Final Group Project Revision Version

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Running head: GERIATRIC QUALITY CARE SPECIALIST: A CERTIFICATE PROGRAM

FOR THE LISCENSED VOCATIONAL NURSE

Geriatric Quality Care Specialist: A Certificate Program for the Experienced Licensed
Vocational Nurse
Group A: Laura Ferguson, Tanya Griesenbeck, Crystal Johnson, Leah Spittle
Texas A&M School of Graduate Studies
EDHP 501
Dr. Kathy Missildine, PhD, RN
August 8, 2013

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GERIATRIC QUALITY CARE SPECIALIST: A CERTIFICATE PROGRAM FOR THE
LISCENSED VOCATIONAL NURSE
Introduction
Licensed Vocational Nurses (LVN) are an integral part of the healthcare team, and are
often the primary direct care givers in long term care facilities. They are the supervisors
of nurses aides in nursing homes and work under the supervision of a Registered Nurses.
According to the Texas Administrative Code and the Texas State Board of Nursing , the
LVN is empowered to use a systematic problem-solving process in the care of multiple
patients with predictable health care needs to provide individualized, goal-directed
nursing care. LVNs may contribute to the plan of care by collaborating with
interdisciplinary team members, the patient and the patients family. (1). LVNs are
accountable for the quality of nursing care provided and must exercise prudent nursing
judgment to ensure the standards of nursing practice are met at all times. They also
ensure continued competence in nursing practice, and develop insight through reflection,
self-analysis, self-care, and lifelong learning (2).
Many LVNs further their education; many ultimately attain qualifications for Registered
Nurse. An intermediate step for many who work in long term care facilities might be
attainment of improved understanding of quality of life care in their employment setting
including a holistic approach to care of patients in the nursing home consisting of safety,
hygiene and sanitation, end of life care , compliance with elder abuse prevention
practices and an understanding of quality improvement and evidence based practice. An
online course designed for the adult learner with direct application in the workplace is
suggested.

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Curriculum Model and Theory
By using the systems theory, we identify common characteristics within all systems to
create our program. Focusing on the big picture, the wholeness, we use systems thinking
to incorporate parts into the systems. Looking at our program, we have an outer layer of
governing bodies or regulating boards (like the Center for Disease Control [CDC]) and
then the institution. Within lies the educational program, like the Geriatric Quality
Nursing Care Specialist. Inside the program encompasses multiple areas like the
philosophy, organization framework, mission, curriculum, curriculum mapping,
educational outcomes, program outcomes, and level outcomes. The innermost section is
program evaluation. We chose this model as it allows for continual improvements. Using
the systems thinking as the framework, educators could combine any two elements for
analyzing and/or explaining how they work together to produce results.
The curriculum is designed to empower the student to take an active role in learning to
apply their knowledge and skills through activities that are competency based. This will
allow the student to apply knowledge from experience and to develop measures to
implement new skills in the focus areas using the principles of quality improvement and
evidence-based practice.
As determined in our target needs assessment, consumers expect quality, safe nursing
care in a nursing home. LVNs will focus on learning outcomes. By utilizing all of these
data collection modalities, we will gather all the needed information to present to key
stakeholders involved in the support and creation of our well-rounded curriculum that
includes all aspects of quality of life care.
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Support for our new curriculum is a very important aspect in this curriculum design
model. The key stakeholders for this new curriculum include: local and regional nursing
school faculty, local and regional medical and dental school faculty that teach geriatric
care, geriatric physicians, psychologists, psychiatrists that specialize in geriatric, social
workers and other governmental and regulatory agencies (e.g. State Department of Health
and Human Services, Joint Commission Accreditation Standards for Nursing and
Rehabilitation Centers). By having a diverse group of stakeholders, there is a greater
chance that a well-rounded curriculum in training for future "Geriatric Quality Care
Nursing Specialists" will be developed.
This certificate program will be taught as a supplemental program to graduates of LVN
programs at a local community college. The certificate course will be taught by some of
the key stakeholders that support this program. An LVN who will enroll in this program
will have recent two-year work experience as LVN in nursing home. Upon completion of
the course, the LVN will receive a certificate showing completion of the program as a
"Geriatric Quality Care Nursing Specialist"

