Massachusetts
Department of Higher
Education
Nursing
Education
Redesign Grant
Program
Final Project
Implementation
Report
Submitted by:
Berkshire Community College
November 30, 2012
Executive Summary – Overview of Project Accomplishments
Redesigning the curriculum in both the practical nursing certificate program and the associate
in science in nursing program to incorporate gerontological concepts, increase quality of care,
and further develop critical thinking skills, has led to the following curricular changes:

In NUR-202 (Physical & Mental Health IV), students who have not had a long-term care
experience will have a three week rotation in a long term care facility and address four of
five Gerontology Clinical Objectives in their clinical journal.

The summer workshop, Advanced Clinical Concepts in Geriatric Care, resulted in
students expressing significantly more confidence applying gerontological concepts after
the workshop.

Acute Care Nursing Student Educational Forums (twelve scheduled for winter/spring
2013) for both the A.S. degree in nursing students and the practical nursing students
provide expert information on topics ranging from medication safety to coordination of
care along the continuum.
In addition, the collaboration between the two programs (A.S. in Nursing and Practical
Nursing) has increased the awareness of each program to the other’s role in preparing
practitioners and working as a team to teach quality care and safety. Professional development
workshops for faculty from both programs provided an opportunity for faculty to learn from each
other and discuss future directions for curriculum to ensure a seamless path for LPN students to
bridge into the degree program, and develop faculty expertise in gerontological quality and
safety education. A faculty retreat provided an opportunity to reflect on the accomplishments
thus far, and plan for continuation of programmatic changes for the future. The department chair
for the practical nursing program has served as the liaison between the programs and will
provide ongoing leadership for the gerontological clinical rotations, further strengthening the
links between the two programs.
Research Findings to Date
Gerontology Workshop Outcomes
To measure the outcomes of student confidence in applying gerontological concepts, a
survey of ten items was administered to 13 participants before and after the workshop. An
unpaired-samples t test indicated that the mean Gerontology pre-workshop scores (M = 2.96, SD
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= 0.45) were significantly greater than the mean post-workshop scores (M =1.82, SD = 0.27), t
(17) = 6.45, p= .001. Therefore, students expressed significantly more confidence applying
gerontological concepts presented after the workshop’s presentation. Table 1 shows specific
content area pre and post workshop student scores.
The one content area that did not show a significant difference between the pre and post
scores was student confidence, “knowing what clients need when they are discharged from the
hospital to be admitted to extended care facility or go home.” It may be that this concept is too
broad for the recent nursing graduate to begin to feel confident clinically. Focusing on a specific
health condition, for instance, the patient with heart failure being treated across health care
systems, allows students to identify critical signs and symptoms requiring interventions prior to
discharge from the acute care setting and/or extended care setting. Because item 6 “Beginning to
see what clients need in care transitions” may capture more accurately a new graduate’s level of
confidence faculty may consider presenting patient movement though care transitions within the
nursing curriculum.
Table 1
Gerontology Workshop Pre and Post Mean Scores Measuring Participant’s Level of Confidence on
Specific Content 1 (N = 13)
________________________________________________________________________
___________
Pre Workshop
M
Post Workshop
M
p*
1.
Teaching client medications & self-care to avoid rehospitalization
2.76
1.84
2.
Handoff to other staff during shift or discharge
transitions
2.86
1.69
3.69
2.00
2.38
1.23
2.84
3.00
2.46
2.92
3.76
1.84
1.84
1.69
2.00
2.30
0.001
0.001
0.01
0.03
3.00
1.84
0.001
3.
Knowing client’s needs when discharged from
hospital to extended care facility or home
4. Respecting other nurses across care settings to share
responsibilities and accountability
5. Beginning to coordinate and collaborate
6. Beginning to see clients transitional needs
7. Assessing client’s level of functioning
8. Practicing in a long-term care facility
9. Using geriatric nursing resources like
consultgerirn.org
10. Using evidence-based practices
0.001
0.001
na
0.001
0.001
1
On a scale of being extremely confident (1) to being not at all confident (5), rate your level of confidence in the
following clinical areas.
Note. * 2- tailed
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Nursing Implications: Focusing on specific health conditions,( i.e., patient with heart
failure being treated across health care systems), allows students to identify critical signs and
symptoms requiring interventions prior to discharge from the acute care setting and/or extended
care setting. Faculty should consider presenting patient movement through care transitions
within the nursing curriculum either in clinical settings or through patient simulation in a
controlled environment. This workshop demonstrates areas of graduate student confidence in
working in a long term facility and a need for faculty to focus on core curriculum use of geriatric
nursing resources and evidence based practices. The outcomes demonstrate that students’ level
of confidence increases after a gerontological workshop offered after graduation.
A similar survey instrument (pre and post-professional development) was administered to
all faculty (A.S. degree in nursing and practical nursing) to assess confidence in teaching
gerontological concepts. The results will be analyzed and disseminated to faculty and staff
during the spring 2013 semester.
Changes implemented and plan for sustainability
Berkshire Community College (BCC) partnered with Berkshire Health Systems
(Berkshire Medical Center-BMC) to present multidisciplinary forums for students early in spring
