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School, skilled nursing center teach students geriatric nursing skills

By BETSY TAYLOR

A nursing school and a Catholic skilled nursing center have teamed up in Massachusetts on an educational model providing nursing students one-on-one training in geriatric care skills. The collaboration gives students hands-on experience, links them to nurses in the workplace who can share their real-world experience, and leads some students to consider employment in a care setting working with the elderly when they hadn't previously.


University of Massachusetts Lowell School of Nursing student Nadine-Christine Daou, left, sharpens her skills in caring for an elderly population by learning from nurse Kerry Foley at D'Youville Life and Wellness Community, also located in Lowell.

Nursing students aren't always immediately drawn to caring for an elderly population. There is a common misperception that nurses working in long-term care or nursing home settings don't encounter as many challenges as hospital nurses or have the opportunity to use their critical thinking skills in ways that nurses in acute care environments do, but that's not the reality, explained Naomi Prendergast, president and chief executive of the D'Youville Life and Wellness Community in Lowell, Mass. Patients at skilled nursing facilities these days often are there for short-term post-acute care.

In Massachusetts, more than half of the residents admitted to skilled nursing facilities return home within a month after a rehabilitative stay, according to the Massachusetts Senior Care Association, the state's largest long-term care provider association.

On D'Youville's 75-acre campus, staff members care for short-term rehabilitation patients, residents in a nursing home, including patients with dementia, and residential hospice patients. (The property also has apartments for independent living and will begin construction this spring on 15 assisted living apartments and 45 apartments of supportive housing, where residents will have access to coordinated home care services.)

The University of Massachusetts Lowell School of Nursing and D'Youville received a $50,000 grant in 2011-12 from the Massachusetts Department of Higher Education, part of it for use on an academic-practice partnership. They formed a clinical education model known as a "dedicated educational unit," where nurses in a skilled nursing environment at D'Youville serve as clinical teachers for nursing students.

A rotation for a nursing student often involves one professor visiting a clinical setting with six to eight students. Under the model being used by the UMass Lowell School of Nursing and D'Youville, junior year nursing students are paired up with a nurse at D'Youville's Center for Advanced Therapy during a seven-week rotation in gerontological rehabilitation nursing. They work directly with select nurses who applied to take part in the program.

The nurses working with the students used to receive a stipend through the grant. When the grant ended, the D'Youville nurses opted to continue their instruction of the students, telling program organizers it was energizing to know they were able to contribute to the students' education. Ninety-six UMass Lowell students have completed the rotation, and some of the D'Youville nurses working with the students have returned to school to pursue higher-level degrees, motivated to pursue more education because of their time with the students and the program.

Karen Devereaux Melillo, director and chair of the School of Nursing in the College of Health Sciences at UMass Lowell, said most of the clinical teachers on-site at D'Youville are registered nurses. If they don't have a baccalaureate degree, they still can educate the students while at D'Youville, but an additional level of oversight is put into place.

The nursing students learn hands-on skills, such as how to change a complex dressing or assist with an intravenous line, and Melillo said they also learn how to integrate body, mind and spirit care for older adults. They learn psychosocial interventions that are a dimension of caring for older adults. For instance, students learn specific ways to reminisce, ways to have a dialogue with structure, as a patient intervention. "Therapeutic use of the self can make a difference in the life of an older adult," she said.

Melillo said sometimes nursing students don't know about the many workplace options available to them beyond the emergency departments or neonatal intensive care units they've seen on television shows. "What they don't know is what they haven't been exposed to." As part of their education, the UMass Lowell students also have clinical rotations in maternity, psychiatric and mental health nursing, and pediatric nursing followed by more training in critical care their senior year.

The rotation at d D'Youville has led some nursing students to consider careers working with an older population. Nicole VanKuilenburg, a UMass Lowell nursing student from Billerica, Mass., may pursue that path. "I had no interest in working with a geriatric population; but after this rotation, I'm highly considering it," she said.

She said she found the work at D'Youville interesting and she enjoyed forming relationships with those in her care as well as some of their family members. During her rotation, she kept the same hours as Christopher Knickle, the nurse with whom she directly worked. Lea Dodge, a UMass Lowell faculty member, oversees the D'Youville staff nurses in their roles as clinical teachers; the clinical teachers provide input to Dodge for student evaluations, and Dodge assigns the students' written work and grades.

"I had 10 times more patient contact and experience in this rotation than I did in my psychiatric rotation," VanKuilenburg said. "The DEU (dedicated educational unit) program was phenomenal."

 

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