The overarching goal of the Geropsychiatric Nursing Competency Enhancements ([GPNCE] Beck, Buckwalter, & Evans, 2012) and the interprofessional collaborative practice competencies (Interprofessional Education Collaborative [IPEC] Expert Panel, 2011a) is to prepare students who are entering health care professions to effectively work together as a team, with the common goal of building safer, higher quality, and patient-centered systems for older adults. The competencies promote family and patient centeredness and are population focused, process oriented, and outcome driven. The key concepts of the GPNCE are assessment, management, approach to older adults, and role (Beck et al., 2012). The Table shows these geropsychiatric nursing key concepts. The four domains of the interprofessional collaborative practice competencies are: values and ethics, roles and responsibilities, communication, and teamwork and team-based care (IPEC Expert Panel, 2011a). Table A (available as supplemental material in the online version of this article) shows a summary of the interprofessional collaborative practice competency domains. These key concepts and competency domains provide a foundation for a competency-based approach for interprofessional education to transform the geropsychiatric workforce.
Table: Geropsychiatric Nursing Key Concepts
The Institute of Medicine (IOM) introduced interprofessional education in the Educating for the Health Team report (1972). In Health Professions Education: A Bridge to Quality, the IOM (2003) made recommendations to overhaul the education of health care professionals and provide training in team-based skills. Although mental health was not specifically targeted in the IOM’s Retooling for an Aging America: Building the Health Care Workforce (2008), recommendations were made to enhance the competence of the work force, as well as to improve health care delivery for older adults. The vision of interprofessional training and collaboration was also reinforced. Around this time, the Robert Wood Johnson Foundation and the IOM partnered to guide the transformation of the nursing profession. Then, in the Future of Nursing report (IOM, 2010), the IOM recognized the fundamental role of nursing in redesigning health care. It was not until 2012 that the IOM specifically addressed the urgent need for a competent geropsychiatric work-force in The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? (IOM, 2012). As an advisor to the nation, the IOM identified gaps in the health care system, identified the need for collaboration to repair the damage of a fragmented health care system, and identified that the geropsychiatric workforce is almost nonexistent.
Geropsychiatric nursing is founded on a collaborative model for change that is consistent with the recommendations from the IOM for interprofessional education. On one hand, education in geropsychiatric nursing is specialized; however, on the other hand, geropsychiatric nursing concepts must effectively translate into broader interprofessional education to meet the growing needs of older adults with mental health conditions.
Undergraduate and graduate nursing competencies were developed and vetted in partnership with the American Association of Colleges of Nursing, the National League for Nursing, and the National Organization of Nurse Practitioner Faculties. Geropsychiatric nursing practice is based on expert knowledge of age-related changes and later-life psychiatric, cognitive, and comorbid medical conditions (Beck, Buckwalter, Dudzik, & Evans, 2011). Overall, the holistic approach of geropsychiatric nursing blends with all population foci and is infused into all aspects of nursing education.
The nursing profession responded to the proposed changes in health care by developing the Advanced Practice Registered Nurse (APRN) Consensus Model (APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee, 2008). For the next several years, nurse educators were prompted by the APRN consensus model to make overall changes in the organization and competencies in nursing education. Separate competencies were developed for adult–gerontology and psychiatric–mental health. The purpose of this new model is to expand the role of APRNs (APRN Consensus Work Group & the National Council of State Boards of Nursing APRN Advisory Committee, 2008).
With support from the John A. Hartford Foundation, expert nurses formed the Geropsychiatric Nursing Collaborative (GPNC) “to improve the mental health of older Americans by preparing nurses at all levels in geriatric mental health” (Beck et al., 2011, p. 237). The GPNC released the GPNCE on the Portal of Geriatric Online Education’s (POGOe) Web site ( http://pogoe.org). The GPNCE are a supplement to existing nursing competencies. The National Organization of Nurse Practitioner Faculties is in the process of integrating the supplemental GPNCE into competencies across the lifespan. Furthermore, the GPNCE were developed to be used as a tool in a model of interprofessional collaborative change (Beck et al., 2011).
Collectively, leaders across the health care disciplines recognize the need for a uniform model to educate future providers. The IPEC Expert Panel developed competencies to improve interprofessional education and released the Core Competencies for Interprofessional Collaborative Practice in 2011 (IPEC Expert Panel, 2011a). The IPEC Expert Panel includes the American Association of Colleges of Nursing, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Dental Education Association, the American Association of Medical Colleges, and the Association of Schools of Public Health.