semester, 2012. Benefit was found for both the College and BMC and another series of twelve
acute care nursing student forums will be presented in spring, 2013. The multidisciplinary teams
of presenters modeled current practice and raised expectations for students in practice to begin to
develop relationships among interdisciplinary staff in the hospital and other healthcare agencies.
Simulation was focused on increasing critical thinking and reasoning skills using a
progressively complex scenario involving hypoglycemia. Scenarios were developed by faculty
to progress students through a patient’s emerging signs and symptoms and have students
determine when these signs and symptoms begin to impact patient safety or reflect the need for
immediate intervention. Additional scenarios are being developed and will be used during the
fall 2012 for the LPN students, and spring 2013 for the first year associate degree nursing
students. Simple tools such as SBAR (situation- background-assessment-recommendation), and
“hand-offs” between shifts provide evidence-based structure for patient information exchanges
and scenarios can be modified to reflect different situations. Debriefing provides the opportunity
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for both self-reflection by the student, and peer and faculty review. The afternoon simulations
reinforced prior learning and development of interdisciplinary teamwork.
Second year associate degree nursing students who have not had a long-term care
experience will have a three week rotation in a long term care facility and address four of five
Gerontology Clinical Objectives in their clinical journal. This will be piloted spring 2013 and
incorporated into the associate degree nursing program for the future. BCC faculty will continue
to incorporate gerontological concepts and patient quality and safety methods into the curriculum
as well as Nurse of the Future Core competencies.
The summer workshop, Advanced Clinical Concepts in Geriatric Care, will be offered
again in summer 2013. An additional week will be added to the course to provide additional
time for simulation and an expansion of the observation at Fairview Commons. Students will
have a “mini-clinical” experience to apply new skills. The two week workshop will incorporate
the Quality and Safety Education for Nurses Education Consortium Institute (QSEN) approach to
enhance the ability of nursing faculty to reinforce quality and safety competencies with an
expansion of the hands-on clinical component of the workshop.
Barriers encountered, addressed, worked around
It was originally projected that participants would be ready to take the gerontology
certification through the National Federation of Licensed Practical Nurses. It was later
discovered that the National Federation of Licensed Practical Nurses (NFLPN) requires six
months of employment history in addition to a current license. Students were comfortable with
the requirement however, and welcomed the opportunity to hone their skills and reinforce their
knowledge base before applying for the certification. The faculty will follow up with all students
to encourage them to work toward this goal. In addition, while the evaluation of the observation
at Fairview Commons was overwhelmingly positive, many students expressed disappointment at
not being able to have a “hands-on experience. In summer 2013 plans are to meet with Fairview
Commons and other agencies to provide “mini-clinical” experiences in future workshops.
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Ongoing project dissemination
Information regarding the project has been disseminated through faculty meetings,
curriculum discussions (which have included Nurse of the Future Competencies and QSEN) and
at a nursing faculty retreat where faculty in both programs shared information regarding the
project implementation and future directions. On January 9, 2013, the results of this project will
be presented at the Nursing and Allied health Initiative Advisory Council (N&AHI-AC).
Opportunities for scale up projects/dissemination
As we have seen, baby boomers have multiple diagnosis and chronic health conditions
requiring care across a variety of health care settings. Nurses at all levels must be prepared to
function effectively in the healthcare system including long term care. Practicing nurses must
respond to patient emerging health needs regardless of health care setting or educational program
preparation. This project is an important step in providing an additional skill set for students in
the associate degree in nursing program at BCC and for the new graduate LPN to develop more
acutely, critical thinking skills in patient assessment. It also provides an opportunity for
development of interdisciplinary teamwork skills and analysis of the unique health care needs of
the older adult.
This project was designed to strengthen nursing education and career pathways through
enhancing nursing curriculum and developing faculty expertise and student proficiencies in
gerontology. The project activities included: 1) redesigning nursing curriculum to incorporate
gerontological concepts, patient quality and safety methods into the curriculum; 2) developing
faculty expertise in gerontological quality and safety education through professional
development workshops; and 3) providing a “transition into Practice” course for LPN graduates
and incumbent nurses to prepare the LPN and registered nurse (A.S. degree level) for
employment in long-term care.
Key lessons learned
Patients within care transitions require nursing skills linking knowledge, clinical
reasoning and practice that belong in practical nursing education as well as in the RN curriculum.
The LPN student as well as the RN student, uses evidence based practice to determine
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assessments and interventions for effective efficient outcomes based on the science of nursing.
All students found evidence-based nursing tools useful in the objective assessment of the elderly
patient. As with any nursing resource, faculty must select appropriate tools (case studies,
simulation scenarios, analyses of research) for the educational level of the student. Three
assessment tools found useful are:

