Addressing 4Ms of Age-Friendly Health Systems for Older Adults in Family Nurse Practitioner Education through Simulation-Based Learning

Abstract

The population in the United States is aging, and care of older adults is frequently more complex. Addressing older adult competencies in educational programs provides a foundation in which to assess this population, guide the plan of care and aid in decision making. Using the Institute of Healthcare Improvement (IHI) '4Ms' framework, a family nurse practitioner (FNP) program designed a novel approach using an unfolding simulation to integrate the four elements: (a) What Matters Most, (b) Mentation, (c) Medication, and (d) Mobility. The pilot simulation focused on Mentation and What Matters Most in an Advanced Health Assessment course. Students conducted a comprehensive cognitive assessment for an older patient with memory concerns, providing education and resource referrals. Progressive simulations are planned as the patient's cognition declines, building in complexity to include Medications and Mobility while attending to What Matters Most for the patient and their family in each phase. In designing simulations using the 4Ms framework, the pilot simulation provided a teaching strategy and measurement of performance in caring for older adults, and students reported an increase in confidence in communicating and advocating for this population.