Critical Path Network

Nurses, CMs focus on special needs of elderly

Hospital offers classes on geriatric nursing

As a case manager on the congestive heart failure unit at Danbury Hospital, Karen Morgan, RN, MSN, CCM, RN-BC, often manages the care of elderly patients.

When the hospital received a three-year federal grant to develop a family-centered geriatric nursing care curriculum, Morgan signed up, completed the course, and achieved her certification in geriatric care.

"If we understand the special needs of the elderly, we can help maintain them as the person they've always been; but we have to learn to approach them in a different way from the way we approach younger patients. This education helped me tailor case management to meet the needs of elderly patients and their families," she says.

The hospital applied for the grant to give its nurses and case managers the additional skills and competencies to care for its growing elderly population, says Moreen Donahue, DNP, RN, chief nursing office and senior vice president of patient care services at the 371-bed regional hospital, located in Danbury, CT.

Many nurses on the staff received their education before the nursing curriculum included geriatrics and caring for the elderly as a specific population. The course offered them an opportunity to increase their knowledge in caring for their older patients, she adds.

"Nurses and case managers need to understand the special needs of the elderly. Their eyesight may be failing, their hearing may be impaired, and their balance may be affected. Being away from the home setting is very disorienting. The needs of the elderly are very different from those of younger patients, even with the same diagnosis; the treatment process is different, and the discharge process also is very different," Donahue says.

In addition to providing education on geriatric care, the hospital also included educational sessions on providing culturally competent care and including the family in the care plan.

The cultural competency portion of the curriculum focuses on the knowledge and skills nurses should have to identify the needs and deliver care to patients who come from cultures that are different from their own.

"We looked at how cultural beliefs and traditions can affect the care of the patients, including how some cultures view illness, the importance of extended families in post-acute care, and times when patients may be hesitant to discuss their personal health with family members," she says.

An additional component alerted nurses to religious prohibitions and dietary restrictions that taking certain medications might violate. For instance, some insulin has a pork base, which may not be acceptable to people from cultures in which pork is prohibited.

As part of the grant, the hospital included the curriculum to prepare nurses and case managers to be able to take the gerontology nurse certification examination. A number of participants, including Morgan, have become board certified in geriatric nursing.

During the first year of the program, about 100 registered nurses and 50 nursing assistants from the Danbury Hospital and the Danbury Visiting Nurses Association were trained in culturally competent, family-centered geriatric care.

During the next two years, nurses and nursing assistants in the region will have access to the curriculum through a partnership with the Connecticut Hospital Association and the National Institute of Family Centered Care.

The hospital tested the knowledge of the participating nurses and case managers before and after the classes.

"The results were overwhelmingly positive. We determined that after taking the course, the nurses have significantly increased their understanding and appreciation for the unique needs of older adults and the importance of their families to their continued care," Donahue says.

One reason case managers were encouraged to participate in the education is so they can understand the special discharge needs of this population, Donahue says.

"When the elderly have an acute event that results in a hospital admission, the next level of care may be very different from the level of care they were in prior to hospitalization," she adds.

As they develop a discharge plan for the elderly, case managers incorporate an understanding of all components and family capabilities necessary to complete the plan of care.

"Lengths of stay are getting shorter and shorter, which means case managers have to have the knowledge to assess the special needs of the elderly and to get a plan in place to address them in a short time. Case managers need expertise to plan for the appropriate level of care for these patients and to help the families make the best decisions," Donahue says.

Since receiving the training, the case managers are involving the family earlier in the hospital stay after getting permission from the patient to talk to the family member, she adds.

"They are becoming more flexible in how they work around the availability of the family and meeting the needs of the patient," she says.

The case managers make rounds on their elderly patients more frequently and try to see the patients when their family members can be there.

"Elderly patients often need assistance at home, at least in the beginning. The case managers provide the link to the necessary support in order to provide a safe environment after discharge," she says.

Now that the case managers understand the special needs of the elderly, they talk to the family about the importance of good lighting at home, picking up scatter rugs to prevent falls, and making sure that they are monitoring the patient's medication, Donahue says.

As part of its efforts to provide patient- and family-centered care for elderly patients, the hospital created a patient education department, which prepares discharge information in an easy-to-read and easy-to understand format.

"We include the basic targeted information patients need on one sheet front and back. The type is easy to read, and it's less confusing that handing out multiple booklets and sheets of paper," she says.