{Author Name [first-name middle-name-initials last-name]}
{Institution Affiliation [name of Author’s institute]}
Summary
Cooper & McCarter in the article, “The Development of a Community and Home‐Based Chronic Care Management Program for Older Adults” evaluate chronic care management program managed by the nurses association. The article evaluates the program plan, outcomes and implementation. The chronic care program targeted to improve the patient’s self-efficacy, self-management, and clinical measures. Even with the given medical advancements and claims of longevity support, eighty percent of older adults live with at least one chronic ailment while fifty percent of the population suffers two or more chronic ailments. Older adults frequently visit hospitals, physicians and emergency services due to the chronic ailments. The chronic diseases include heart diseases, respiratory diseases, and stroke. Most of the chronic diseases are progressive, last for above a year and require care on a daily basis. The article cites an example of North Penn Visiting Nurse Association (NPVNA) that provides complete health care service to the community including older adult day care and home care services. It is evident to be noted that NPVNA has above sixty percent of home care patients with chronic conditions. The idea of the chronic care management program is to provide critical care and decrease hospitalization load. The program has shown benefit in both terms by improving overall medical outcomes and decreasing hospitalizations (Cooper, & McCarter, 2014).
A study highlighted in the article is from the University of Pennsylvania where Dr. Mary Naylor demonstrated that interaction of nurses with patients post discharge from the hospital empowered the patient for self-care. The interaction along with a follow-up with the primary care provider of the patient adds value to the care of chronic patients. The same model is evident in Wagner’s Chronic Care Model for improving the chronic care outcomes. An essential premise of the model is the consideration of system deficiencies in current management programs of chronic care and lack of coordination. Additionally patients are also inadequately trained for self-management of their ailments. In another observation, Dr. Kate Lorig at Stanford University’s Patient Education Research Center developed a now nationally recognized program CDSMP. CDSMP is workshop based, peer-led and ranges across a period of six weeks where the chronic care patients are taught self-management, skills and techniques for self-care. Other key life-skills like fatigue and pain management, relaxation, exercise, nutrition and emotions management are taught. CDSMP trials have shown positive, cost-effective health-related outcomes. The articles show that these results from CDSMP influenced the program at NPVNA, and key concepts were incorporated there for professional training of nurses and programs of nurse-patient interventions (Cooper, & McCarter, 2014).
Choice of Article
The chosen article was a study conducted by Cooper & McCarter published in Public Health Nursing Journal that is a reputed journal of nursing. The journal offers best and updated practices and studies in the field of nursing that are valuable for nursing knowledge. The article gives important insights into the chronic care management of older adults. The strategy used in the research article is precise and consists of evidence-based findings. The article has been chosen because older adult care is a growing concern, and the article provides excellent study and researches into the chronic patient care management.
Aim of the study
The paper aims to assess a self-care management program directed by a visiting nurses association of Lansdale namely The North Penn Visiting Nurse Association (NPVNA). This association has been providing its services to the community since 1919. This study is based on building a community and home care program for elderly patients. It focuses on the knowledge enhancement among nurses for self-management of chronic diseases and development of self-efficacy among chronic patients with lesser clinical measures as outcomes.
Implications for nursing
Nurses are constantly challenged to stay abreast of new information to proffer the best quality care to the chronic patients. The evidence-based study is a collection, integration and evaluation of valid research combined with clinical expertise and empathetic approach towards patient and their primary care providers (Burns & Grove, 2010). Educational development of nurses prepare them to improve in self-efficacy and clinical outcomes for chronic patients in older adults (LoBiondo-Wood & Haber, 2014). Clinical judgment of the nurses is influenced by their knowledge, education and skill upgrade. The skill development programs have an implication on the reasoning patterns and clinical judgments of the nurses (Tanner, 2006).
Methods used to conduct the study
The programs are highlighted in the studies provided educational development of the nurses by introducing certifications for chronic care professionals (CCP). Patients enrolled in the program also enabled the nurses to increase their knowledge and enabled them to complete the certifications. Such certifications empower the nurses and boost their confidence and knowledge in providing effective chronic patient care. The program resulted in successful completion of exams by the nurses, and an improvement in the patients enrolled in the program (Cooper & McCarter, 2014).
The method used for the study consisted of community nurses, local physicians and patients into the CCM program. The method was developed by NPVNA, and it sought to enroll patients as well into the program after an initial screening. The nurses enrolled were also screened for their participation in the program. The program methods included interviewing, coaching and motivational techniques to support the patients. Goal based approach was undertaken for better self-management of the patients towards an awareness of their illness. The program educates the nurses in the patient care and enables patients to develop self-management skills through a set of the action plan. The program method included documentation, follow-up and completion of the devised action plan. The target for the assessment was to develop a thirty percent increase in self-management skills of the patients by the end of the program. The nurses enrolled in the program supported the development of the skills (Cooper & McCarter, 2014).
Conclusions
Chronic care among older adults is a population-focussed approach that still requires solutions. Interventions into chronic care have been effective in the chronic-care management and has met the needs of a large population. Effective chronic care in older adult populations not only enables them for a better self-care but also lessens the burden on the hospitals to focus on other critical illnesses and cater to a larger population. The program proposed by NPVNA for CCP training has been very effective in empowering the nurses in effective chronic care management. The outcomes of CCP training have been very positive, and all participating nurses cleared the exams with considerably high scores. This achievement by the participant-led NPVNA to become a recognized and professional institute in the field of chronic care management. The article highlights the effectiveness of such a models for chronic care management to meet the needs of patients suffering from chronic ailments. The chronic care model (CCM) beautifully fits and strengthens the existing community-based programs. A well-coordinated support program for older adults with chronic ailments is a need for the day and transitions the home care into a self-management effective care of the patients.
Reference
Burns, N., & Grove, S. K. (2010). Understanding nursing research: Building an evidence-based
practice. Elsevier Health Sciences.
Cooper, J., & McCarter, K. A. (2014). The Development of a Community and Home‐Based
Chronic Care Management Program for Older Adults. Public Health Nursing,
31(1), 36-43.
LoBiondo-Wood, G., & Haber, J. (2014). Nursing research: Methods and critical appraisal for
evidence-based practice. Elsevier Health Sciences.
Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in
nursing. Journal of Nursing Education, 45(6), 204-211.
