Conversations with Leaders in the Field of Patient-Centered Care:
Dr. Mathy Mezey
One of the ways Picker Institute supports patient-centered care is by recognizing significant contributions to achieving patient-centered care state- and/or nationwide. “Conversations with Leaders in the Field of Patient-Centered Care” is a regular feature that highlights these contributions.
This Conversation is with Dr. Mathy Mezey, Ed.D., R.N., F.A.A.N., Professor Emerita, Senior Research Scientist and Associate Director at the Hartford Institute for Geriatric Nursing, New York University College of Nursing. Dr. Mezey received her undergraduate and graduate education atColombiaUniversity. She worked as a public health nurse in New York City and taught at Lehman College, City University of New York. For 10 years she was a professor at the University of Pennsylvania School of Nursing, where she directed the GNP program and the Robert Wood Johnson Foundation Teaching Nursing Home Program. From 1991 to 2008 she was the Independence Foundation Professor of Nursing Education at New York University, and in 1996 she became the founding director of the Hartford Institute.
Dr. Mezey is the author of more than 11 books and 90 publications. Her research and writing focus on geriatric nursing education, the quality of care for older people in hospitals and long-term care, and bioethical issues that affect decisions at the end of life.
Dr. Mezey holds honorary doctorates from Case Western Reserve University and Fairfield University and is a Fellow of the American Academy of Nursing and the Gerontological Society of America (GSA). Among her awards are the Doris Schwartz Gerontological Nursing Research Award and, in 2010, the Donald Kent Award, from the GSA; a Lifetime Achievement Award from the National Gerontological Nursing Association; and the Nascher-Manning Award from the American Geriatrics Society. She sits on the board and chairs the Executive Committee of the Visiting Nurse Service of New York and is a trustee emeritus at Columbia University.
Dr. Mezey led a team investigating “Nursing Homes as Clinical Training Sites: Recommendations to the Field” under a grant from Picker Institute’s Long-Term Care Program. An overview of the project and links to the six e-learning modules that resulted are available at http://pickerinstitute.org/nursing-homes-as-clinical-placement-sites-for-baccalaureate-nursing-students/.
The long-term care project you’ve just completed is a very thorough examination of the use of culture-change nursing homes—simply put, nursing homes where the care is directed largely by the residents, or nursing homes that are deliberately moving in that direction—as clinical training sites for student nurses. This kind of apprenticeship model is fairly common in some professions such as medicine and the law. Is it a new concept as it relates to nursing homes?
Rotations in clinical sites (e.g., hospitals, clinics, nursing homes and home care) have long been a required and integral component of the education of both undergraduate and graduate nursing students. In a typical rotation, students, supervised by nursing faculty, spend several days a week in an agency taking care of patients for a semester or a year.
Similarly, schools of nursing have used nursing homes as sites for clinical rotations for many years, although it is my impression that schools are using nursing homes more often now than has been the case in the past. Undergraduate students might have a rotation in a nursing home at the beginning of their course of study or as seniors for a “capstone” project. Nurse practitioner students might care for a caseload of nursing home residents.
You have developed recommendations for the program in the form of six detailed and highly accessible e-learning modules. Do you think your audience will comprise student nurses who are interested in geriatric nursing? Or do you see them as directed at any student nurse who might be interested if only in expanding their experience? Does the work the students do there count toward course credits?
The e-learning modules are unique in that they are for both faculty and students. Many faculty have never actually worked in a nursing home. The modules help faculty differentiate among homes, select homes that will yield exemplary student experiences and promote positive attitudes among students. Students are usually assigned to a nursing home by faculty and may hold negative attitudes to homes and residents. The modules help students understand how homes are structured and how to better care for residents. The modules introduce resident-centered care and culture change, concepts often unknown to both faculty and students.
The goals you’ve developed for student nurses and the means of achieving them are very ambitious. In a sense, you’re asking the students and the nurses who are employed at the nursing home to add another string to their bow: learning and teaching, respectively. Do you think these duties can be comfortably and productively accommodated in the time available?
The e-learning modules were developed to enhance nursing students’ required and elective clinical rotations in nursing homes. For faculty, the objective was to enhancing student rotations by providing a context for care in nursing homes that faculty may not be aware of. For example, by better understanding culture change and resident-directed care, faculty can help students identify the extent to which culture-change principles are evident in the nursing home, or help students suggest to staff ways to enhance resident autonomy.
Faculty can assign the modules to students and then ask them to compare and contrast content in the modules with what they are seeing and experiencing during their actual clinical rotation.
While the modules were not developed to be used by nursing home staff, they might be beneficial to new staff who are unfamiliar with how nursing homes are structured, how nurse staffing is configured or how nursing homes are paid and regulated.
You’ve had a good response to the modules as they are presented online. Do you know of any nursing home and/or nursing educational institute that has actually put the program in place? If so, have there been any reports on its efficacy?
The webinars we presented to introduce the modules (in conjunction with the American Association of Colleges of Nursing, AACN) have been viewed by more than 1,300 people (both live and archived). We do not have specific examples as to how faculty is using the modules. We do know, however, that 23 schools of nursing competed for an award offered by the American Association of Colleges of Nursing to recognize innovation in creating clinical experiences for students in culture-change nursing homes.
A vision like this one sometimes, in the real world, encounters obstacles that may have to do with job descriptions, e.g., an RN who says “That’s not in my job description;” union membership, e.g., an RN or other employee who says “The student can’t perform that function because my union says it is exclusively my domain;” et al. How have you prepared for that eventuality?
Before selecting a nursing home for a student rotation, faculty typically explain to the home the activities that students will need to engage in with residents, e.g., providing personal care; giving injections or other procedures; and taking histories and performing examinations. Sometimes, these arrangements are written in the form of a contract between the school of nursing and the home. When careful preparation occurs ahead of time, there are rarely conflicts as to what students can and cannot do.
You’ve gotten very strong and diversified support for this project. Why do you think it is so appealing? Do you think it is part of an increased interest in geriatric and long-term care as the country’s aging population grows?
I do think that schools of nursing are increasingly turning to nursing homes for clinical rotations for students. There are probably several reasons for this. Increased competition is making it more difficult to arrange for rotations in hospitals. The f act that residents are more diverse than was the case in the past makes rotations in nursing homes more attractive. With early discharge from hospitals, many older adults now recuperate in a nursing home rather than a hospital, and many nursing homes provide palliative and hospice care. Thus faculty has come to appreciate the diverse and rich learning experiences that nursing homes can provide for students. I also think that the culture-change movement has enhanced faculty enthusiasm for taking students into nursing homes, where they can now see exemplary care.