Type of Journal Format: Structured Journaling
BIO-317V (BIO-317V-0101)
Abstract
The research investigates the current state of healthcare services for the elderly and proposes the ways of improving it. The study investigates the challenges that the nurse-assistants face when giving care services to the elderly. The researcher collects data from 25 respondents in 2 Long –term Care Organizations (LTCOs) in New York. The researcher uses structured interview for collecting data from the respondents. A majority of the respondents are females. The researcher categorizes his interview questions into four topics: Job description, Challenges for providing care to the elderly, time-related challenges, and challenges during recruit-integration in to the LTCO. The researcher analyzes the data according to the categories of the interview. The findings of the study indicate that the learning institutions that train the nurses do not give them adequate skills for providing care to the elderly. The nurses face knowledge gaps that hinder the quality and safety of their services to the elderly. Teamwork is important for solving most of the challenges facing care for the elderly. The study recommends that the hospital administrations and nurses should perceive teamwork as the solution to the challenges rather than an obstacle.
Introduction
The current healthcare environment faces the challenge of providing healthcare services that do not fully address the needs of the elderly. The challenge is present in the healthcare sector despite the trends that reveal the increasing number of the elderly. The population of the people above the age of 65 years is expected to continue increasing. However, the healthcare system has not realigned its policies to develop quality healthcare services for the aging population (Bennett & Flaherty-Robb, 2003). Quality nursing care includes technical competence, cognitive competence, and affective skills such as empathy and caring (Izumi et al., 2010). There is need for the healthcare sectorto implement the changes in the education and training of the nursing assistants so that they understand how to deliver high quality and safe services to the elderly. Long-term care organizations (LTCOs) need to integrate changes that will make the nursing assistants capable of providing patient-centered and quality care services for the elderly (Aubry, Etheridge, and Couturier, 2012). The current state shows that LTCOs in industrialized nations should improve their practices so that they focus on the needs of their patients (Tolson et al., 2011). Improving the practices includes focusing on the growing needs of the elderly as their population grows. The current curriculum has to be re-evaluated in consideration of the changes that are taking place among patients in LTCOs. The contents of training modules for nurse assistants has to assessed so that the needs of LTCO patients are better served,
The aim of the study is to identify the ways in which the government and players in the healthcare sector can realign the quality and safety of the healthcare services for the elderly to meet their medical, long-term care, and social needs. The study focuses on investigating the factors within the practice of nursing that hinder the nurses from delivering services that are suitable for the elderly. The question that this study answers is: What factors prevent nurses and nursing-assistants, in their working teams, from changing their services to deliver the care that meet the elderly’s needs?
The study area for the research shall be New York, America. The researcher studies how the long-term care organizations within New York integrate nurses into their systems. The researcher shall find how the informal integration method that the LTCOs use affects the ability of the nurses and nursing assistants to provide good care for the elderly. The researcher shall also explain the role teamwork plays in the implementation of change. Despite the current existence of teamwork among the nurses, they have been slow to deliver quality services for the elderly. The researcher shall, therefore, find if teamwork supports change implementation or if it undermines it.
Study Methods
This section of the research describes the methods that the researcher uses in collecting data for the study. The section also describes how the researcher analyzes the data for the study. The researcher conducts the study in two different long-term care wards in New York. The care wards are non-specialized, and they belong to different long-term care organizations. The researcher collected data by interviewing 25 respondents from the two organizations. The timeframe for the interviews was between August and October, 2014.
Sample Size
The following table explains the demographics characteristics of the participants in the study. The table explains the respondents in terms of their gender, average age, and duration of service. The total number includes nurses and nurse assistants.
The study selected the participants from the two LTCOs using the criterion of their willingness to become responds in the study (Heyland et al., 2013). The sample of the respondent included 5 head nurses and 20 assistant nurses. Only the nurses who expressed their willingness to participate became respondents. The researcher requested that the nurses and nurse assistants allow the interviews to be held outside of their work schedules. This arrangement was made to prevent the researcher from interrupting the nurses and nurse-assistants during their working hours. The majority of the participants were females. There were 19 out of the 25 participants who were female. The fact that 76% of the respondents were female does not represent the researcher’s bias in sampling the participants. It is a reflection of the gender disparity among the healthcare workers in New York. The average length of service was considerably high (13 years). This researcher believes that nurses with longer length of service in the LTCOs would be able to provide more information about the research focus because of their experience in attending to the needs of the elderly patients. They would have been more exposed to different situations that take place inside the LTCOs. The implication of the long service of the respondents in nursing meant that they were in better position to give high quality data on the research problem.
