Traditional Care for Elders - Research Paper Example

Traditional Care for Elders The is Transitional care of older adults Hospitalized with Heart failure: A Randomized, controlled Trial. The title represents the content of the study in clear and concise manner. The content of the study takes into consideration the efficacy of transition care intervention delivered by APNs to the elderly in hospitals diagnosed with heart failure. The study is randomized, and has controlled trial having a follow-up of 52 weeks. The clarity of title representation is also depicted by the manner in which the study is arranged in sections. Abstract This is a critical analysis of the health care intervention model researched by authors in the past over the effectiveness of procedures in caring for the elderly. The authors of the reference article present information from for the purpose of their research from the start. They begin by introducing the various sections of the article, such including what it covers, the objective and other key sections of the article. Further, they draw into the contents within the article to explore the sections creating the base knowledge and formulating an expectation in the readers’ mind of the features they expect to in within the context of the paper. The abstract additionally outlines the methodologies as discussed in the paper, the result presentations, findings and conclusions of the study. The others also introduce factors of keywords in the text, creating an expectation for discussion to lean along that direction as the reader explores the article. Thus, the introductory abstract is useful in introducing the reader to the contents of the article. Introduction The growing scientific body suggests that older adults are remarkably vulnerable during the transition from hospital to home as they face a multitude of comorbid conditions as well as therapeutic regimens. From a past study, the research review, of 94 studies that occurred from 1985 to 2001 indicate that the elderly as they transit from hospital to home faced preventable poor discharge outcomes (Mary, Dorothy, Roberta, Greg, Kathleen, & Sanford, 2004). These studies provided both individual and system factors affecting the transition process. Personal factors include functional deficits, poor health behaviours, emotional and physical support and cognitive impairment. System factors include communication and follow up breakdown between providers and health agencies, inadequate caregiver education on patient and poor continuity of care (Mary et al., 2004). Thus, from the introduction, it is clear that the research has background information checked from previous studies. The authors give foundation for their study from previous studies and elaborate how their study will extend their findings accordingly. The authors of the research evaluate the factors building to the objective of their study accordingly, gathering relevant information as concerns the study from previous studies and presenting these findings as the foundation for the study. They cite the various findings that are relevant to the areas their research will feature, elaborating the subject of elderly care from past cases to build on the objectives and thesis of this research. After the elaborate literature review of past researches, they then present the objective of their study, which they state clearly. They present discussion on past two studies into effectualness of care management strategies carried out for the elderly that suffer from an acute episode of heart failure with complications from other conditions. They present elaborate explanation of their objective for the research. They state objective as examining sustained effect of a 3-month comprehensive transitional care (discharge planning and residence follow-up) intervention by sophisticated practice nurses for elders hospitalized with heart failure; from first readmission to death (Mary et al., 2004). The research hypothesis is that the comprehensive transitional care intervention program increased the length of the period between hospital discharge and death or re-hospitalization for the elderly suffering acute heart failure. Methods In conducting the study, the authors of the research present several essential procedures of conducting a successful study. They first begin by presenting the study sample as they applied in their study. The study occurred at six different Philadelphia academic and community hospitals. Since it was about elderly care, it featured a sample in which all patients studied were 65 and above years, admitted to the hospital from their homes between the period February 1997 and January 2001 with cases of heart failure (Mary et al., 2004). There was the screening of a designated diagnosis-related group of 127 validated at discharge. The validated participants had to have literacy in English, be alert, oriented, and reachable after discharge, and be residing within 60-mile radius of the service area of the admitting hospital. The enrolees consists of 239 persons, with mean age at (76 v. 77, P= 0.089), race consisting of 64% v. 69% white, P=2.0) and sex at (57% v 59% female, P=0.804) (Mary et al., 2004). This sample constituted the entire study group. The study design entailed first gaining approval of the study protocol from the University of Pennsylvania review board. Thus, it seeks the relevant approval making it legal and procedural. Secondly, after screening of the patients, the research assistants (RAs) obtained the social-demographic and health status data and reported the findings to manager. The manager assigned the patients to various study groups using computer generated, institution based block 1:1 random algorithm (Mary et al., 