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Chapter 4, Evidence-Based Practice
Chapter 4, Evidence-Based Practice
Caring for older people
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Recommended: Chapter 4, Evidence-Based Practice
Evidence-Based Quality Improvement for Older Adults
For this paper, I will discuss five current evidence-based articles to examine several aspects that impact quality improvement for older adults. I will discuss age-related physical and emotional changes and how they challenge quality improvement in the elderly, barriers and solutions to quality improvement programs, and how these will impact the quality outcomes for the aging adult.
Age-Related Changes
There are many theories that describe the aging process, but current thought is that physical changes begin as early as the 20s and 30s in most adults. Normal aging affects every system in the body because organs become more inefficient. Heart muscle thickens, and oxygen uptake lessens. Arteries become less elastic, and it becomes more difficult to circulate blood. Lung and bladder capacity declines and kidneys cannot excrete waste products as well. Muscle mass declines and mineral loss occurs in bones. Vision close-up and at a distance becomes difficult. Low light environments and glare from headlights can compound this issue and make driving at night challenging. Hearing can diminish but is more prevalent in men than women (Toblaski, 2014-a).
Literature Review
Keeping the elderly patients safe is the most critical and challenging aspect of gerontological nursing due to generalized diminishing function. I reviewed five research articles to look at various improvement programs and how they relate to QAPI (Quality Assurance and Performance Improvement). QAPI is a framework of government guidelines for quality improvement programs in nursing homes (Centers for Medicare & Medicaid Services, 2014).
Training Model Effects on Oral Care in a Long-term Care Facility
The first ar...
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...ents increase strength and mobility.
In conclusion, the aging process presents many challenges to providing safe, high-quality care for elderly patients in long-term care facilities. Nursing homes should focus on engaging and involving all departments and staff in quality program initiatives. QI leaders should make staff education an integral piece of improvement efforts and should model their programs using the elements of the QAPI process. While resources are scarce, QI staff need to look at creative ways to encourage staff to adopt EBP. Researchers should increase data collection from real world settings to develop evidence-based practices. As the elderly adult population rapidly increases, the areas of research, nursing care, and quality improvement need work together to find ways to deliver the safest health care available to this vulnerable population.
According to Statistics Canada Report 2013, “life expectancy in Canada is one of the highest in the world” and it is expected to grow, making the aging population a key driver to our health-systems reform. By 2036, seniors in Canada will comprise of twenty five per cent of the population (CIHI, 2011). Seniors, those aged 65 years and older are the fastest growing population in Canada. Currently there are approximately 4.8 million Canadians aged 65 or greater. It is projected that this number will increase to 9 to 10 million by 2036 (Priest, 2011). As the population get aged the demand for health care and related services are expected to increase. Currently, the hospitals in Ontario are frequent faced with overcrowding emergency departments, full of admitted patients and beds for those patients to be transferred to. It has been reported that 20% of the acute care beds in the hospital setting are occupied by patients that do not require acute hospital care. These patients are termed Alternate Level of Care (ALC). ALC is “When a patient is occupying a bed in a hospital and does not require the intensity of resources/services provided in this care setting (Acute, Complex, Continuing Care, Mental Health or Rehabilitation), the patient must be designated Alternate level of Care at that time by the physician or her/his delegate.” (Ontario Home Care Association, 2009, p.1).
Leaders recognize improving clinical quality will have many benefits for both, residents and the organization. For example, it will benefit residents by improving satisfaction, reducing complications, and improving their quality of life. It will benefit NCH by reducing turnover, improving occupancy rates, attracting top talent, and enhance employee satisfaction (Advancing Excellence in America’s Nursing Homes, n.d.). Increasing professional development opportunities will be key for improving clinical quality. Professional development enhances the clinical staff’s competencies and will decrease turnover, which will enable NHC to experience a greater financial return on their development
Evidently, the healthcare management discipline has interests that overlap (and can be used to study) the Green House nursing home model. The Green House Project offers unique insights regarding changes in nursing home management philosophies that can improve both, the health of residents, as well as the job satisfaction of CNAs. Since nursing home budgets, residents’ healthcare and CNA turnover rates, are important factors in nursing home management, the Green House Project is an excellent case study for the field of healthcare management, as
Moss, A. J. et al. Design and operation of the 2010 National Survey of Residential Care Facilities. Vital Health Stat. 1. 1–131 (2011). at
Nurses are key components in health care. Their role in today’s healthcare system goes beyond bedside care, making them the last line of defense to prevent negative patient outcomes (Sherwood & Zomorodi, 2014). As part of the interdisciplinary team, nurses have the responsibility to provide the safest care while maintaining quality. In order to meet this two healthcare system demands, the Quality and Safety Education for Nurses (QSEN) project defined six competencies to be used as a framework for future and current nurses (Sherwood & Zomorodi, 2014). These competencies cover all areas of nursing practice: patient-centered care, teamwork and collaboration, evidence-based practice, quality
Expect the best, prepare for the worst and capitalize on what comes (Zig Ziglar). The demand for talented, educated and experienced nursing home administrators is increasing, and filling this demand is becoming more challenging. In this paper, the qualifications, responsibilities, and duties of a nursing home administrator, professional staff, nonlicensed staff, and consultants will be identified. We will explore trends that are likely to affect assisted living in the future. We also will explore new changes in regulation related to the F490, the Facility assessment and how it will impact the role of the administrator.
