dvancing Gerontological Nursing - Prof A Coffey AIGNA Conference 2018

1. Advancing Gerontological Nursing through
the identification of competencies for
working with older people
Dr Alice Coffey
Professor of Nursing and Midwifery, University of Limerick
alice.coffey@ul.ie
AIGNA 10th Annual Conference “Celebrating Advances in Older Persons Nursing”03rd May 2018, Clayton Hotel,
Galway
Authors:
Coffey, A., Savage, E., Leahy-Warren, P., Mulcahy, H., Wills, T., McCarthy, V., Fehin, P., Ó Doibhlin, D.,
McLoughlin, K., Benefield, L. E., O’Sullivan, B., Hegarty, J., Hoey, C., Lang, D.

2. Population ageing is a
success story
(National Positive Ageing Strategy, 2013).
• Total population > 65 years
637, 537
• Up 19.1% from 2011
• A demographic change with
health, economic, social and
political implications.
CSO 2016
65 - 69 years 211,236
70 - 74 years 162,272
75 - 79 years 115,467
80 - 84 years 81,037
85 years and over 67,555

3. AIGNA 10th Annual Conference “Celebrating Advances in Older Persons Nursing”03rd May 2018, Clayton Hotel,
Galway
NATIONAL STRATEGY

4. National Clinical & Integrated Care Programmes
Policy Direction/Recommendations
Specialist Geriatric Team
Guidance on Comprehensive
Geriatric Assessment
Policy Direction

5. • Almost 22% of all hospital emergency department attendees are
aged >65 (HSE Emergency Taskforce Report 2015)
• Older people account for 40% of all acute emergency medical
admissions and 47.3% of total hospital bed days (Smyth et al. 2017).
• Approximately 22% of persons aged 85+
require residential care
• 50% of Nursing Home residents have dementia

6. • 94.7 % persons aged 65
and over were living in
private households (CSO,
2016)
• 26.7% live alone
• 24% of community-
living Irish people aged
65 years and older are
frail, 45% are pre-frail.
Most Older People live in
the Community

7. Healthcare professionals need
to have the right skills and
competency to manage a more
demanding role in the future
in order to offer effective
services for older people
(Engstrom & Fagerberg, 2011)
Global shortage of skilled
healthcare professionals and
a lack of interest or desire on
the part of professionals to
work within the ageing
context
(Coffey et al., 2015).

8. The attainment of knowledge, intellectual
capacities, practice skills, integrity, and
professional and ethical values required for
safe, accountable and effective practice (NMBI, 2015).

9. European Core
Competencies Framework
for working with older
people
European Later Life Network
supported by
European Lifelong Learning
Programme (LLP -project)
Dijkman, B., Roodbol, P., Aho, J., Achtschin-Stieger, S., Andruszkiewicz, A., Coffey, A. et al, (2016)
European Core Competences Framework for Health and Social Care Professionals Working with Older
People. Available at http://ellan.savonia.fi/

10. Research with nurses found
technical knowledge and skills
shown during physical care to
be important attributes, these
seemed to be interconnected
with the nurse’s attitudes i.e.
the former could not be
performed adequately without
the latterIn research with older
persons the relational
aspects of care and the
psychosocial
characteristics of carers
more often mentioned
when compared to
technical aspects of
competence

11. A strategic vision
and educational
framework for
Gerontological
nursing
AIGNA 10th Annual Conference “Celebrating Advances in Older Persons Nursing”03rd May 2018, Clayton Hotel,
Galway
Project Commissioned by NCPOP
Office Nursing Midwifery Services Director

12. AIMS
• To identify, describe and appraise empirically tested
models/frameworks for education that could be applied to
gerontological nursing.
• To explore a vision for high quality health and social care for
older people in acute, residential and community care.
• To determine the nursing competencies (i.e. knowledge, skills,
practices, attitudes, abilities, behaviours) required to deliver
on the vision
• To Develop an educational framework that will enable nurses
to acquire and maintain the necessary knowledge, skills and
competence, at the appropriate level to deliver quality
person-centred care to older people.

13. METHODOLOGY
Literature Review
• Comprehensive review of
empirical and grey
literature
• No model or framework
identified
• Similarities in specific
knowledge, skills and
behaviours highlighted.
National focus group
• “World Café” events social
constructivist approach
• Five locations n=190
individuals : nurses (55%),
older people (20%),
remainder = health and
social care professionals
other than nurses
Educational framework with domains of competence, associated
standards and nursing roles

14. MIND MAP
Visual representation of themes relating to competencies for nurses working in the home and
community context using a mind map

15. Data integration and triangulation using the
results of the systematic literature review and
analysis of the qualitative focus group data.
A framework describing the domains of
competence, related standards, nursing roles
and associated cues necessary for all nurses
working with older people within their
professional role.
BUILDING CAPACITY FOR AGE ATUNED CARE

16. Educational Framework for Gerontological Nursing

17. DOMAINS OF COMPETENCES, ROLES AND CUES

18. Domain 1: PROFESSIONAL NURSING : related standards
Based upon respect for the person with
genuine value being placed upon person-
centeredness.
The nurse promotes real choice and
flexibility for the person. The nurse is an
ethical, reflective practitioner who is
passionate and interested in working with
older people.
The nurse is responsible for their own
professional development
The nurse strives to improve the quality
of gerontological nursing practice and the
health and social care services provided
to older persons wherever they access
services.

