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• W2121569791 abstract "ONE HEALTH CARE SETTING FRAUGHT WITH RISKS FOR ERROR AND INJURY TO THE OLDER POPULATION IS THE EMERGENCY DEPARTMENT (ED). Older adults experience more adverse events while in the ED, and after discharge, when compared with other age groups (Aminzadeh & Dalziel, 2002). Tang, Stein, Hsia, Maselli, and Gonzales (2010) reported 17.5 million visits by older adults to EDs in 2007. The distinct physiological and psychosocial developmental changes that older adults experience profoundly affect the provision of safe, competent, and holistic nursing care. (See Figure 1.) When physiologic and psychosocial changes are not appropriately addressed, errors in management and poor outcomes may ensue. New graduate nurses tend to struggle when managing elderly patients, especially if they have not received appropriate training while in nursing school. In response to the need to include older adult-focused content in a baccalaureate nursing curriculum, a faculty member at Tennessee Technological University Whitson-Hester School of Nursing collaborated with an adult health/gerontology nurse practitioner to design a Legacy Cycle that engages students in challenge-based learning. The Legacy Cycle approach is a product of the National Research Council and a multi-institutional biomedical engineering education initiative funded by the National Science Foundation (Bransford, Brown, & Cocking, 2000). A strong research foundation for the application of Legacy Cycle modules exists in other disciplines. Biomedical engineering educators have found Legacy Cycles to be effective tools for training students to think efficiently and creatively (Brophy, 2003; Martin, Rivale, & Diller, 2007; Pandy, Petrosino, Austin, & Barr, 2004). The Legacy Cycle approach is easily adapted for educating nursing students as they develop critical thinking, collaboration, and communication skills. Modules on topics such as emergent care of myocardial infarction, acid-base balance, and transitioning clients from parenteral to oral anticoagulant therapy were designed by the author and have been implemented as both graded assignments and as formative assessment tools. This Legacy Cycle is not currently graded. Rather, it serves as a formative assessment by providing ongoing evaluation of nursing students' ability to synthesize multiple pieces of data and prioritize findings concerning the care of older adults. Since the implementation of Legacy Cycles and other guided instructional design strategies (Bransford et al., 2000), the nursing program has achieved an NCLEX-RN[R] pass rate consistently greater than 95 percent. Anecdotally, students and employers report superior clinical reasoning and safe decision-making when compared with new graduates from comparable programs. The Legacy Cycle Design A Legacy Cycle makes use of a contextually based challenge followed by a sequence of instruction where the students offer initial predictions (Generate Ideas), gather information from multiple sources (Multiple Perspectives), integrate the knowledge gathered and extend this knowledge (Research and Revise), and formalize their solutions in formative and summative assessment activities (Test Your Mettle and Go Public) (Pandy et al., 2004). The learning goals are contextualized in a realistic scenario; for example, Figure 2 presents the case of a 72year-old woman who visits the ED after becoming dizzy and falling at home. Figure I. Physiological and Psychosocial Developmental Changes Faced by Older Adults Neurological Impaired cognitive function affects nearly one quarter of the older adult population presenting to the emergency department, and 7 percent to 10 percent will present with some form of acute delirium with or without dementia (Milbrandt, Eldadah, Nayfield, Hadley, & Angus, 2010). Terrell et al. (2009) identified cognitive assessment as the most important step an emergency room provider can complete to ensure quality medical and nursing care. …" @default.
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• W2121569791 date "2012-06-01" @default.
• W2121569791 modified "2023-09-26" @default.
• W2121569791 title "Engaging StudentsinClinical Reasoning When CaringforOlder Adults" @default.
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• W2121569791 doi "https://doi.org/10.5480/1536-5026-33.3.190" @default.
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