2004). Thus, there was no bias in initiating the study design. Further, the research study incorporated a control group to facilitate comparative findings of their hypothesis. The control group consists of patients receiving routine care from the admitting hospitals, including features such as site-specific heart failure-patient management and discharge planning and home agency care consisting of comprehensive seven days per week services. The standards of care considered include institutional policies to guide, document and evaluate the discharge planning. The planning as applied the various hospitals and home care used was similar. The attending physician determines the discharge date. The study further presented intervention group, which involved collaboration of patients, physicians and three APNs (Mary et al., 2004). The intervention extended for three months after the index hospital discharge. Intervention incorporated standardized training, and orientation programs guided by a multidisciplinary team of heart experts, pharmacists, specialists, social workers, nutritionists and therapists (Mary et al., 2004). There was use of Quality-Cost Model of APN Transitional Care, implemented in collaboration of APNs patients, physicians, educational and behavioural strategies. The protocol applied consisted of APN visits within 24 hours of admission, and a daily visit during the index hospitalization. It also includes at least eight home visits by the APN, weekly visits during the first month, bimonthly visits in second and third monthly. The APN visits depend on the needs of patient and 7-day telephone availability from morning to evening on weekdays and morning to noon on weekends (Mary et al., 2004). In the case of re-hospitalization during the study, the APN resumed daily visits to facilitate the transition. The protocol also allowed the APN considerable flexibility to individualize care. There was expert preparation for nurses on management conditions for elderly adults. After training completion, the APNs assumed responsibility for discharge planning of the hospitalized patient. After discharging patients, assessment continued at their homes. There were face-to-face interactions between patients and physicians during hospitalization and initial follow up visits (Mary et al., 2004). The APNs provided the physicians, caregivers and patients among other care providers with summarized progress and unresolved issues as well as recommendations on the study of each patient. The outcome measures entailed conducting-standardized follow-up at 2, 6, 12, 26 and 52 weeks after hospital discharge to facilitate information on re-hospitalization and unscheduled acute cases (Mary et al., 2004). The study process used the Enforced Social Dependency Scale to evaluate the functional status of the patient. It also applied the Minnnesota Living with Heart Failure Questionnaire to assess the quality of life. They used Investigator-developed instrument at second and sixth week of post index hospitalization to assess patient satisfaction. The control patient group did not have home follow-up, and hospital experience was detached for accurate recall and generation of reliable data. The study procedure also incorporated a statistical analysis for the final measurement of outcomes. Thus, it is an empirically involving study, with a remarkably high rate of completion for the study. Only 49 out of the 239 subjects failed to complete the study. The enrolled ended with 118 intervention and 121 control group subjects. Secondary analysis indicates that the death constituted 24/239, a 10% of the loss suffered (Mary et al., 2004). The researchers further used the Group-specific Kaplan-Meir survival curves and proportional hazards regression to assess efficacy of the intervention. The Kaplan-Meier survival estimates helped in computing the average cost per patient of the intervention. Tertiary analysis incorporates comparisons on quality of life, functional status and patient satisfaction using the Wilcoxon rank sum tests. The findings and scores are from raw scores gathered during the information collection. Results The intervention and control groups were of the same baseline and social-demographic characteristic. The results as gathered from the study replicate the procedural progress of the research process. The results presentation is in tabulated form, presenting the findings of the study elaborately. Further, the intervention group consisting of APNs alongside the practitioners leading the study collected information from the observations, summarized it into reports and presented it to the supervising physician as well as the patients. Of the total patients under the study, 24, constituting 10% died within the 52 weeks of study (Mary et al., 2004). This included 13 of the control group against 11 from the intervention group, P= 0.830. The study follow-up was relatively similar, with the mean 281 control v. 279 intervention days, P= 0.871. The re-hospitalization and deaths at the 52 weeks were lower for the intervention group as compared to the control. The post-discharge re-hospitalization in the intervention group was 44.9% against 55.2% of control group (Mary et al., 2004). These are among the various findings among several others from the study. The research presents the evaluation of the findings from the perspective of effect persistence cost analysis of the study process and intervention plan as proposed. They also present findings and summary on quality of life, functional status, and patient satisfaction for both the control and interventions groups. The presentation of the results incorporates the statistical findings as employed in the research methods to collect reliable information and