Taking In-Service Learning Technologies into Nursing Homes: The Duke Endowment Supports Patient Care Simulator Training in North Carolina Skilled Nursing Facilities

Long-term care facilities depend on several levels of nursing personnel to accomplish their goals of providing the highest levels of medical and nursing care to residents, while at the same time making certain that the life experiences of these residents are of the highest possible level of quality. In addition to registered nurses (RNs), many of the nursing care providers in these facilities are licensed practical nurses (LPNs) and nursing assistants (NAs or CNAs). Several North Carolina nursing homes are beginning to hire nurse practitioners to augment their overall medicalnursing care and to provide a more highly specialized level of care for residents under their care. Residents of most North Carolina nursing homes are often older and require caregivers with gerontological skills. The specialized needs of older adult patients are a major concern for nursing care providers in these facilities, where residents r equire 24-hour skilled nursing care. Given the preponderance of persons with serious physical or cognitive impairments, the acuity of nursing observational skills is critical to the assurance of both patient safety and quality of care in these facilities. The complexity of the nursing skills required, and the frequency with which new and more effective ways to manage common health conditions in such populations are developed, necessitates that these facilities find ways to offer in-service or extramural skill enhancement training. However, because of limited staff in most long-term care facilities, it is difficult for these facilities to arrange for lengthy absences of any substantial number of nursing care staff in order to take advantage of training offered at extramural sites (e.g., AHEC facilities or at one of the nursing schools in our state). It would be most useful to have some reliable means of offering sound instructional programs in clinical nursing relevant to long-term care that could be offered on-site for all levels of nursing personnel, thus eliminating the need for extended absences from normal responsibilities in these facilities. The FutureCare of North Carolina Project: An Itinerant Model Simulator-Based Training Program