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New report highlights boosts in nursing students’ confidence in geriatric care

Findings show intraprofessional simulation training helps prepare future nurses to care for Hawaii’s aging population.

A patient in a wheelchair, covered with a blanket, talks with a small group seated in a circle in a clinic room, including two nursing students in teal scrubs, a woman taking notes on a clipboard, and two other observers. Everyone is smiling and engaged in conversation.
The Aging With Grace simulation has expanded to interprofessional education, pairing nursing students with social work students.

As Hawaii’s population ages and demand for geriatric care grows, an innovative simulation program at the University of Hawaii at Manoa School of Nursing and Dental Hygiene (SONDH), Department of Nursing is preparing the next generation of nurses to care for older adults. The educational program, which pairs undergraduate nursing and graduate nurse practitioner students to care for a simulated patient across three care settings, received high ratings from students and significantly increased their confidence in using telehealth, according to a new report published in the Journal of the American Association of Nurse Practitioners.

The findings underscore the need for innovative educational programing/curriculum that prepares the future workforce as Hawaii and the nation face increasing shortages of health care professionals trained in geriatric care. 

“Our novel geriatric simulation curriculum can build the knowledge, confidence and collaborative skills needed to care for older adults with increasingly complex health needs,” says Courtnee Nunokawa, assistant professor and director of the doctor in nursing practice program and adult-gerontology primary care nurse practitioner specialty program coordinator. “The evidence-based Aging With Grace curriculum was designed by our faculty to address a critical workforce need.” 

In Hawaii, nearly one in five residents is 65 or older, and the state’s life expectancy is the highest in the nation. Yet only a small percentage of Hawaii’s registered nurses and nurse practitioners are certified in geriatrics.

A patient in a wheelchair, covered with a blanket, sits with hands folded, looking down in a clinic room.
Actors from HealthCAST, a partnership between UH Manoa Nursing and UH Manoa Department of Theatre and Dance, portray simulated patients, adding a level of realism to the simulation.

To help prepare students for those workforce needs, this simulation based curriculum focused on the Age-Friendly Health Systems 5Ms framework: What Matters, Medication, Mentation, Mobility and Multimorbidity. Undergraduate nursing students and graduate nurse practitioner students partnered to care for a trained simulated patient, an actor trained to portray a real patient. Students follow the patient’s progress from independent living to post-stroke rehabilitation and eventually long-term care. By following the same patient across multiple care settings, students gained a deeper understanding of the complex needs of older adults.

Faculty also incorporated emerging technology to make the simulation more immersive. The team used artificial intelligence to generate a photograph of the patient’s deceased spouse, which became part of the patient’s story and helped the actor portray the emotional impact of aging, loss and chronic illness throughout the simulation.

The simulation was conducted over six sessions in March and April 2024 and included 125 students. Of the 112 who completed evaluation surveys, students consistently rated the experience highly and reported significant gains in confidence using telehealth across every area measured.

Based on the positive results, Aging With Grace is now a required competency activity for both undergraduate nursing and graduate nurse practitioner students at SONDH. Educators are now exploring partnerships with other health disciplines, health care organizations and community partners to expand the model beyond nursing education.

Citation for the full report: Nunokawa, Courtnee, et al. “Aging with Grace: Intraprofessional Nursing Simulation to Improve Hawai’i’s Geriatrics Workforce Readiness.” Journal of the American Association of Nurse Practitioners [Philadelphia, PA], vol. 38, no. 8, August 2026, pp. 658–62, https://doi.org/10.1097/JXX.0000000000001265.

 

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