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Call for more study on ageing in uni courses

From dementia to palliative care, the ageing population will present myriad issues for the health system. Darragh O Keeffe asks nurse educators how they are preparing the future workforce to meet the challenge.

Whether you are a nursing, medical or paramedic student at the University of Tasmania, you can’t complete your studies without taking Perspectives on Ageing, a theory-based, one- semester unit which looks at ageing, the health and aged care systems, and key issues such as dementia.
The inclusion of a mandatory, specific unit on ageing, facilitating inter-professional engagement between students, puts UTAS in the minority.

While there is a lack of recent analysis on the content of undergraduate nursing curricula nationally, and a considerable variation between universities in this regard, most educators agree Australia could do better when it comes to preparing future nurses to deal with the challenges our ageing population will present.

Andrew Robinson, professor of aged care at UTAS and the academic behind the Perspectives on Ageing unit, said with the ageing of the population we are seeing clusters and intersections of chronic diseases in ways not witnessed before.

Robinson, who was speaking from the perspective of his own institution, says curricula are structured around 20th century ideas, and we are yet to embrace ageing as a key issue in healthcare provision.

“We’ve uncovered that our first- and second-year nursing students have less knowledge of dementia than unregistered workers in aged care. If we were producing students for 21st century we would be including much more about dementia, assessment, ageing. Certainly that’s what has emerged out of our evaluation.”

Robinson and his colleagues have realised the importance of a strong and overarching theme of ageing across the curriculum. “There needs to be, in a sense, a champion for ageing in each unit, so if it’s around acute medicine, for example, you look at how ageing is implicated and fits in with it.”

The notion of a cross-curricular theme of ageing is something Professor Helen Edwards is familiar with. In fact, Edwards, the head of the school of nursing at Queensland University of Technology, recommended as much following her 2004 analysis of the ageing content in undergraduate nursing curricula.

Her report, commissioned by the federal Department of Health and Ageing, resulted in a series of principles for teaching and learning related to aged care – one of which was that it should be a compulsory component integrated across the curriculum.

“That it should feature throughout the three-year program, building incrementally across the study with a significant component in the final year, which would act as a refresher for students before they go out into the workforce,” Edwards says.

Another principle details the importance of universities having the necessary expertise on staff to deliver the teaching of ageing content across the curriculum. Indeed she says this was an issue several universities highlighted during the project.

“Related to that is the importance of having involvement from industry and clinicians to bring in that expertise, so consulting with industry and peak bodies about the content and how it features,” she says.

The challenge of a crowded curriculum – one where ageing and aged care must jostle with other competing yet equally virtuous demands – was another issue. “At the time of our study there was a push for making sure you had enough mental health content, cancer and palliative care, safety,” Edwards says.

Indeed, the crowded curriculum is a bugbear for Professor Patrick Crookes.

For Crookes, who is chairman of the Council of Deans of Nursing and Midwifery (Australia and New Zealand), ageing is just one area that he and other deans of nursing are frequently asked about in terms of curricula.

“Various government taskforces and others have sought to influence preregistration nursing programs, be it in terms of quality and safety, e-health records, aged care, mental health or various other areas,” says Crookes, who is dean of the Faculty of Health and Behavioural Sciences at the University of Wollongong.

Any debate about undergraduate nursing curricula and the various competing specialist areas must bear in mind that universities cannot cover everything that is required for people to function in specialist practice upon graduation. Rather, what they must do is incorporate knowledge, skills and behaviour into programs that prepare people to work in a range of areas, Crookes says.

“We are expected to produce a comprehensively prepared practitioner who, upon graduation, continues in terms of their development in specialist practice. I don’t think some people fully appreciate that. They look at nurse education as if it’s the equivalent of inoculation; it’s something you have early on in life and it lasts you a lifetime.”

Crookes argues that an examination of most undergraduate nursing curricula, and indeed the accreditation guidelines governing them, would show that content is delivered in such a way that it covers the lifespan, as well as various groups such as culturally and linguistically diverse people and Aborigines.

“That’s the expectation of nursing programs. Now, there may be some programs that have more of an emphasis on aged care than others, some with more focus on mental health, but at the end of the day, we don’t have specialist registrars anymore, we have one register and specialist preparation commences on graduation.”

Further, Crookes argues that “significant efforts” are made in all curricula to prepare people to deal with the issues associated with an ageing population.

However, he points to a structural problem in career pathways and ongoing learning, particularly around specialisation, and says industry has a key role and responsibility.

“No one talks about people going to medical school and becoming a doctor, they talk about medical training lasting upwards of 14 years. That doesn’t exist in nursing; people graduate and its left to the market in terms of graduates deciding to work in a particular area and funding themselves to undertake postgraduate courses in that area. That’s not workforce planning.

“We need to develop a system where we produce good graduates, but then industry of whatever persuasion is able to assimilate them into their workforce and facilitate the further development of their skill and expertise.”

The university-industry link is one also noted by Robinson, who refers to the new teaching nursing home initiatives UTAS is developing with local aged care providers.

He sees this as crucial for the effective delivery of content and training in ageing issues to all nursing, medical and paramedic students. The two teaching nursing home projects will see the number of clinical placements per year rise from the 12 nursing students currently to 150 students (20 paramedic, 80 medical and 50 nursing). It represents an increase in placement days from 600 to more than 1300.

Robinson hopes this will overcome a key issue UTAS has identified. Nursing students have a strong focus on biomedical outcomes, developing competence and acquiring skills. Aged care placements are often not structured to provide these learning experiences, he says.

The initiatives will hopefully lead to a strong practice-based focus in the course.

“So the students take that same approach to aged care, and think ‘I need to develop my skills in assessing elderly people, in cognitive assessment, in relating to people with dementia and their families’ – acquiring the complex technical and social skills needed around supporting older people with a multitude of complex needs,” he says.

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