Nursing Research: Challenges In Transitional Care Implementation Phase

Running head: CHALLENGES IN TRANSITIONAL CARE Challenges in Transitional Care Frank Calderon Florida National University Dr. Jorge Hirigoyen 2/1/2019 1 CHALLENGES IN TRANSITIONAL CARE 2 Challenges in Transitional Care Introduction to the Problem The case of failure in transitional care for the elderly and the chronically ill patients shows the challenges in transitional care. Transitional nursing is the continuity of treatment of the patients during the movement from one health center to another or home. The incidence rehospitalization of people who have been released from the medical facilities to go home for recovery is high. According to Ortiz research, in 2015, 35.6% of hospital readmission within 30days of discharge is of elderly patients of age 75- 84. The authors indicate that this is due to the patients worsening instead of getting better. Caregivers report that they do not know how to handle the patients that are left in their care. Storm and Aase (2014) elaborate that physicians say that elderly patients who have acute conditions are in vulnerable positions of breakdown if the proper transition is absent. This is after evaluating that some of the deaths reported of elderly patients in home-based and community- based care be caused by poor. Ye and Quan (2016) point out that in 2012, China had the practice of the medical practitioners discontinuing patient’s care once the patient is discharged. The recovery care task was left with caregivers. This practice led to 30 percent of patient declining in their well-being and regular functioning after been released from the hospital especially the elderly. In the homebased care, they lacked professional monitoring. In addition to the issue in the transition of the elderly from the hospital to their home, the other failure is the transitional care within the medical setting. Ortiz (2019) explains that the main case identified is medication mix-up and CHALLENGES IN TRANSITIONAL CARE 3 error during the movement of the patient emergency department to the intensive care unit. It also includes the surgical unit setting. Problem Statement Lack of specialized nursing intervention is the cause of the challenges in transitional care. It causes the readmission of elderly patients with acute illness. The handoff of patients with no clear communication to the caregivers on how to take of them cause mishandling of the patient (Morphet & Williams, 2014). Most caregivers as well not trained on how to provide primary care to their patient. As a result, they develop other conditions, or their case elevates and hence the need to go back to the hospital. In some case, the patient may lack friends or family members to look after him or her. In such a situation, the patient requires a transitional nurse to fulfill his/her medical needs. The absence of one threatens the life and well-being of the patient. The difficulties of transitional care within the medical setting are as a result of lack of specialized nurses who are skilled and knowledgeable about providing professional care. Storm and Aase (2014) illustrate that the issue of delay in the provision of therapy places the patient at risk. This is a challenge that results because of unprofessional nurse handling the transfer of the patient from unit to another. A specialized nurse is aware of the importance of timely and complete communication. Poor transitional care in chronically ill people exists due to improper coordination between the emergency department nurse and the one in the ICU. Ortiz (2019) asserts that lack of organization confuses the right therapy for the patient which in turn causes the delay in the recovery of the patient or the development of complications. Furthermore, unlike a regular nurse, a specialized nurse provides quality transitional care. They are experienced, well-trained and knowledgeable in giving transitional care. A CHALLENGES IN TRANSITIONAL CARE 4 general nurse will administer primary care for an ill person who is hospitalized. It is evident that the provision of transitional care by ordinary medical practitioners is the cause of low-quality care. This creates patient and caregiver dissatisfaction. The significance of the problem to Nursing The research problem is significant to nursing. The problem is; lack of specialized nursing is the cause for the challenges in transition care. It directly concerns the nursing profession. It raises awareness of the weakness of nursing in transitional care. It identifies that nursing service in transitional care is poor. Patients are sent off without continuity care from professionals till they fully recover. Moreover, the wrong care is given to the patients when they are moved within hospitals from one setting to entity as nurses commonly provide the wrong medication. The problem also informs the nurses their weakness in communication. It implies that unspecialized nurse is not keen in providing timely and complete information to facilitate continuity care. It mainly raises concerns in nurses in units where that transfer takes place. The problem as well illuminates to nurses that poor professional coordination between them is resulting in transitional care challenges since it hinders consultation and provision of information. It similarly notifies the nurses their shortfall in performing specific crucial nursing roles.