Interviews
The researcher used semi-structured interviews to collect the data (Aubry, Etheridge, and Couturier, 2012). The researcher spent an average of 65 minutes interviewing one respondent. The researcher interviewed the nurses and the nurse assistants on on four topics. However, the researcher prepared the schedule with the questions prior to data collection. The first topic on which the researcher interviewed the respondents was the description of their work. The researcher also interviewed the respondents on the problems that they experienced when they are doing their tasks as nurses or nurse assistants assigned to the elderly patients. The other topics were how their organizations recruited new nursing assistants and problems with time management during their work. Table 2 (below) shows the topics and sample questions.
Data Analysis
For data collection, the researcher recorded the interviews using a tape recorder and transcribed these for future reference during data analysis. The researcher compared the written and tape-recorded data to ensure that they possessed the element of agreement. For data analysis,
the researcher grouped the data (findings) according to the topics of interviews. The four categories were job description,’ ‘challenges in providing care to the elderly,’ ‘time-related challenges,’ and ‘how LTCOs integrate new recruits.’
The reason the researcher chose the semi-structured interview method is was because of its high success rate in the study that Aubry, Etheridge, and Couturier (20120 conducted in Canada. The researchers used the semi-structured interviews how Canadian hospitals implemented changes in their LTCOs. Since the study investigates how new recruits care for elderly patient in New York’s LTCOs, the researcher believes that semi-structured intereviews can be an effective data-gathering method.
Research Results
The focus of the interview’s content was on the challenges that the nurse-assistants faced while providing healthcare to the elderly. Also, the interview gave data on the problems related to how the hospitals recruited their nurse-assistants, the problems that the nurses faced in their teams, and the problems that were related to time factor. The researcher presents the findings for each category of the interview below.
- Challenges of providing healthcare for the elderly
85% of the respondents stated that the training they received did not prepare them adequately to offer healthcare to the elderly. They stated that the training they underwent gave them general skills for attending to the average patient. They did not specialize in providing care for the elderly. Consequently, they stated that providing care to the elderly is something they learned in the workplace. However, they stated that the workplace had a lot of workload, something that did not give them time to learn how to handle the elderly patient on the job. Furthermore, the respondents stated that their LTCOs did not have on-the-job training to give them the specialized skills for responding to the needs of the elderly patients.
Most of the respondents agreed that there was a gap between the values that their training institutions incorporated in them and the experience they met in the field as recruits. 89% of the nurse assistants stated that they did not possess the specific skills for providing care to the elderly. They stated that they served the elderly as any other patients. They used the prescriptions that the physicians gave them and they focused on medication only, without including the other needs of the elderly. They stated that their teams did not help them because most of them lacked the skills of providing care to the elderly.
Only 11% of the respondents stated that their teams helped them cope with the challenges of caring for the elderly. The 11% of the respondents stated that their experienced nurses offered them the skills for dealing with the elderly. However, the 89% of the respondents stated that their experienced nurses had little time to supervise them, giving them little help in serving the elderly patients. 95% of respondents stated that they did not get time to visit the elderly patients in their homes. They explained that they had a lot of tasks at their workplace. They attended to the elderly patients who came to the hospitals and left the home-care for their family members.
- Working with new recruits
A majority of the respondents stated that the new work environment was hostile to the new recruits. They observed that many recruits experienced knowledge gaps in the first months of service, and sometimes the gaps extended for years. They explained that the recruits complained about the kind of training they received, stating that it did not help them much at the workplace. One recruit explained that their instructors told them to take their time while delivering heathcare at the workplace. However, they did not find time because there was a lot of pressure at the workplace.
