Acumentra Health: Safety & quality initiatives

"Acumentra Health assists health care providers (hospitals, physician practices, home health agencies, nursing homes, behavioral health, managed care, and others) in a wide range of initiatives to improve patient safety, cost effectiveness, and quality of care."

Acumentra Health assists health care providers and clinicians in a wide range of initiatives to improve patient safety, effectiveness of care delivery, and quality of care including nursing home safety and quality initiatives. The Medicare projects include pressure ulcer prevention and reduction of restraint use. Other initiatives include "Advancing excellence in America's Nursing Homes and Pain Management Resources. Comprehensive resources for restraint use reduction: patient safety/resident safety culture surveys; tools and resources; falls investigation guide toolkit (coming, not posted as of 11/30/11); links to other useful tools from other organizations such as:

• Hand hygiene video training (somewhat dry) and self-assessment tool
• STAR (Setting Targets Achieving Results)

Faculty can have student access site to learn more about patient safety, restraint use and pain management. Comprehensive resource for restraints

Alzheimer’s Disease Association Videos/Interactive material

Website for this global organization (content offered in multiple languages). The mission of the Alzheimer’s Disease Association is to “eliminate Alzheimer’s Disease through the advancement of research, provide and enhance care and support for all affected, and reduce the risk of dementia through the promotion of brain health.”

This site is a goldmine of resources targeted to the public, family caregivers, health care providers, and researchers. Materials include interactive presentations, video clips, fact sheets, stories by families, quizzes and assessment tools, and text-based information. Has a lending library of text and media resources. Provides links to local chapters and other key resources for people affected by Alzheimer’s Disease (patients, families, providers, researchers).

Content includes information on brain health, pathology associated with A.D., clinical manifestations and treatment, suggestions for caregivers, financial information for families, legal and policy implications of the disease, and resources for researchers. Here are a few examples of content:

1. Inside the brain: An interactive tour. Sixteen-slide overview of the brain, its anatomy and the pathology associated with A.D. and symptoms. Interactive; excellent, basic review of brain function and changes associated with progressive A.D.http://www.alz.org/alzheimers_disease_4719.asp
2. Differential Diagnosis of AD Algorithm: AHQR guidelines for ruling out conditions that are similar to A.D. including specific diagnostic activities. http://www.alz.org/professionals_and_researchers_diagnostic_procedures.asp
3. What is Alzheimer? Text with illustrations that discuss the disease, symptoms, presentation, progression. References cited. http://www.alz.org/alzheimers_disease_what_is_alzheimers.asp
4. Video Understanding A.D. http://www.alz.org/research/video/alzheimers_videos_and_media_understanding.asp target="balnk" 13 minute video clip r/t the importance of early diagnosis. (Developed by HBO & NIA)
5. Library Look at the various resources available from the A.D. These are for lay people and professionals.http://www.alz.org/library/lists.asp

Aging in the Know: Health in Aging

Created by the American Geriatrics Society Foundation for Health in Aging (FHA), Aging in the Know offers up-to-date information geared towards Older Adult consumers on health and aging. Overseen by a team of experts on caring for older adults, Aging in the Know content is based on resources that the American Geriatrics Society has developed for its professional members.

In depth information about the aging process, and questions for consumers to ask themselves and health care providers. Geared towards Older Adults, there is an active mailing list to receive the latest news, research updates page, glossary of terms. Information on common diseases and disorders that affect older adults. The "What to Ask" Series provides older adults with practical questions and tips to help them work with their provider on developing the best plan of care for the older adult. Also useful for family caregivers of older adults.

Faculty can have students in the community (population)course, leadership course, and chronic I and II access site to learn more about the aging process, health care decisions and trends in the elderly population. The site also provides specific information about community-based care, hospital-based care, and nursing home care. This website is geared towards educating older adults and family caregivers.

Bandwidth: The online Communications Resource for Grantees of The John A. Hartford Foundation

Bandwidth is the John A. Hartford Foundation's one-stop, online source for communications tools and information. The site is designed to help grantees and other professionals enhance, strengthen, and add visual impact to a variety of publications, presentations, and communications about aging and health.

Images, Stories, examples of key messages, how to create public announcements and share them quotes, poster tutorials and examples and a newsletter.

Students could use this in developing presentations, using the quotes add images, ideas for disseminating research data sharing etc.

Best Practices for Elder Care

The Best Practices for Elder Care course focuses on critical care nursing with older adults. The self-paced program consists of four units of instructional content, four units of interactive case studies, and one 17-question self-assessment unit. Completion of the course is worth 4.0 hours of continuing nurse education (CNE) credit. AACN offers this CNE credit at no charge to AACN members. Nonmembers shall remit a reduced fee of $12 to receive their CNE certificate.

Online Education Module for critical care nurses working with older adults. The four modules are titled 1) Considerations for care 2) Physiologic changes of aging 3) Healthy care framework 4) Other frameworks for care. Once the modules are complete then you have the option of exploring four case studies. The course can be slow to load at times.

Have students work through module case studies and have them explain usefulness. Preparation for a critical care clinical experience/rotation.

Better resources for better care: A new look at the old Lippincott’s Learning Center.com

This site provides information about the care of those over 65, derived from cutting-edge research and best practices, is now available to nurses and other providers in either print format or streaming video, at any time and at no cost, through this series called "A New Look at the Old". The print series began in the August 2004 issue of AJN, and continued until December 2006. You can read or download the articles. The broadcast series is based on the content of the articles found in AJN, but includes additional content. Those interested in viewing the 60-minute or 30-minute programs which began in January 2005, can click on the titles under the broadcast heading. These programs are archived for viewing at any time. No charge for above materials. Some items include continuing education units for a small fee.