Influences on Curriculum
Needs assessment for curriculum for Geriatric Nursing Care Specialist
The International Association of Gerontology and Geriatrics, and the World Health
Organization propose the development of sustainable strategies to enhance confidence
among older people and their relatives in safe, patient and family centered, clinically
appropriate, respectful ,compassionate care by appropriately prepared providers and staff.
(3) The pressure to improve nursing home care has been exerted by the media, regulatory
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and accrediting agencies, advocacy groups, third party payers as well as patients and
family members and the staff of nursing homes themselves, Although now a decade old,
an article by Kane 2003 (4) serves as a landmark for determining quality measures for
nursing home care and that work has been advanced.
To assess the need for this certification as well as to plan the curriculum, input may be
garnered from local nursing homes administrators, nursing leadership, LVNs
themselves, physicians, patients in nursing homes and/or their families. Information may
be gathered by a combination of surveys(including opportunity for anonymity) and focus
groups. Additionally, regional nursing faculty and medical school faculty may be
approached for their input to potential development of such a program and curriculum
and to be aware of the elements of basic LVN curriculum which may be reinforced by the
new curriculum without true redundancy.(8) Patients in nursing homes and their families
would also be invited to participate with regard to quantitative assessment of satisfaction
as well as qualitative input with regard to ideas for improvement. Lastly, data available
for local nursing homes either in individual or aggregate form from the Department of
State Health Services, Joint Commission or other agencies may prove useful to identify
areas for needed improvement and consideration for inclusion in the curriculum.
Despite the challenges in caring for patients who are generally declining in health in the
nursing home setting, there are many aspects of the care plan that must be implemented.
Maintenance of hygiene and general sanitation, ensuring safety in medication
management and prevention of elder abuse and end of life care in a holistic manner with
a focus on patient and family centered care optimizes physical, social and mental health
for these patients and must be a focus for quality care. The healthcare team in the nursing
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home is composed of administrative staff, health care providers who direct patient care
via orders, nursing staff , and in some settings, therapists, behavioral health providers,
social workers , dental hygienists and others. These disciplines represent stakeholders in
the care of patients and therefore in the education of the LVN who seeks a specialist
certification in geriatric care. Enhanced quality of life training may provide nursing
homes residents and their families better care experiences, comfort and reassurance.
Internal and External Pressures
There are both internal and external pressures on the training of LVNs. Nursing home
administrators are faced with the above mentioned concerns in addition to the feasibility
of providing continuing education and excellent quality improvement practices for the
multidisciplinary team. Primarily, the LVN and nurses aides perform most of the direct
care for residents and often have the most contact with their families. Since many nursing
homes are located in suburban areas, small towns and rural areas, access to inter-
professional education resources can be limited. External pressures on nursing home care
include the regulatory and accrediting agencies such as Joint Commission, state
departments of health and human services, and the Center for Medicare and Medicaid
Services. While families have always been integral in the lives of nursing home residents,
most residents are in the nursing homes because families are unable to provide care or
routinely visit. Increased emphasis on patient and family centered care and an emphasis
on outcomes had primarily been expected to be physician-lead. With the increased access
to technology, consumers are questioning more about healthcare, possibly causing
tension between medical team and resident or families. Media pressure for improvements
in quality care in the nursing home is evidenced by high profile cases of abuse,
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deplorable conditions related to sanitation (including hygiene) and safety (including
medication management) and societal debate about end of life care and other ethical
issues.
Geriatric Quality Care Nursing Specialist Mission Statement:
Our mission is devoted to supplementing LVNs with the knowledge, attitude, and skills
to support and focus on the resident-centered quality of life in the nursing home. We
believe high quality; innovative education will assist LVNs who provide focused-based
assessments to promote the holistic well-being of residents and their families.
Geriatric Quality Care Nursing Specialist Curriculum Design
Certificate Program Prerequisites includes
1. LVN/LPN certificate with active license
2. Two years of experience working in a nursing home or long term care facility. This
will ensure that each student will bring real world experiences to their learning and
understanding.
Student Centered Curriculum Characteristics
Prior to beginning course content, the LVN who enrolls in the course is asked to consider
their own learning needs and the environment in which they have worked and to
complete an individual learning needs assessment including:
1. Topics perceived by the student in their own care setting as representing an area for
improvement in quality of life care
2. A baseline assessment of their knowledge and skills in the areas including:
A) Professionalism and ethics
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B) Quality Improvement
C) Standards for nursing home accreditation and regulation
D) Patient and family centered care
E) Identification, reporting and management of elder abuse
F) Oral health promotion, oral health care and oral disease management in the nursing
home
G) End of life care (including advance directives, medical power of attorney)
Problem Based Learning:
Our program is based on an assessment of current needs and evidence based nursing
practice to attempt improvement in quality of life care in nursing. This includes: oral
care, ethical and professional standards, end of life care, and proper medication handling.
This is very important for clinicians as it uses real-world scenarios and allows the
students to develop their critical thinking skills. Students that complete the course will
identify an array of problems in the workplace that involve care for the elderly and will
develop strategies to improve care utilizing new skills.
Integrated Curriculum:
A multidisciplinary approach to improving quality of care for the elderly requires input
from instructors in fields such as psychology, medicine, dentistry, and social work, with
expertise in medico legal ethics, patient and family centered care, and cultural
competency. This program integrates knowledge and skills already learned in the
original LVN program with experience learned on the job and newly acquired
knowledge and skills derived from this course.
Courses within the core curriculum:
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The core content of the program is to ensure that each student upon completion will be
able to provide better and more accurate quality of life care. Courses will provide both
competency based learning in a didactic setting and externally in a community based
setting where they can apply what they have learned in a real world aspect.
Systematic Methods:
Our program will use systematic methods for teaching, testing, and evaluating each of the
students progress throughout the course. Curriculum mapping will be used in order to
have a well-organized curriculum that looks at what the student has already learned and
builds upon that information to optimize performance in geriatric nursing. Curriculum
mapping must be adequately employed to fulfill its primary goals which are to ensure that
program objectives and accreditation requirements met and to integrate the courses
content. It will also serve to identify any gaps and redundancies and to aid in course
planning. Lastly the map will assist in providing a efficient and logical sequence making
sure that the sequence and content is transparent.
Program Description
The curriculum for a certificate as a Quality Care Nursing Specialist allows the LVN an
opportunity to enhance the provision of quality of life care in nursing homes. Those
receiving a certification as a Quality Care Nursing Specialist will provide and promote
holistic nursing care, will receive enriching knowledge, advance their assessment skills,
and be able to better assist with planning and implementation of novel programs to
enhance the resident and family experience in the nursing home setting.

