Expanding the Gerontological Nursing Role in Guided Care

Guided Care is a new interdisciplinary health care model designed to improve the quality of life and efficiency of resource use for medically complex older adults. The Guided Care Nurse (GCN) performs an assessment, develops an evidence-based plan of care, monitors and coaches the patient in self-management, coordinates the patient's transitions, educates and supports family caregivers, and facilitates access to community resources. Nurses completed an education program based on these clinical processes. Monthly meetings following the education program provided a mechanism for ongoing learning, support, and role clarification. The delivery of GCN educational programs that facilitate role transition will be necessary for dissemination of Guided Care into the health care system. This article describes the Guided Care model, the role of the Guided Care Nurse, and the educational program developed to facilitate role transition for gerontologic nurses who provide Guided Care.