Interprofessional education is the wave of the future. According to the World Health Organization (2010), “Interprofessional education occurs when two or more professions learn from and with each other to enable effective collaboration and improve health outcomes” (p. 13). The IPEC Expert Panel (2011a) report reflects a “vision of interprofessional collaborative practice as key to the safe, high quality, accessible, patient-centered care designed by all” (p. i).
Nurse educators play a critical role in designing, integrating, and implementing how to effectively incorporate the GPNCE into interprofessional education and improve geropsychiatric care. In the Future of Nursing document (IOM, 2010), the IOM continues to recognize nurses as full partners with other health care professions. According to the IOM (2010), “nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States” (p. 1).
Nurses were one of the first disciplines to embrace the vision and development of interprofessional education. In 1971, Dr. Eleanor C. Lambertsen, Dean of the Cornell University School of Nursing, was appointed by the IOM to the 11-member interdisciplinary steering committee. The committee made recommendations for changes in the interprofessional education of health professionals across the nation. Notably, some of nursing’s most influential members, Dr. Madeline Leninger, Dr. Hildegard Peplau, Dr. Faye Abdellah, and Dr. Barbara Resnick, were listed as active participants of this report (IOM, 1972), and they provided leadership and vision for the early interprofessional education initiatives.
The care of older adults with mental health conditions depends on the interprofessional health care team. Nurses are in a position to provide expert knowledge and skills that contribute to the interprofessional care of older adults with mental health conditions. The timely development of the GPNCE brings nursing to the front lines and in equal partnership with other disciplines to work collaboratively to bolster the geropsychiatric workforce and redesign health care based on the recommendations of the IOM (2012).
Nurse educators must carefully consider how to infuse the GPNCE into entry-level nursing programs, as well as into various graduate specialty programs, such as the Adult-Gerontology Nurse Practitioner, Nurse Practitioner, and Clinical Nurse Specialist programs, recognized within the APRN consensus model. It is equally important for nursing to establish its role and identity in the expert care of geropsychiatric conditions within the interprofessional domains of practice. Unfortunately, few nursing programs have incorporated the GPNCE into nursing curricula. Even fewer nursing programs have included both the GPNCE and interprofessional collaborative practice competencies into their curricula.
Now, some 40 years after the IOM’s Educating for the Health Team report (1972), what are the barriers that prevent implementation of interprofessional education for older adults? When one of five older Americans has a mental health condition, why is health care delivery still spinning its wheels while the cost of mental health care for older adults spirals out of control? Is the goal for interprofessional education too lofty, or do changes in the educational structure of health care providers provoke fear of moving into unchartered territory?
Profession-specific competencies can be found across health care disciplines. Similar to other specialty disciplines, geropsychiatric nursing education has followed the traditional pattern of educating students without much understanding of how other health care professionals educate or participate in the care of older adults. However, to strengthen professional working relationships across disciplines, team members must share language, attitudes, and experiences.
Health professionals are educated to specialize. However, without an interprofessional perspective, students from health professions risk graduating with textbook knowledge that does not translate into a successful model for collaborative geropsychiatric practice. The barriers to interprofessional collaborative practice are lack of a common language for competencies, lack of understanding of roles, professional isolation, and limited teamwork. Interprofessional education identifies professional silos and breaks down barriers that hinder opportunities for collaborative geropsychiatric practice.
A Common Language of Competencies for Health Professionals
The Partnership for Health in Aging (PHA) developed competencies with a common language for health professionals that can be applied to geropsychiatric care. The PHA was supported by the American Geriatrics Society to form another workgroup, which addressed the specific needs of health care providers who serve older adults. The PHA was represented by the disciplines of physical therapy, pharmacy, occupational therapy, dietetics, social work, nursing, psychiatry, physician assistants, and dentistry. The workgroup developed broad competencies with a common language and an emphasis on person-centered care that can be applied to all disciplines and published the Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-Level Health Professional Degree (PHA/American Geriatrics Society, 2010) report. These competency domains include: (a) health promotion and safety, (b) evaluation and assessment, (c) care planning and coordination across the care spectrum (including end-of-life care), (d) interdisciplinary and team care, (e) caregiver support, and (f) health care systems and benefits. The competency domains “are intentionally broad” (PHA/American Geriatrics Society, 2010, p. 2) and could be used to provide a common language to redesign interprofessional education for health professionals in geropsychiatric care.
