Australian Aged Care Nursing:
A Critical Review of Education, Training, Recruitment and Retention in
Residential and Community Settings
Annotated Bibliography
Nursing Education and Training
Article: 1
Howe, J.L., Mellor, M.J. & Cassel, C.K. (1999). Cross disciplinary approaches to teaching interdisciplinary teamwork and geriatrics. Gerontology and geriatrics education, 19(4), 3-17.
Method:
Program description
Outcomes/recommendations/conclusions:
This article outlines the Mount Sinai Medical Center Geriatric Interdisciplinary Team Training Program (GITT), designed to prepare future health professionals; nurse practitioner trainees, social work students and medical residents, to work within interdisciplinary geriatrics teams and deliver quality care. The program aims to ensure that trainees have a shared knowledge base, attitudes, skills about teamwork and care of older people. The program offers two choices for training: an intensive training program and a less intensive program consisting of one-day workshops. The intensive training program consists of practicum-based experience and didactic curriculum, that are flexibly integrated in the course. For nursing students, the course length is typically 15 weeks in duration. Students also have the option of a comprehensive one-day workshop, offered 2-3 times each academic year. Topics covered in the course include geriatrics and gerontology, working in interdisciplinary teams, and managed care. The program uses a variety of teaching approaches, including team teaching, journaling, standardised patients, 'real time' experiences, one-day workshops and program enhancements.
The program has been running for two years, and its coordinators are continuing to assess and refine the program through ongoing reviews. The authors reported on the positive and enduring impact of the training program on the faculty and management team, clinical sites, and academic institutions involved in the program. The program has been reported as an impetus for a critical review of clinical teaching, precepting and team functioning in participating clinical institutions. In the participating schools of the academic institutions, geriatrics and gerontology have been given a 'heightened status', through the existence of the GITT program. Schools (social work) have also been reported to effect change in their curriculum, to identify gaps in learning related to ageing and interdisciplinary teamwork.
Article: 2
Orb, A. Rural health and the educational preparation of nurses for aged care. Australian Journal of Rural Health, 4, 262-269.
Method:
Cross sectional survey of 1874 nurses registered with the Health Dept Australia, including nurses from nursing homes, agencies, and medical services.
Outcomes/recommendations/conclusions:
This study examined the gerontological learning needs of nurses working in rural areas of Australia.
The findings indicated that overall, 64.7% of nurses worked regularly with elderly people. Only 41% had received some form of education specific to aged care. Nurses were asked to rate the relevance of the nursing competencies required to be a competent gerontological nurse. Forty-four competencies were identified by nurses, subdivided into 5 main areas: problem solving, ethical/legal, communication, collaboration, and nursing care. Seven specific competencies were identified by nurses as most relevant; legal knowledge, handling of disturbed patients, needs for continuing education, protection of patients' rights, prevention of harmful situations, accountability, and practicing in an ethical manner.
Overall, 46% of nurses were interested in undertaking an external educational package in gerontology, with 63% of nurses who regularly worked with elderly people indicating that they would be interested in the course. Nurses who were undertaking part-time or casual employment were more interested in interactive learning (including audio-visual materials) than those who were working full-time, who indicated a preference for text-based learning.
Article: 3
Illefe, J., & Kennerson, R. (1995). Professional development: The course to take. The Lamp, September, 17-19.
Method:
Review of current professional development courses
Outcomes/recommendations/conclusions:
In a review of some current professional development courses in Australia, Illefe and Kennerson (1995) identified several postgraduate courses in the field of Gerontological Nursing:
- Postgraduate Certificate at the NSW College of Nursing.
- Postgraduate discipline specific or multi-disciplinary diplomas at a number of universities
- Continuing education courses by distance education offered by the NSW College of Nursing and a number of universities, many of which offer credit transfers for formal courses
- Professional organisations such as the Alzheimer's Association offer a range of continuing education courses for members and the wider profession.
The authors argued that specialty education in aged care is considered essential in ensuring quality care for older Australians, and that educational preparation for Gerontological Nursing is well established. However, changes to Australia's ageing population, health care delivery and promotion, and community support are all influencing the skills mix, and as a result, educational needs of those in aged care. The authors further argue that it is essential for education providers to ensure that course content is relevant to current practice and care delivery standards.
Article: 4
Tsey, K., Morrish, S., & Lucas, A. (1998). Training in aged care advocacy for primary health care workers in Central Australia: an evaluation. Australasian Journal on Ageing, 17(4), 167-171.
Method:
Evaluation of a training manual.
Outcomes/recommendations/conclusions:
The paper reports on the findings of an evaluation of a Trainer's Manual for delivering workshops to health care providers, primarily remote nurses, on standards of care for frail aged Aboriginal people. The workshop is designed to be run with small groups of up to 15 people, for approximately 3 hours depending upon the requirements of the group. The manual and workshop use a variety of educational techniques, including open discussions and brain storming, case studies, and feedback.
