A Geriatric Education Model for Graduate Entry Students

Review Article

Austin J Nurs Health Care. 2015;2(1): 1012.

A Geriatric Education Model for Graduate Entry Students

Abraham Ndiwane1, Robin Klar2, Omanand Koul3, Kimberly Silver Dunker3*, Kathleen Miller3 and Ruth Remington4

1MGH Institute for Health Professions, School of Nursing,Charlestown Navy Yard, Boston MA USA

2New York University College of Nursing,New York

3Associate Dean for Clinical Scholarship, Diversity, and Evaluation University of Massachusetts, Worcester

4Framingham State University, Department of Nursing,Framingham MA

*Corresponding author: Kimberly Silver Dunker, Department of Nursing, University of Massachusetts Worcester, Graduate School of Nursing, USA

Received: March 05, 2015; Accepted: March 13, 2015; Published: March 31, 2015


The United States is experiencing the onset of a “silver tsunami” as increasing numbers of adults reach age 65 over the next couple of decades. The expansion of this population will have a major impact on the health care system. To meet these older adults’ current and future health care needs, schools of nursing must prepare students in geriatric care at the pre-licensure and graduate levels. The Geriatric Internship Program at our graduate nursing school was one component of a larger project, Comprehensive Geriatric Nursing and Education across Settings I, designed to increase the knowledge of nursing students, faculty, and personnel to improve the quality of care for older adults. Students in the program increased their understanding of the complexities of geriatric care while making a commitment to further their education in advanced practice nursing specialties with this population focus.

Keywords: Geriatrics; Nursing education; Graduate entry students


The number of older adults in the United States is expected to increase exponentially over the next three decades. The population of Americans 65 years and older is projected to more than double to 70 million by the year 2030, while the number of centenarians will increase from 65,000 to 381,000 [1]. Older adults have more acute and co-morbid conditions that will require an increase in hospital and community-based health care services [2]. To promote more positive outcomes for this population in their encounters with health care providers, nursing students must be educated about the best practices in geriatric care [3,4]. Indeed, achieving better outcomes for older adults requires professional nurses committed to the care of this population across settings. The interest in this population often starts in nurses’ professional education. To this end, the authors developed a geriatric education model building upon an existing accelerated post baccalaureate curriculum with additional learning opportunities for students. This curriculum change focused on including evidencebased theories of practice, integrating selected clinical experiences, and offering geriatric professional and advanced practice nurse preceptors to prepare the next generation of professional nurses committed to the care of older adults.

Graduate Entry Curriculum

Accelerated nursing programs were developed to educate applicants with a baccalaureate degree in another discipline as professional nurses. As of 2011, the United States had 235 such programs, with 63 granting a Master of Science degree in Nursing [5]. These graduate entry programs prepare students as professional and advanced practice nurses through curricula designed to build upon their previous learning experiences [5]. The graduate entry program targeted for the geriatric education model was created at our graduate school of nursing in 2004 to address shortages of professional nurses and advanced practice nurses. Students in this pre-licensure program were prepared as professional nurses and were eligible to take the National Council Licensing Examination for Registered Nurses after completing their first year and receiving a Certificate of Completion [6]. Specialty graduate options for these students included the Dual Track Gerontological Nurse Practitioner Specialty with either the Adult Nurse Practitioner or Adult Acute/ Critical Care Nurse Practitioner Specialties [7]. These specialty offerings were started in response to the need for advanced practice nurses prepared as gerontological nurse practitioners in primary and acute care [8]. The students in these specialties also included nurses with a baccalaureate degree in nursing seeking graduate education as geriatric advanced practice nurses. Implementing this curriculum change created several challenges. The first was focusing the geriatric didactic and clinical experiences on evidence-based practice. This change required intensive review of the current literature for scientific outcomes or “best practices” in geriatric care. The second challenge was maintaining students’ interest in elder care, as they transitioned through caring for populations across the age spectrum in their graduate entry program education. This challenge was met by the faculty’s commitment to educating students at the professional practice level to meet the care needs of this growing older population and their enthusiasm about geriatric care, which motivated students to continue with this area of study in primary or acute care. The third challenge in this program was the requirement for additional courses, clinical hours, and costs to provide the specialty education. To address this issue, faculty at our graduate school of nursing applied for and received grants from federal and foundation sources for scholarships and traineeships for selected students. One grant covered tuition and fees [9], while another helped cover these costs plus attendance at nursing leadership conferences [10]. The fourth challenge during the inception of the graduate entry program was educating nursing and hospital administrators, nurses, other inter-professional providers, and alumnae on the valued added of this educational pathway to nursing. The faculty addressed these concerns on an ongoing basis prior to and during inception of the graduate entry program, whose students have had a positive impact as professional nurses during their education in this program. Throughout the program, the faculty addressed each challenge to provide students with evidencebased content and clinical experiences, preceptorships with geriatric professionals and advanced practice nurses, and funding to support their nursing education.