Understanding Professional Roles
In addition to the lack of a common language, in 1971 the IOM’s interdisciplinary steering committee recognized attitudes toward professional roles as being a significant barrier to implementing interprofessional education. The committee identified barriers that included (a) “the captain” (IOM, 1972, p. 68) of the health care team and turf wars among professions, (b) the blurring of scope of practice, and (c) professional isolation (IOM, 1972). Ironically, these same barriers exist today.
For geropsychiatric care, the physical presence of a physician or advanced practice nurse may be absent. To meet the mental health care needs of the older adults with mental health conditions, the roles of some providers may need to be extended, whereas other roles are limited (IOM, 1972). Registered nurses working in nursing homes may be the primary health professionals with the most direct care responsibilities for older adults with delirium, depression, and dementia. However, all health professionals must build the science of geropsychiatric care through interdisciplinary research. As suggested by the IOM (1972), the roles of health professionals are complementary. The role of the “captain” (IOM, 1972) for geropsychiatric care may be passed from nurse to psychiatrist, from nurse to dentist, or from nurse to physical therapist or other health professional.
The blurring of the boundaries between adult–gerontology, psychiatric–mental health, and family nurse practitioners or psychology and psychiatry may be confusing, even to members within a profession. Any profession that is educated in isolation and is not socialized to collaborate as a member of the health care team is unprepared for the geropsychiatric workforce. Prerequisite courses on the history of health care professions and appreciation for the specific roles of health professionals could be included in the requirements for nursing and other programs for health professionals.
Promoting interprofessional geropsychiatric education requires a partnership between academic and organizational leadership so students can learn by using the latest informational technologies, real-world simulations, and appropriate clinical placements. Faculty must have training in interprofessional education and geropsychiatric expertise to value and fully participate in interprofessional geropsychiatric education.
Interprofessional Teams and Geropsychiatric Care
Overall, interprofessional education results in lower health care costs, decreased length of stay for hospitalized patients, greater patient safety, and increased quality of care (IOM, 2003). Innovative educational strategies can be utilized that will result in team members being knowledgeable in care, education, and research (Young et al., 2011). Gerontology and geropsychiatric care or interprofessional education programs need to adopt a model proposed by the pharmacy discipline to “start small and go slow” (Buring et al., 2009, p. 6). In environments where there are limited teaching resources, a strategic approach of implementing competencies gradually has been successful.
Although the smallest interprofessional team consists of a nurse and physician (IOM, 1972), the team might expand to include other individuals from the disciplines of psychiatry, dentistry, social work, dietetics, as well as other health care professionals. Several contemporary models for interprofessional collaboration (Young et al., 2011) can be applied to team development and interprofessional education of the geropsychiatric workforce.
Resources for Interprofessional Education and Practice
Clinical settings provide obvious advantages for hands-on team development. Geropsychiatric nursing and interprofessional education clinical experiences may be found in geropsychiatric units, acute care for elder units, nursing homes, teaching hospitals, and simulation laboratories. However, online learning, case studies, professional organizations, the Hartford Centers for Geriatric Nursing Excellence, and universities with well-established interprofessional learning experiences can provide strategies and models for curriculum development for geropsychiatric care.
POGOe is an interprofessional Web site that may serve as a resource for curriculum development. Essentially POGOe is an online library that provides free access for educators and learners. The Web site contains competencies, case studies, PowerPoint® presentations, and other teaching materials in geriatrics and gerontology (Association of Directors of Academic Programs, 2013).
Elder Care is another example of a successful Web site that includes geropsychiatric content for interprofessional providers. Elder Care is featured on the Arizona State University Web site ( http://www.reynolds.med.arizona.edu/html/ElderCare.html). Elder Care is a series of free resources that is supported by the Donald W. Reynolds Foundation, the Arizona Geriatric Education Center, and the Arizona Center for Aging. Elder Care is a collaborative effort that is written and updated by editors from multiple disciplines, including nursing.
Unfolding case studies from the Advancing Care Excellence for Seniors found on the National League for Nursing Web site ( http://www.nln.org/facultyprograms/facultyresources/ACES/unfolding_cases.htm) can be used in simulation experiences when facility sites for interprofessional geropsychiatric care are scarce. The case studies are complete with objectives, simulation scenarios, audio, chart templates, discussion questions, critical thinking exercises for completing the case study, an instructor manual, and a guide for incorporating the case study into the curriculum.
