| The Geriatric
Mental Health Training Series(GMHTS):
A Brief Overview
Overview of the Need.
The need for geriatric mental health
and illness training in long-term care (LTC) settings was
highlighted in the years following the Nursing Home Reform
Act of the Omnibus Reconciliation Act of 1989. This need
continues to grow as the Baby Boom generation ages and increases
the sheer number of older individuals who experience mental
disorders. Today, as in 1989, as many as 70% to 90% of all
residents living in long-term care settings suffer from
some sort of mental disorder, with depression and dementia
being the two most frequently encountered disorders. Although
considerable progress has been made in providing training
to long-term care (LTC) staff, assistance to better understand
and manage behavioral problems associated with mental illness,
or threats to mental health, is often needed.
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The Geriatric Mental
Health Training Project. In
1989, Kathleen C. Buckwalter, PhD, RN, FAAN, received a
three-year grant from the Division of Nursing, Bureau of
Health Professionals, Department of Health and Human Services,
to provide training to nursing home personnel on geriatric
mental health topics. A two-year extension was granted in
1992 to further refine and expand work completed in the
first three years including evaluation of the programs'
relevance to other populations and settings. The program
materials provided here are revised and updated by Marianne
Smith, GMHTS, project director, from the original Geriatric
Mental Health Training Series (GMHTS) that was developed
during this project.
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Detailed Training Materials.
Realizing that most LTC nurses are
already faced with competing demands for their time and
attention, training materials were specifically designed
to be easy-to-use and understandable. The comprehensive
six-part manual that resulted was organized to facilitate
quick access to pertinent information, and included all
needed materials to train additional staff. Complex concepts
were reduced and explained in understandable language, and
psychiatric jargon was eliminated to facilitate understanding.
All materials were designed to help LTC nurses be more knowledgeable
about the causes of "problem" behaviors, techniques
to manage those troubling behaviors, and the influence of
the care providers' own feelings and behaviors in response
to resident behaviors (e.g. the role of values and beliefs,
personal needs, and stress in the work place). The training
materials were designed to be flexible, and strongly encouraged
individual trainers to adapt the modules to meet their unique
needs and audiences. Throughout the training materials,
trainers are urged to personalize the materials by using
real-life examples from their facility, try out suggested
interventions with residents prior to training staff, and
use as many meaningful examples as possible to help staff
apply the program concepts in their day-to-day practice.
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Module Topics/Titles.
Six topics that are based on needs
assessment survey are believed to be the cause of many behavioral
difficulties in LTC settings were the focus of the training
series. Six "core" modules were developed and
evaluated in Years 01-03 of the project, including an overview
of mental illness, problems related to control issues, communication
strategies, depression, dementia, and management of aggressive
behavior. Additional, supplemental modules were developed
and evaluated in Years 04-05 to complement and supplement
the core program, including topics like delirium, paranoia,
and anxiety.
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Independent Evaluation.
To verify the effectiveness of the
training materials and model, the project employed an independent
evaluation based at the University of Iowa. Nurse trainers
and their trainees both gave the program materials and training
an average rating of 4.5 or above on a six-point scale were
1=poor and 6=excellent. The written remarks were overwhelmingly
positive with few comments made under the "least useful"
section. A variety of articles were published describing
the outcomes, as highlighted next.
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Project Outcomes. Over
the course of this 5-year project, over 2,800 nurses and
nursing personnel were provided new knowledge using a train-the-trainer
format to disseminate research, theory and best practice
literature to nurses who might otherwise not come into contact
with this knowledge. Detailed program materials were purposefully
assembled in a "user-friendly" format to encourage
busy nurses to tackle training that might otherwise be deemed
too time-consuming or difficult. Each is structured to lead
staff from commonly encountered behaviors (perceived as
"difficult" or "problematic") through
a brief discussion of the underlying causes of the behavior,
methods to better assess and understand the behavior, and
finally to practical, hands-on interventions designed specifically
with day-to-day care providers in mind. Although this project
employed specialized training for trainers to enhance their
comfort and confidence with the program concepts, the materials
have been used successfully by health care providers who
have not attended special training. Finally, the program
materials have been used with diverse audiences, including
a wide range of LTC facility staff, as well as with acute
care, adult day health care, and home health care personnel.
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Revisions and Updates.
The original structure of the GMHTS
modules, as described in the section above, is maintained
in the modules provided by the HCGNE. Training modules are
updated to reflect current research and practices and are
provided in electronic format. To facilitate widest dissemination
and use of the training modules in the GMHTS, the original
paper and slide format has been modified so that materials
may be accessed as electronic versions. Updated copies in
Microsoft Word and PowerPoint, as well as materials converted
to PDF format, are provided. Permission is granted
for individuals to print, copy and otherwise reproduce these
program materials in an unaltered form for use as personal
development activities, inservice education programs, and
other continuing education programs for which no fees, or
only fees to cover expenses, are charged. Use of
these materials for personal profit is prohibited. Users
are asked to give credit to the Hartford Center of Geriatric
Nursing Excellence, College of Nursing, University of Iowa,
for use of the training materials.
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