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Nursing Response to Elder Mistreatment - About this Curriculum
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Nursing Response to Elder Mistreatment Curriculum
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About this Curriculum

Course Outline (download)

Need for the Course
Scope of Elder Mistreatment Addressed
Course Goal, Objectives, and Outcomes
Course Structure
Target Audiences
Use of the Instructor's Manual
Module Organization
Instructor Qualifications
Instructional Approach
Logistics for Course Organizers and CEs

Modules

Resources

Need for the Course

Nurses routinely care for older adults in a variety of settings.  As the aging population in America rapidly increases,  nurses are not only interacting with a greater number of older adults, but there also is an increased likelihood of encountering individuals who are dependent on others for help with activities of daily living (such as bathing, dressing and toileting) and instrumental activities of daily living (such as shopping, managing finances and using the telephone).  Dependence on “trusted others” for basic care needs increases the risk of elder mistreatment. 

No national, formalized curriculum exists that provides nurses with foundational knowledge about elder mistreatment and helps them develop skills to improve their capacity to respond to this problem.   There are also no national-level education programs to build nurses’ basic forensic skills to enhance screening, assessment, intervention and referral in cases of actual or potential elder mistreatment.  Forensic nursing skills can be useful to nurses in cases when health and legal issues intersect, including when older adults are affected by intentional or unintentional injury.   This formalized curriculum, created by the International Association of Forensic Nurses (IAFN), with funding from the U.S. Department of Justice, provides nurses the opportunity to improve their responses in elder mistreatment cases.

Scope of Elder Mistreatment Addressed

The term “elder mistreatment” describes (1) intentional acts by a “trusted other” with a duty of care (e.g., adult son or daughter, intimate partner, paid caregiver or fiduciary) that cause harm or pose serious risk of harm to a vulnerable older adult; and/or (2) acts of omission wherein a “trusted other” with a duty of care fails to meet basic needs of a vulnerable older adult.   Elder mistreatment may occur in community (domestic) or long-term care (institutional) settings.   Distinct types of elder mistreatment include: 

  • Neglect—failure to provide for the basic needs (e.g., safety, food, clothing, shelter and hygiene) of a vulnerable older adult.

  • Abandonment—leaving a vulnerable older adult without the means or ability to obtain one or more of the basic necessities of life.

  • Physical abuse—use of physical force against a vulnerable older adult that results or may result in bodily injury, physical pain or impairment.

  • Sexual abuse—coerced sexual activity with a vulnerable older adult.

  • Emotional or psychological abuse—use of verbal and/or non-verbal acts to inflict anguish and/or distress upon a vulnerable older adult.

  • Financial exploitation—the illegal or improper use of a vulnerable older adult’s resources (money, property and/or assets).

  • Violation of personal rights—ignoring the rights and capability of a vulnerable older adult to make his/her own decisions.  In long term care facilities, this term has broad meaning and can include the right to medical services, choice of physician, right to remain in the facility and freedom from physical and chemical restraint.

More information can be found in the Course Overview.

Course Goals, Objectives and Outcomes

The goal of this course is to help nurses acquire essential knowledge and skills to appropriately respond to elder mistreatment.  This course prepares nurses to integrate nursing and forensic sciences into the care of vulnerable older adults who have been mistreated or are at high risk for mistreatment by trusted others.  (Note that the course does not fully prepare them to be forensic nurses, which requires more specialized education and clinical practice.)

Objectives.  Participants who complete this course will be able to: 

  • Describe nursing roles in responding to elder mistreatment and the priority of promoting patient safety and health;

  • Recognize the critical need for multidisciplinary team approaches to these cases and nurses’ roles as part of that team;

  • Distinguish the roles of nurses with and without forensic education and experience in these cases;

  • Recognize characteristics of the older population and the relationship of aging to vulnerability for risk of mistreatment;

  • Describe the scope and nature of elder mistreatment;

  • Identify laws, regulations and policies relevant to elder mistreatment;

  • Discuss ethical issues in providing patient care in actual or potential elder mistreatment cases;

  • Describe how to screen and assess patients for elder mistreatment, as well as to gather information from others, such as caregivers, guardians and family members; 

  • Discuss steps in identifying, evaluating and documenting signs of elder mistreatment;

  • Recognize the need to preserve and minimize damage to forensic evidence during the screening and assessment process, while prioritizing care of acute injuries, and identify the scope of nurses’ roles related to collecting evidence;

  • Discuss the need for and basic techniques of photo-documentation in actual or potential elder mistreatment cases;

  • Discuss documentation of acute complaints, pertinent historical data, assessment findings, interventions and communication of findings to outside agencies;

  • Recognize the importance of accurate and objective medical documentation to legal proceedings; and

  • Identify issues and actions to be considered during discharge/ care transition planning in actual or potential elder mistreatment cases, keeping patient safety and health as priorities.

Desired outcomes.  Enhanced nursing responses in elder mistreatment cases can serve to validate and address concerns of vulnerable older adults and ultimately, promote their safety and health.  It can also serve to increase the likelihood that evidence (including written and photographic documentation) may help stop current mistreatment, prevent future mistreatment, enhance criminal investigations and hold perpetrators accountable.   Nurses who complete this course may serve as resources in their agencies and communities on the topic of elder mistreatment.

