Functional Decline Of Hospitalized Older Adults

“Nurses are more than caregivers in today’s healthcare settings. They are teachers, advocates and pioneers in improving healthcare. They are stepping out of the old model and taking ownership for changes in healthcare. Nurses are developing their own scientific research programs to improve patient care. They are playing a pivotal role in healthcare reform. Nurses are becoming leaders, not followers in healthcare reform.”

The role of nurse practitioner is valuable when discussing collaborative care. There are so many levels of care, so many health entities, and so many insurer criteria involved that it is instrumental to have a role that can work towards help bring all aspects together. In addition to diagnosing, treating, and managing care, the role of the nurse practitioner is to manage simple and episodic acute health issues along with chronic disease (Sangster-Gormley, Martin-Misener, & Burge, 2013). It is important to note that although this is a function of this role, nurse practitioners also practice from a holistic point of view which allows them to help manage patient conditions or wellness in a more complete fashion. This includes helping patients have access to care beyond primary and secondary care settings. This encourages nurse practitioners to work alongside other health care and allied health professions, and families to create an individualized plan for every patient (van

The role expansion of nurses to meet efficiency targets has meant that nurse-led services in the healthcare setting are expanding as one means of coping with a growing, increasingly ageing population. For those nurses running nurse-led services the focus for that reason, needs to be on treatment that improves the quality of someone’s life and represents an

Budzi, Lurie, Singh, and Hooker (2010) state, “Nurse Practitioners’ (NP) interpersonal skills in patient teaching, counseling, and patient centered care contribute to positive health outcomes and patient satisfaction.” According to their research they encourage healthcare systems in the U.S. to hire more NPs to allow for better access affordable, and quality care (Denisco & Barker, 2016). With the demand for primary care providers, The NP role aids in delivering a solution to some of the healthcare issues that exist today. Organizations like the Institute of Medicine (IOM) and Centers for Medicare and Medicaid (CMS) all agree to allow nurses to practice to their full abilities to make healthcare more accessible and affordable, especially for the aging baby boomers and less accessible rural neighborhoods, and densely populated urban areas. Research has proven that NPs that provide primary care have similar health outcomes to primary care physicians (DeNisco et. al., 2016). NPs particularly take pride in their holistic approach, forming therapeutic relationships between other providers of the healthcare team, patients, and their families, aiding the informed decision making process, use of the evidence based practice approach in health management (Brown, 2005). Some of the other actions or qualities that

A pivotal IOM recommendation was the expansion of opportunities for nurses to lead and diffuse collaborative improvement efforts with physicians and other healthcare members (The Future of Nursing Leading Change, Advancing

The nurse is challenged with the care of patients over a lifespan. Each stage of life brings its own physical and emotional changes which directs the care needs. The care needs of the pediatric patient will be much different from the needs of the geriatric population. The geriatric population has very specific needs which has prompted the government to establish the Quality Assurance & Performance Improvement (QAPI) program. The QAPI provides the framework for nursing facilities to develop and implement changes which address deficiencies the facility was found to have. Also, the QAPI program requires practices and policy be put in place to monitor care of the residents. The purpose of this paper is to list some of the changes the elderly go through as they age, and demonstrate these changes in a quality improvement project. After review of literature, I will discuss the challenges, barriers, and solutions as related to quality improvement. Lastly, I will discuss the quality of care for the geriatric in the future.

Over the past few decades, many drastic changes occurred in U.S health care delivery.   Our current healthcare trends demand nurses to take more active role in the health care decisions in hospital setting, long term care setting and in community healthcare setting. Since “nursing is based upon a body of knowledge that is always changing with new discoveries and innovation” Potter and Perry (2005), nursing profession is compelled to grow from being just a traditional bedside nurse. IOM’s future of nursing report which is released in 2010 calls nurses to be “more highly educated, diverse nursing workforce”.

