Introduction
The USA has one of the largest elderly populations in the world. As it stands, the current number of elders aged 65 or older is around 45 million people, which, according to the Population Reference Bureau (2016), is estimated to increase to about 98 million by the end of 2060. At the same time, the average fertility rate in the USA is 1.81, which means less than two children per woman, which promises an impending crisis associated with a demographical gap. As it stands, the number of nurses in the USA is shrinking due to inefficient policies, long shifts, high turnover rates, and the likelihood of burnout. In other words, the possibility of a healthcare crisis in the future is high. While all available resources should be spent on rectifying this situation, an effort must also be made to prepare for a situation where a smaller number of nurses will have to deal with an increased number of patients.
Elderly patients constitute a demographic group that requires medical assistance on a regular basis due to possessing a variety of chronic diseases and being vulnerable to injuries (Hirschman et al. 2015). Post-acute care is related to transitional care in nursing and is one of the most likely services to suffer from personnel shortages. As it stands, post-acute care is primarily being done via home visits and telephone calls. In the event of a nursing crisis, the available nurses would not be able to leave their posts in order to perform home visits. At the same time, developments in communication technology would make long-distance nurse-patient communication possible. The purpose of this research is to investigate whether more elaborate and frequent web-based and telephone-based communication channels would be an effective substitute for nursing visits in post-acute transitional patient care.
Identification of the Problem
The suggested framework for this research is the Patient, Intervention, Comparison, Outcome, Time (PICOT) framework. It helps identify all the crucial aspects of the problem and the suggested intervention in an accurate and succinct manner.
P (Population): Post-acute care patients aged 65 or older.
I (Intervention): Daily web-based and phone-based communication
C (Comparison): Standard protocol for post-acute transitional care (nursing visits and telephone instructions)
O (Outcome): Decreased number of accidents and re-hospitalizations
T (Time): Estimated timeframe for this research is 12 months.
Significance of the Problem for Nursing
The significance of this problem to nursing is two-fold. First, the lack of personnel to perform home nursing duties is significant even at this point, whereas in the future, with the number of elderly patients in acute and post-acute home care increasing, it is going to become even more challenging and resource-demanding (Hirschman et al. 2015). Secondly, nursing home visits are very time-consuming tasks, especially when patients live far away from healthcare centers. Lastly, keeping a large body of nurses is financially taxing for healthcare institutions, which is going to be a financial burden for the federal budget. Thus, finding alternative solutions with an emphasis on preventive care, self-care, and long-distance monitoring is important to avert the current and future crisis.
Purpose of the Research
The purpose of this research is to increase the quality and efficiency of transitional post-acute home care. Telephone hotlines and long-distance care have been thoroughly researched and integrated into modern hospital systems. At the same time, nursing home visits have remained the primary intervention tool for post-acute transitional care. While the ability to see and inspect the patient in person is more efficient than what any communication device could provide, it is a slow, expensive, and limiting process, as not all patients would have the same access to direct nursing care. According to Comans et al. (2016), over 62% of post-acute re-hospitalizations could be prevented through various means, some of which include patient education and preventive care. This research will help realize whether an increased quantity and quality of web-based and telephone instruction and care would be able to compensate for lack of frequent and timely nursing home visits, as it often happens in real-life scenarios.
Research Questions
The proposed research will investigate and compare several factors and scenarios in order to answer the following research questions:
- Our web and telephone-based patient communication with a video feed a more efficient way of patient instruction and communication compared to regular phone-based communication?
- Is extended web and phone-based patient communication with video feed more efficient than standard post-acute transitional care protocol?
- Can nurse visiting be replaced with extended web and phone-based patient communication for post-acute home-based patients in non-dangerous scenarios?
- How costly and labor-intensive is the proposed intervention compared to the standard post-acute transitional care protocol?
These questions will be answered in the course of our research and will be used to define the effectiveness (or lack thereof) of the proposed intervention.
Master’s Essentials aligned with the Topic
Identifying master’s essentials is necessary in order to determine how well the proposed topic of research correlates with my studies and the nursing profession in general. Three major master’s essentials, aligned with my selected topic, are as follow:
– Quality Improvement and Safety. This essential subject has a connection to my research as one of the purposes of the study is to understand whether an emphasis on telephone-based and online care would improve the quality and safety of home practices for post-acute elderly patients.
– Informatics and Healthcare Technology. The basis for the proposed research and intervention lies in advancements in healthcare technology, communication technology, and informatics. The use of new means and ways of communication is expected to increase the patient’s capabilities for self-care as well as the hospital’s awareness of the patient’s state of health. Without informatics and healthcare technology, this intervention would be impossible to organize and perform.
– Clinical Prevention and Population Health Improvement. This essential of nursing studies constitutes for the purpose of this proposed intervention and study. The emphasis on patient communication is done with the scope of improving the skills and abilities of self-caring. In accordance with Self-Care Deficit Nursing Theory by Dorothea Orem, every patient wants to feel better and to be able to facilitate healthcare without having to rely on outside assistance. The purpose of this intervention is to act on that need and to provide tools and means of communication with healthcare professionals in order to be able to receive instructions and facilitate self-care.
Other essentials, such as organizational and systems leadership, health policy and advocacy, and interprofessional collaboration for improving patient and population health outcomes, are also present in this paper, though their influence fades into the background in comparison to the three essentials that this work is built around.
References
Comans, T. A., Peel, N. M., Hubbard, R. E., Mulligan, A. D., Gray, L. C., & Scuffham, P. A. (2016). The increase in healthcare costs associated with frailty in older people discharged to a post-acute transition care program. Age and Ageing, 45(2), 317-320.
Hirschman, K. B., Shaid, E., McCauley, K., Pauly, M. V., & Naylor, M. D. (2015). Continuity of care: The transitional care model. The Online Journal of Issues in Nursing, 20(3), Manuscript 1. Web.
Population Reference Bureau. (2016). Fact sheet: Aging in the United States.