Improving the quality of life in elderly patients through a holistic approach towards quality of care has always been one of the primary goals of the US healthcare system. The USA sees an increase in the elderly population, standing at 46 million people aged 65 or older. By 2060, this number is expected to double. Numerous reasons contribute to this development, ranging from an increase in life expectancy to the availability and quality of hospital and palliative care. To promote health and quality of life, nurses must find ways to improve patient satisfaction with their treatment.
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In elders, hospitals are often associated with invasive and unpleasant procedures, overwhelming medications, and personal isolation. While the first two factors often have little in terms of alternatives, it is possible to reduce the feelings of isolation among patients. According to Sprague, Reynolds, and Brindley (2016), patient isolation due to contagious diseases is often associated with feelings of depression and loneliness, which reduces the quality of life and satisfaction with the treatment. The purpose of this study is to determine how structured daily nursing visits would affect patient satisfaction in patients aged 65 or older.
The dependent variable for this research is the level of patient satisfaction in elder patients hospitalized for a time of one week or longer. Independent variables include the presence (or absence) of structured daily nursing visits and the quality of these visits. To remove the second independent variable from the equation, the nurses participating in this research would be instructed to use a unified visitation program.
The main hypothesis for this research: The introduction of structured daily nursing visits for elderly patients would improve patient satisfaction and quality of life.
Null hypothesis: The introduction of structured daily nursing visits would have no significant effects on patient satisfaction and quality of life.
This research is based primarily on the theoretical framework developed by Jean Watson, which is called the Theory of Human Caring. This theory involves a transpersonal approach to healthcare and the concept of healing. One of the primary factors, according to Watson, is an interpersonal relationship between the patient and the nurse. The major points in this relationship are the commitment to care, caring actions, knowledge, and emotional interconnectedness. The nurse and the patients are partners in one journey towards health and wholeness (“Jean Watson’s philosophy of nursing,” 2012).
This fact transitions well into the main goals behind the proposed intervention, as the purpose of structured daily nursing visits is to help the patient achieve harmony in both mind and body. The frequency and certainty of the nursing visit are expected to induce feelings of protection, enhancement, and an overall improvement in the patient’s perceptions of quality of life. Besides, benevolence and understanding provided by the nurse ought to drive back the feelings of loneliness and depression, which elder patients often suffer from due to their gradual isolation from society. Having someone to talk and communicate personal worries to is expected to promote psychological and spiritual healing, which is very important within the scope of Watson’s theoretical framework wholeness (“Jean Watson’s philosophy of nursing,” 2012).
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Review of Literature
Hospital stay in elder patients is often associated with social and physical isolation. Sprague et al. (2016) state that due to higher susceptibility towards diseases, especially contagious airborne diseases, elderly patients often find themselves confined to geriatric wards and other types of isolated facilities meant to prevent the spreading and further contamination in a hospital setting. However, these precautions have a negative side – in many cases, elder patients develop psychological disorders associated with isolation, such as depression and degradation of social skills. This fact is especially true for patients who are forced to stay in hospital care for prolonged periods. This article is useful to the research as it helps identify the main problem that the proposed intervention is aimed to counteract. Interpersonal contact should alleviate the feelings of loneliness and promote a higher quality of life.
During patient visits, empathy and listening are considered the most important factors to contribute towards patient satisfaction and ease of mind. According to Pollak et al. (2011), hospitalized patients appreciate having someone to listen to their problems and respond empathetically in turn. This is especially true for elder patients, who do not have anyone to talk to, as their circle of friends and acquaintances becomes smaller, and their children move out to pursue their own lives.
Therefore, a nurse is not only viewed as a medical worker but also as a council and a friend, which greatly contributes to patient satisfaction and promotion of health. This information is important for our research, as it gives a clear perspective on what the proposed structured daily nursing visits should be focusing on. Also, this source supports nursing visits as a valid intervention, as the patients who were visited by physicians reported an increase in patient satisfaction ranging from 11 to 29 percent, depending on the perceived levels of empathy.
Large-scale meta-analyses also find patient-nurse relationships to be an important factor in patient satisfaction with the quality of provided care. Schoenfelder, Klewer, and Kugler (2011) identify nursing kindness and frequency of visits as the second most important contributing factor to patient satisfaction, topped only by the overall result of the treatment. This proves the inherent value of nursing visits to patient satisfaction, as structured visits would expose the patients towards nursing empathy and kindness. This source supports the conclusion of other articles mentioned in this review on a greater scale, as the meta-analysis by Schoenfelder et al. (2011) was conducted in 39 hospitals.
