Guided Care Nursing

Title & description

Transforming Chronic Care for Older Adults - 
Comprehensive Primary Care for Complex Patients

Patients at risk for generating high health care expenditures often receive fragmented, low-quality, inefficient health care.  Guided Care is designed to provide proactive, coordinated, comprehensive care for such patients. In the Guided Care model, RNs work closely with primary care providers to offer comprehensive assessment, evidence-based care planning, proactive monitoring, care coordination, transitional care, coaching for self-management, caregiver support, and access to community-based services.

Who should take this course?  Care managers, case managers, care coordinators, patient navigators, medical home coordinators, transitional nurses, and of course, guided care nurses.  The knowledge and skills learned are relevant to all RNs practicing in the field of chronic care for older adults.

This comprehensive online series provides 20 core courses -- Overview of Guided Care, Patient Preferences for Care, Motivational Interviewing for Patient Self-management, Communicating with Physicians and Other Providers, Clinical Decision-Making and Triage, Medicare Coverage, Assessing Patients' General Status, Assessing Patients' Specific Conditions, Interviewing Patients' Caregivers, Care Planning, Ongoing Guided Care, Monitoring and Coaching, Patient and Caregiver Education, Community Resources, Supporting Caregivers, Coordinating Providers, Transitional Care, Integration Into Practice, Teamwork, Boundaries.

It also provides 17 clinical courses with current content about common health problems of older adults -- COPD, Chronic Persistent Pain, Constipation, Coronary Artery Disease, Cultural Competence, Delirium, Dementia, Depression, Diabetes, Elder Abuse, Falls, Heart Failure, Hypertension, Osteoarthritis, Osteoporosis, Sleep Disorders, Urinary Incontinence.

Comments from past course participants:

  • My department was developed around the Guided Care Model. I use the knowledge I gained in this class on a daily basis in my nursing practice.
  • I am using the Motivation Interviewing techniques when I am coaching and monitoring my patients.
  • The supplemental modules have helped tremendously when educating my patients and assessing their needs.
  • My nursing team works directly with PCP, Internists and Pediatricians. I apply the GCN concepts when engaging with physicians and office staff, especially when primarily interacting telephonically with patients and physicians.
  • I use the skills I learned every day. It helped me understand how to effectively communicate with patients when asking them questions.
  • I am using a lot of motivational interviewing, the caregiver assessment, and have adapted the model to work with the population I manage.
  • The idea of creating an action plan and care guide have been introduced to the providers here. We now have case conferences for our top complex cases and review as a team. From this meeting we solidify a plan of care that infuses the patients goals and priorities with the providers goals and priorities.
  • The guided care course helped me to focus in on what I should be doing for my patients and how to direct them appropriately using motivational interviewing techniques. I have also run into situations where being aware of others' cultural differences has come into play.
  • Loved the supplementals, and found them ALL very helpful, pertinent information. 
  • They [supplemental courses] were very helpful with educating my patients and the additional information that can be accessed through websites given.
  • All the modules, were instrumental to give direction to my position, where it had none. We started this position with an ideal job description, putting it to practice would have been difficult without the GCN Course.
  • This course was incredibly relevant to my work at that time. In fact I have since recommended it to care managers as a great training tool. It's a slightly different model, but the elements and components are still spot on to our work with patients in a PCMH.
  • Motivation Interviewing will be helpful especially when coaching and monitoring my patients. Transitional care was very important to ensure our patients are receiving the care and resources they need.

The Guided Care Nursing course was developed in collaboration with the Johns Hopkins Bloomberg School of Public Health with support from the John A. Hartford Foundation.  It is endorsed by the National Gerontological Nursing Association and sponsored by SeniorBridge.  

For more information about Guided Care, see:


  • Accreditation Statement:  The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
  • Statement of Contact Hours:  This 40 contact hour educational activity is provided by The Institute for Johns Hopkins Nursing.
  • Conflict of Interest:  It is the policy of The Institute for Johns Hopkins Nursing to require our continuing nursing education program faculty and planning committee members to disclose any financial relationships with companies providing program funding or manufacturers of any commercial products discussed in the program.  The planning committee and program faculty report that they do not have financial relationships with manufacturers of any commercial products they discuss in the program.
  • Commercial Support:  This educational activity has not received any form of commercial support.
  • Non-Endorsement of Products:  The Institute for Johns Hopkins Nursing and the American Nurses Credentialing Center does not endorse the use of any commercial products discussed or displayed in conjunction with this educational activity.


SKU: Activity set_2494
Time & place
Start and expiration dates: 
Friday, January 24, 2014 - Sunday, January 24, 2016
Price: $795.00
Guided Care Nursing
Available credit:
  • ANCC: 40.00
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