Review of Literature
Callahan et al. (2012) argue that transitional care model is best for preventing the prehospitalization of critically ill patients. There are a lot of things that have to be considered when looking at transitional care for any patient. An all-inclusive discharge plan should be drafted and communicated to the patient and family members before a patient lives the hospital. Additionally, a follow-up routine has to be done to make sure that the patient and the family are following the instructions that were provided. The review of literature will be divided into the four research questions of the study.
Effectiveness of Transitional Model and Post-Discharge Life of Elderly Patients with Chronic or Other Condition
Szebehely and Trydegård (2012) are of the opinion that transitional care is effective in ensuring quality of life for elderly patients with chronic illnesses. According to Wysocki, Kane, Dowd, Golberstein, Lum and Shippee (2014), the model is very nurse-centered. It gives the nurses involved an upper hand in developing the recovery plan of the patient, even after the patient has left the hospital. Additionally, transitional model also allows for the incorporation of the six activities of daily living (Kamp & Hvid, 2012). The six activities of daily living include feeding, taking a bath, dressing, going to the toilet, transferring from one place to another, and maintaining continence (Kamp & Hvid, 2012). All patients discharged have to be able to do the said activities for them to be considered well.
Additional Interventions and Activities that Make the Model Effective
From the discussion given, one of the factors that make the model more effective is the activities of living. Szebehely and Trydegård (2012) argue that activities of living are basic household actions that affect the quality of life either positively or negatively. As mentioned, there are six activities of living namely, feeding, taking a bath, dressing, going to the toilet, transferring from one place to another, and maintaining continence. Analyzing the concept of feeding, for instance, chronically ill patients are often on medicine and have to eat well. While at the hospital, nurses tend to push the patients to eat well. Once discharged, however, the same becomes very difficult. RNs are guided by the activities of living on some of the things that have to be considered when making a discharged and follow-up plan.
Influence of Lack of Specialized Skills of Nursing Professionals in Transition of Older Patients
The skill level of nurses affects the transition of older patients in various ways. The section refers to skills other than the required RN skills for practice such as formal education. It can be argued that more skilled nurses record better results in transitional care than less skilled nurses.
Watkins, Hall and Kring (2012) explain that whereas many nurses know the medical care that is needed by their patients, in this case, those under transitional care, a larger number do not know about alternatives of increasing the quality of life, and wellness. Watkins, Hall and Kring (2012) assert that interpersonal skills are very relevant in transition care. The RN has to be knowledgeable on how to deal with people, how to ease their fears of going home, and how to encourage the families to adopt a lifestyle that is suitable for the patient, and so on.
Limitations of Transitional Care Model with Regard to Elderly Patients
One of the limitations of transitional care model with regards to elderly patients is the fact that it pushes out the family members. As mentioned, the model is nurse-centered. Comans, Peel, Hubbard, Mulligan, Gray and Scuffham (2016) explain that modern practices encourage incentives that are patient-centered and not nurse-centered. Therefore, to some extent, it can be argued that the model is ‘old’.
This section looks into the methodology that will be used in the study. Some of the things that will be discussed include the design of the study, sampling methodology and tools that will be used in the study.
Design of Study
The study will use a qualitative research design. One of the reasons why a qualitative research design is preferred is the fact that it can be descriptive. The researcher will employ the use of a structured questionnaire to collect the data needed. The questionnaire will be developed by the researcher, with the help of two research assistants. The questionnaire, being structured, will have provided answers that the participants can choose from as opposed to open answers.
The second reason why the qualitative design was preferred is that it allows for a long duration of study. The transition period can at times be long. Due to the nature of qualitative study, the researcher will be able to take the time needed to collect the data, analyze, and present it without interfering with the quality of the experience. Additionally, due to the period of the survey, credibility of the data collected is easier to prove. Transferability is another key element that was considered in the choosing of the research design. The survey/ questionnaire makes it easier for the same data to be transferred to a different setting without bias. The fact that the survey is also descriptive makes it rich with information that the researcher can use to test the four objectives/ research questions that guide the study.
The sample was chosen based on the quota concept. The quota system in qualitative research allows the researcher to divide the sample size into various groups that have variations that can be tested to either agree or disagree with the hypothesis of the study. The study involves three sub-groups that can be tested. Therefore, the researcher has three sub-groups to cater for as per the research questions. The sample size has to be adequately divided into three sub-groups. The said groups are nurses, patients and families of patients. A total of 300 individuals will be sampled with 100 individuals forming one group. It is also important to note that the individuals will be identified across several health facilities to allow for diversification of skills brought on by enabling work environment.
The sub-groups in the sample size will also be divided further based on the different institutions they come from, or the location. The main reason for the classification is to determine whether distance from the patients’ to the hospital has any impact on the transition. Also noteworthy, is the patient’s age. The age can also be used to determine the level of confidence in getting treated at home versus in hospital.
There are cases where patients refuse to transition due to a fear of getting worse while at home. It is important to note that each participant of the survey will get the same questionnaire. The researcher will develop questions that target the four research questions/ objectives that were posed. Each of the answers will then be analyzed based on the different groups, and any other categories, that would have been created.
There are two main features of the qualitative research that will require use of tools. The first is the data collection and the second is the data analysis. The questionnaire will serve as the data collection tool and will be developed by the researcher. The researcher will then use both programing and non-programing data analysis tools to determine the results of the study. To ensure credibility, the researcher will use both manual and digital tools. The manual tools include Excel, which is a non-programing tool. There is a number of Computer Assisted Qualitative Data Analysis Software (programing) that can be used to analyze the data. The researcher has identified MAXQDA as the software that will be used.
Validity of Tools
The tools mentioned will be validated before use. The researcher will test the tools with a sample that will not be included in the actual study. The sample will comprise of nursing students from a nearby university. It is expected that the validity of tools will pinpoint some of the loopholes that would have been experienced in both the collection and analysis of data. Once the loopholes have been identified, the researcher will modify the tools to make them full-proof.
It is important to note that there are a lot of ethical considerations for the study. The main concern is consent, especially from the patients and their families. Due to the age, and the health of the patients, the researcher might find it difficult convincing them to participate in the survey. However, the participation will be on a voluntary basis and all participants will be informed of their rights before the start of the survey.
Callahan, C. M., Arling, G., Tu, W., Rosenman, M. B., Counsell, S. R., Stump, T. E., & Hendrie, H. C. (2012). Transitions in care for older adults with and without dementia. Journal of the American Geriatrics Society, 60(5), 813-820.
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 & Ageing, 45(2), 317-320.
Kamp, A., & Hvid, H. (2012). Elderly care in transition: Management, meaning and identity at work, a Scandinavian perspective. Scandinavian Review, 89, 1-13.
Szebehely, M., & Trydegård, G. (2012). Home care for older people in Sweden: A universal model in transition. Health & Social Care in the Community, 20(3), 300-309.
Watkins, L., Hall, C., & Kring, D. (2012). Hospital to home: A transition program for frail older adults. Professional Case Management, 17(3), 117-123.
Wysocki, A., Kane, R. L., Dowd, B., Golberstein, E., Lum, T., & Shippee, T. (2014). Hospitalization of elderly Medicaid long-term care users who transition from nursing homes. Journal of the American Geriatrics Society, 62(1), 71-78.