- Integration of new recruits
The respondents shared the view that their hospitals did not integrate the new recruits in the correct way. They stated that the work patterns that their organizations used for integrating the recruits were fast-paced. They also stated that their organizations gave the recruits a lot of work from the beginning of their integration. The respondents stated that the work environment was new to the recruits. They did not complete most of the tasks that their supervisors assigned them because of the knowledge shock and lack of experience.
The recruits faced numerous challenges during the integration, and they learned to overcome the challenges through their experienced counterparts. The respondents agreed that the teams were important in assisting the recruits to counter some of the challenges they faced. Time management was the main challenge the recruits faced. They stated that while offering services like toileting and bathing to their elderly patients, they were confused between cultivating positive relationship with them and concentrating on providing the care services to them. They stated that the time that they had (15 minutes) for each of the activities (toileting and washing) was not enough, and they did not find time to develop good working relationship with their clients, e.g. through communication. WHERE IS THE RESULTS SECTION ?
Discussion
- Does teamwork improve the ability of the nurses to give the elderly quality and safe care?
Team work remains an important working strategy in the geriatric environment (d’Arcy et al., 2013). The elderly people face numerous health challenges that develop with the advancement of their age. However teamwork can only help the assistant nurses if it admission is done correctly. Since the nurses work with new recruits, they require time to mentor the recruits. However, due to pressure of work in the geriatric healthcare environment, the nurses do not have enough time to help the recruits learn how to provide the elderly with quality and safe care. The nurses, especially the recruits, require more time to assess and manage pain among the elderly patients (Hanks-Bell, Halvey, and Piace, 2004). However, since the recruits receive a lot of assignments and they have little time, they do not cultivate positive relationships with their clients through communication. They also fail to assess their patients’ problems accordingly and give them the correct care they need. Time is, therefore, an important determinant of how teamwork can improve the ability of the nurses to provide good care to the elderly.
Oliviera et al., (2013) discuss the correct perception towards teamwork. The nurses do not have to perceive it as an impediment to change. Teamwork can be the best strategy to manage change. The change that has occurred in the care for the elderly is because of the increase in their population, which means that the problems affecting them have also increased. For teamwork to help the nurses address the healthcare challenges of the elderly, the nurses must consider it as the tool for facilitating change. On the other hand, the hospital administrations should improve the efficiency of their teams by assigning them experienced supervisors who can guide the nurse-assistants. The administrations should also assign the nurses tasks in a reasonable way. New recruits lack the necessary experience to handle many tasks. In addition, the recruits require the time for learning the new skills they did not acquire during their training. The training of the nurses has numerous inadequacies. The training institutions should find the reality of the culture shocks that the new recruits experience in the work environment. The training should prepare them to work under pressure. The training should also incorporate adequate skills of handling the elderly patients who are becoming complex increasingly.
- Are there challenges in the integration of the recruits to the LTCO environment?
The study has established that the recruitment of the new nurse-assistants posses several challenges. The LTCO administrations do not consider the knowledge gaps that the recruits have. They do not consider that the gaps affect the quality of care that the recruits give the elderly. The administrations employ the recruits with the assumption that they are qualified to work under pressure yet their trainers advise them to take their time while offering the care services.
The recruitment of the new nurse assistants should occur in phases. The LTCOs should develop programs for adopting the recruits into the new system (Edlund, Lufkin, and Franklin, 2003). On-the-job-training is necessary for the recruits, especially training them on how they should deliver quality care to the elderly patients (Bennett and Flaherty-Rob, 2003). The respondents for the study stated that their training does not include the changing trends about the elderly patients. To prevent culture shocks among the recruits, and to improve the quality of services for the elderly, the administrations should train the recruits on the skills they need to serve the elderly effectively (Potcanowitcz, Hartman-Stein, and Biermann, 2009). Alternatively, the government should ensure the training organizations offer specialized skills on care for the elderly (Tan and Chua, 2013).