Oral hydration
Bathing the older adult with dementia
Sensory impairment
Presentation of illness in older adults

Students interacting with people with older adults. Many of the resources address concepts that are applicable across care settings and with diverse older populations. These resources might be tapped for acute or chronic illness courses as well as leadership, population health and integrative practicum.

Campaign for Better Care

A website for the Campaign for Better Care a broad-based coalition group that has an agenda to improve the health care delivery system for all people, including older adults. Website describes the campaign and issues regarding our current health care delivery system, stories from people in communities, and how to help the group. From their website “The Campaign for Better Care is led by the National Partnership for Women & Families, Community Catalyst, The Leadership Conference on Civil and Human Rights, and the National Health Law Program — and funded by The Atlantic Philanthropies. The National Partnership is a non-profit, non-partisan organization.”

Information about the Affordable Care Act (ACA) including a time line for implementation of specific features of the Health Care Reform Act and their impact on older adults, recent press releases and articles from organizations as well as stories and photos about people dealing with the current health care system and upcoming legislation. Provides 'fact sheets' on chronic illness including demographics, socio-economic implications and policy implications. Links to other excellent websites such as the Kaiser Family Foundation that has a 10-item quiz, 'test your knowledge' about the ACA. Compares individual scores with national knowledge about the ACA; dispels myths about the ACA: http://healthreform.kff.org/the-basics.aspx Includes information about electronic health records, and several current/proposed models for seamless and more effective health care delivery (e.g., PACE model; Medical Care Home model).

Excellent policy site related to health care reform. Describes this group's principles for reform and metrics for measuring reform success. Review the website's fact sheets on chronic illness and the time line and activities behind the Affordable Care Act (ACA), could be used in Chronic Illness, Leadership and Community (Population) Health courses.

Center for Personal Assistive Services (CPAS)

The CPAS website has a wealth of information regarding personal assistance services, including research, training, dissemination and technical assistance. Personal assistance includes paid assistive personnel, family caregivers, and devices that promote independence . A very large website that covers a broad range of information, research, and issues around assistive services. Includes webcasts, journal articles, links, presentations, webcasts, policies, guide for caregivers and workers, guides for workplaces, legislation and state-by-state resources. The Guide to Center Information organizes site content by target audience (e.g., person with a disability, caregiver, researcher, professional health care provider).

Six main content areas on website regarding PAS: For PAS users, Disability Statistics, Home and Community Based Programs, Caregivers & PAS Workers, Economics and Workplace, and Emergency Preparedness.

Content is appropriate for use in a Chronic Illness course, Community (Population) nursing course. Have students watch the video about Richard and address issues about functional health, safety, and quality of life.

CHAMP Advancing Home Care Excellence

A large diverse website that has e-learning courses, resources, expert advice, best practice documentation and recommendations available to the community. "Collaboration for Homecare Advances in Management and Practice. The CHAMP Program is the first national initiative to advance home care excellence for older people. CHAMP makes the latest evidence based tools, e-learning and expert advice easily accessible to home care clinicians, from any computer". Much of the content comes from links to other sites (e.g., ConsultGeriRN; PHI). However, this site is very comprehensive and home-care/community-based nurses will find the resources appropriate and very helpful.

Online education modules for RNs, Certified Clinical Case Managers, Frontline Nurse Managers and more (course costs range $50-$150). Resource section has Tools (assessment/management tools listed by topic), evidenced based guidelines, journal articles, and meta-analyses available to download. Links section of website has links back to other organizations interested in health care quality, older adults and team-building. Copies of presentations about the CHAMP program as well as topics at their meetings and workshops are also available for download. The news and events section of the website is up to date and includes national conferences as well as virtual webinars.

Content is appropriate for use in a Chronic Illness course, Community (Population) course, or Leadership Nursing course. Students will find resources for planning in-service projects for ancillary staff as well as basic content about community-based care for older adults (e.g., culture change, coaching-supervision of staff, practice protocols for pressure ulcer prevention). The resources section is probably the most helpful section.

ConsultGeriRN.org

“ConsultGeriRN.org is the evidence-based geriatric clinical nursing website of The Hartford Institute for Geriatric Nursing, at New York University's College of Nursing.”

ConsultGeriRN.org is part of the “practice” portion of the Hartford Institute of Geriatric Nursing. “ConsultGeriRN.org addresses the need that many nurses face to improve older adult patient outcomes through better staff education and access to evidence-based knowledge.”

On ConsultGeriRN.org you will find:

• Evidence-based Geriatric protocols for managing common geriatric syndromes and conditions;
• Portals to specialty nursing associations’ geriatric care knowledge bases and national geriatric web sites;
• The Try This Assessment tools series with over 30 nationally recommended instruments for use with older adults;
• Hospital competencies for older adults for use in nurse orientation and evaluation and much more.”

The site contains videos and articles on various protocols and topics pertaining to the older adult. There is the Try This:® Series which focuses on “assessment tools and topics specific to a syndrome, specialty and the older adult population.” The videos are excellent, demonstrating use of the assessments with real nurses and real patients/clients.

This is an excellent resource for nurses at all levels. Students will see modeling of nurse-patient interaction, assessment techniques, and more. Instructors can use portions of videos in class and refer students to videos for independent study. The tools are useful in all care settings: Acute care, Population/community based nursing, Long-term care.

Delirium in the Older Person

A web page developed by the Vancouver Island Health Authority Mental Health and Addiction Services Agency. This is a very specific resource for distinguishing delirium it is geared towards families and health professionals.

They have developed many PDF downloads that are available for free in the subject areas of About Delirium, Quick Reference Tools, Prevention, Recognition, Assessment, Intervention, Quizzes to practice your delirium knowledge and Professional Practice Resources as well as book recommendations on the subject. There is also an engaging video called Delirium in the Older Person Family Guide with three different parts. (http://www.viha.ca/mhas/resources/delirium/family_guide.htm). There are also award winning DVDs that they have developed available for purchase.

