When it comes to caring for the elderly, Joan Nelson, DNP, RN, ANP-BC knows the score—from helping students prepare to pass expanded geriatric content on the 2013 nurse practitioner certification exam to effectively dealing with patients in a clinical setting.
Dr. Nelson has worked as an adult nurse practitioner serving the frail elderly since 1997. As an associate professor at the University of Colorado College of Nursing, she has been involved in efforts to improve teaching and learning. Gone are the days of lecture and regurgitation of materials. “Sixty percent of what we learn will be obsolete in five years,” she observes. Instead, she works on helping students develop critical thinking skills, access literature and use resources and synthesize what is learned into working knowledge.
“Now, our students do a lot of group work and actively solve problems from one of our real-life practices,” Dr. Nelson says. “We’re changing the way they think and the way they approach problems.”
Winner of CU’s excellence in teaching award, Dr. Nelson knows what students need to know in gerontology. She is a test writer for the national certifying body for nurse practitioners (ANCC). She and other test writers have been developing expanded questions for the geriatric nurse practitioner and adult nurse practitioner exams. There are national pressures for nursing programs to incorporate this material, Dr. Nelson observes.
The College of Nursing recently expanded the geriatric component in two degree programs:
Adult-Gerontology Nurse Practitioner
Adult-Gerontology Clinical Nurse Specialist
The presence of other disciplines and specialties at the Anschutz Medical Campus creates an ideal learning and research environment, interdisciplinary in nature and practice. “By its nature, geriatrics is interdisciplinary,” Dr. Nelson observes. “On our campus we have many opportunities to collaborate.”
Even those studying from a distance online are able to engage in collaborative, group learning through interactive TV.
Dr. Nelson practices what she teaches. She is one of five nurse practitioners and three physicians with a company providing home visits, Physician Housecalls. Primary care in the home is a rapidly-growing field, and for senior adults, it can get complicated.
“We are caring for geriatric patients in multiple care settings,” Dr. Nelson explains. “Transitions among settings are a problem. That’s true nationally. One of the physicians our practice added recently covers long term care and rehabilitation. He and his team use the same electronic medical record we do, so when a person leaves hospital for skilled nursing or a rehab facility before going home, we can reduce communication problems.”
Dr. Nelson’s scholarship focuses on practice-related quality improvement. She hopes to use her practice to develop a model that improves support for caregivers of patients with dementia and chronic illnesses through a phone outreach system.
“By definition, quality improvement involves implementing best evidence into your practice,” Dr. Nelson says. “Sometimes we discover there is no best evidence, so our effort turns into research.” For over a year, Dr. Nelson has grappled with a way to reduce overuse of antibiotics to treat suspected urinary tract infections for patients with dementia. Developing best practice standards will improve quality of care.
Nurses who want to pursue an advanced practice degree may not necessarily think first of serving the elderly. “There’s some evidence that when students start their primary care rotations, they’re surprised that they like working with older adults,” Dr. Nelson says. Their experience has been limited to the acute care environment. “They need information on healthy aging. People are always surprised to learn that loss of functional status, presence of co-morbidities and chronic illness is not the norm.”