A nurse-driven community education program for older adults

Organizational involvement in community service is a key component of the American Nurses Credentialing Center’s Magnet Recognition Program®. Healthcare organizations with Magnet® recognition can address community healthcare needs through partnerships and programs. This article describes how nurses at a big-city specialty hospital developed and evaluated a nurse-driven community education program for older adults.

From research to program launch

Self-care management education in the community setting is an evidence-based approach for addressing key healthcare reform objectives, including better health, better health care, and value. Self-care education workshops can improve key aspects of chronic disease management, like medication compliance and patientprovider communication.

In 2012, nurses from the Hospital for Special Surgery (HSS) in New York City launched a nursing community education program for underserved older adults. The program came about after an internal nursing research study (N = 125) by Quinlan and colleagues showed decreased self-care knowledge is independently associated with increased aging (p < 0.05) and poor treatment adherence is independently associated with living in a low-income neighborhood (p < 0.05).

Based on these findings, HSS nurses formed the Nursing Community Education Committee (NCEC) consisting of interdisciplinary members. Committee goals aligned with the hospital’s community service plan, which reflects shared governance to sustain a professional practice model committed to partnerships, accountability, and interdisciplinary collaboration toward a sustainable, prevention-focused wellness intervention in the community setting.

NCEC partnered with graduate nursing students to develop a structured, nurse-led community education program and address the healthcare needs of older adults in underserved areas of the city. The evidence-based approach included:

• review of the literature and best practices


• identification and assessment of potential learning sites for seniors

• recruitment strategies for nurse teachers and learners

• development of course content and delivery methods

• cost analyses for program implementation measures of effectiveness.

Three of the capstone project’s participants were hospital employees, which allowed easy facilitation of meetings and brainstorming throughout the project. For example, the cost analysis was drafted by a capstone nurse and senior director of nursing excellence (coauthor Patricia Quinlan). The manager of patient education and research (coauthor Jack Davis) bridged the work of the capstone group and NCEC. The final product, which took a year to create, was a highly structured community education program for older adults.

Program implementation

A study approved by the hospital’s institutional review board (IRB) accompanied implementation of the education program. Study design took the form of a pretest and a posttest to evaluate effectiveness of the program on older adults’ knowledge and satisfaction. Fourteen classes consisting of didactic lectures were given to 122 participants in two older-adult community centers from August 2012 through November 2013. Presentation topics were based on results of the hospital’s community health-needs assessment, which showed interest in self-care education specific to older adults’ needs, such as medication management and patient-provider communication.

Across sessions, the average mean increase in knowledge assessed through pretests and posttests was 9%. Eighty-nine percent of survey respondents said they learned something new and 98% rated the courses as good or excellent.

Program expansion

With success of the program, outreach expanded to additional senior living centers. To accommodate this expansion, committee members recruited more staff to volunteer to teach and develop content. Recruitment strategies included:

• committee members recruiting from their respective units

• presentation and call for speakers at the hospital’s annual Nursing Education & Research Day

• program summary published in the hospital’s internal newsletter

• volunteer opportunities through the annual nursing needs assessment.

Recruitment succeeded, as shown by the increased number of nurse and other clinician volunteers— from two in 2012 to 18 in 2015. (See Program growth over 4 years.)

Medication skills training

In 2014, the committee sought to further explore the effects of community education beyond knowledge and satisfaction. Through grants from the hospital’s Academy of Medical Educators and the department of nursing, we enhanced the community education program by adding skills training to our medication management classes, provided through a four-class series workshop for seniors.

The IRB principal investigator and co-investigators completed an IRB-approved quasi-experimental study design to compare participant knowledge, confidence, and skills before and after the workshop. Trained staff facilitators assessed participants’ skills in three competencies:

• reading medication labels

• creating a medication list

• communicating with a healthcare provider.

The workshop was piloted at two local senior living centers with a convenience sample of 30 participants from December 2014 to May 2015. The mean change in knowledge score was 26.4 (p = 0.008). (See Participants’ knowledge scores: Before and after.)

Although confidence for each skill increased slightly, the change wasn’t statistically significant. Nearly three-quarters (74%) of participants successfully completed the three skills competencies. At study completion, 93% reported they were adhering to their medication regimens and 54% said they were using a medication list. All participants ranked the workshop as excellent and said they’d recommend it to a friend.

The medication skills training—a more intensified program with additional personal nurse attention—seemed to be a more effective teaching method than simple didactic lectures. The intervention in the first study (involving lectures) resulted in a slight increase in knowledge; but the second study with its active learning model led to a greater knowledge increase. These findings have influenced current practice, as nurses at HSS have incorporated more active learning in other community and in-house education.

The authors work at the Hospital for Special Surgery in New York, New York. Kelsey Vukov is a patient educator. Jack Davis is manager of Patient Education & Research. Patricia Quinlan is assistant vice president for Nursing Excellence.

Selected references

National Council on Aging. Chronic disease management. April 2, 2014.

Ory MG, Ahn S, Jiang L, et al. Successes of a national study of the Chronic Disease Self-Management Program: meeting the triple aim of health care reform. Med Care. 2013;51(11):992-8.

Quinlan P, Price KO, Magid SK, et al. The relationship among health literacy, health knowledge, and adherence to treatment in patients with rheumatoid arthritis. HSS J. 2013;9(1):42-9.

 

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