The evaluation of the manual and workshop was based upon 4 workshops run by a trained nurse, for a total of 30 health personnel, including nurses and general practitioners. The feedback revealed mixed views, however the findings indicated that the majority of participants found the workshop methodology and format useful, and that the hypothetical case study was the most interesting and thought provoking section. Approximately half of the participants wanted to learn more, with two main areas identified; types of aged care resources available and how to access them, and cultural issues affecting caring for the aged.
Article: 5
Gattuso, S. (1997). Literature in the teaching of gerontology. Australian Journal on Ageing, 16(4), 186-187.
Method:
Opinion paper and brief literature review on the use of literature as a teaching tool in gerontology.
Outcomes/recommendations/conclusions:
Gattuso (1997) indicates that literature is a successful teaching tool in nursing, and argues that the use of novels, poems, plays and short stories may facilitate students' knowledge of the diversity of older people, and break the stereotypes held by students of older people. Gattuso encourages the use of two particular novels, 'Coda', and 'The Toucher' in encouraging students to develop an empathic understanding of the lives of older women.
Article: 6
Joy, J.P., Carter, D.E., & Smith, L.N. (2000). The evolving educational needs of nurses caring for the older adult: a literature review. Journal of Advanced Nursing, 31(5), 1039-1045.
Method:
A literature review on the professional educational preparation needed by nurses wishing to move from acute settings to community aged care.
Outcomes/recommendations/conclusions:
The literature reviewed addressed the specialist skills and knowledge that are required to provide adequate care for older adults; with a call for the development of gerontological nurse specialists who are able to demonstrate detailed knowledge of older people's health and social needs, and who are highly competent practitioners skilled in holistic care. A vast body of the literature has indicated the lack of aged care specific educational opportunities. Many nurses had undertaken nursing education at a time when little focus was placed on gerontology, and more recent concerns have also been expressed regarding the aged care knowledge and experience nursing educators, and inadequate course time spent on aged care in current nursing curricula. Lack of opportunities for post-registration aged care education was also noted in the literature. One study indicated that less than 25% of the staff in a number if nursing homes had undertaken any form of continuing professional education.
The authors conclude that there is little evidence to suggest an agreed plan of educational requirements for nurses wishing to prepare for entry into aged care. However several suggestions aged care education and training were identified in the literature, including; the multidisciplinary approach to meeting the needs of older individuals, and collaborative approaches by nursing educators that includes professional input from a range of disciplines in aged care settings, services and organisations. The literature also indicates a need for a flexible framework for education and clinical experience. The authors suggest that links between nursing homes and academic institutions may provide a potential for establishing further aged care education and training.
Article: 7
Timms, J., & Ford, P. (1995). Registered nurses' perception of gerontological continuing education needs in the United Kingdom and in the USA. Journal of Advanced Nursing, 22, 300-307.
Method:
A convenience sample of 123 gerontological nurses in Britain, 152 randomly sampled gerontological nurses in the US, and 10 nursing experts were surveyed, to identify the perceived needs in gerontological continuing education. Nurses were asked to rate the needs for both themselves, and for nurses in general.
Outcomes/recommendations/conclusions:
Nurses indicated a need for each of the topics presented in the survey, with little consensus amongst nurses on the most necessary topics, which included; normal changes in ageing, death and dying, medications, health promotion, nutritional needs, safety/fall prevention, mobility problems, psychosocial issues and physical assessments. Each topic was listed by some nurses, within their 'top 5', suggesting the importance of a large range of specialty topics in aged care nursing. Overall, there was a greater perceived learning need for nurses in general, rather than the respondent's personal learning needs.
Article: 8
Smith, P. (1998). Education for staff in nursing homes. Nursing Times, 94(22), 61.
Method:
Opinion article & description of one aged care course
Outcomes/recommendations/conclusions:
Smith outlined a 2-year project on education for Registered Nursing Home Association staff, that aimed to provide courses on the principals and practice of palliative care to nurses and other aged care staff. The palliative care course was developed upon three main areas that were identified at the start of the project by registered nurses working in aged care homes: the assessment and management of pain and other symptoms, communication skills, and support of families and colleagues following a bereavement. The educational team developed a problem-based reflective practice framework for the course that drew upon nurses' experiences. Each course was presented during 12 days over a 6-month period. Nurses were required to identify an area of practice that they hoped to change as a result of the learning. Therefore a 3-month gap in the course was provided, to enable nurses to adopt changes in their practice and report back on their progress and any issues that arose, at the end of the course. Participants indicated several benefits to the course, including improved ability to cope with residents and family, increased confidence in raising issues, and improved understandings of the support needs of relatives. The author stressed the importance of designing a course that is specific to aged care homes and staff.
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