The Geriatric Interdisciplinary Team Training and Building Interdisciplinary Geriatric Health Care Research Centers are two programs supported by the John A. Hartford Foundation (Young et al., 2011). The John A. Hartford Foundation/Geriatric Nursing Initiative is instrumental in faculty development, disseminating resources, and building the science (Bednash, Mezey, & Tagliareni, 2011) of geriatric and geropsychiatric nursing. These initiatives supported interdisciplinary health care in education, practice, and research. The Hartford Institute for Geriatric Nursing supports ConsultGeriRN.org ( http://consultgerirn.org/), which is a Web site that houses information for clinical decision making, evidence-based practices, certification, and other resources, including resources for interprofessional geropsychiatric nursing.
The John A. Hartford Foundation, the Mayday Fund, and the Atlantic Philanthropies also supported the Building for Academic Geriatric Nursing Capacity (BAGNC). The BAGNC programs have supported more than 200 nurse leaders (BAGNC, n.d.) to advance the science of gerontological and geropsychiatric nursing. In 2012, the Gerontological Society of America became the home to the Coordinating Center for the National Hartford Centers for Geriatric Nursing Excellence, formerly known as BAGNC.
The BAGNC alumni scholars formed a group of nurse leaders, the GPNC Work Group. The GPNC Work Group was formed to sustain the work of the GPNC. The GPNC bridged partnerships with organizations such as the American Psychiatric Nurses Association, the Gerontological Advanced Practice Nurses Association, and the American Association for Geriatric Psychiatry. The GPNC Work Group continues the work of the GPNC to (a) provide resources and a voice for geriatric nursing, (b) define the scope and practice in line with the APRN consensus model, (c) infuse geriatric mental health into nursing education, and (d) collaborate with interprofessional colleagues in education, practice, and research (Evans, Beck, & Buckwalter, 2012).
The goal of the GPNC Work Group is to prepare nurses at all levels for collaborative practice and to build the science for geropsychiatric care. Members are active in education and the dissemination of research to guide geropsychiatric care. The group members participate in webinars, writing case studies, maintaining POGOe products, infusing the GPNCE into nursing curricula, sustaining the goals and work of the GPNC, and research. Looking to the future, certification in interprofessional geropsychiatric care may be an avenue by which to provide older adults with an opportunity for access to care by experts. The GPNC Work Group views geropsychiatric care from an interprofessional lens with a concentration of future work in collaboration with health professions and partnerships with professional organizations.
Dr. Mary Wakefield, Administrator for the Health Resources and Services Administration, stated, “The time is right [for collaborative care]. Our resources are limited, and it’s our obligation to determine and apply our health resources as effectively and robustly as possible in ways that produce better care outcomes for patients” (IPEC Expert Panel, 2011b, p. 8). Teams of providers have the advantage of combining their expertise to support decisions that ultimately lead to a competent geropsychiatric work force that is sufficient to meet the needs of older adults with mental health conditions (IOM, 2010).
This article has focused on the vision of the IOM, the GPNCE, and the IPEC Expert Panel for the best education of health professionals in geropsychiatric care. Nurses play an integral role in redesigning health care for older adults with mental health conditions across all settings. The future of mental health care for older adults is in the hands of the transformative leadership by nurse educators; therefore, nurse educators must build bridges for interprofessional education. Nurse educators need to deliberately use competencies and innovative strategies to establish a culture change. Nurse educators must continue to make a difference in the thoughtful and organized preparation of the next generation of nurses for collaborative practice as critical members of the geropsychiatric workforce to improve geropsychiatric care.
- APRN Consensus Work Group, & the National Council of State Boards of Nursing APRN Advisory Committee. (2008). Consensus model for APRN regulation: Licensure, accreditation, certification, and education. Retrieved from https://www.ncsbn.org/Consensus_Model_for_APRN_Regulation_July_2008.pdf
- Association of Directors of Geriatric Academic Programs. (2011). Geriatrics education coordinating center and POGOe. Retrieved from http://adgap.americangeriatrics.org/educationcenter_new.php
- Beck, C., Buckwalter, K. & Evans, L. (2012). Geropsychiatric nursing competency enhancements. POGOe—Portal of Geriatric Online Education. Retrieved from http://www.pogoe.org/productid/20660
- Beck, C., Buckwalter, K.C., Dudzik, P.M. & Evans, L.K. (2011). Filling the void in geriatric mental health: The Geropsychiatric Nursing Collaborative as a model for change. Nursing Outlook, 59, 236–241. doi:10.1016/j.outlook.2011.05.016 [CrossRef]
- Bednash, G., Mezey, M. & Tagliareni, E. (2011). The Hartford Geriatric Nursing Initiative experience in geriatric education: Looking back, looking forward. Nursing Outlook, 59, 228–235. doi:10.1016/j.outlook.2011.05.012 [CrossRef]
- Building Academic Geriatric Nursing Capacity. (n.d.). About us. Retrieved from http://www.geriatricnursing.org/about/about.asp
- Buring, S.M., Bhushan, A., Broeseker, A., Conway, S., Duncan-Hewitt, W., Hansen, L. & Westberg, S. (2009). Interprofessional education: Definitions, student competencies, and guidelines for implementation. American Journal of Pharmaceutical Education, 73(4), Article 59 doi:10.5688/aj730459 [CrossRef] .