Have students watch the videos, download the PDFs and take the quizzes about delirium.

E- Aging

Western Australian Center for Health Aging online aging resource. Developed after focus groups with audiences to determine their needs. 10 modules each with an interactive case study to deepen the learning. Each module has objectives, pre-module test, and resources with power point downloads. Also within each objective is a case study which includes images, history of complaint, medical history, medication history, social history and assessments and an interactive interview where you click on the question to get the answer from the client. Final state of the interview includes a physical examination where you can hover your mouse over different parts of the body to get different results. Then you get to see results of various tests and select the diagnosis you think most appropriate, feedback is given on all options.

The module topics are Delirium, Continence, Dementia, Falls, Depression, Geriatric Assessment and Planning , Stroke, Rehabilitation, Health Aging and Residential Care.

Have students complete a case study based on the topics they are currently covering.

Geriatric Medication Management Course (Collaboration for Homecare Advances in Management and Practice CHAMP)

CHAMP's Geriatric Medication Management course has been approved by the Commission for Case Manager Certification (CCMC) as a continuing education activity for certified clinical case managers.

Fee: $149
1. Medication Reconciliation Process Lesson Demonstration Video (Length 2:07 minutes): http://www.champ-program.org/static/3080-demo/Unit2Lesson2/Unit2Lesson2.htm Learning outcomes:
Unit 1: Current Medication Management Practices

• Describe the impact of medication-related problems in older home care patients.
• Describe your team's current medication management practice.
• Unit 2: Medication Reconciliation
• Define Medication Reconciliation and explain its importance in medication management.
• Describe the 3-step process for conducting a medication reconciliation.
• Identify how to improve your team's medication reconciliation practice using the tools and strategies provided in this unit.

• Define Medication Reconciliation and explain its importance in medication management.
• Describe the 3-step process for conducting a medication reconciliation.
• Identify how to improve your team’s medication reconciliation practice using the tools and strategies provided in this unit.

• Explain which important medication-related problems you should be communicating to the patient's physician.
• Define the Situation-Background-Assessment-Recommendation (SBAR) technique
• Identify how to use the SBAR technique to effectively communicate medication-related issues to physicians.

• Re-measure your clinical team's medication management performance.

Possible leadership course or nursing student discussion (eg. brown bag medication review with clients). Designed for frontline nurse managers, clinical directors, QI/QA officers, and clinical case managers. 10 CE hours for registered nurses and certified clinical case managers. Tuition $149 per participant for lessons.

Geriatric Pain

This web resource (GeriatricPain.org) is to identify and share best practice tools and resources that support recommendations for good pain assessment and management in older adults. The web site is organized into categories of emphasis with tools selected to assist nurses with responsibility for pain care in the nursing home. Free evidence-based tools and best practices for nurses who work in nursing homes.

Excellent resource about pain management, interventions, myths, communication - educational content for educators, family caregivers, nursing home & long term care setting staff. Website has power points, pdf files, & word documents.

Learning outcome: Describe the core principles of pain assessment, recommendations for effective pain management and tools for assessing, documenting and monitoring pain in cognitively intact and cognitively impaired older adults. Review of terminology, key principles for pain management, and tools for documenting and communicating pain treatments and response to treatment; communicating with prescribers; and monitoring analgesic therapy.

World Health Organization WHO Ladder (pdf file with drawing). Review of WHO's Pain Ladder, part of an overall pain treatment method: WHO Ladder

Side Effects Management - List of side effects associated with opioids and recommendations for management: Side Effects

Serial Trial Intervention Overview - Brief explanation: Serial Trial Intervention Overview

Putting the Serial Trial Intervention into Practice - Step by step process for implementing the Serial Trial Intervention for use for patients with advanced dementia: Putting the Serial Trial into Practice

Documenting Use of the Serial Trial Intervention - Form for documenting the use of the Serial Trial Intervention: Documenting Serial Trial Intervention

• Overview
• Cold
• Controlled Breathing and Guided Imagery
• Distraction
• Heat
• Massage
• Music
• Positioning
• Relaxation

Communication tools for pain management (Use these tools and resources to help you communicate information about pain assessment, pain symptoms, and pain treatment recommendations):http://www.geriatricpain.org/Content/Management/Tools/Pages/default.aspx

Faculty can provide students with these easy to use resources on pain and addiction terminology as well interventions such as the WHO Ladder, side effects management, non-drug management, brief introduction to Serial Trial Intervention. Faculty can review the communication tools with students when studying pain management. Review list of myths about pain with "reality" explanation including table listing assessment and intervention approaches for specific older adults and family barriers to pain management: Pain Myths

Geriatrics and Palliative Care Blog

Forum for discourse, recent news and research, and freethinking commentary. Won the Best Clinical Weblog of 2010.

Brief review of palliative care and geriatrics for faculty/students - information is based on expert opinion.
Objectives for blog are:

• To create an online community of interdisciplinary providers interested in geriatrics or palliative care;
• To provide an open forum for the exchange of ideas and disruptive commentary that changes clinical practice and health care policy;
• To change the world. They aim to be inclusive and welcome the perspectives of generalists, specialists, gerontologists, palliative care clinicians, and anyone else interested in care of the elderly or palliative care.

Faculty and students can access site for review on palliative care, end of life care and geriatrics. Faculty can have students explore current concerns and perspectives of a wide range of health care providers.

Hartford Institute for Geriatric Nursing

Gerontological Nursing Certification Review Course Sign-up

Fee: $150
To help nurses prepare to sit for the American Nurses Credentialing Center's (ANCC) Gerontological Nurse Certification Examination. Provides a summary of current key clinical information and issues central to caring for the highly specialized needs of older adults and the current financial, social, political, and cultural issues that affect nursing care for the older adults.

Review course to sit for the ANCC Gerontological Nurse Certification Examination. Fee for this course is $150.00 and earn 10 Contact Hours.

