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Integrating the Transitional Care Model into Nurse Practitioner Curricula to Improve Outcomes for High-Risk Older Adults

Managing transitions in care for older adults and their family caregivers, no matter the care setting, is especially challenging in a rapidly changing health care system. Patient discharges which typically require prescription writing, discharge summary creation, and team consultations for home care entail more complex coordination and planning.

Educators and researchers at the University of Pennsylvania School of Nursing (Penn Nursing) share practices in a new article in the Journal of Professional Nursing describing how the Transitional Care Model (TCM) has successfully been incorporated into nurse practitioner curricula to address this issue. The article explains how the TCM’s evidence-based interventions have helped better prepare nurse practitioners to engage acute care providers to more effectively manage the care coordination of older adults with complex care needs.

“When the nurse practitioner students became aware of and engaged in the TCM, they learned how to make clinical decisions supporting a smooth transition from one level of care to another among multiple healthcare team members and across settings, such as hospitals and homes,” says lead-author Maria LoGrippo, PhD, RN, MSN, NE-BC, Practice Associate Professor and the Kehler Family Assistant Dean of Curricular Affairs and Innovation. “This competency-based approach prepares adult-gerontology acute care nurse practitioners to identify and address gaps in transitional care, thereby improving cost and quality outcomes for high-risk older adults.”

The article “Incorporating the Transitional Care Model Within NP Program Curricula to Achieve Care Coordination Competency” is available online. Co-authors of the article include Patricia Griffith, PhD, CRNP, ACNP-BC, Advanced Senior Lecturer, and Kathleen McCauley, PhD, RN, FAAN, FAHA, Professor Emerita of Cardiovascular Nursing, both of Penn Nursing.