Introduction
Qualified and timely nursing care for vulnerable categories of the population is evidence of a sustainable and effectively controlled healthcare system. Through adequate interventions and addressing the key needs of the relevant citizen groups, medical professionals implement professional objectives comprehensively and perform meaningful patient safety tasks. One of these vulnerable population groups is older adults since numerous chronic diseases and other disorders develop precisely in adulthood, creating additional difficulties for these citizens. The inability to self-care enhances the value of nursing work with these patients. Therefore, out of the six key domains of care, the Effectiveness of Care is chosen, and as one of the performance measures to evaluate in the Prevention and Screening category, Care for Older Adults (COA) is selected.
By analyzing three different interventions for this performance measure, results will be emphasized, principles for applying the findings to professional practice will be presented, and the main advantages of the planned activities in enhancing patient ratings will be suggested. The interventions reviewed are meaningful initiatives to address different aspects of the target population’s well-being and determine the relevance of such solutions in the context of improving care options.
Advance Care Planning for Older Adults
One of the main prerequisites for using advanced care planning as an intervention in the care of older patients is the importance of comprehensive preparation for emergency hospitalizations. As Farrell et al. (2020) argue, immediate care may be required in this age group, and such procedures as mechanical ventilation and other forms of emergency help should be carried out in strict accordance with a predetermined action plan to avoid errors. Moreover, due to limited mobility, impaired cognitive functions, and other difficulties that are characteristic of the elderly, support programs are urgently needed (“Care for Older Adults,” n.d.). Therefore, the targeted intervention can be based on creating a list of decisions to apply in the case of older patients’ emergency hospitalizations.
Intervention Mechanism and Measuring the Outcomes
Interventions based on advanced care planning may include several steps. The first one is the collection of health data from the target audience. For instance, by engaging older adults from a certain area, a group of nurses can compile information about the dynamics and intensity of manifestations of chronic diseases in these patients, evaluate such indicators as admission and recovery rates, and determine the frequency of calling the medical staff at home. The second stage is the distribution of citizens into appropriate categories in accordance with specific diseases and complaints. Farrell et al. (2020) give the example of patients with chronic lung disease and note that citizens of this group need more careful care during the COVID-19 pandemic. By following these lists, medical staff can respond more quickly to specific requests, which, in turn, may lead to more effective emergency care.
The third stage is the formation of an electronic database based on the previously performed work. For the convenience of monitoring targeted patients, intensive care unit staff can have quick access to all the necessary data, thereby realizing an individual approach to each citizen, which is a valuable prerequisite for effective care. As a mechanism to evaluate the effectiveness of the given intervention, after a certain period of time, say six months, the results should be summarized by utilizing the aforementioned database as a tool to compare patient outcomes. The evidence obtained after the analysis can help determine whether the implementation of this advanced monitoring system is justified. In addition, such an issue should be considered as a hospital-associated disability, namely a condition associated with a long stay on treatment, which, according to Loyd et al. (2020), complicates the care process due to concomitant moral and physical difficulties patients experience. The real reduction in mortality rates and the increase in hospital discharges is evidence of the value of applying such an intervention in the chosen older adult community.
Improved Patient Outcomes and Cost Savings
The implementation of the proposed intervention does not require high costs because the main work concerns the combination of patient data, which can be performed in the simplest computer programs. At the same time, for the target population and nursing practice in general, such an initiative carries several advantages. Firstly, according to Hughes et al. (2019), care delivery, associated with planning, allows for structuring all work aspects for the staff, which, in turn, stimulates productivity and eliminates errors in work. Secondly, by using a convenient system of access to patient data, nursing staff can expect a likely increase in older citizens in departments based on the overall dynamics of morbidity or other factors that can be statistically assessed. With this information, medical employees can prepare all the necessary materials in a timely and evaluate the intensity of upcoming activities, thereby distributing the workload adequately. Each patient can count on individual care, which increases the likelihood of recovery. Finally, due to planning, both labor and budgetary resources are allocated wisely, which eliminates the possibility of unnecessary costs and allows funds to be distributed to specific needs at the most favorable time.
Improved Patient Ratings
Improving targeted patient ratings through the proposed intervention can be done through a variety of methods. For instance, as McMahan et al. (2020) remark, enhanced patient-provider communication is a positive outcome of advance care planning, and faster recovery rates are directly related to favorable interactions. This is due to the attention on the part of medical staff to the specific needs of older people because a preliminary analysis helps prevent complications. Another reason why patient ratings can rise, and which follows logically from the previous one, is the satisfaction of the target audience with the quality of care provided.
