The ACES Framework: Guiding Nursing Education and Clinical Practice to Provide Competent, Individualized, and Humanistic Care to Older Adults

Nursing Education Perspectives, September-October 2010 | Go to article overview

The ACES Framework: Guiding Nursing Education and Clinical Practice to Provide Competent, Individualized, and Humanistic Care to Older Adults


Over the past year, the National League for Nursing, in collaboration with Community College of Philadelphia, has assembled teams of faculty experts to develop a framework that serves as a foundation for the advancement of excellence in caring for older adults in a variety of home, institutional, and community-based settings. Four unfolding cases developed by the faculty teams will help faculty incorporate the ACES framework (Advancing Care Excellence for Seniors) into their teaching and learning activities. The first unfolding case study is now available on the NLN website.

The ACES framework guides nursing education and clinical practice to provide competent, individualized, and humanistic care to older adults. It is based on the NLN core values of caring, integrity, diversity, and excellence and on the NLN Educational Competencies Model (2010), which calls for graduates of nursing programs to be prepared to: a) promote and enhance human flourishing for patients, families, communities, and themselves; b) show sound nursing judgment; c) continually develop their professional identity; and d) maintain a spirit of inquiry as they move into the world of nursing practice and beyond.

The ACES three-year grant is funded by the John A. Hartford Foundation with additional funding from the Independence Foundation of Philadelphia. Laerdal Medical Corporation is providing support to develop the simulations and unfolding case studies related to the care of older adults.

The Faculty Teams The two faculty teams are known as PEGNE (Panel of Experts in Gerontological Nursing) and STAGES (Simulation Team Advancing Gerontological Education Strategies).

PEGNE developed the framework based on the following underlying beliefs about aging and about older adults:

* INDIVIDUALIZED AGING Since the aging process is manifested uniquely by each individual, assessing function and expectations of care is essential.

* COMPLEXITY OF CARE The care of older adults requires specialized knowledge in the art and science of both nursing and geriatrics to manage the interplay of factors that influence quality of care.

* VULNERABILITY DURING LIFE

TRANSITIONS Older adulthood is dynamic as the person transitions from one form, state, activity, or place to another.

The STAGES team used the ACES framework to design the unfolding case studies. An unfolding case is defined as one that evolves over time in a manner that is unpredictable to the learner at the outset. Elements and new situations develop and are revealed to the learner with each encounter.

The template for each case is outlined as follows:

* A first-person monologue (available as an audiofile and a script) introduces the individual or couple and the complex problems they are facing.

* Three simulation scenarios are designed to help students practice assessing function and expectations of their patient(s). Links to appropriate assessment tools from the "How to Try This" series are included.

* An innovative final assignment asks students to "finish the story."

* An instructor toolkit offers suggestions on how to use the various parts of the unfolding cases and incorporate them into the curriculum.

Together, the PEGNE and STAGES teams generated a list of items that would be part of every unfolding case. The list includes: complexity; missing information; varied settings; family dynamics and role strain; common syndromes of aging, including differences in responses of older adults to illness; the assessment of risks/benefits in the context of respect for an individual's preferences and values; evidence-based practice and the use of validated tools; and a multidisciplinary team approach.

Testing the Case Scenarios The four cases outlined by the STAGES team--Millie Larson, Red Yoder, Henry and Ertha Williams, and Julia Morales and Lucy Grey--were designed to increase in complexity. …

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