Integrating gerontological nursing into the baccalaureate curriculum is one of the most important challenges facing nursing education today. The number of Americans reaching old age is dramatically increasing and is presenting a challenge to our health-care system. Nurses must have specific sensitivity to the special needs of these older people who usually have more complex health problems. Nursing education must meet this challenge by providing nurses with a sound scientific foundation for the practice of gerontological nursing.
The integration of gerontological nursing into the baccalaureate curriculum of nursing schools has been recommended for many years by nurse educators. The success in integrating gerontological nursing content into their respective educational programs has been slow in part because many nursing schools have not had faculty with the educational preparation, experience, and motivation to initiate such curriculum changes (American Nurses Association, 1982; Joel, 1987; Lee, 1987; Mezey, 1986; Oakley, 1986).
A study by Edel in 1984 aimed to determine the present status of gerontological nursing curricula and the educational preparation of faculty in gerontological nursing in baccalaureate nursing programs accredited by the National League for Nursing (NLN). The results showed that of 4,762 faculty in 197 NLNaccredited nursing programs, only 4.41% had completed course work in gerontology or gerontological nursing, which revealed a paucity of educationally prepared faculty members (Edel, 1986).
Other hindrances toward improvement of the gerontological nursing curriculum were reported to be a lack of time and competition with other specialties. Taylor and Gallagher (1988) reported that not all faculty members see the need for gerontological nursing content in the curriculum. Some faculty do not understand this specialty and lack a commitment to teaching about the specific aspects of the nursing care of older patients. These negative attitudes on the part of a few faculty members have been a major obstacle to including gerontological nursing content in the curriculum. It may become necessary to do some "lobbying" with these faculty members to convince them of this need. The building of a "powerbase" of faculty members who agree with the need of including gerontological nursing content in the curriculum is needed to implement the desired changes.
More recent studies suggest that there is currently a significant effort on the part of baccalaureate nursing programs to include gerontological nursing content and clinical experiences in undergraduate programs, and there are more faculty with formal academic backgrounds in gerontological nursing (American Nurses Association, 1986; Hogstel, 1988; MaIliarakis, 1990).
One program designed to improve the quantity and quality of teaching gerontological nursing in educational programs is the Faculty Preparation for Teaching Gerontological Nursing project sponsored by The Southern Regional Education Board (1990). The project was implemented in 1990 and will continue through 1992. These workshops were designed to acquaint faculty with the current scope of gerontological nursing practice and its implications for curriculum, instruction, and research. The master curriculum plan incorporates content about successful aging and health promotion of older adults, as well as management of common health problems with related clinical observation experiences. Conferences and workshops such as these are an ideal way to inform more faculty about trends in gerontological nursing education.
Undergraduate nursing programs vary greatly in purpose, organization, and expected outcomes. In developing a program of study in gerontological nursing content within the existing curriculum model, the faculty should define a planning process that will ensure that careful consideration is given to the numerous issues in the study of gerontology as well as to major concerns basic to any curricular modification or change. Some curricula may require extensive restructuring by modifying existing courses, whereas others may require very little restructuring by bringing together existing courses to establish a unified purpose (Davis, 1986).
Hogstel (1988) outlined a sample list of content related to gerontological nursing that could be included in a baccalaureate nursing curriculum. Although the list is not exhaustive, it could be used by nursing schools to determine what kind of topics are missing and needed in their own curricula. Additional topics that could be included are wellness, especially health and health maintenance including priority assessment needs; differences in presenting signs and symptoms of illness; geropsychiatric nursing, especially the differences between delirium, dementia, and depression; psychotropic medications; ethical issues related to research on older adults; and functional abilities including maintaining independence in activities of daily living and instrumental activities of daily living.