analyze the findings. In view of the results, various factors over the subject of results are evident. To begin with, the experiment incorporates clear adherence to reporting of information gathered from patients, evaluating the findings from various grounds, including race, gender, and control groups. Further, there is professionalism in protecting the patients identities with respect to reporting the findings gathered. The presentation of results in easily elaborate table structure and consideration of statistical analysis of the results present the findings as reliable, useful and in the course with the objective of the entire study process (Mary et al., 2004). The researchers used the statistical data accordingly leading to findings and establish that indicate the realization of their objective. The data convenes with the thesis of the study. Discussion and Conclusion In view of the research study, the methodology of the process and result presentation, several aspects follow within the discussion of the results and conclusion. The process of discussing the findings presents a remarkably critical understanding of the procedures of the study and various methods of analyzing research findings. From the evidence of the research sample, the study design, and the outcome measurements, the study employs exemplary and effective tools for gathering and analyzing the results. The study design focuses on directing the entire procedure towards the inclination of the objective of the study. Further, the inclusion of the control group forms the basis for comparative analysis in testing the hypothesis of the study (Mary et al., 2004). Thus, in view of these establishments within the discussion section, the study manages to test the hypothesis of the study effectively. The literature review facilitates the basis of this research, realizing the limited research process put in evaluating the effectiveness of intervention plans in elderly care. Thus, the author in the study pursues the course of the objectives as they relate to the literature, gathering relevant and reliable information to advance their course accordingly. Thus, the authors through the research remain glued to the course of advancing the relevance of their study. Through the discussion section, they indicate the relevance of their findings through the recommendations section (Mary et al., 2004). The findings do not include generalized information as the research empirically ad critically explores all the measure from the individual subject reports to arrive at the overall finding. The extent of generalizations only affects the sections of similarity of the various groups. The authors fail to describe that extent of the similarity between the intervention and control group. The conceptualization of the entire research is in the conclusions of the writers of the research. The study sought to appraise the effectiveness of the intervention plans in addressing the matters concerning heart attack and complications in elderly patients. Thus, as the authors edge on the conclusions, they rely entirely on the results of their tests to provide a conclusive, final report of the study. The discussion also features the sources of error and tests them accordingly, featuring the drawback of the study (Mary et al., 2004). The author expands on the stated drawbacks, leading to the findings as they appeared. The findings further reflect little interference from the various drawbacks as the study encompassed succinct measures in alleviating these drawbacks. Thus, the authors present a detailed discussion and a conclusion that draws into the hypothesis and objective of the research. Overview The growing scientific approaches to research continue to influence the procedures engaged in a research process (Boswell & Cannon, 2011). Some researchers use this technological advantage to institute generalized report. However, with respect to the research procedures as represented in this study, the article is extensive in its employment of methodological research procedures. This makes the findings of the research highly reliable and highly relevant to the course of the study. The authors established a procedural approach to the study, working the report from step to another, with a detailed explanation of sections and procedures conducted in the study. Thus, it is a sufficiently done report, with reliable information about the case in the study. For future research on the research, the design of this report should improve on the aspects of result analysis as employed in measuring outcomes. There are relatively better tools of analyzing and presenting findings of a report of this magnitude. Further, the explanation of the procedures on the control group does not elaborate the methods used in evaluating the patients. Thus, this is an area for improvement in future studies. Through this research article on elderly care, there is remarkably useful clinical information to apply in the working filed. Care of the elderly requires personalized intervention plans, as the findings indicate. The quality for care with successful intervention can determine the quality of life and success of the care model as administered to the patient (Boswell & Cannon, 2011). Therefore, for application, this study facilitates the implementation of future interventions in the care of elderly and terminally ill persons. References Mary D. N, Dorothy A. B., Roberta L. C., Greg M., Kathleen M. M., & Sanford S.( 2004). Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial. By the American Geriatrics Society Boswell, C., & Cannon, S. (2011). Introduction to nursing research: Incorporating evidence-based practice. Sudbury, Mass: Jones and Bartlett Publishers. Read More