Hospital Elder Life Program (HELP)

This website provides information about recognizing delirium (new mental confusion). It also describes a program that prevents delirium in hospitalized older people, the Hospital Elder Life Program (HELP).

Preventing & treating delirium in the hospitalized older adult. Family materials: going from hospital to home; Hospital visitation guide; & links. Confusion Assessment Method (CAM), detailed document for assessment of the Hospitalized elder. (link to CAM) http://www.hospitalelderlifeprogram.org/private/cam-disclaimer.php?pageid=01.08.00

Students can review delirium, safety in transitioning from hospital to home, and how to avoid confusion in the hospital.

Improving Nursing Home Compare: Five star Quality Rating System

Center for Medicaid and Medicare developed an online Power Point Presentation to inform consumers on changes to how they are improved their website Nursing Home Compare LINK. An in depth power point explaining their 5 star rating system and how the system is applied to individual nursing homes. Background information about as well as screen shots of their new web interface are shared. Go to Nursing Home Compare for acutual comparison database.http://www.medicare.gov/NHCompare

37 slide power point.

Review for deeper understanding of how CMS regulates nursing homes and provides this knowledge to the public.

Look at me - Video hosted on YouTube

"A video that paints the portrait of one resident of a nursing home, reviewing his life that led him to where he is today. Show this video with a brief discussion afterwords or in conjunction with the home vs. homelessness exercise. From the Veterans Administration, used with permission."

YouTube video with the poem, "Look at Me" set to music (Length: 3 minutes, 50 seconds). Depicts of the life of one man and looking beyond the surface. Addresses stereotyping, ageism.

Use video in class or as assigned & reflect on impressions after viewing. Useful to develop empathy, avoid stereotyping elders.

Making Oregon Vital for Elders (M.O.V.E.)

Mission: "To create and sustain personalized, enriching communities where older adults and those who support them can thrive."

Vision: "Oregonians will live and work in communities that embrace aging; where individual contributions are valued, unique talents celebrated and personal life experiences honored."

This is a national grassroots organization committed to changing the culture of aging in America. Oregonians, from a variety of organizations, developed a statewide coalition in which ideas and actions come together to support culture change.

"Culture change has been defined by the Pioneer Network as "a transformation anchored in values and beliefs that return control to elders and those who work closest with them. Its ultimate vision is to create a culture of aging that is 'life-affirming, satisfying, humane, and meaningful.' Culture change can transform a 'facility' into a 'home,' a 'resident' into a 'person,' and a 'schedule' into a 'choice.'"

Website has descriptions of culture change and vision with excellent resources linking to other sites and organizations that share the same vision.

1. View site for current & previous projects geared towards empowering elders:
   Projects include: Client Care Monitoring Unit (CCMU) Culture Change Initiative, Oregon Local Area Network for Excellence (O-LANE), Enriched Clinical Learning Environments through Partnerships (ECLEPs), Jobs to Careers, Nursing Home Collaborative (Hartford Center of Geriatric Nursing Excellence), OGEC Resource Center (part of the Oregon Geriatric Education Center), Hartford Center of Geriatric Nursing Excellence Best Practices Initiative (BPI), Better Jobs Better Care (BJBC), and Leading Edge Network.
2. Culture change resources (newsletter, publication, articles, books)
3. Link to quick tips and tools

Faculty and students can use this website to connect with other organizations in Oregon and access resources dedicated towards empowering elders and learning more about culture change. This site has tools for measuring readiness for culture change and artifacts for culture change and is useful for chronic illness or population-based nursing courses to evaluate the environment.

Medicare- Health and Drug Plans

Medicare.gov is a consumer beneficiary Website that provides access to information about Medicare, Medicare health plans, contact information and publications, as well as information about health care fraud and abuse and nursing homes.

Tools with "personalized search (eg. entering zip code) may provide you with more accurate cost estimates and coverage information." Provides basic knowledge on Medicare benefits Parts A, B, C, and D.

Faculty and students can use this site for Medicare information and complexities of Medicare. Useful for chronic illness, population-based nursing, and leadership courses to understand federal health care benefits for people over 65 years old.

National Database of Nursing Quality Indicators (NDNQI)

The National Database of Nursing Quality Indicators, established in 1998, is a proprietary database of the American Nurses Association. The database collects and evaluates unit-specific nurse-sensitive data from hospitals in the U.S. Participating facilities receive unit-level comparative data reports to use for quality improvement purposes. "University of Kansas School of Nursing administers the NDNQI program and provides ongoing nursing-sensitive indicator consultation and research-based expertise to the NDNQI. The School of Nursing primarily conducts research on clinical and health policy topics in two areas - health behavior and symptom management research, and clinical and organizational systems research."

Pressure Ulcer training program (1.5 contact hours): https://www.nursingquality.org/NDNQIPRESSUREULCERTRAINING/SelectModule.aspx Pressure Ulcer training program - After reviewing the training modules and passing module tests, you will be able to:

• Accurately stage pressure ulcers from photographs and wound description
• Differentiate a pressure ulcer from other types of wounds
• Describe pressure ulcer data collection procedures
• Distinguish among a community-acquired, hospital-acquired and unit-acquired pressure ulcer

Increase knowledge about hospital quality improvement and the role of the American Nurses Association. Pressure ulcer identification training program has excellent photos and clear descriptions of different stages of pressure ulcers and other tissue damage. Could be used as a self-paced, independent learning activity related to pressure ulcer identification. The Pain Care Quality Survey takes the participant through the detailed process of data collection in research. Content includes information on the challenges of reliably collecting study data. This training program also illustrates the need for translational nursing research that could stimulate discussion about the importance of research for practice and ways to participate in nursing research. Could be a springboard for discussing human subject protections, bias in research, and how investigators minimize error in data collection.