- Evans, L.K., Beck, C. & Buckwalter, K.C. (2012). Carpe diem: Nursing making inroads to improve mental health for elders. Nursing Outlook, 60, 107–108. doi:10.1016/j.outlook.2011.12.002 [CrossRef]
- Institute of Medicine. (1972). Educating for the health team. Washington, DC: National Academy of Sciences.
- Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, DC: National Academies Press.
- Institute of Medicine. (2008). Retooling for an aging America: Building the health care workforce. Washington, DC: National Academies Press.
- Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.
- Institute of Medicine. (2012). The mental health and substance use work-force for older adults: In whose hands? Washington, DC: National Academies Press.
- Interprofessional Education Collaborative Expert Panel. (2011a). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative.
- Interprofessional Education Collaborative Expert Panel. (2011b). Team-based competencies: Building a shared foundation for education and clinical practice. Washington, DC: Interprofessional Education Collaborative.
- Partnership for Health in Aging/American Geriatrics Society. (2010). Multidisciplinary competencies in the care of older adults at the completion of the entry-level health professional degree. Retrieved from http://www.americangeriatrics.org/files/documents/health_care_pros/PHA_Multidisc_Competencies.pdf
- World Health Organization. (2010). Framework for action on interprofessional education & collaborative practice. Geneva, Switzerland: WHO Press.
- Young, H.M., Siegel, E.O., McCormick, W.C., Fulmer, T., Harootyan, L.K. & Dorr, D.A. (2011). Interdisciplinary collaboration in geriatrics: Advancing health for older adults. Nursing Outlook, 59, 243–250. doi:10.1016/j.outlook.2011.05.006 [CrossRef]
Table A: Interprofessional Collaborative Practice Competency (IPCPC) Domains
Table A: Interprofessional Collaborative Practice Competency (IPCPC) DomainsIPCPC Domain: Values and Ethics. The first IPCPC domain, values and ethics, is primarily process oriented, emphasizing a climate of mutual respect and culturally sensitive care. Ethical conduct competencies apply to the delivery of care and management of ethical dilemmas. Responsibility for practice is discussed in terms of maintaining competence in one’s own profession.IPCPC Domain: Roles and Responsibilities. The roles and responsibilities domain emphasizes role differentiation to reduce role conflict, allow access to safe care, and high-quality outcomes. Interdependent professional relationships and communication are encouraged to promote teamwork and prevention of errors underpin this domain.IPCPC Domain: Interprofessional Communication. The general communication competency statement applies to all team members, including patients, families, and health professionals. Communication competencies are designed to improve efficiency, promote safety, and allow all members of the team to feel valued.IPCPC Domain: Interprofessional Teamwork and Team-based Care. Like communication, team-based care can safely be delivered only through effective team dynamics that include care coordination, collaboration, and shared problem solving and decision making. Relationship-building values and principles, consensus building, collaboration, problem solving, and leadership skills are important in all settings and team roles to promote efficient, safe, and quality care.
Note. The domains shown above were summarized from the Core Competencies for Interprofessional Collaborative Practice (Interprofessional Education Collaborative Expert Panel, 2011a).
Geropsychiatric Nursing Key Concepts
| Normal aging|
| Instruments and evaluation tools|
| Adapted assessment procedures|
| Atypical presentations|
| Common disorders|
| Comprehensive assessments|
| Stressors and mental health|
| Care transitions|
| Behavioral interventions and communication|
| Decisional capacity and health literacy|
| Patient, family, and peer physical and mental health interactions|
| Ethical, legal, and socioeconomic factors|
|Approach to older adults|
| Age-related adaptations|
| Age and culturally appropriate interventions and communication|
| Recognize personal and societal bias|
| End-of-life care|
| Promotion and safety risk factor reduction|
| Knowledge of geriatric mental health, mental illness|
| Lifelong learning|
| Policy and advocacy|
| Research participation and utilization|
| Quality improvement|
| Delivery systems|
| Service barriers|