Development of The Evidence Based Geriatric Nursing Protocols for Best Practice Guideline originated with the goal of providing strategies that would allow nursing to monitor and support family caregivers (Agency for Healthcare Research and Quality, n.d.). Evidence selection and collection occurred utilizing the PICO question methodology to hand search primary and secondary relevant published literature, in addition to electronic database searches. The data was then analyzed via a meta-analysis of the published materials garnered from the search in addition to a systematic review of the evidence. From the preceding analysis of the evidence, major recommendations arose for
Improvement in quality of healthcare: Work in interprofessional teams, employ evidence-based practice, utilize informatics, provide patient-centered care, and apply quality improvement (QI).
Nursing provides the best quality of care by exercising six models formulated by QSEN: patient-centered care, teamwork, and collaboration, evidence base practice, quality improvement, safety and informatics (Competencies, n.d.). Following the competencies set forth by QSEN decreases errors and gives patients the care they desire and
Nursing assistants work in many types of settings including nursing homes, hospice, mental health centers, assisted living residences, home care agencies, hospitals, rehabilitation and restorative care facilities (Sorrentuino & Remmert, 2012). There are many types of Long-term care centers. For this paper, I will focus on the long-term care centers often referred to as nursing homes. These LTCs are "licensed facilities that provide extended care for individuals who do not require the acute care provided in a hospital but who need more care than can be given at home" (U.S Department of Health And Human...
Due to an ageing population , The Francis Report recommends the introduction of a new status of nurse, the “registered older persons nurse”. One of the illnesses linked in with this is dementia, and multiple factors relating to dementia are having an impact on how nurses are trained and their deliverance of services. In 2013, the Royal College of Nursing (RCN) began a new development program to transform dementia care for hospitals. There aim is to develop skills and knowledge related to dementia, the roles of all those who are involved, understanding the development of action plans that identify key changes.
The Quality and Safety Education for Nurses (QSEN’s) goal is to prepare future nurses with the knowledge, skills, and attitudes (KSAs) that are needed to continuously improve the quality and safety of the healthcare systems within which they work. QSEN focuses on six main competencies; patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. As we have learned in earlier classes these competencies and their KSAs offer a base to help us and other nurses as we continue our education and become RNs. As we will learn in this class these KSAs go hand in hand with health assessment.
Quality care, safe practices and principles, and accountability constitute the foundation of any health care organization (Huber, 2014). Addressing patient safety issues and improving health care quality may include reorganizing operations to improve efficiency, coordinating care with interdisciplinary team members, and using information technologies (Wang, Cha, Sebek, McCullough, Parsons, Singer, & Shih, 2014). In this paper, I will review my organization’s quality program goals, objectives, and management structure, how quality improvement (QI) projects are selected, managed, and monitored, and how nursing staff are trained and supported in
In response to concerns about staffing and quality of care, the American Nurses Association (ANA) launched the Patient Safety and Nursing Quality Initiatives in 1994 to address the impact of health care restructuring on patient care and nursing. To facilitate the initiative, ANA established the National Database of Nursing Quality Indicators (NDNQI) in 1997, with two goals: (1) to develop a database that would support empirical monitoring of the impact of nurse staffing on patient safety and quality of care across the nation, and (2) to provide individual hospitals with a quality improvement tool that includes national comparisons of nurse staffing and patient outcomes with similar hospi...
Understanding quality measurement is essential in improving quality. Teams need to be able to understand whether the changes being made are actually leading to improved care and improved outcomes. For data to have an impact on an improvement initiative, providers and staff must understand it, trust it, and use it. Health care organization must understand the measurement of quality provided by the Institute of Medicine (patient outcomes, patient satisfaction, compliance, efficiency, safe, timely, patient centered, and equitable. An organization cannot improve its performance if it does not know how it is performing. Measuring quality improvements is essential as it reflects the quality of care given by the providers and that by comparing performance