Nursing Home Compare

Medicare guide step-by-step on comparing nursing homes. Go to Improving Nursing Home Compare: Five star Quality Rating System for a slideshow describing this rating system.

"This tool has detailed information about every Medicare and Medicaid-certified nursing home in the country." Find Nursing Homes in your area. Search by name, city, county, state, or ZIP code. Compare the quality of the nursing Homes you're considering using the Five-Star Quality Ratings, health inspection results, nursing home staff data, quality measures, and fire safety inspection results.

Students can learn about evaluating and comparing nursing homes, filing complaints, and nursing home client rights. Useful for chronic illness, population-based nursing, and leadership courses.

National League for Nursing (NLN)

The National League for Nursing advances excellence in nursing education that prepares the nursing workforce to meet the needs of diverse populations in an ever-changing health care environment.
A three-year Advancing Care Excellence for Elders (ACES) grant, funded by the John A. Hartford Foundation, is a collaborative effort between the National League for Nursing and Community College of Philadelphia (CCP).
This grant has four objectives:

• Develop a set of minimum standards of the knowledge, skills, and attitudes required to care for older adults for pre-licensure nursing students.
• Disseminate and publicize minimum standards and existing resources.
• Provide NLN-based faculty development workshops about use of the minimum standards and other products and tools developed with Hartford Foundation funding.
• Enhance student expertise in geriatric care by incorporating appropriate content into clinical nursing education through the innovative use of simulations and unfolding case studies.

Advancing Care Excellence for Elders (ACES):

1. Guides the teaching of nursing students to provide competent, individualized, and humanistic care to older adults.
2. Addresses the complexity of decision making about care for the older adult in a variety of home, institutional and community-based settings.
3. Provides a foundation for faculty to advance care excellence for seniors.

1. Millie Larsen - An 84-year-old Caucasian female living alone at home. Medical problems include: hypertension, glaucoma, osteoarthritis of the knee, stress incontinence, osteoporosis, and hypercholesterolemia. She is taking several anti-hypertensive medications. She is now in the hospital with a diagnosis of urinary tract infection and dehydration. Her presentation is atypical and she is confused. Faculty can choose from 3 possible scenarios.

The learning objectives focus on assessment, appropriate use of assessment tools such as the SPICES and Heinrich Falls Risk, and Confusion Assessment Method (CAM); communication skills; conflict between Millie and her daughter on living arrangements; functional assessment; discharge teaching; and making appropriate referrals.

2. Red Yoder - An 80-year-old farmer who lives alone in his farmhouse. Medical problems include insulin dependent diabetes complicated by an open foot wound, incontinence, and difficulty sleeping.
The first scenario occurs in Red's home during a visit by the nurses from the home health agency to assess the breakdown on his toe. During the assessment, Red reveals that he is having problems sleeping and some urgency incontinence. The scenarios depict a variety of situations including a trip to the hospital to rule out sepsis, psychosocial issues such as functional decline, alcohol use, and possible elder abuse.
The learning objectives focus on general assessment, appropriate use of assessment tools such as SPICES, the Katz Index of Independence in Activities of Daily Living assessment tool; the Pittsburgh Sleep Quality Index (PSQI), the Elder Mistreatment Assessment, and the Alcohol Use and Screening Assessment. In addition conflicts regarding living arrangements are addressed.
3. Henry and Ertha Williams - A 69-year-old African American, a retired rail system engineer who lives in a small apartment with his wife Ertha. Henry is concerned about Ertha because she is experiencing frequent memory lapses. Henry is admitted to the hospital when he could not catch his breath. Henry has several medical problems including COPD, hypertension, and high cholesterol. The simulation scenarios focus on the physical and psychosocial changes that Henry encounters over the next few weeks.
The learning objectives focus on assessment and appropriate use of assessment tools such as SPICES (tool that deals with Sleep disorders, Problems with eating and feeding, Incontinence, Confusion, Evidence of falls, & Skin breakdown), the Geriatric Depression Scale, the Modified Caregiver Strain Index, the Beers Criteria for Potential Inappropriate Medication Use in Older Adults, and the General Anxiety Disorder 7 (GAD-7). The objectives also focus on psychosocial issues with Henry's wife and their daughter-in-law's concern for their living arrangements, the proper use of the SBAR tool (Situation, Background, Appearance, Request), and making appropriate community referrals.

4. Julia Morales and Lucy Grey Julia Morales, age 65, and Lucy Grey, age 73, are partners who have been together for more than 25 years. Julia has lung cancer, which has been treated with chemotherapy and radiation, and now she wishes to stop treatment. Lucy is supportive and feels she will be able to care for Julia in their home. Lucy's past medical history includes a knee replacement. Their support system includes Julia's son, Neil, and Lucy's niece, Nora.
The scenarios begin with the home health nurse evaluating Julia after she has decided to stop treatment for her lung cancer. In the second scenario the end of Julia's life is near and she is surrounded by her loved ones and the hospice nurses. Julia dies during this scenario. The learners are introduced to supportive measures for both the patient and the family during this process. The final scenario concentrates on Lucy and the difficulties she has adjusting to her new life after Julia is gone.
The learning objectives focus on the students' assessment of Lucy's grieving process, how well she is coping, and the physical changes that she has experienced over the past few months.

Faculty can use the well-designed unfolding cases for acute care, chronic care, population, and leadership courses. Faculty can modify the cases to meet the needs of their curriculum and have students access function and care depending upon each unfolding situation.
"Using ACES, the teacher assists the student to develop nursing judgment, to notice what is happening by assessing the person's functional status as well as the strengths, resources, needs, cultural traditions, wishes, and expectations of the older adult and caregiver. Teacher and student use evolving, evidence based geriatric knowledge, technology and best practices to encourage a spirit of inquiry and provide competent care for the older adult."

Older Adult Focus: Competency Development and Evaluation for Health Professionals and Others who Work with Older Adults.