Comprehensive Geriatric Education and Mentoring Across Settings (COGEMS) I

This project was conceived in 2006 with a tripartite mission: to enhance the knowledge of students, nurses, and interprofessional personnel caring for older adults. To achieve this mission, the project is comprised three programs: a Geriatric Internship Program for pre-licensure students, a Geriatric Clinical Program for nursing personnel, and a Geriatric Fellows Program for nurse faculty and nurse administrators. The overall goal was to improve the quality of care and safety of older adults in private and public hospitals, subacute care facilities, and long-term care facilities [11]. The aims of the Geriatric Internship Program were: (1) to enhance the knowledge of geriatric care for graduate entry students, and (2) to increase the numbers of students committed to geriatric professional nursing [11]. This program within the Co-GEMS project, was guided by the geriatric education model.

Review of the Literature

Schools of nursing have focused on curriculum innovations in undergraduate nursing education through various national initiatives. The Hartford Geriatric Nursing Initiative funded by the John A. Hartford Foundation (JAHF) partnered with the American Academy of Nursing and the Hartford Centers of Geriatric Nursing Excellence to establish the project, Building Academic Geriatric Nursing Capacity Program for pre-doctoral scholars and postdoctoral fellows [12]. The JAHF also funded the AACN to enhance geriatric content in baccalaureate and graduate nursing programs, along with awarding graduate scholarships [9]. The Hartford Centers of Geriatric Nursing Excellence have also developed and implemented curricular activities that integrate new geriatric content and clinical experiences into baccalaureate curriculae, focusing on competencybased geriatric education, expanding opportunities for baccalaureate in nursing to PhD pathways, and developing nursing and interprofessional web-based geriatric courses [13].These innovations have benefited undergraduate curricula by grounding them in evidencebased practice, generating interest in geriatric nursing, enhancing commitment to graduate education in geriatric advanced practice nurses, and fostering interest in research-focused doctoral programs [14].

The United States has made positive strides in improving health outcomes for Americans, starting with Healthy People 2000 [15]. This project followed Healthy People 2010, whose health indicator data demonstrated a trend toward improved life expectancy based on gender and race, whereas women and white populations previously had longer life expectancies than the Black population [16]. Since older adults are the fastest growing population cohort in the country, Healthy People 2020 was updated to include objectives to promote positive outcomes for this population [17]. Older adults have higher morbidity and mortality rates for major health problems than their younger counter parts. They are often at risk for chronic conditions, e.g., arthritis, diabetes, dementia and heart failure. Complicating these issues is that many older adults are living at poverty levels in greater numbers than are younger adults [17].These risks and complications are faced by pre-licensure nursing students in caring for their geriatric patients in both acute care and community-based settings, especially around discharge planning.

Older adults have been estimated to comprise 20.3% of the US population by 2030 [18]. The numbers of older adults with acute and chronic diseases will increase exponentially, resulting in rising mortality rates for this population [19]. Integrating innovative models of geriatric education will increase the cadre of professional nurses prepared to meet the challenges of caring for older adults now and in the future.

Graduate Entry Curriculum

When the graduate entry curriculum was first developed, it included health problems that contributed to increased mortality and morbidity as priority areas for the care of adults and older adults. As a result, the curriculum was developed to also incorporate objectives of Healthy People 2000 [20]. And its subsequently updated versions [21, 22].The framework for the curriculum also included the outline and competencies for professional nurses as reported in The Essentials of Baccalaureate Education for Professional Nursing Practice [23], and Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care [24]. As these Essentials and Competencies were updated, they were also incorporated in the curriculum [25]. These resources not only served as guides for the faculty teaching geriatric content and supervising clinical learning experiences, but also provided the foundation for developing and subsequently modifying the curriculum.

The graduate entry curriculum continues to be offered over five semesters, with the majority of theory and clinical experiences in the first three semesters. Content on the care of older adults is threaded throughout the curriculum. This integration of geriatric care into the curriculum starts with the foundational courses, continues in the specialty courses, and culminates with the community health courses.

Geriatric Integration

Curriculum changes grounded in evidence-based practice refocused the content of selected graduate entry didactic courses and clinical learning experiences on geriatric care. The geriatric emphasis in each course focuses on health promotion and disease prevention. These courses also integrate the rewards and challenges of working with older adults to maintain or regain their function with acute or chronic illness. Presentations on geriatric nursing care also integrate evidence from research studies and systematic reviews. Traditional teaching strategies for integrating geriatric content included the use of case studies, role-play, and integrating technology. These methods have helped our students to gain a deeper understanding of caring for older adults using the affective domain, along with the traditional cognitive and psychomotor domains. The integration of geriatric content into the curriculum is identified in (Table 1).

Citation: Ndiwane A, Klar R, Koul O, Dunker KS, Remington R and Miller K. A Geriatric Education Model for Graduate Entry Students. Austin J Nurs Health Care. 2015;2(1): 1012. ISSN : 2375-2483