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Terminal Learning Outcomes (TLOs)
The terminal learning outcomes were developed with reference to the Center for Disease
Controls quality of life for older adults initiative (7). It is this initiative that described,
straight forward, significant, quality of life needs, for the older population in nursing
homes and long term care facilities. After doing research on the primary needs for
quality of life care, these terminal learning outcomes were developed. The terminal
learning outcomes include:
1. Integrate evidence-based nursing practice into facility and individual resident needs
assessments.
2. Assist with the development and implementation of policies and compliance measures
related to regulations appropriate to nursing home settings.
3. Demonstrate professional commitment to geriatric care in nursing homes by providing
quality care.
4. Demonstrate ethical accountability by recognizing and reporting abuse within the
nursing home and implementing a care plan for victims
5. To develop understanding and comprehension of health promotion and disease
prevention in all areas of care as it relates to care of the elderly in nursing home
settings.
6. Communicate with an interdisciplinary team to ensure that each healthcare member
involved in a residents care will be aligned with goals of the healthcare team.
7. Demonstrate critical thinking skills to provide holistic care to meet residents and their
families in nursing home setting
8. Provide quality resident-centered end of life care to residents and their families.
Curriculum Map

The curriculum map was developed to outline how the courses will address all of the
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terminal learning outcomes. The terminal learning outcomes are listed down the left
hand side of the chart. The standards this curriculum wishes to achieve, are listed along
the top of the map. These standards were also developed in conjunction with the Center
For Disease Controls initiative in mind (7). The cells of the curriculum map include: the
course name, course number, and the level of achievement that each student should strive
to understand in relation to each standard and terminal learning outcome. It is important
to note that this curriculum map is not designed to the standards of an accrediting agency
since this is not a certification program, rather it is a certificate program designed to
supplement the current knowledge of Licensed Vocational Nurses in relation to quality
care. In each cell I, D or M is noted for the level of achievement expected which are
acronyms corresponding to Introduce, Developed or Mastered.

Enhance the
ability to
identify and
implement
effective
strategies,
policies, and
programs to
promote and
protect the
health of
older adults.
Expand
efforts to
integrate
public health
and aging
services and
enhance
health
promotion
and disease
prevention for
older adults.
Promote
health and
preserve
health-
related
quality of
life for older
adults within
health care
and other
systems and
address end-
of -life
issues
Emphasizes
providing the
necessary care and
services to attain
or maintain the
highest practicable
physical, mental,
and psychosocial
well-being, as
defined by and in
accordance with
the comprehensive
assessment and
plan of care.
Provides a
comprehensiv
e approach to
well -being
investigating
areas of
medication
management,
evidence
based
practice, oral
health care
and clinical
practice.
Using clinical
guidelines and
standardized
measures; must teach
how to collect and
analyze data on
quality of care in the
nursing home based
on a needs
assessment.
Integrate
evidence-
based nursing
practice into
facility and
individual
resident needs
assessments to
ensure safety
and quality of
life
QNC 201:

I
QNC 203:

M
QNC 213:

D
QNC 213:

I
QNC 223:

M
QNC 243:

I
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Assist with the
development
and
implementatio
n of policies
and
compliance
measures
related to
regulations
appropriate to
nursing home
settings to
improve
quality of life
for residents

QNC 201:

D

Demonstrate
professional
commitment
to geriatric
care in nursing
homes by
providing
quality care.