The curriculum focus and framework would dictate the specific choice and placement of the content. The author is employed in a college of nursing that has used a modified block curriculum for a number of years with the conceptual framework composed of three major components: nursing process, Maslow's hierarchy of needs, and seven curriculum strands (communication, group process, professionalism, management/leadership, research, critical thinking, teaching-learning). The curriculum did not have a separate course in gerontological nursing to emphasize the essential components of this specialty. The gerontological nursing content was integrated selectively into other nursing courses, such as growth and development, medical-surgical nursing, psychiatric nursing, and community health nursing.
The baccalaureate nursing program is a separate college in a small private university. The author is one of only two faculty members with formal graduate education in gerontological nursing, although several other faculty have a special interest in this field. The College of Nursing also has an endowed professorship in gerontological nursing, but does not have a graduate nursing program. Students include generic nursing students, registered nurse students, and a number of students who have baccalaureate and master's degrees in another field. Clinical nursing courses begin in the second semester of the sophomore year.
The College of Nursing faculty organization consisted of the following clinical councils: community health, medical-surgical, maternity, pediatrie, and psychiatric /mental health. The primary purpose of the clinical councils was to monitor, evaluate, and revise the clinical content in the curriculum. The faculty wanted to increase gerontological nursing content in the curriculum with a minimum of change because a major curriculum revision was planned within the next 2 years. A Gerontological Nursing Clinical Council was approved and added to the organizational structure to monitor the inclusion of gerontological nursing content in the curriculum. The council initially consisted of seven faculty members from the specialities of community health, women's health, medical-surgical, and psychiatric/mental health nursing. Primary goals adopted by the council were to:
* Determine the amount of gerontological nursing content in the current curriculum by reviewing all course overviews and syllabi for objectives, content, and references;
* Consult with faculty to determine other areas of emphasis on gerontological nursing not obvious in the course overviews or syllabi;
* Consult with other clinical councils to determine how concepts of gerontological nursing could be integrated within these clinical areas;
* Determine the feasibility of students using nursing homes for nursing management practicum;
* Review, evaluate, and recommend media related to gerontological nursing for use in specific courses;
* Evaluate the quantity and quality of books and journals on gerontology and gerontological nursing in the university library and recommend additional references;
* Develop and offer a gerontological nursing elective;
* Propose undergraduate level courses in gerontology to be offered to all university students; and
* Sponsor community workshops on gerontological nursing.
On completion of the review and evaluation of the current courses for gerontological nursing content, the Gerontological Nursing Clinical Council recommended to the Curriculum Committee, and subsequently to the total Faculty Assembly, several changes in the curriculum content of existing courses and the establishment of new courses. A general gerontological nursing textbook was recommended to be required during the first clinical nursing course and to be used by students throughout the curriculum. Other recommendations included incorporating the words "older patients /clients," "aging," and "gerontology" in all pertinent courses and unit objectives where appropriate to reflect the gerontological nursing content that was already being taught.
Also recommended was the addition of references from gerontology and gerontological nursing literature to all course syllabi where appropriate. There were several recommendations for specific courses, such as to include specific objectives and content on perioperative nursing care of older patients in the first medicalsurgical nursing course. It was recommended that more instructional media on the care of older adults be added to specific courses. For example, a videotape, Drugs and the Elderly, was recommended for the pharmacology course and Assessing the Frail Elderly was recommended for the health assessment course.
The Foundations of Nursing I course in the first semester of the junior year emphasizes the concepts relating to wellness and health, including sociocultural and psychological influences, while developing the nurse as a teacher and a practitioner.
It was recommended that this course include more content on chronic illness, caregiver stress, and respite care while strengthening content on death, dying, and bereavement. Also, it was recommended that this course include specific objectives on teaching health promotion and discharge planning for older adults.
The Foundations of Nursing ? core course in the second semester of the junior year focuses on the ethics of individual providers and recipients of health care. The primary roles of the nurse as a clinical practitioner and researcher are developed in this course as well as the study of the legal implications of practice and the theoretical basis for practice. Legal implication references, objectives, and content, including power of attorney, guardianship, and conservatorship relating to older adults, was recommended to be added to this course or to the psychiatric /mental health nursing course. Another recommendation was to strengthen content on active and passive euthanasia relating to older adults.
