A Community College Responds to Changes in Health Care Delivery
Irons, Patricia D., Meehan, Susan, Reilly, Margaret J., Nursing and Health Care Perspectives
THE NURSING FACULTY AT Queensborough Community College has recognized a need for curriculum change to reflect the rapidly changing health care system and the expanding role of the nurse. To prepare associate degree graduates to function effectively in acute care settings, where patient care needs are highly complex, and in community-based settings, where there is a need to care for an increasingly culturally diverse and aging population, the following changes in the curricula have been initiated:
* There has been an increase in gerontologic nursing theory and the provision of clinical experiences with older adults. The final semester includes a three-and-one-half week rotation in an extended care facility where the focus is on the management of care of older adults with multiple chronic illnesses and deficits.
* Community nursing theory and community-based clinical experiences are included in nursing courses. The final semester includes a three-and-one-half week rotation in community-based facilities where the focus is on assessment, teaching, and the management of care.
Emphasis is on health promotion, health maintenance, and disease prevention.
* Students have a greater opportunity to develop skills in patient assessment, along with an increase in theoretical learning.
* The latest technology is used (including interactive video, projection presentation systems, laptop computers) to encourage the development of critical thinking skills and increase participation of students in the learning process. Students use information technology in the development of patient education projects.
* An emphasis on patient education is incorporated in all nursing courses.
The Gerontologic Component With 12 percent of the U.S. population aged 65 or over, nine million Americans receive long-term care. Of these, two million receive care in nursing homes (1). Of those who turned 65 in 1990, it is estimated that between 36 and 45 percent will use a nursing home before they die (2). Thus, long-term care for the elderly is expanding and will continue to expand, in the community and in long-term care facilities.
The clinical rotation in an extended care facility was developed using research conducted by the Community College-Nursing Home Partnership, a four-year demonstration project funded by the W. K. Kellogg Foundation at six sites in urban and rural areas (3). It emphasizes the following:
* Caring for the institutionalized older adult, including ventilator-dependent residents.
* Gerontologic assessment skills.
* Management of groups of residents.
* Practicing rehabilitation and restorative nursing care.
* Practicing therapeutic modalities of care, medication administration, and treatment administration for a group of residents.
* Coordinating care with registered nurses, licensed practical nurses, and nursing assistants.
* Communicating and interacting with all members of the interdisciplinary health team.
* Planning a student group-teaching project for well/frail elderly in nursing facilities and community senior centers.
In preparation for this clinical experience, the students have a college laboratory, prior to which they are required to view videos related to problems in long-term care. Another prerequisite is completion of the first two sections of a study guide on ongoing health care for older adults, which emphasizes chronic illness and long-term care services. The guide was developed for this clinical rotation.
The college lab helps prepare students to work in long-term care facilities while heightening their awareness of the needs of older residents. It includes lectures, discussions, demonstrations, and films on agitation, restlessness, and wandering.
Topics discussed in the lab include quality of care and quality of life in nursing facilities; demographics of residents and reasons for admission; the role of the interdisciplinary health team and interdisciplinary care planning; common problems of residents, including impaired cognition, communication, mobility, and urinary incontinence; resident assessment and mental status assessment; pain management; fall assessment and interventions; polypharmacy; management skills; medication and treatment administration; the living environment; and rehabilitation skills. …