Conclusion
The findings of the study show that there are several interventions to improve the quality and safety of the elderly patients. The challenges that the elderly experience today are because of training, administration, and teamwork challenges. The training institutions should prepare the nurses adequately for the work environment that has a lot of workload. The trainers should advise the nurses according to the reality in the workplace. There is no time and the nurses should be ready to think and implement good decisions fast. The teams are important for the recruits and the serving nurses. They can get assistance from their experienced counterparts. However, the hospitals should change their attitude towards teamwork. They must embrace it as the way of handling the changes in the healthcare demands for the elderly patients. The government should monitor and change the curricular that the training institutions use. It should ensure that the curricular support the needs for the elderly. The administrations should also assign tasks to the recruits in a reasonable manner, considering that they have knowledge-gaps that reduce the quality and safety of the care they give the elderly. Developing on-the-job-training programs and placing the recruits under experienced nurses can help them improve the quality and safety of their services for the elderly.
References
Aubry, F., Etheridge, F., & Couturier, Y. (2012). Facilitating Change Among Nursing Assistants in Long Term Care. OJIN: The Online Journal of Issues in Nursing, 18(1).
Bennett, J. A., & Flaherty-Robb, M. K. (2003). Issues affecting the health of older citizens: Meeting the challenge. Online Journal of Issues in Nursing, 8(2), 2.
d'Arcy, L. P., Stearns, S. C., Domino, M. E., Hanson, L. C., & Weinberger, M. (2013). Is geriatric care associated with less emergency department use?.Journal of the American Geriatrics Society, 61(1), 4-11.
Edlund, B., Lufkin, S., & Franklin, B. (2003). Long-term care planning for baby boomers: Addressing an uncertain future. Online Journal of Issues in Nursing, 8(2), 3.
Hanks-Bell, M., Halvey, K., & Paice, J. A. (2004). Pain assessment and management in aging. Online Journal of Issues in Nursing, 9(3), 1-18.
Heyland, D. K., Barwich, D., Pichora, D., Dodek, P., Lamontagne, F., You, J. J., & Canadian Researchers at the End of Life Network (CARENET). (2013). Failure to engage hospitalized elderly patients and their families in advance care planning. JAMA internal medicine, 173(9), 778-787.
Oliveira, J. M., Ferreira, C. P., Lúcio, I. M., Rozendo, C. A., Vasconcelos, E. L., & Brandão, G. C. (2013). Nursing care to the elderly in the family health strategy: integrative review. Journal of Nursing UFPE on line [JNUOL/DOI: 10.5205/01012007], 7(12), 7165-7174.
Potkanowicz, E., Hartman-Stein, P., & Biermann, J. (2009). Behavioral determinants of health aging revisited: An update on the good news for the baby boomer generation. OJIN: The Online Journal of Issues in Nursing, 14(3).
Tan, P. X. Z., & Chua, G. C. (2013). Nursing Care of the Elderly Surgical Patients. In Colorectal Cancer in the Elderly (pp. 121-140). Springer Berlin Heidelberg.
Tolson, D., Morley, J. E., Rolland, Y., & Vellas, B. (2011). Advancing nursing home practice: the International Association of Geriatrics and Gerontology Recommendations. Geriatric Nursing, 32(3), 195-197.
The research subject matter is very interesting. I found a lot of confusing information. When I read the research article and compare it to the sample journal I find many similarities. I do not see much originality. The research paper seems to just focus on the information from the provided journal. I was under the impression that the research paper was about how the newly hired nursing assistants are not prepared for the elderly’s medical challenges. I was confused when you mentioned “hospitals” and “nurses”. I would suggest you re-read your research paper and determine if you are talking about nursing assistants and LTCO’s.
I am not sure if you wrote your abstract last? The abstract does not set up the theme of the research article. Your introduction mentions the background of the problem that was discussed in the research paper. There were some citations but I did not see any quotes to support your research. I was not able to identify what you were hoping to learn by this research paper.
I did not identiy a results section. The result section should be the largest and main part of your paper. Various topics need to be discussed in an organized fashion. There should be sub-headings that divide your various topics. The method section contained a lot of information that should be put in the result section.
The content you discuss is important and informative; however allow your thoughts and knowledge support the hypothesis. I am not too sure what your thesis is, I suggest keeping your thought process on either how prepared the nursing assistants are or what is needed to prepare them to care for the elderly patient.
Good job overall, keep up the good work!