Course Structure

This 24-hour course contains 12 modules; with inclusion of optional activities, the total time increases to 30 hours.   It is designed as a stand-alone continuing education program, but it may be incorporated as part of a more extensive existing curricula.  The course curriculum includes three components for each module—the Instructor’s Manual, Participant Materials and PowerPoint Slides. 

Target Audiences

This course was developed for registered nurses who provide direct care to vulnerable older adults in various settings (e.g., acute care, long-term care, home health and public health).  Nurses in supervisory positions who complete the course may also enhance their direct care skills and increase their awareness of policy and systems issues related to responses to elder mistreatment.  The course was crafted assuming nurse participants have little or no formal education or experience in forensic or geriatric nursing. 

Secondary audiences that may find some or all of the modules useful include (1) other nurses and health care providers (e.g., forensic and geriatric nurses, licensed practical nurses, certified nursing assistants, nursing students, physicians, physicians’ assistants and emergency medical technicians and paramedics); and (2) first responders to elder mistreatment outside of the health care field (e.g., domestic violence and sexual assault victim advocates, long-term care ombudsmen, adult protective services professionals, social workers, crisis counselors, emergency dispatchers, law enforcement personnel, attorneys and judges). 

Use of the Instructor's Manual

The Instructor’s Manual was developed to help instructors prepare for and deliver this course.  Each module in the manual has corresponding participant materials (with case studies, questions, key points, additional information and additional reading suggestions, as applicable to each module) and a slide presentation.  Prior to beginning the course, instructors should review the entire curriculum to grasp the full extent of the material, as well as to maintain consistent content threads across modules.

Module Organization

Each module, as presented in the Instructor’s Manual, includes a module introduction followed by a lesson plan.  The introduction provides a quick overview of the module, including purpose, topics, learning objectives and instructor preparation suggestions.  The lesson plan consists of instructional activities, including:

  • Small group exercises.

  • Large group instructor/learner dialogue.

  • Case studies using guided inquiry questions. 

  • Short lectures. 

  • Film presentations with directed questions.

Note that use of films that need to be rented or purchased has been kept to a minimum in this curriculum.  Viewing of rented or purchased film clips is typically listed as an optional activity.  There are many other films that could supplement this curriculum.  One resource is Terra Nova Films at http://www.terranova.org/Title.aspx?ProductCode=JPLVHS.        

Instructor Qualifications

The course is designed to be presented by a core multidisciplinary team of instructors—for example, a nurse educator, an elder mistreatment expert and a trainer with relevant legal/adult protective expertise.  

Instructional Approach

Key learning principles driving this curriculum include:

  • What learners discover supports better learning.  Instructional activities which are provided in authentic contexts, with hands-on activities requiring critical thinking and problem solving, tend to create deeper, longer-lasting learning.

  • Learning best takes place in a supportive learning environment that clearly articulates expectations.  By presenting participants with a problem and allowing them to solve it on their own or in small groups, the instructor conveys that participants have valuable life, educational and professional experiences and are encouraged to voice their opinions in class.

  • Learning outcomes must be geared not to mere recall of data, but to behaviors required of nurses to be successful in the clinical setting.

  • The attention span of adults is seven to 20 minutes for passive engagement activities (listening, watching and reading).  Mental engagement is better than passive engagement; mental engagement in critical thinking and problem solving is the most effective learning activity.  Activities that facilitate dialogue among participants and with instructors produce physical and mental engagement and support a continuous check of learning and tailors instruction to the needs of participants.

  • Effective instruction engages learners in skill building, critical thinking and problem solving activities.  By providing these activities in a low-risk environment, along with debriefing opportunities, participants can identify what was effective about their performance, what they would change and what knowledge, skills, practice or feedback they need to enhance their responses to elder mistreatment.

  • Rather than randomly presenting topics, this curriculum is structured to teach in a “just in time” manner so that participants gain knowledge and skills in each module that build upon what was learned in the previous modules.

Logistics for Course Organizers

Class Environment.  As organizers consider their options for class space and room setup, they should be aware of the following:

  • An optimal number of participants for this course is 16 to 35. 

  • The optimal setting is a classroom with enough small tables to allow for groups of four to six participants to converse.  Chairs should be easy to move, allowing participants to face the front of the room for lectures and break into small groups.

  • Participants may sit wherever they choose or seating may be assigned in advance to achieve various outcomes.  For example, instructors may want (1) participants of various skill levels to work together so that the less experienced benefit from the expertise of those with more experience; (2) participants to work with others from their organization to promote internal collaboration; or (3) participants to work with members of other organizations to promote interagency collaboration.

Equipment, supplies and materials.  Before the course begins, organizers should arrange for the following equipment and materials to be available as needed. Review the Course Overview for a full list.

Continuing Education Credits (CEUs).  Instructors or the agencies sponsoring the education course need to determine if and how participants will be offered CEUs for course completion.

 

This project was supported by Grant No. 2003-DD-BX-K006, awarded by the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this publication are those of the authors and do not necessarily reflect those of the U.S. Department of Justice.


 


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