Primary care settings are increasingly challenged with the complex health needs of older adults. Effective clinical diagnosis and comprehensive health assessments are crucial in this domain, especially when dealing with geriatric patients who often present with multiple comorbidities and intricate medication regimens. Recognizing the growing need for specialized expertise in this area, particularly within advanced practice nursing, the National Hartford Center for Gerontological Nursing Excellence has honored Carol Delville, PhD, RN, ACNS-BC, and Glenda Joiner-Rogers, PhD, RN, ACNS-BC, as Distinguished Educators in Gerontological Nursing. This prestigious award acknowledges their significant contributions to preparing nurses for the complexities of geriatric care.
The Pivotal Role of Advanced Health Assessment in Geriatric Care
Advanced health assessment is not merely a procedural checklist; it is a cornerstone of effective clinical diagnosis, especially when caring for older adults. This population frequently experiences overlapping health conditions and polypharmacy, making accurate assessment paramount. As clinical assistant professors at the UT Austin School of Nursing, Delville and Joiner-Rogers are deeply involved in the Adult-Gerontology Clinical Nurse Specialist (AGCNS) program. This program emphasizes the leadership role of AGCNS professionals in achieving optimal patient outcomes and fostering interdisciplinary collaboration to address multifaceted healthcare challenges.
Left to Right: Carol Delville, PhD, RN, ACNS-BC and Glenda Joiner-Rogers, PhD, RN, ACNS-BC
“The goal of the adult gerontology CNS is to stabilize individuals for maximum function, preserve current function and prevent the progression of loss of function,” explains Delville. She further highlights the intricate nature of older adult care: “The older adult population is extremely complex because of overlapping co-morbidities and the number of medications prescribed to deal with those health issues. Many older adult patients may be subject to a polypharmacy… which can impair their cognition and ability to function physically or care for themselves.” This underscores the necessity for advanced assessment skills to accurately identify and manage the diverse health issues prevalent in older adults.
Strategies for Clinical Diagnosis and Patient Management in Older Adults
The expertise of Delville and Joiner-Rogers extends to equipping future AGCNS professionals with the skills to navigate the complexities of clinical diagnosis in older adults. Their program at UT Austin integrates in-depth knowledge of diseases and medical treatments with advanced assessment and diagnostic techniques. Graduates are prepared to exercise prescriptive authority, enabling them to provide comprehensive pharmacologic and nonpharmacologic treatments, order diagnostic tests, and effectively manage the specialized health problems of their patients.
Joiner-Rogers elaborates on a critical aspect of geriatric patient management: “Our students soon realize it is imperative to manage and treat the patient problems, but also know how to peel away the non-critical medications in hopes of improving the individual’s quality of life. We advise students to go back and, in collaboration with the patient and family, figure out the priority in the older person’s care.” This patient-centered approach to clinical diagnosis and treatment planning is essential for enhancing the well-being of older adults.
A testament to the program’s effectiveness is Aline Zeringue, MSN, RN, ACNS-BC, an alumna who now runs ATX Primary Care. Zeringue emphasizes the program’s lasting impact on her practice: “The holistic way I approach caring for a patient, the systematic way in which I evaluate information, and the way I implement current literature and research into my practice are all direct results of the way I was educated at UT Austin.” She specifically points to the program’s emphasis on critical thinking skills as instrumental in her ability to address complex patient scenarios in primary care.
Fostering Excellence in Gerontological Nursing and Long-Term Care
Beyond their roles in the AGCNS program, Delville and Joiner-Rogers are actively involved with the School of Nursing’s Center for Excellence in Aging Services and Long Term Care. This center, in partnership with the Texas Health and Human Services Commission, is dedicated to enhancing the quality of long-term care through education and training for providers and community members.
The Center actively disseminates research-based best practices in geriatrics and disability care through its website and regular seminars. They also co-host an annual geriatric symposium, bringing together a multidisciplinary group of healthcare professionals, including social workers, pharmacists, and recreational therapists. Delville notes the unique value of this interprofessional collaboration: “Rarely do we get to hear from multi-disciplinary groups and get their perspective and share ours.” This collaborative approach is vital for advancing clinical diagnosis and comprehensive care strategies for older adults across various healthcare settings.
The recognition of Delville and Joiner-Rogers as Distinguished Educators underscores the critical importance of specialized knowledge and skills in gerontological nursing, particularly in the context of advanced health assessment and clinical diagnosis within primary care. Their work is instrumental in shaping the future of geriatric healthcare and ensuring that older adults receive the high-quality, comprehensive care they deserve.