The absence of errors and attention to the individual problems of each case helps nurses establish a sustainable regimen of care in which older citizens can feel protected. Finally, through an advanced planning system, the risks of possible disease exacerbations are reduced since data on each patient and the dynamics of his or her treatment are available to the medical staff. By analyzing this information, nurses can anticipate likely hospitalizations and thus provide faster and more efficient care to older adults.
Medication Management Optimization
Another intervention aimed at helping older adults and included in the spectrum of the Effectiveness of Care domain involves establishing a sustainable medication management system. This aspect is crucial for the presented target group and requires attention both from patients themselves and from medical providers. According to Tabi et al. (2019), due to various circumstances, for instance, daily routine, cognitive dysfunctions, or other factors, the intake of prescribed medications may be inadequate and not comply with the rules specified by the physician. In this case, the risks of complications arise because the irregular intake of the necessary medications or, conversely, exceeding the permissible dosage makes a particular drug dangerous for the patient. Sometimes, complex regimens for taking medications, which older adults often have to adhere to, increase the relevance of introducing an adequate system of control over this process (“Care for Older Adults,” n.d.). As a potentially powerful tool to implement this intervention, the use of a virtual medication monitoring application is a convenient and efficient solution.
Intervention Mechanism and Measuring the Outcomes
The optimization of the medication management system can be accompanied by the introducing of innovative digital products utilized as drug monitoring tools. To begin with, it is essential to select the appropriate application from the list of available ones. Tabi et al. (2019) argue that today, one can choose the desired program with a different set of options, including for free, using the available channels to download the appropriate software. The next step is to familiarize the nursing staff responsible for medication management with the features and specifications of the chosen application.
In some cases, additional training of medical staff on how to use such a program may be necessary, but, as a rule, young nurses are well aware of digital innovations and easily operate such applications. The most important step is the distribution of the selected application among the target audience. As Tabi et al. (2019) note, many programs of this type come with the necessary instructions. However, some older patients may have difficulty using digital software. Therefore, to achieve maximum effectiveness of the intervention, the target audience should be familiarized with the functional characteristics and capabilities of such a program.
Intervention outcomes can be measured through the same application in which the data of the different patients involved can be entered. To determine the effectiveness of this initiative, the results need to be compared with the period before and after the intervention. In addition, a feedback system needs to be developed to obtain objective information from patients themselves regarding the benefits of utilizing such an application and their ideas regarding the usability of the virtual assistant program. Nussbaum et al. (2018) note that these tools can be used to monitor the intake of different medications, and through a common monitoring system by evaluating data in a single application linked to the care department account, the assessment of the effectiveness can be performed. The key factors to be addressed are the improved health outcomes of the participants involved, namely the reduction in complaints of poor health and the reduction in the number of home visits from medical staff. Analyzing all of this information available in one app can help evaluate the effectiveness of the intervention.
Improved Patient Outcomes and Cost Savings
One of the central benefits of the proposed intervention from the perspective of improving patient outcomes is increasing the accuracy of taking prescribed medications and, therefore, enhancing positive health effects. As Nussbaum et al. (2018) state, such applications also have a wide range of additional functionality; for instance, they track physical activity, offer additional educational materials, and signal the necessary measures to be taken in case of emergency. Due to all these options, older patients can monitor their health indicators on their own, less often resorting to the help of medical staff. From a cost perspective, such apps can be free, which eliminates any expenses to purchase and maintain them. Since no additional funding is required, nurses responsible for selecting and overseeing appropriate programs can monitor patients’ health indicators remotely, which reduces the burden on staff and streamlines workflow.
Improved Patient Ratings
Among the specific results directly related to improved patient ratings due to the use of a virtual application for optimizing medication management, one can note a reduction in the risk of complications caused by incorrect medication intake, as well as positive educational changes. Summarizing information about the health status of older patients can help provide a comprehensive picture of physical data, treatment dynamics, and possible alternative methods of interaction, for instance, remotely. According to Park et al. (2019), “combining quality assessment and user testing of apps with qualitative analyses” allows medical employees to identify the exact dynamics of care and determine what improvements may be needed in the future (p. e11919). The perspectives of enhanced self-care and better control of prescribed medications are significant prospects for the introduction of a special monitoring application, which is directly related to improved patient outcomes.