Try This: ®and How to Try This series which present geriatric syndromes with
several assessment tools in a variety of media.

INTERACT Tool Kit (Interventions to Reduce Acute Care Transfers), which can
be used to help nursing home staff identify when a residents’ care changes, what
to further assess, and when to communicate changes.

ACES (Advancing Care Excellences for Seniors NLN, 2010a) provides a
framework acknowledging the complexities of care and patients vulnerabilities
during transitions. This nursing resource provides unfolding case studies and
teaching strategies for the older adult client.

Recommendations for DHE
It is important to recognize that nursing program outcomes build on core values and
integrate concepts across all levels of nursing education, starting with Practical Nurse and ending
with Doctoral prepared nurse. Teamwork and collaboration is a core nursing competency and
underscores the value of involving students in interdisciplinary clinical health care forums and
simulations scenarios as a way to have students participate in interdisciplinary teamwork. As the
long term care continuum evolves, nursing students are presented with challenging and complex
learning environments. It is critical for the LPN to acquire the advanced skills necessary to
ensure patient safety, become increasing aware of patients worsening symptoms and conditions,
and respond appropriately to such situations critical to long-term care nursing. Improving skills
helps reduce patient complications preventing unnecessary hospital admissions. Establishing an
education career ladder for LPN to RN to NP or Nurse Educator is a critical component to keep
in the forefront of nursing education. With the evolution of nursing education, it is important to
have multiple entry levels and make room in healthcare for all levels of practitioners.
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Development of faculty expertise through professional development workshops and onsite training with technology helped to build confidence and provided additional assessment tools
that included best practices. Having an interdisciplinary approach to both training and teaching,
models the teamwork that is important for students to incorporate in their own practice. In
addition, the multidisciplinary forums allowed students to appreciate the interventions of the
different areas presented. They could see immediately the interactions among healthcare
professions as the various disciplines presented clinical management issues related to nutrition,
cardiac failure, diabetes mellitus, oral health, patient care navigation, and other topics related to
acute care nursing. It became clear to students that there was a cumulative effect on patient
outcomes with each discipline’s intervention.
Findings from the student evaluations are providing direction for future consideration for
the summer workshop. From comments made by participants, it was noted that there was great
value in having both first year nursing students and practical nursing graduates in the workshop.
They were able to work together and each student was able to see their role within the team. In
addition, the faculty represented both programs, again modeling the teamwork approach to
healthcare.
In closing, it is essential to have highly educated, skilled nurses to provide a competent
workforce. Competencies and clinical objectives should be specific to the older adult, and
student learning outcomes assessed. Students as well as practicing nurses working with older
adults should be confident in identifying the scope and complexity of gerontological nursing.
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