Running Head: Enhancing Medication Compliance in Elderly Individuals
Research Utilization Paper
An Intervention Study to Enhance Medication Compliance in Community-Dwelling Elderly Individuals
Chris Elmer
HSCI 401
Fall 2001
My research study was to determine whether daily videotelephone or regular telephone reminders would increase the quantity of prescribed cardiac medication taken in a sample of elderly individuals who have congestive heart failure (CHF) (Peteva, 2001).
Within this research I would disseminate the new scientific knowledge with the help of the pharmaceutical company that makes the congestive heart failure medication. With the help and support of the pharmaceutical maker, I would provide a full in-service to the nursing staff of hospitals and doctor’s offices alike. In doing this, this would provide a friendly and educational atmosphere in a nursing practice setting to get complete understanding of the research findings and how they as nurses can make a difference in the consumption of prescribed medication.
Secondly, I would write a journal article and have it published in the pharmaceutical’s bulletin to include a well-known nursing journal. These journal articles would contain the findings of the research and suggestions on how the nursing staff can help the patients improve the compliance of taking prescribed medication.
Once the information is disseminated into the medical public, the nurses will apply the learned knowledge to their practice for the elderly patients who are taking congestive heart failure medication. First, the nurse will collect all the patients that are currently taking congestive heart failure medication and explain to them on a one-on-one basis the benefits of having reminders to comply with taking prescribed medications. Then nurse would also explain the pros and cons of the reminders and that the videotelephone reminders would be provided at no cost to the patient. If the patient agrees to utilize the videotelephone reminder, the patient would sign a patient confidentiality agreement and liability agreement for legal reasons. What the agreements would stand for is a “need to know basis,” meaning that the patients information is strictly confidential and those who are on a need to know basis would have access to the patients information. The liability agreement is so that the patient could not sue the pharmaceutical company or the medical facility where they are being treated if a complaint involved only the videotelephone reminder program.
Once the videotelephone reminder program is implemented the pharmaceutical company and myself would provide quarterly visits to the medical site to collect data on the progress of the program.
In the article “Why Your Office Needs More Bratty Millennials”, the author Emily Matchar expresses a variety of reasons why the new generation in the workforce (millennials) needs to have their voices heard. She uses different terms to discuss this generation of workers, including Generation Y, another common name for millennials. Matchar’s exposition of why millennials are changing the workplace is broken down into specific points. She references the declining job market and why, due to circumstance, it is hard for millennials to get jobs as it is. Moreover, millennials are now pushing for a “customizable” workplace, such as being able to set their own hours. It appears that Generation Y is executing the wishes that other generations of workers subdue, and are subsequently portrayed as a vocal group by default. As a result of millennials’ demands, various companies are now beginning to conform to the ideas this generation presents. As such, new policies are being implemented,
Heart disease is the leading cause of death in the United States and the estimated cost of treatment is $32 billion yearly. Approximately 5 million people living in the United States suffer from congestive heart failure (CHF) and half of those diagnosed will die within 5 years. An individual may present to the hospital with weakness, short of breath (SOB), swelling of the extremities, ascites, and breathing difficulties while lying down. The quality and length of life for someone suffering from heart failure can be improved with early diagnosis, medication, physical activity, and diet modification (CDC, 2013).
The millennial generation is made up of people that were born from 1978-1999. People from older generations say the millennial generation people are growing up being unprepared for the real world. In an article titled “The Tethered Generation” written by Kathryn Tyler she talks about why the millennial generation is so different than any other generation. She also explains how they depend heavily on their parents well into adulthood. In this article Tyler allows the reader to see why HR professionals are worried about the millennial generation entering their work force. Using Toulmin’s schema the reader can judge the effectiveness of Tyler’s essay to the audience, and this schema is used to persuade the audience to
Boomer’s see millennial’s as having a short attention span which is not what millennial’s intend. If they don’t see a job working out, they are faster to jump ship than Boomer’s and that fearless attitude actually leverages them more power with their company. Sherry Buffington, co-author of Exciting Oz: How the New American Workforce Is Changing the Face of Business Forever and What Companies Must Do to Thrive, says that they have the upper hand because they are perfectly fine working dozens of different jobs in their lifetime. “In a survey conducted by IdeaPaint of 600 employed Millennials, 49 percent believe that poor management is dragging their company down; 45 percent attribute that to the lack or misuse of technology solutions.” (Avallon) This helps the reader to better understand the mentality of millennial’s. They are typically more tech savvy then their older bosses and feel they could make more of an impact if they were in charge. Millennial’s are hard-wired to think that time really is their most important resource. If they feel they aren’t being treated completely fair then they won’t hesitate about trying to find a new
The systematic review indicated (1) ‘Case management interventions were associated with reduction in all-cause mortality at 12 months follow up, but not at six months’. (Takenda, et al, 2012) The systematic review also went on to state that while case management interventions were not associated with reduced mortality, case management interventions were indicated to reduce the occurrence of patients presenting to hospital with exasperations of chronic heart failure. The benefits of case management based interventions were apparent after 12 months had lapsed. Six of the twenty five studies assessed (2) heart failure clinics, and the evidence for this intervention was less convincing with the review stating ‘there was no real difference in all-cause mortality, readmissions for HF or between patients who attended a clinic and those who received usual care’. (Takenda, et al., 2012)
In his essay, “The New Greatest Generation: Why Millennials Will Save Us All,” American journalist Joel Stein suggests that the same conditions that have caused millennials to be narcissistic and have a sense of entitlement growing up can also empower millennials to be more innovative and create new opportunities.