“The materials on this website were created for people who work with or plan to work with older adults but may not have had specific education in gerontology or geriatrics.”

The content was developed by Linda Felver, PhD, RN & Catherine Van Son, PhD, RN. Updated 2011.

This is an excellent resource full of useful information and tools:

• Use the subject index to find resources on a specific topic, such as driving, polypharmacy, or dementia.
• Use the teaching tool index to find videos, audio clinical stories, puzzles, evidence-based assessment tools, and other materials ready for you to use in teaching and learning.
• Nine competencies have been developed to assist and structure your learning. Three of them focus on individual older adults, three on older adults and caregiver issues, the last three focus on older adults and system issues.

Nursing faculty can access the multiple learning activities that include assessment tools, audio clinical stories, case studies, fact sheets, handouts, and power point presentations on a wide variety of topics in gerontology. Students can complete various competencies; for instance, increasing an awareness of attitudes, values, and expectations about aging and their impact on care of older adults and their families. These excellent and thorough competencies can be used as self-paced, independent learning activities.

Oregon Geriatric Education Center

The Oregon Geriatric Education Center (OGEC) serves the state of Oregon. The mission of the OGEC is to improve the care of older adults through the interdisciplinary education and training of health care providers.
The OGEC is a consortium of key faculty and staff from the following institutions:

• Oregon Health & Science University Schools of Nursing and Medicine
• Oregon State University Extension Service and College of Pharmacy
• Portland State University Institute on Aging and School of Social Work

A membership library located at Portland State University. The library maintains a collection of 1,500 resources, including books, videos, DVDs, games and other instructional materials related to geriatrics and gerontology. Members can access educational materials by searching the on-line catalog or by stopping by the Center. Materials can be picked up in person or mailed directly to members at no additional cost:
Access list of educational materials with links: Click here to get educational materials

1. Oral Health Care brochure (pdf)

2. Geriatric Assessment Card Set 2009 - Excellent resource card (quick reference lists) with information about principles of prescribing older population and what medications to avoid in the elderly, medical decision making, guardianship, capacity assessment for writing a will, functional assessment, incontinence algorithm, geriatric depression screen, alcoholism screen (CAGE), Modified Caregiver Strain Index, antidepressants, Confusion Assessment Method (CAM) Diagnostic Algorithm, Origin of Behavioral Symptoms, comparing and contrasting types of dementia, Cognitive Evaluation, mini-mental state examination (MMSE), Symptomatic approach to behaviors in dementia using medications & targeting symptoms (pdf).

3. Tai Chi: The Way to Better Balance (OSU student video) on Youtube (Length: 12:51 minutes)

4. General Tips for Management of Delirium - Succinct and useful guide, including medications to avoid (pdf).

Faculty and students can use this site for accessing educational materials, video link on maintaining balance by Tai Chi to decrease falls, and downloading the Geriatric Assessment Card Set and pdf file on tips for managing delirium.

Parkinson's Disease Foundation:Take Action: Help to Ensure the Best Nursing Care for People with Parkinson's

Read the latest Parkinson's community news - events in the Parkinson's community, personal stories of living with Parkinson's Disease (PD) and new resources to help those living with Parkinson's.

(from website) "An online course - Parkinson's Disease Across the Lifespan: A Road map for Nurses - ensures that nurses have the opportunity to learn the latest in Parkinson's comprehensive care. Designed by Parkinson's nurse specialists, the course was taped in front of a live audience on May 21 at the New York Academy of the Sciences in New York City and web cast to hundreds more nurses throughout the US."

"The course includes modules discussing the challenges of Parkinson's throughout the lifespan, and the vital role that nurses can play in managing care. Modules are led by Parkinson's nurse specialists, physical therapists and people with PD. Nurses can earn continuing education credits by watching four modules, each of which is approximately one and a half hours in length, and by taking brief exams following each one."

Nurses can complete the course at one sitting, or can finish each module separately. The course will be available online, 24 hours a day, seven days a week, until June 1, 2011. This was still available on 10/3/2011.

Nursing Educators: Show the online course to your students and ask them to complete the online tests at home. From the site:
"If you are teaching a nursing class, we would be pleased if you would share this resource with your students. You can do this by broadcasting the course in class, one talk at a time, when it is convenient to your teaching schedule. If your students want to test themselves and get educational credit, they would then need to sign up themselves and take the four, short online tests to get their own certificate."

PHI Training & Organizational Development Services

PHI offers both home- and facility-based providers training and organizational development services to manage change and create dynamic relationship-centered organizations that better serve elders, people with disabilities, and their families.

Staff training resources for culture change & best practice [building skills for relationship centered care]. Best practice profiles; Blog: what matters most to residents; exemplars of care. Learning modules:

• Adult Abuse & Neglect Prevention Training: Twelve modules, each 60 minutes long, focus on developing skills to prevent abuse and neglect, as well as other communications and relational skills [includes detailed modules with fun activities such as "behavior bingo" with detailed descriptions of how to use curricula]
• Adult Learner-Centered Training: An Introduction for Educators in Home and Residential Care
• Fall Prevention Awareness: An enhanced training curriculum by PHI and the National Council on Aging
• HeartWork: A video celebrating the lives of direct-care workers. Cost: $149 for the DVD or video.
• Free glimpse of video (HeartWork, A play about Home Health Aides: Janie Dixon's Story): http://www.youtube.com/watch?v=Z-jNdFfBj6c
• Peer Mentoring: A workshop series for direct-care workers in home and residential care
• Personal Care Services Curriculum: Providing Personal Care Services to Elders and People with Disabilities
• PHI Coaching Supervision?: Introductory skills for supervisors in home and residential care
• Spanish Language Curricula: Currículos en Español
• Successfully Employing Your Personal Assistants: A Workshop Series for People with Disabilities

Resource for students to view best practices in long-term care (LTC) & a variety of community based settings. Portions of the curricula could be used regarding falls prevention or Abuse & Neglect Prevention. Courses: Health promotion, chronic & community-based nursing.

