Introduction
The focus of the research is on determining how the changing role of the field of Transitional Nursing can affect the quality of healthcare that is provided to the elderly population. Initial research has revealed that people above the ages of 50 are considered to be more at-risk for contracting chronic diseases, and also for relapses because of various demographic and lifestyle factors. The focus of this paper is on developing a study design and sampling methodology for the research, as well as formulating flow charts and maps in order to better understand the dependent and independent variables involved in the research framework .
Literature Review
Medical researcher and author of several papers on the subject of Transitional Medical Care, Karen B. Hirschman, defines transitional medicine, in her article Continuity of Care: The Transitional Care Model, as “a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care within the same location. Transitional care encompasses both the sending and the receiving aspects of the transfer” .
Several medical researchers including Yue Zhao, Jacqueline Allen and Sue E. Durkin, to name a few, back this basic definition of this field of medicine. In the article cited above, Hirschman has identified several problem areas that are contributing to deteriorating health of the elderly, when measured in terms of their frequency, intensity and extent of relapses and readmissions. The most important and direct causal factor, in Hirschman’s opinion is the lack of engagement and communication between the transitional nursing staff and the patient .
In the article Continuing care for older patients during the transitional period, Yue Zhao mentions that the lack of a proper system of follow-up visits for the elderly is also an integral problem in the current system . He further attributes the inadequate monitoring of elderly patients after their initial discharge and/or treatment as further exacerbating their health situation, which in turn, adds to the country’s burden of health expenses. This is primarily because most of the people, who are readmitted or have relapses, do not have any medical insurance and mostly rely on social welfare setups to pay for their medication and treatment .
As medical research-based author Jacqueline Allen highlights in her article titled Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review, avoidable re-hospitalizations among the elderly account for almost 355 of the total Medicare expenses in a year . In her view, it is the living conditions of the elderly, most of who she discovered lived on the streets or in shantytowns that have the most profound linkage with their health and how well they recover after being treated for a health condition.
The article Transitional Care Models for Seniors by Sue E. Durkin further adds to this debate by saying that lack of a basic education prevents the elderly population from fully comprehending the disease they may have been diagnosed with. Since cognitive functioning, according to Durkin, is typically compromised in these individuals, even if post-op care is advised, they are usually unable to understand and follow-through .
It is here that the role of the transitional nurse comes in ensuring that records are collated and maintained, that patients understand their health risks and ensure, as far as possible, how their living situation can be improved with help .
Methodology and Study Design
Five research questions were formulated in order to determine how Transitional Nursing Care could translate into improved health outcomes for the elderly population. These included identifying the patient characteristics that increase the risk of the elderly requiring repeated medical attention in outpatient clinics or emergency departments of hospitals; possible alternative strategies (to the current practice) of administering prescriptions for the elderly; and lastly, the existing structural obstacles that make it difficult to provide quality transitional nursing services for this population group .
The literature review reveals that an important factor that adds to the health risks of the elderly population is their literacy levels. Therefore, the method of data collection that will be utilized to answer the primary questions mentioned above, will be observation, secondary research, survey-based questionnaires administered to transitional nursing staff, and detailed interviews conducted with those elderly individuals who are suffering from a long-term medical condition that requires follow-up visits.
The scope of the initial secondary research (literature review section compiled earlier in the paper) will be expanded as work on this research problem progresses and the risk factors and population demographics identified here will serve as the basis of primary data collection through questionnaires and interviews .
Observation is an effective data collection method in situations where the research subjects are either incapable or unaware of pointing out the underlying factors or causes that influence their habits and actions. For the purposes of this research, the Observation Method will prove to be particularly useful since most of the elderly population that does not have access to quality transitional nursing constitutes those belonging to the lower income groups, without family members to look after them on a regular basis (or homeless) and without having a basic level of education. Therefore, using a questionnaire to acquire information about their quality of life factors and medical history would not have worked, since most of them may not fully comprehend the diseases and complications they may be dealing with and the nature of the treatments/medications they may have received so far .
Consequently, in-person interviews with them based on open-ended questions is a more effective tool for data gathering in this case. The interview questions will be divided into the following categories so as to obtain a complete personal and medical history of the patients:
Personal Information: Name, Age Group, Level of Education, Ethnicity, Religion, Marital Status, Family Members, Address
Demographics and Lifestyle Indicators: Occupation/Profession, Source of Income, Current Medical Insurance Plan, Frequency of Regular Check-Ups
Health Profile: Disease/Disorder Diagnosis (date if they can recall), Names of Regular Medications (length and frequency of usage), Surgical/Invasive Procedures, Tests or Treatments Received
Survey-based questionnaires are ideally used for well-educated respondents who have the expertise and knowledge to answer close-ended questions (multiple choice or rating-scale based). Therefore, this research collection tool is ideally suited to be given out to the transitional nursing staff that has the most interaction with the elderly population group . The questions included in the questionnaire document will primarily cover:
The most common kinds of diseases/disorders that the at-risk research population is diagnosed with
The common demographic factors that are common to most of the elderly who have relapses or require readmission
The opinion of the transitional nursing staff on the possible strategies to remedy this situation (structural challenges of the healthcare industry, lack of government intervention, role of social welfare organizations).
The results from all these sources will be combined in order to develop a research framework that explains the reasons why the elderly population in America is at such great risk for developing health problems, and not receiving the kind of care that will improve the quality of their life and well-being.
Given the focus of the research, most of the data that will be collected will be qualitative in nature, and utilized more for developing causal relationships between the factors contributing to deteriorating health conditions of the elderly, as well as the measures that will prove to be the most effective in improving their health.
Sampling Methodology
The reason why convenience-sampling works in this scenario is that the literature review and initial secondary research has revealed that there are certain basic trends that have been identified in population demographics that increase the likelihood of a certain group to be at greater health risk. These trends can more or less be generalized for most of the population across the country, hence the need to carefully select a probability sample, representative of the entire population is not needed in this case.
References
Allen, J. (2014). Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC Health Services Research, 8-17.
Durkin, S. E. (2013). Transitional Care Models for Seniors. Journal of Nursing Research, 12-23.
Hirschman, K. B. (2015). Continuity of Care: The Transitional Care Model. The Online Journal of Issues in Nursing, 11-21.
Naylor, M. (2013). Transitional Care: Moving patients from one care setting to another. Journal of Nursing, 23-43.
Wright, P. (2015). Development of a Home-Health Transitional Care Program for Elderly. Journal of Nursing, 12-20.
Zhao, Y. (2014). Continuing care for older patients during the transitional period . Journal of Chinese Nursing Research, 5-13.