Content on suicide, paraphrenia, depression, organic mental disorders, and substance abuse among older adults was recommended for the psychiatric/mental health nursing course. Geriatric case studies, including home safety for older adults and elder abuse, was suggested to be added to the community health nursing courses.
Older adult developmental tasks (Havighurst) and ages of man (Erikson) were recommended where appropriate in the community health and in the junior and senior medical-surgical nursing courses. Recommendations for the senior nursing management course were to include teaching projects for nursing home staff about special problems and needs of older patients in nursing homes.
It was recommended that a gerontological nursing elective course be developed, approved, and implemented for students seeking additional study in this field and a general gerontology course be developed and approved to be offered to all students.
On approval by the Curriculum Committee and the General Faculty Assembly, members of the Gerontoiogical Nursing Clinical Council assisted in integrating these recommendations into the curriculum. A concentrated effort was made to review, evaluate, and recommend media related to gerontological nursing for the College of Nursing Learning Resource Center. An elective course in gerontological nursing has been taught for two semesters and a separate course in gerontology open to all students was offered in the fall 1991 semester. A new curriculum is being developed in the College of Nursing. Faculty are deciding whether to continue integrating this content or to require a specific course in gerontological nursing for all students.
An ongoing evaluation is necessary to monitor the integration of gerontological nursing content into current nursing courses and will obtain the data to determine the appropriateness of the content changes and if the students perform better as a result of these changes. Although the number of students who have chosen the gerontological nursing elective is small (6 the first time and 11 the second time), interest was high and the course has received an excellent evaluation from the students. One student stated: "this was one of the few college courses I took in 4 years that left me deep in thought about the topic. What I learned will not only help me to pass the state board examination and to take better care of my elderly patients, but it has enlightened my view about aging and life in general." Another student stated: "my attitude toward the elderly has improved. They are not old people, but people who happen to be old. I don't jump to conclusions about the elderly any more."
The faculty members of the Gerontological Nursing Clinical Council believe there has been significant improvement in the focus on older adults in the curriculum. As a result of their vigorous and sustained activities over the last few years, they will continue to evaluate the courses so that the students will gain the knowledge and ability to care for the increasing number of older people.
With the dramatic increase in older Americans who will need specialized health care, nursing education must take the initiative to prepare nurses to provide this care by including and strengthening the content of gerontological nursing in their curricula. Studies show that some faculty members have been obstacles to this effort by displaying negative attitudes, or perhaps a lack of knowledge of this specialty. Also, there has been an insufficient number of educationally prepared faculty to teach gerontological nursing. However, these obstacles are slowly decreasing because of an understanding of the necessity for this content to be included in the curriculum.
What is the best method for restructuring the curriculum to include this content? Each program must be analyzed to determine the best method, as this content could be integrated into existing courses, into separate all-inclusive courses, or by a combination of these methods. This analysis must determine how much gerontological nursing content is needed in the baccalaureate curriculum and what types of clinical experiences are needed for students to attain the knowledge and experience to provide quality care for older people.
The integration of gerontological nursing content into the curriculum of a specific baccalaureate nursing program has been presented. Continuing evaluation is necessary to ensure that the content is consistently presented and to measure the effectiveness of the curriculum. The efforts of a committed faculty who are interested in and who are educationally prepared to teach gerontological nursing will provide future practitioners with the knowledge and ability to give quality care to the increasing numbers of older people.
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- American Nurses' Association, Division on Gerontological Nursing Practice. A challenge for change: The role of gerontological nursing. Kansas City, MO: Author, 1982.
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- Southern Regional Education Board. Faculty preparation for teaching gerontological nursing. Atlanta: Author, 1990: 1(1).
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