Pioneer Network : Changing the Culture of Aging

"Pioneer Network advocates for culture change in eldercare models from long-term nursing home care to short-term transitional care to community-based care in order to create homes that are consumer-driven and person-directed." Formed in 1997 by "prominent professionals in long-term care to advocate for person-centered care."

A collection of culture change tools, resources, & information for providers, consumers, educators, & policy makers. This is a comprehensive site that explains culture change, why it is important, and how to accomplish it. There are tools for consumers, providers, and policy makers. Below are listed some of the topics but this site is too extensive to list all here.
Interactive resources & tools:

• Artifacts of Culture Change
• Design on a Dollar
• Consumer Community Outreach Toolkit
• Tools for Change
• Promising Practices
• Case Studies

• Getting Started Manual
• Design on a Dollar
• Positive Outcomes of Culture Change
• Case Studies
• Artifacts of Culture Change: register to use for benchmarking (an assessment tool)
• Promising Practices
• For Nurses
• Creating Home Consumer Project
• Provider Tools, Articles and Links: link to the "readiness assessment tool from NC Nova

Have students observe interactions of staff or students with elders after reading module and identify "elderspeak" issues. Have them practice and give feedback to each other.
Have students use the "readiness for culture change assessment" as part of an environmental assessment of a long term care or residential care agency.

http://www.pioneernetwork.net/Providers/ProviderTools
http://www.ncnova.org/upload/doc/nc_nova_assessment_tool.pdf

Have students "research" as a consumer for a nursing home for their family member & identify aspects they view as important.

Assess the home environment and identify where their agency is on the continuum of culture change. Then identify a cost-effective change that is evidence-based, that would move the agency further on the continuum.

POGOe - Portal of Geriatric Online Education

"Portal of Geriatric Online Education (POGOe) is a free public repository of a growing collection of geriatric educational materials in various e-learning formats, including lectures, exercises, virtual patients, case-based discussions, simulations, as well as links to other resources. New products are added every month. POGOe's mission is to promote geriatric education through the provision and encouragement of free exchange of teaching and assessment materials that support the fields of geriatrics and gerontology."

POGOe is a repository with some original content organized into: Content Library, Product Library, Video Library, Geriatric Competencies, and Forums. ReCAP (Repository of electronic Critically Appraised Papers) is a valuable resource for the latest evidence-based articles.

The "Product Library" makes searching for geriatric Educational Materials easy. They are listed by title and resource type. There is a 5-star rating system for users but has few entries at this time.

There are many useful resources on this site. Some videos reviewed by faculty that may be especially useful are listed below: link: http://www.pogoe.org/video-library

• Oral hygiene & Care resistant behavior - excellent practical information on how to approach the older adult with dementia. (30 min.)
• Virtual Patient: Karl Andrews- series (13) of short videos of older adult visiting HCP over 10 years with diabetes and atherosclerosis.
• STEP: Senior Teacher Educator Partnership - 6 min. video introducing the STEP program partnering seniors with medical students. This could be a valuable model to use for nursing students as well.
• A Good Tug - series of functional assessments (stand, balance, etc.). Short clips of real seniors from the "Stealth Geriatrician" series.
• Focused Neuro Exam for Patient with Memory Loss.
• Plus more videos for the practitioner education.

Many of the videos could be used to enhance case studies or "virtual" client assessments for acute care, chronic care, and community based courses. Portions of videos could be used in class to spark discussions or as preparation for clinical.

Quality Measures: Nursing Home Quality Initiatives

Centers for Medicare & Medicaid Services

Nursing home quality initiatives including downloadable documents in pdf format. Also links to MDS 3.0 information.

Have students research quality measures for nursing homes. Do "mock review" of one measure. Use for health promotion, population, leadership, integrative practicum. Excellent resource for learning how nursing homes are evaluated by Medicare for safety and quality issues.

Resources for Teaching Gerontological Nursing

This website (product of the Northwest Coalition for Geriatric Nursing Education) is designed to provide a variety of teaching resources for nursing faculty who want to include content on older adults in their curricula. Website is still being developed but is a good resource as it stands now.

Rich website for instructors that deserves a full investigation by anyone who teaches geriatric nursing or wants to teach gerontology. Many links to resources & activities for students. Topics include: environmental assessment, functional assessment, falls prevention, global aging, medications, sensory changes, transitions to different health care settings. Link for pdf files: http://www.geronursinged.org/topicalactivities

Many activities & resources for students with thorough descriptions for suggested use on website.

Retirees and Those Near Retirement Have Different Views of Golden Years

Results of a poll from NPR, Robert Wood Johnson Foundation, and Harvard School of Public Health regarding retirement from the view points of pre-retirees and retirees. Results show that pre-retires may underestimate health, financial challenges of retirement. One in four retirees think life in retirement is worse than it was before they retired, according to the poll.

The poll covers the following areas: 1) The retirement experience of retirees and the expectations of pre-retirees; 2) Perspectives on the timing of retirement; 3) Steps taken to stay healthy in retirement; 4) Views on the role of Medicare and Medicaid in retirement; 5) Perceptions of what makes a community a healthy place for retired people; and 6) Concerns about being admitted to a nursing home during retirement.

Retirement and Health Poll: Powerpoint

Faculty can use poll results to increase knowledge about the differing views of older adults in retirement or as they near retirement. The slides from the power point can be used in the classroom setting to discuss issues and challenges facing older adults as they retire.

Teepa Snow Dementia Expert

Occupational therapist Teepa Snow is a dementia expert who trains and consults for health care professionals and families privately.

Videos and links to videos explaining dementia & care techniques for the resident with dementia. Video: what happens with vision when a person has dementia.

