20 Clinical competencies of the clinical nurse specialist in Care of the Older Person in a geriatric assessment unit

Abstract Background Access to geriatric assessment, coordination between healthcare providers and integration of care across the health system are critical to meet the care needs of older adults living in the community with complex care needs. Clinical Nurse Specialists (CNS) with knowledge and clinical skills in gerontological nursing are key for the provision of care in this cohort. Our aim was to conduct an audit of CNS activity in the Geriatric Assessment Unit (GAU) in relation to specialist nursing clinical competencies. Methods We conducted a retrospective audit of CNS activity during the first quarter of 2023 with a focus on the CNS clinical core competencies as defined in the Framework for the Establishment of Clinical Nurse\Midwife Specialist Posts in two GAU in Louth. Results In total, n = 301 patients attended the two GAU in the first quarter of 2023, 58% female, with mean age 79.90 (95% CI 79.18–80.62), n = 78 of whom were new to the service. Within an interdisciplinary approach, a Comprehensive Geriatric Assessment (CGA) is conducted by the CNS, which includes obtention of a detailed medical history, nutritional assessment, falls risk, skin integrity, frailty and dependency level, assessment of continence, cognitive screening and swallow screening. These assessments led to n = 273 referrals to community-based services, including Public Health Nurse (n = 51), Occupational Therapist (n = 38) and Memory Rehab (n = 18). Mean waiting time to attend the clinic for the first time was 104.13 days (95% CI 89.79–118.47). Conclusion The CNS in Care of the Older Person conducts a CGA, identifies unmet care needs and plans, coordinates and initiates person-centred care for older adults living in the community with complex care needs. CNS input is key to achieve adequate management of complex care needs while avoiding negative outcomes and promoting quality of life.