field notes; weekly documentation/reporting). Will work on during the
winter break.
d. Dr. Jackie Dowling (with the assistance of a graduate student, Kristyna
Lampman) will take the lead on the varied student internships in the LTC.
e. Dr. Juliette Shellman will be working with the Graduate Students involved in the
evaluation of the grant to develop a manuscript
Opportunities for scale up projects/replication
As described in Plans for Sustainability above.

Key lessons learned
The LTC DEU model did allow UMass Lowell, in partnership with D’Youville, to address a
critical shortage of long-term care nurses, faculty and clinical sites needed to support a rapidly
growing number of students, by enhancing nursing education and collaboration between the LTC
nurses at D’Youville Center for Advanced Therapy and nursing faculty at UMass Lowell. We
believe the education of nursing students, nursing staff, and faculty in gerontological nursing was
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improved. This exposure to the LTC DEU allowed us to highlight nursing care for older adults
in this setting. As was noted in the MDHE evaluation site visit in April 2012, some of the
student nurses who had not considered gerontological nursing as a specialty area of interest, were
reporting that their exposure to the DEU had significantly impacted their intentions to not only
reconsider LTC and gerontological nursing as an area for future employment, but they
specifically identified D’Youville as a potential employer that they would seek out for this
opportunity.
One of the key lessons learned was the value and critical importance in establishing and
maintaining the academic-practice partnership throughout the process and outcomes of
developing, implementing, evaluating and disseminating the LTC DEU. Establishing trust and
open dialogue at monthly meetings, and in communications via email/telephone in the interim,
assured that the importance of the DEU activity implementation was always foremost in our
discussions. Furthermore, both institutions (UMass Lowell and D’Youville) have identified
university-academic practice partnerships as a component of our strategic vision and documented
plans. The expertise of both UMass Lowell and D’Youville complemented the partnership effort
and enabled the positive outcomes to be achieved. There were, indeed, mutual benefits to both
partners in the way of professional development, exposure to state-of-the-art transitional care
environment, developing leadership opportunities, and promoting larger scale partner
commitment for sustainability.
Further lessons learned related to the need for openness to challenges and opportunities,
including: recognizing the time constraints each is under; faculty and facility clinical staff
turnover; academic credentials needed for clinical teachers; recruitment process for clinical
teachers, internship, preceptorship, and post-grad residency; scheduling meetings; assuring
inclusive agenda; dissemination efforts; and regular ongoing communication in between formal
partner meetings was essential.

Recommendations for DHE
As noted in my email communication of 9-27-12, one recommendation I would offer, in terms of
proposals for the future, is based on furthering the DEU effort to involve interprofessional
education as well (if this could be in alignment with the Nursing and Allied Health Initiative). I
had an international conference call on 9-27-12 with Baycrest Geriatric Services Center in
Toronto, Ontario, CA, with Raquel Meyer, PhD, RN, Centre Director, where I will be spending
part of my sabbatical time next summer. They have invited me to present an overview of our
MDHE DEU in LTC with an online education format (scheduled for December 3, 2012), and I
will be traveling to their Centre in mid- to late-February where they have received a substantial
$750,000 Ministry of Health Grant and LTC this past year as well for establishing an
interprofessional DEU involving LTC on two different floors of their very large complex (about
1,000 beds). With the IOM report and priorities for interprofessional education, this really could
be the ‘next step’ for some settings to consider (especially in a College/University setting where
multiple health professionals and other majors could contribute – SW, Pharmacy, PT, Exercise
Physiology, Nursing, Medicine, OT, et cetera) and partner with clinical agency(ies). I wonder if
this could be a potential suggestion of a possible funding priority, and perhaps it could involve
the full Nursing and Allied Health Initiative in doing so.