Video clips: http://www.youtube.com/results?search_query=teepa%2Bsnow&search_type=&aq=f

Show videos in class with discussion after. Independent study for students about dementia and Alzheimer's disease. Appropriate for community/population-based courses, chronic illness, & health promotion.

This Caring Home

"This Caring Home provides tips and tools to enhance home safety for persons with Alzheimer's and other types of dementia." This site is designed for caregivers and won the "2010 National Alzheimer's Caregiver Award" for an Award Winning Website.

This site for caregivers includes an interactive "virtual home" with product guides, safety information, videos and animations. This site is well organized and addresses all aspects of the daily life of the dementia client and helpful hints and guides for the caregiver. There are links to other videos, experts, and product information. There is an emphasis on safety for both the caregiver and receiver.

Students could explore this site in order to gain an appreciation for the complexities of caring for dementia clients at home. Have a discussion on what they learned or what was most helpful (biggest "ah ha"). This is a good resource for the "day in the life" activity and the student could imagine what it might be like to be a spouse or other family caregiver of a loved one with dementia. Could be used in Chronic or Population courses.

Transitional Care & Pressure Ulcers Project Toolkit : Acumentra Health

"Acumentra Health assists Oregon nursing homes in projects to improve clinical care of residents, including a cross-setting pressure ulcer initiative with nearby hospitals and a project to reduce restraints and prevent falls." This entry is specifically for the Pressure Ulcers Toolkit.

Toolkit materials designed to "support your organization's quality improvement efforts. They can be used by care providers who want to improve their individual organization's measures for preventing or minimizing pressure ulcers. They can also be used to guide a cross-setting cluster of care providers who want to achieve improvements in pressure ulcer care within their community." Oregon Best Practices:

• Hospitals
  Best Practices
  Audit/Checklist
• Nursing homes
  Best Practices (updated 10/26/10 to reference MDS 3.0)
  Audit/Checklist
• Community-based care
  Best Practices

Audit/Checklist
• Home health & hospice

Best Practices
Audit/Checklist
• Other tools

Braden Scale for Predicting Pressure Sore Risk
Pressure Ulcer Definition and Stages
Summary of Pressure Ulcer Assessment Variables
Clinical Signs and Symptoms for Infection
Nutritional Care Guidelines
Pocket card: positioning, pressure points
Recommended Interventions to Prevent or Minimize Pressure Ulcers

Background information r/t pressure ulcers. Independent study re: examples of audits/best practices. Population nursing, leadership, chronic & acute care courses. A good resource for planning a performance improvement project (PIP) or for auditing pressure ulcers.

Transitional Care Model (TCM) - When You or a Loved One Requires Care

The heart of the TCM is the Transitional Care Nurse (TCN), who follows participating patients from the hospital into their homes, and using an evidence-based care coordination approach, provides services designed to streamline plans of care and interrupt patterns of frequent acute hospital or emergency department use and health status decline. The TCN collaborates with patients' physicians in the implementation of tested protocols with a unique focus on increasing patients' and caregivers' ability to manage their care. In published studies of the model, the nurse who implements the intervention is an Advanced Practice Nurse who has a masters degree in nursing with advanced knowledge and skills in the care of older adults.

This site originally provided information on training. You need to email for information on training. The Introductory video (8:42 min) is still there along with detailed explanation of the model, and how it differs from ongoing Case Management.

Use all or parts of video as introduction to elements of discharge planning for students in acute care & community nursing courses.

United Hospital Fund (UHF) Next Step in Care | :: Next Step In Care Homepage

Designed to help family caregivers of chronically or seriously ill patients navigate the health care system. Next Step in Care provides easy-to-use guides to help family caregivers and health care providers work closely together to plan and implement safe and smooth transitions for chronically or seriously ill patients." A campaign of United Hospital Fund.

Contains many resources for family caregivers with pages that are easy to read and navigates. Provides a guide: "How to Get the Most from the Next Step in Care Website." Caregiver guides are also provided in Chinese, Spanish, & Russian. This site is a good starting point for family caregivers (hence, Next step!) There is a "Nursing Home Self Assessment Survey on Patient Transitions and Family Caregivers" and a companion survey for families: "The Nursing Home (Rehabilitation) Experience: Some Questions for You as a Family Caregiver" (in English, Spanish, Chinese, & Russian) Also contains guides for HCP. These are very brief guides that provide an overview on each of the topics below. Most are adaptations from other sources and the original sources are referenced:

• Assessing Family Caregivers' Needs - Provider's Guide
• Medication Management - Provider's Guide
• Reducing the Stress of Hospitalization for Patients with Dementia and Their Family Caregivers: A Provider's Guide
• Hospital Discharge Planning - First Steps with Family Caregivers

Use the "Reducing stress…" guide for students in acute care, as background information or as reflection post-clinical. The "self assessment" could be used in Leadership or Population-based courses. Independent study: Have students evaluate the site from the family caregiver perspective. Would they refer families to this site?

Virginia Geriatrics: Quick Consults

"Geriatric Quick Consult is a primer on acute geriatric care that will very soon be linked to the clinical computing system of the Virginia Commonwealth University (VCU) Health System (CERNER). It gives clinicians direct access to focused information about care of acutely ill older patients..."

One-page guides (evidence-based) on various topics to help the clinician address issues in the older adult: Topics include:

• Addressing unrealistic expectations
• Delirium (a.k.a. acute confusion, sundowning, AMS, agitation)
• Falls in older adults
• Medications to avoid in the elderly
• Patient can't sleep
• Patient's decision-making ability impaired
• PEG tube decisions
• Placement problems
• Pressure ulcers (note: lacks detail & does not address do's & don'ts)
• Urinary incontinence

Good reference for students in the acute care setting needing information in a brief format, quick overview. Could be used as a first stop place for students on the listed topics.