Pain Assessment Intervention
Care of older adults is often accompanied by the need for adequate control of symptoms to obtain the most accurate data on patients’ well-being, their morale, and other factors. Since many chronic and incurable diseases develop in old age, one of the aspects that aggravate the treatment of older citizens is pain, which they often have to cope with on their own. The decline in physical capacity, manifested as the deterioration of the functioning of body systems, exacerbates the issue and often brings suffering to older people (“Care for Older Adults,” n.d.). Therefore, as a potential intervention, the pain assessment program is suggested. Herr et al. (2019) attribute the relevance of this work to age-related challenges, such as dementia. Thus, designing a care program for older patients with pain is a responsible task.
Intervention Mechanism and Measuring the Outcomes
The intervention involving pain assessment in older patients involves following three main steps. The first one is direct interaction with the target audience to collect data on the nature of the pain they experience, as well as the effective methods of dealing with it, which they encountered. This procedure can be carried out through a standard survey by asking for personal data and using a rating scale to obtain information from each patient engaged individually. Domenichiello and Ramsden (2019) distinguish chronic, intermittent, and other types of pain, and the analysis of specific indicators can help provide a relatively accurate picture of the dynamics of manifestations. The second stage is the evaluation of the collected data, which can be performed through statistical analysis utilizing basic calculation algorithms. Such a procedure is necessary to identify the most common types of pain and to compile preliminary lists of risk factors and their consequences.
In the third step, the participants involved should receive recommendations from the medical staff who evaluate the results of the survey. For instance, cancer patients can expect a detailed list of instructions to help them assess the nature and frequency of their pain, as well as the most effective ways to treat it with medications. According to Domenichiello and Ramsden (2019), there is a direct relationship between persistent pain and premature death due to not only physical but also cognitive disorders that develop under the influence of persistent pain. Therefore, older people should have a comprehensive knowledge of how to better cope with the inevitable pain due to illness, including from a psycho-emotional perspective. The tools used to collect data and analyze the results are simple and effective methods of interacting with each patient individually, which increases the practical value of the intervention.
Improved Patient Outcomes and Cost Savings
Both from the standpoint of improving patient outcomes and from the perspective of cost savings for nursing practice, the proposed intervention has undeniable advantages. As Lu et al. (2022) argue, the majority of older adults in geriatric departments experience pain of varying degrees of intensity, which is a prerequisite for the use of different painkillers. By monitoring the progression of acute pain attacks and providing drugs timely, nurses can reduce medication consumption while helping patients. The relief of pain in the early stages can have a beneficial effect on the psycho-emotional state of older adults, which, in turn, is a prerequisite for a faster recovery. Understanding risk factors and timely action are valuable incentives to improve the quality of nursing staff. This characteristic, which is often measured in terms of the ability to provide timely assistance, is a significant indicator. Thus, the target patients’ recognition of the effectiveness of the pain assessment program can be the main evidence of the intervention’s effectiveness.
Improved Patient Ratings
An individual approach to each patient in assessing pain and the dynamics of its manifestations is a significant practice aimed at improving patient ratings. Ersek et al. (2019) note that personal characteristics associated with pain severity are crucial to evaluate so as to correlate this information with other health problems, such as sleep disturbance or depression. In addition, by resorting to the principle of grouping pain into appropriate categories, nurses can rely on objective information and, therefore, apply rational care practices. The acceptance and endurance of pain are individual characteristics, and the unification of approaches to its relief is not the optimal method. The intervention in which every older patient can count on the attention of the medical staff contributes to improved quality of care and guarantees improved health outcomes. Moreover, when speaking of real practical results, one may note that a different number of patients may be involved in such work. This expands the possibilities for effective pain assessment and contributes to the well-being of the older population.
Conclusion
The three considered interventions are aimed at addressing the Care for Older Adults (COA) performance measure in the Effectiveness of Care domain. As such, initiatives, advance care planning, medication management optimization, and pain assessment procedures have been analyzed. Each of the three interventions addresses the concerns of the target audience and employs different implementation strategies. Based on the analysis of the measurement tools involved, patient outcomes, and cost savings, one can say that the interventions are programs that can be implemented in any care environment and optimize nursing practice through improved quality of care, including through preventive measures. Older patients require increased medical assistance due to the exacerbation of chronic diseases and related health problems, and the initiatives discussed are potentially valuable supplementary action plans.
References
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