Heart failure is a major clinical, social and economic problem in the United Kingdom according to the Department of Health [DH] (2013).The National Institute for Health and Clinical Excellence [NICE] (2010) reported that about 900,000 people suffer from heart failure in the United Kingdom. The National Institute for Cardiovascular Outcomes Research [NICOR] (2011) conducted a national audit which found that one in every 20 people over the age of 65 is diagnosed with heart failure which demonstrates that it mainly affects the elderly. As a leading cause of mortality, heart failure contributes to more than 6,000 deaths each year (NICOR, 2011). Newly diagnosed cases of heart failure have a 40% risk of dying within a year (NICOR, 2011). Despite advances in therapy, mortality is still high and only half of patients are alive five years after being diagnosed with heart failure (NICE, 2010).
My clinical rotation for NURN 236 is unique in that all patients I care for at Union Memorial Hospital in Baltimore, Maryland have a diagnosis of heart failure (HF). HF occurs when the heart is unable to pump adequate blood supply, resulting in insufficient oxygen and nutrients to the tissues of the body (Smeltzer, Bare, Hinkle, and Cheever, 2012). Approximately 670,000 Americans are diagnosed with HF each year and is the most common hospital discharge diagnosis among the elderly (Simpson, 2014). Moreover, according to the Centers for Medicare and Medicaid Services (CMS), HF is the leading cause of 30-day hospital readmission followed by acute myocardial infarction (AMI) and pneumonia (medicare.gov|Hospital Compare, 2013). This information along with my weekly HF patient cohort prompted my curiosity regarding impacts of HF readmissions, factors of HF readmission, and to compare suggested evidence based practice with policies utilized at Union Memorial for reducing the 30-day readmission rate for HF.
Growing up during the beginnings of MTV exposed me to a lot of popular music and artists. Videos from artists like Michael Jackson and Madonna were a part of my daily life. There was one video that caught my attention because it did not look or sound like anything I had heard before. That video was of a song called “Rockit” by Herbie Hancock. Here is the video: https://www.youtube.com/watch?v=GHhD4PD75zY
Polypharmacy among the elderly is a growing concern in U.S. healthcare system. Patients who have comorbities and take multiple medications are at a higher risk for potential adverse drug reactions. There is a great need for nursing interventions in conducting a patient medication review also known as “brown bag”. As nurses obtain history data from patients at a provider visit, the nurse should ask “what medications are you taking?” and the answer needs to include over-the-counter medications as well. If the response does not include any medications other than prescribed meds, it is incumbent upon the nursing professionals to question the patient further to ensure that no over-the-counter medications or supplements are being consumed. This is also an opportunity for the nurse to question about any adverse reactions the patient may be experiencing resulting from medications. Polypharmacy can result from patients having multiple prescribers and pharmacies, and patients continuing to take medications that have been discontinued by the physician. Nurses are in a unique position to provide early detection and intervention for potentially inappropriate medications and its associated adverse drug reactions.
As nurses we need to continually expand our skill levels, gain new knowledge and expand our technological and scientific practice potentials. Nurses need to be willing to commit time to research, seeking out evidence based practices and become change agents within their communities, organizations, local, state and federal governments. I believe it is a nurse’s responsibility to inform and educate patients. In my opinion, this is an example of translating research into practice, which I believe to be an important nursing role, in healthcare
Workers are often pitted against each other in the work place as a form of competition. One division that is commonly seen is gender and race, but there is also a divide concerning age that isn’t discussed as frequently. Baby Boomers are those who was born between 1946-1964, when WWII soldiers came back home, settled down and started the “Baby Boom”. While Millennials are those born around 1981-2000, and have a similar population size as Baby Boomers. In the workplace, Millennials are categorized as being bad workers due to how they were raised in sheltered lifestyles and require a different environment than the previous generation, but that is not accurate. Even though the two generations view work different, sometimes to the point of conflict,
They struggle with low self-esteem. They struggle with making independent decisions. They struggle with succeeding in the workforce. However, none of these struggles are their fault. They are the millennials. According to Simon Sinek, millennials are a group of young, ambitious and hardworking individuals currently entering the workforce. Nonetheless, they are encountering hurdles that have been unheard of until now due to several external factors. As there are constant changes in societal expectations as well as personal expectations, millennials often have difficulty finding where they truly belong. Over the course of his discussion, Sinek targets several different factors and how they contribute to the downfall and characteristics of millennials. Therefore, I believe that there is no doubt that Sinek’s depiction of millennials as low self-esteemed and narcissistic
Parties can range from house warming parties, to birthday parties, holiday parties, engagement parties, etc. You can even throw parties just to have fun. Find a reason to celebrate, whether it is a holiday, a special occasion, an achievement, a big announcement, a new endeavor, a job well done or a journey completed. The reason you are partying will set the tone.
Secondly, they advise their patients in assuring the appropriate use of medications. It is important to tell the patient about the name of the drug, what is it for, when to take the drug, how many times per day, whether it should be taken before meals, after meals or with meals, the method of taking the drug and its side effects and possible drug-drug interactions. (Swanson, 2005)