19. DOMAIN 2 Nursing practice & Clinical decision making: related standards
The nurse endeavours to get to know the
older person; enter the world of the person
; where they are and advocates with and for
the person.
The nurse conducts a timely and considered
comprehensive and systematic assessment
to inform clinical decision making.
Translates and integrates evidence into
practice in partnership with the person to
enable independence for as long as
possible.
Creative care planning, incorporating
interventions social in origin, which have a
combined health, disease, wellness and
living focus.

20. DOMAIN 3: Knowledge and Cognitive processes: related standards
The practice of the nurse in
gerontology is based upon the best
available evidence in making decisions,
the person’s preferences, a sustained
focus on quality improvement and the
nurses critical and analytical skills.
The nurse endeavours to provide safe,
quality nursing practice within person-
centred and evidence-based practice
frameworks which are underpinned by
a shared gerontology vision and
philosophy.

21. DOMAIN 4: COMMUNICATION: related standards
Based upon respect for the person,
their life experiences and their unique
needs.
The nurse spends time with and
purposefully listens to the person, takes
time to get to know the person and
actively engages in developing
therapeutic relationships with the
person and their family.
The nurse places the person and their
needs at the centre of all
communication, interdisciplinary
collaborations and care activities.

22. DOMAIN 5: Organisation and management
The gerontological nurse
demonstrates accountability and
the judicious use of resources to
plan, organise, and deliver
effective, timely quality care for
the person.
The nurse keeps the older person
at the centre in all management
decisions whilst being cognisant of
the need to balance risks with
preferences of the older person.

23. DOMAIN 6: Leadership and professional scholarship: related standards
The nurse advocates for, contributes
to, and leads systems that support safe
quality care, professional partnerships
and professional growth of self and
others.
The nurse seeks to positively influence
policy, clinical practice, gerontological
nursing as a specialism through their
leadership, collaborations,
professional organisations.

24. All registered nurses coming into
contact with older people in their
professional roles need to have an
understanding, awareness and
familiarity with the needs of older
people and the challenges they face
Education is an important element in
the development of high quality care
and services for older people, however
care and learning environments need to
be age attuned and age – friendly.
KEY MESSAGES

25. It is imperative to ensure that nurses
are competent to provide the highest
quality of nursing care and maintain
professional standards of care when
working with older people.
The core nursing roles and competencies
outlined within this empirically developed
framework are relevant to all nurses who
interact with older people including registered
general nurses, psychiatric nurses and
intellectual disability nurses.

26. The framework should be used as a resource to underpin:
• The development and implementation of future professional
regulatory framework requirements for public health nursing
• Continuous professional development programmes for all
nurses
• The design of a continuing competence framework for
gerontological nurses
NCPOP is
working with NMBI/ HEI’s and DOH around
new roles and NMBI competency
framework

27. Framework be used as a resource to underpin:
– The integration of gerontology into the
undergraduate programme for nursing
– The design and delivery of curricula for specialist and
advanced gerontological nursing
– The development and implementation of future
professional regulatory framework requirements for
gerontological nursing
NCPOP has Established
a HEI Interest Group
Mapping current &
new educational
programmes to the
framework

28. Thank you
Questions?

29. References
• Coffey, A., Savage, E., Leahy-Warren, P., Mulcahy, H., Wills, T., McCarthy, V., Fehin, P., Ó Doibhlin, D.,
McLoughlin, K., Benefield, L. E., O’Sullivan, B. and Hegarty, J. (2017). Systematic literature review and
national focus groups to support the development of a strategic vision and educational framework for
Gerontological Nursing. Dublin: Health Service Executive.
• Coffey, A., Tyrrell, M., Buckley, M., et al (2015) 'Attitudes to ageing and perceptions of working with older
people of students of health and social care'. RCN Nursing Older People 27(1):33-37.
https://www.ncbi.nlm.nih.gov/pubmed/25633708
• Dijkman, B., Roodbol, P., Aho, J., Achtschin-Stieger, S., Andruszkiewicz, A., Coffey, A. et al, (2016) European
Core Competences Framework for Health and Social Care Professionals Working with Older People. Available
at http://ellan.savonia.fi/
• Engstrom & Fagerberg, (2011) Attitudes towards older people among Swedish health care students and
health care professionals working in elder care. Nursing Reports DOI 10.4081/nursrep.2011.e2
• Health Service Executive (2015)Emergency Task Force Report
http://health.gov.ie/blog/publications/emergency-department-task-force-report/#
• Smyth B., Marsden P., Donohue F., Kavanagh P., Kitching A., Feely E., Collins L., Cullen L., Sheridan A., Evans
D., Wright P., O'Brien S., Migone C. (2017) Planning for Health: Trends and Priorities to Inform Health Service
Planning 2017. Report from the Health Service Executive. ISBN 978-1-78602-037-6
• Soares, C.C., Marques, A.M., Clarke, P. et al. (2018) Older people’s views and expectations about the
competences of health and social care professionals: a European qualitative study European Journal of
Ageing https://doi.org/10.1007/s10433-018-0466-3