QNC 243:

D
QNC 253:

D
QNC 263:

D
QNC 283:

D

Demonstrate
ethical
accountability
by
recognizing
and reporting
abuse within
the nursing
home and
implementing
a care plan for
victims

QNC 263:

I
QNC 263:

D

To encourage
understanding
and
comprehensio
n of health
promotion and
disease
prevention in
all areas of
care as it
relates to care
relates to care
of the elderly
in nursing
home settings.
QNC 233:

D
QNC 253:

M

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Communicate
with an
interdisciplina
ry team to
ensure that
each
healthcare
member
involved in a
residents care
will be aligned
with goals of
the healthcare
team.

QNC 283:

M

Demonstrate
critical
thinking skills
to provide
holistic care to
meet residents
and their
families in
nursing home
setting

QNC 201:

D
QNC 223:

D
QNC 253:

D
QNC 283:

M

Demonstrate
ability to
provide
quality
resident-
centered end
of life care to
residents and
their families.
QNC 233:

D

QNC 283:

D

(I)Introduced (D)Developed (M)Mastered

List of Courses

QNC 201: Introduction to Quality Improvement in Elderly Care
QNC 203: Regulation Agency Standards for Geriatric Nursing
QNC 213: Introduction to Evidence Based Practice in Geriatric Nursing
QNC 223: Integration of Public Health and Aging Services in Geriatric Care
QNC 233: Preventative Oral HealthCare and the Prevention of Oral Disease in the
Elderly
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QNC 243: Psychosocial Issues of Aging
QNC 253: Medication and its Impact on the Elderly
QNC 263: Nursing Home Abuse and Neglect
QNC 283: Quality End of Life Care in a Nursing Home

Summary
In conclusion, the Licensed Vocational Nurse is a dedicated healthcare team member
who is involved in the direct care of residents. This curriculum has great need and
significance because residents living in a nursing home or long-term care facility deserve
excellent quality of life care by a staff dedicated to their well-being. This curriculum was
designed to provide a well-rounded education for these Licensed Vocational Nursing
students by increasing their awareness of different aspects of quality of life care. This
paper described the curriculum model and theory, the influences that this curriculum has
on quality geriatric care including a needs assessment and internal and external
influences, the important mission statement that will be included discussing the reason
this curriculum is important, the curriculum design itself and the terminal learning
outcomes, and finally the curriculum map that will be the core of the curriculum itself.
By having this curriculum it will produce Licensed Vocational Nurses that are competent,
understanding, and educated Quality Care Nursing Specialists.

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References
(1) Texas Board of Nursing . Position statement 15.27. The LVN Scope of Practice.
2011. Accessed: 2013. http://www.bon.texas.gov/practice/pdfs/position.pdf
(2) 22 Texas Administration Code. Standards of Nursing Practice. 217.11.
November 15, 2007. Accessed: 2013.
http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p
_tloc=&p_ploc=&pg=1&ti=22&ch=217&rl=11
(3) Tolson, Debbie et. al. International Association of Gerontology and Geriatrics: A
Global Agenda for Clinical Research and Quality of Care in Nursing Homes. JAMDA:
Long Term Care: Management and Applied Research and Clinical Issues. 12.3 (March
2011): 184-189.
(4) Rosalie A. Kane Definition, Measurement, and Correlates of Quality of Life in
Nursing Homes: Toward a Reasonable Practice, Research, and Policy Agenda The
Gerontologist (2003) 43 (supply 2): 28-36 doi:10.1093/geront/43.suppl_2.28
(5) Mathy D. Mezey, Ethel L. Mitty, and Sarah Green Burger
Rethinking Teaching Nursing Homes: Potential for Improving Long-Term Care
Gerontologist 2008 48: 8-15.
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(6) Sefton, N, Craig, K and Meadows, S; FPIN's clinical inquiries. Quality of life in
older persons with dementia living in nursing homes. Am Fam Physician. 2008 Apr 1
;77(7):1011-2.
(7) Center for Disease Control and Prevention. Healthy Aging: Improving Quality of
Life Among Older Americans. National Center for Chronic Disease Prevention and
Health Promotion. 2009. Accessed: 2013.
http://www.cdc.gov/nccdphp/publications/aag/pdf/healthy_aging.pdf
(8) Johnson R. H., Puglia, C. J., Designing A Needs Assessment Survey for Clinical
Nurse Educators. Nurses Staff Dev. 2010 Sep-Oct; 28(5):225-8.

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Running head: GERIATRIC QUALITY CARE SPECIALIST: A CERTIFICATE PROGRAM

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