Abstract
The research highlights the reasons why the role of Transitional Nursing Services has become increasingly important of late. The particular focus of the research is on determining the potential benefits that an elderly patient can receive from a Transitional Nurse, which will in turn, automatically improve their overall health and well-being.
The limitations of the physician in actively engaging in transitional medical care has also been emphasized, in order to establish that it is the Transitional Nurse who is in a unique position to act as a bridge between the physician, the patient as well as the patient’s family. Each member of this trio has a crucial function to perform. The doctor/surgeon is responsible for diagnosing/treating a health problem, however, in the long-run, it is the nurses and family members who ensure that medication prescriptions are accurately filled out and administered, while monitoring daily habits and dietary practices of the elderly patients .
Transitional Nursing Problem Identification
Defined as the set of actions required in order to ensure coordinated and continuous medical care for at-risk populations as they move between healthcare facilities, such as community clinics, hospitals and nursing homes, Transitional Nursing is an emerging area of study that has become increasingly relevant today . This is because medical expenses and insurance costs and population growth in most states are on the rise, which in turn has decreased the level of access for people to a minimum required standard of healthcare.
This is particularly true for the elderly population segment in the United States of America, which, according to the American Nurses Association, is the most vulnerable group, due to their chronic health conditions, varying levels of cognitive impairment that develop over time, as well as age-related physical disabilities. This is primarily why the concept of Transitional Nursing is the most relevant for this population sub-group, which for the purposes of this research paper, have been categorized as ‘individuals aged 60 years and above’ .
The main underlying issue, in the present scenario, is that there is a complete absence or a severe dearth of coordination in transitional healthcare for the elderly. This implies that the required and relevant information regarding the diagnosed medical condition of an elderly patient, the treatment that was provided, probably during an in-patient visit, and the post-release medication, rehabilitation, precautions and care, are not transmitted between the various healthcare delivery points .
As a result, patients are often discharged from hospitals without being properly informed and briefed about their health and well-being. The problems include not being completely aware of the disease or disorder they may be suffering from, the health ‘red flags’ to lookout for, the schedule and duration of administering their prescription medications, as well as the temporary or complete lifestyle changes that are often required to be made. It is this lack of understanding that increases the likelihood of relapses and patient readmissions, even in cases when the medical condition that an elderly person may be suffering from, is preventable and treatable, such as diabetes.
An often ignored aspect of Transitional Nursing is the role that caregivers, whether they are family members or trained nursing staff, can play in eliminating each of these problems by ensuring a smooth and uninterrupted flow of communication . This is also the main question that the paper will look to address, mainly, what strategies can be implemented to improve the quality of transitional nursing that is provided to the elderly.
Significance of Quality Transitional Nursing Care to the Elderly
A recent research study conducted by the American Association of Nurses reports that almost one fifth of all patients (aged 60 years and above) were readmitted to hospitals within 30 days of their discharge, while approximately one thirds had to be brought to emergency units within three months. Such high rates of readmission, combined with the excessive expenses of treating this population, estimated to be around $20 billion in 2014, are the basic reasons why transitional nursing has gained importance and relevance in the last few years .
A review of the literature on the subject reveals that it is the ‘silo’ format of America’s healthcare system that has considerably aggravated the situation for the elderly. This is because different health practitioners have different priorities when they come in contact with their patients.
A doctor in the hospital’s emergency room is more focused towards saving a patient’s life, but lacks the resources, the most important of which is time rather than cost, to keep tabs on the health status of patients once they are shifted out from emergency . Similarly, a physician in a community clinic is more likely to focus on treating as many people as possible, which despite his/her best intentions, often translates into a compromised health assessment. For instance, a diabetic may be diagnosed accurately and prescribed the appropriate medication, however, the patient may not be informed of what lifestyle changes to make, which means they may continue engaging in the risky behaviors that may have caused the illness in the first place .
This is where transitional nurses can fill a crucial gap that has been created as a result of such a low high patient to physician ratio. Trained Transitional Nurses have the knowledge to conduct a pre-examination assessment of patients to identify the likely causes of a disease. Also, getting accurate and comprehensive patient medical history is a crucial function, as it helps in developing an understanding of the circumstances of patients’ lives .
Equally important is the post-examination follow-ups with at-risk patients to ensure that their actions are not reversing the benefits of the medication and treatment that they have received. Transitional Nurses are also in a position to ensure that accurate patient records are maintained and are shared with the relevant health professionals if they are treating a patient. Also, explaining to the primary caregivers of the patients the kind of healthcare they will need is equally important. This is because most elderly patients do not have the physical or mental competence to be able to follow directions that are critical for their continued well-being. Also, since private nursing homes, where patients may receive individual attention, are expensive, most elderly individuals are dependent on a family member to take care of them on an ongoing basis .
Purpose of the Research and Research Questions
As mentioned earlier, the primary research purpose of this paper is to develop a possible framework that can help improve the quality of healthcare for the elderly, as they move between different kinds of medical facilities over the course of, what are possibly, the last years of their life.
The questions that will help in achieving the objectives of this research paper include:
What are the different types of transitional nursing support that can be extended to the elderly population?
Which patient demographics are the most likely to contribute to an increased risk of relapses and readmissions?
What are the possible strategies to eliminate, or at least reduce, the issue of inaccurate filling of prescriptions for elderly patients post discharge, or a hospital visit?
What are the basic set of challenges in providing institutional transitional nursing services to the elderly?
How can these issues be addressed effectively so that transitional nursing services can be improved for elderly patients?
Alignment with Master’s Essentials
Essential III of The Essentials of Master’s Education in Nursing, relates to Quality Improvement and Safety, and is the most relevant for the implementation of transitional nursing services . This is because maintaining quality patient records, preventing information and communications breakdowns, all require that standards of quality are maintained by the nurses. In the context of elderly patients, this becomes more important than ever since their condition is usually complicated, because they suffer from multiple health conditions, and an information or attention lapse of the slightest, can result in serious, often deadly consequences.
Both Essential VII, concerned with Inter-professional Collaboration for Improving Patient and Population Health Outcomes, as well as Essential VIII: Clinical Prevention and Population Health for Improving Health, are also equally relevant. This is because Transitional Nurses can develop collaborative partnerships (official and unofficial) that can enable them to make a substantial difference at the core level.
References
Aase, K. (2013). Quality and safety in transitional care of the elderly: the study protocol of a case study research design (phase 1). BMJ Open, 6-13.
Burke, M. (2009). Transitional Care: What Does It Mean for Nurses? Journal of Gerontological Nursing, 3-6.
Naylor, M. (2009). Transitional Care: Moving patients from one care setting to another. American Journal of Nursing, 58-63.
Naylor, M. D. (2014). Transitional Care for Older Adults: A Cost-Effective Model. Journal of American Nursing, 15-19.
Storm, M. (2014). Quality in transitional care of the elderly: Key challenges and relevant improvement measures. International Journal of Integrated Care, 14-19.