However, there are disadvantages to the proposed intervention. Mason, Leavitt, and Chaffee (2014) point out that the American hospital system is already overwhelmed with work and understaffed, meaning longer shifts and greater workloads on the nurses. These factors greatly contribute to nursing burnout and lack of emotional empathy towards patients. The proposed intervention would require nurses to spend additional time on structured visits for elder patients, which means additional workload. Mason et al. (2014) state that any excess of care would involuntarily increase nurse burnout rates and overall costs of medical care. This source is important to our research as it provides an opposing view of the proposed intervention and highlights the non-medical factors that may influence its adoption and implementation within the parameters of the American healthcare system.
The research will use simple random sampling as its primary sampling method. It is a qualitative study that will use the HCAHPS survey as its primary collection tool. The reasoning behind this type of research is that quantitative studies provide concrete results that are much less open to interpretation. The use of surveys to grade patient satisfaction is necessary because there is no other way of objectively grading patient satisfaction. The HCAHPS survey is an official standardized instrument used for data collection and understanding of the patients’ perspectives towards hospital care. It is approved, supported, and endorsed by various healthcare associations, one of which is the National Quality Forum (NQF).
The sample size for this study will vary from 40 to 100 patients, depending on how many nurses and patients would be available for participation in the project. The patients will be split into two groups – the test group and the control group. The members of the test group will be visited by nurses daily, whereas the control group members would receive standard hospital treatment. Criteria for the participants are as followed:
- Age of 65 years or older
- The duration of hospital stay is more than one week.
- The patient is coherent and is capable of answering the questionnaire at the end of the treatment.
Since the intervention itself is non-invasive, no particular measures of protection of human subjects are solicited. However, the patients would be allowed to refuse nursing visits if they wish to do so.
The data received from the questionnaires will be compiled and processed using digital statistical software. The primary data analysis method will involve the Z-test, which is a standard tool in hypothesis testing and is useful when the sample size exceeds 30. As the estimated sample size for this study is 40 participants or more, the Z-test will offer a higher degree of accuracy when compared to the standard Student’s T-test. The results of the test group will be compared to those of the control group as well as the hospital’s general patient satisfaction score. It is expected that the results of the test group would exceed that of the control group.
Applicability to Nursing
As evidenced by the literature presented in this proposal, the relationship between nurses and patients is one of the core factors in improving patient satisfaction. Patient satisfaction is associated with improvements in healthcare outcomes and increases in quality of life. This research will add to the information already available on the subject, as it proposes a very easy and applicable intervention, which could be easily incorporated into hospital routines that deal with the treatment of elderly patients during a prolonged hospital stay.
Although some sources suggest possible increases in nurse workload and cost increases for hospital care, these increases are expected to be marginal because the proposed intervention requires no additional materials or medications, while offering impressive results. As Watson stated in her theoretical framework, one of the main goals of healthcare involves improving the patients’ quality of life, justify the proposed measures. At the same time, relatively low costs and high potential returns make structured nursing visits for elders a perfect tool for incorporation into almost any hospital schedule. The research proposal is well illustrated and is easy to replicate in a different setting or on a greater scale, and can be used as a blueprint for future studies.
Jean Watson’s philosophy of nursing. (2012).
Mason, D.J., Leavitt, J.K., & Chaffee, M.W. (2014). Policy and politics in nursing and health care. New York, NY: Elsevier.
Pollak, K.I., Alexander, S.C., Tulsky, J.A., Lyna, P., Coffman, C.H., … Ostbye, T. (2011). Physician empathy and listening: Associations with patient satisfaction and autonomy. The Journal of the American Board of Family Medicine, 24(6), 665-672.
Schoenfelder, T., Klewer, J., & Kugler, J. (2011). Determinants of patient satisfaction: a study among 39 hospitals in an in-patient setting in Germany. International Journal for Quality in Healthcare, 23(5), 503-509.
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Sprague, E., Reynolds, S., & Brindley, P. (2016). Patient isolation precautions: Are they worth it? Canadian Respiratory Journal, 2016(1), 1-5. doi: 10.1155/2016/5352625