It's important for nurses to be actively involved with an interdisciplinary team because of the increasing complexity and scope of patient problems. As these complexities and problems increase, patient care necessitates the combination of efforts of physicians from different disciplines. Actually, comprehensive patient care in today's healthcare settings incorporates attempts to solve problems that are beyond the scope of expertise and training of a single professional. Therefore, the active involvement of nurses in interdisciplinary teams is vital for the provision of comprehensive and effective patient care that help in dealing with the evolving patient problems

“All health care disciplines share a common and primary commitment to serving the patient and working toward the ideal of health for all.” (American Association of Colleges of Nursing, 2014, p. 1) There are many different professional members in the healthcare system. Each of them, have a specific specialty and responsibility to the patient and play an important role in the patient’s overall plan of care. “The scope of health care mandates that health professionals work collaboratively and with other related disciplines. Collaboration emanates from an understanding and appreciation of the roles and contributions that each discipline brings to the care delivery experience.” (American Association of Colleges of

The healthcare industry has intensely advanced throughout the world, in turn changing the principles that incorporate the practice and culture of nursing practice. Altering the model of care to a patient-centered mode signifies an organizational culture shift and requires the participation of executives at the senior level (Cliff, 2012). To practice this care to provide the best care possible, it goes beyond the nurse to all healthcare professionals and senior leadership. The days of patients and nurses following a physician’s order without favor to care has now loaned themselves to more of an interdisciplinary approach to practice. Though, it is encouraged that the patient makes decisions for themselves, after receiving the proper education and information on their condition. Part of the patient-centered care is to be the patients’ advocate, by letting them know you are there for them when they are unable to speak and advocate for themselves and what is in their best interest. That goes in hand with educating them on “self-management of care, health literacy, patient, and family education through nurse-patient communication and interaction (Finkelman & Kenner, 2016, p. 271).”

In a study conducted by Chow and Wong (2014), they analyzed a case management team led by nurses and the effectiveness of the care coordination regarding older adults whom are diagnosed with co-morbidities. Utilizing a randomized controlled trial during 2010 to 2012, the researchers analyzed older adults who suffered from at least two chronic illnesses (Chow & Wong, 2014). Those chosen to be analyzed were then further divided into three groups, including one control groups and two study groups (Chow & Wong, 2014). Baseline data was gathered and collected at four weeks and then again at twelve weeks from the two hundred and eighty one patients participating (Chow & Wong, 2014). The two study groups in which interventions in which nurse led case management occurred, resulted in lower readmission rates within an eighty four day frame after discharge from hospitalization. Additionally these participants rated their health and self- sufficiency at a higher level than the control group (Chow & Wong, 2014). Conclusions gathered from research indicates that care coordination after discharge led by nurses whom empower patients are effective in improving clinical outcomes for older patients with co-morbidities (Chow & Wong, 2014). This research conducted is crucial to my selected topic as is provides evidence that coordination of care after discharge can improve outcomes.

The role that nurse practitioner (NP) plays within the increasing complex health care system is a constant changing role with the Consensus Model and the introduction of the Affordable Care Act in 2010. The scope of the nurse practitioner (NP) includes the care of the young, the old, the sick and the well. The educational needs of a nurse practitioner vary greatly from that of a Registered Nurse (RN), in the amount of education as well as the focus of the education. NPs provide coordinated primary care with the use of comprehensive health histories and physical examinations, diagnosing and treating acute and chronic illnesses, the management of medications and therapies, ordering and interpreting tests results, and educating and

Nursing practice is also one of the key messages addressed in the IOM report. The report suggests that “nurses should practice to full extent of their education and training”. Furthermore, “nurses should be full partners with physicians and other health professionals, in redesigning health care in the United States. This report has a great impact on nursing practice. The IOM report suggests that greater focus on managing the transition from nursing to practice. It recommends that regulatory reforms must be made to allow nurses to expand their scope of practice (IOM report, 2010).

In November of 2010, the Institute of Medicine (IOM) released “The Future of Nursing: Leading Change, Advancing Health”. This special report examined the current state of nursing and changing landscape of the American healthcare system and offered recommendations for the future role nurses should play. The committee that released the report, Committee on the Robert Wood Johnson Foundation, divided it into three parts. Part II of the study, focused on transforming the nursing profession in order to improve America’s healthcare system. In order to achieve this transformation, the committee recommended that nurses attain higher levels of education and training, practice to the full extent of that education and training, and assume more

Changes in the Health Care System and the Practice of Nursing have become complex. Technological changes, complicated client needs, short hospital length of stay, and departure from acute care to community based care, all these changes have underscore the need for professional nurses to think critically in order to provide safe and effective client care. A better educated nursing workforce can provide good health education to patients and their families. The affordable care of 2010 has required the need for nurses to expand their role of practice to meet complicated patient demands. This has prompted the Institute Of Medicine to review the “Future of Nursing, Leading change and Advancing Health”. {Creasia & Fribery,2011}