GEDI team
Professional development for GEDI nurses that is specific for aged care can be difficult to gain in the ED. An educational resource Care of the older person in emergency has been developed to support both GEDI nurses and primary ED clinicians in knowledge of the older person. Linking with inpatient teams or accessing education opportunities external to the ED or even the hospital may also be beneficial. One opportunity that may exist within the health service is case conferencing. It is suggested GEDI staff attend specialist geriatric inpatient multi-disciplinary team meetings where GEDI patients seen in the ED are often discussed. This assists in GEDI team members learning about the complexities in geriatric patient care. Online resources that may assist in education and professional development of the GEDI team include:
- GERIatric ED and GERI EM websites;
- The Silver Book (Cook et al., 2012) and the Geriatric Emergency Department Guidelines (American College of Emergency Physicians, 2013);
- Geriatric nursing learning modules (See Appendix F to see these and other useful websites).
Queensland Health Nursing Staff are allocated time and remuneration for professional development in the Enterprise Bargaining Agreement that is undertaken as part of establishing the salary of any registered nurse. The GEDI nurses can utilise this for paid education in care of the older person. Conferences may also be a way to increase knowledge in this area.
Professional development
GEDI staff should be encouraged to attend courses that extend their knowledge of acute geriatric care. Where relevant, community experience would be a good adjunct to their CN role in a GEDI model. This community exposure provides them with situated learning of their patients care needs and identification of the potential barriers commonly seen in community settings. This also provides familiarity with the referral pathway and service availability in community settings.
ED primary nurses and medical staff
GEDI staff are expected to also have an in-depth knowledge of care of older people and as such will provide education of the ED multidisciplinary team through planned education sessions and opportunistically whilst providing direct care in the department.
The members of the GEDI team may work with the medical and nursing educators to provide a program of education related to the care of the older person in the ED. Topics that may be included in the program include:
- Attitudes to ageing and older persons (see earlier information p 24 Attitudes to older persons)
- Recognition of the physiological changes associated with the ageing process
- Recognition of cognitive impairment and delirium screening
- Trauma/falls assessment and management
- Pain assessment in the confused older person
- Wound care (skin tear management)
- Palliative care in the ED
- Polypharmacy
- Bladder and bowel management.
A suite of educational PowerPoints have been developed to facilitate education in the ED.
ED nurse educators and clinical coaches need to consider education regarding the older person as part of the core business for all ED staff. It is suggested that the GEDI ED physician leads the geriatric portfolio for medical training and education. This will ensure that concerns particular to the geriatric patient receive equal focus to other age groups based on the specific needs of this vulnerable cohort.
