The project, known as CHEERS - Coalition for Health Enhancement of Elders and Referral Services - provides student participation in a real-life, grassroots community project as part of the educational experience during enrollment in the online RN-BSN nursing program.

Students enrolled in the community and population-focused course work collaboratively with the Top of Alabama Regional Council of Governments (TARCOG), the regional Area Agency on Aging, located in Huntsville, to conduct home visits and provide health-related services for clients served in Limestone, Madison, Marshall, DeKalb, and Jackson counties. Over a period of one semester, these nurses go into the homes of clients, particularly in rural, isolated areas, and conduct screening, using an Elder Risk Assessment instrument that was developed to assess specific risks for loss of independent living in this population. RN students conduct risk and family assessments, as well as answer health-related questions, discuss management of health issues, and provide companionship. In response to the findings, the nurses provide education, needed services, and referrals.

Thus far, over 1300 clients have been served and more than 500 nurses have been educated about the needs of the elderly. Analysis of outcomes indicates that this program has been a highly effective method for educating nurses about gerontological and community health nursing, as well as for meeting the needs of vulnerable elderly clients through collaboration between an educational institution and local service providers. Based on the client’s assessment, students develop and implement a teaching/wellness plan, with emphasis on improving patient education and safety.

Data collected during the students' visits indicate that the needs of this population are startling and available resources are minimal. The benefits that these nurses have provided through this educational experience are astounding, as are the benefits provided to the students from the collaborative, interdisciplinary nature of the project. The College of Nursing is proud to work with the agency toward the betterment of the entire older adult community.

Before visiting the clients, students identify local resources within each county. Health care access, emergency services, pharmacies, public transportation, and general businesses among others are identified. After obtaining permission from each client the students identify individual problems using screening and interviewing techniques. Health status as well as social, financial, and environmental conditions which are known to threaten independent living are assessed. Bonding with the clients and establishing trust are major goals during the initial introductory phase and remain important throughout the entire process. In collaboration with the client, students develop and implement a patient-centered teaching/wellness plan, with emphasis on improving patient education and safety. Fall prevention, management of diabetes, and medication management and safety are examples of commonly covered teaching topics.

Many of the interventions involve teaching and making referrals to appropriate health care and social agencies. We carefully address how well the clients are managing their medical conditions in light of their understanding of the recommended treatments prescribed. Blood pressure, vision, medication and environmental safety screenings are performed.

Much teaching is directed toward increasing the clients' knowledge of medication taking practices to avoid errors. Nutritional education addressing dietary habits is provided and referrals are made, particularly under circumstances when clients cannot afford adequate food.

Crime risk and prevention is discussed with each client. Environmental home safety risks are assessed including the presence of working smoke detectors, fire extinguishers and factors within the home that place an older person at risk for falling. To minimize risk, referrals are made to CASA (the Care Assurance System for Aging) and other local agencies that initiate necessary home improvements such as the building of ramps and installing hand rails.

Clients are screened for signs of depression and receive support to reduce loneliness and increase availability of social support. Of the services that we perform, possibly the most appreciated and critical to our clients is that of providing companionship. For many of our clients we are possibly the only people who routinely listen, talk, laugh, and cry with them. This experience offers a return to the basics of nursing care...a return to the comfort of home.