The first one is ensuring the patient with no caregiver receives transitional care from them. Secondly, it is educating the caregivers on how to handle the patients. In addition to informing the nurses on the weak areas, it is enlightening them how to improve the nursing job. It is asserted that specializing in transition care will enhance their task of providing care to patients. Therefore, it is recommended that nurses who deal with transitional care get additional education CHALLENGES IN TRANSITIONAL CARE 5 to gain skill. Finally, the problem cautions the nurses on the impact of lack of knowledge and expertise. It shows that the implications are detrimental to the patients whose health are already vulnerable. Purpose of the Research The purpose of the research is to improve the quality of transitional care. There is a lot of research about the quality of the general health in the hospital. Therefore, various stakeholders have invested in facilitating quality treatment. Nevertheless, the issue of transitional care has not little study and as a result their no broad awareness of the matter concerning transitional care, its challenges, and importance. This, in return, has led to little attention from the government, physicians and donor, individuals who can contribute to promoting good transitional care. This prompted my research on challenges in transitional care to implore the health stakeholders to look into the issue and promote quality transitional care.

Furthermore, I considered research into the challenges of transitional care would be a way to inform the nurses on the areas of their weakness and as a result, encourage them to improve. It will eventually translate to quality transitional care. My research exposes the challenges faced in transitional care and the problem which is lack of specialized nurses. In addition to the nurses, it also creates awareness for the caregiver and relevance of seeking help from transitional nurses. My study likewise enlightens the medical trainers on the significance of including transitional care in the nursing curriculum. Consequently, all nurses will have basic knowledge of rendering such care Finally, through researching the subject on transitional care, I offer a platform for further research into the area. Therefore, it will promote a better understanding of the issues facing transitional care. This helps the stakeholders to see the severity of the issue and provide CHALLENGES IN TRANSITIONAL CARE 6 assistance. Further research will likewise suggest better solutions to address the problem facing transitional care. Research Questions What is the impact of unspecialized nursing in transitional care? Why do unspecialized nurses promote low-quality transitional care? What are the pros and cons of specialized nursing versus general nursing? Master’s Essentials Alignment with My Topic Master’s essentials align with my topic. It concurs with what my topic implies.

The second essential indicates that organizational and system leadership is crucial in quality and safe patient care. My topic, on the other hand, illuminates on the importance of leadership in patient care as some of the challenges like communication and corporation are due to lack of leadership. Master’s essential III as well support the topic problem which suggests that lack of specialized nurses is the cause of challenges. The essential state that master-level nurses are aware that quality care goes hand in hand with the methods and tools used. Similarly, the topic indicates that the use of unspecialized nurses who have no master is the cause of the low-quality transitional care. Essential VII, interprofessional collaboration asserts that masters prepared nurse is a leader and member of the team who can communicate, cooperate and consult with other professionals.

Similarly, the topic agrees as it suggests that the challenges of lack of communication, coordination, and consultation. It adds that this due to the use of unspecialized nurses implying that nurses with maser can overcome the challenges. CHALLENGES IN TRANSITIONAL CARE 7 The topic as well matches with essential IX. It is concerned with master-level practice. It states that nurses with master’s level have scientific knowledge and the capability to apply it into practice. My topic suggests that unspecialized nurses are not as competent as the specialized ones who have a master’s degree. Therefore, they pose challenges in transitional care which wouldn’t have been the case if specialized nurses conducted the care. This essential as well claim that master’s prepared nurses can influence positive healthcare result. The topic echoes that specialized nurses perform transitional care better compared to general nurses. CHALLENGES IN TRANSITIONAL CARE 8 References Morphet, J., Griffiths, D. L., Innes, K., Crawford, K., Crow, S., & Williams, A. (2014). Shortfalls in residents’ transfer documentation: Challenges for emergency department staff. Australasian Emergency Nursing Journal, 17(3), 98-105. Ortiz, M. R. (2019). Transitional Care: Nursing Knowledge and Policy Implications. Nursing Science Quarterly, 32(1), 73-77. Storm, M., Siemsen, I. M., Laugaland, K., Dyrstad, D., & Aase, K. (2014). Quality in transitional care of the elderly: Key challenges and relevant improvement measures. International Journal of Integrated Care, 14(2). Ye, Z. J., Liu, M. L., Cai, R. Q., Zhong, M. X., Huang, H., Liang, M. Z., & Quan, X. M. (2016).

Development of the Transitional Care Model for nursing care in Mainland China: a literature review. International journal of nursing sciences, 3(1), 113-130. Running Head: DESIGN PHASE 2 1 Design Phase 2 Frank Calderon Florida National University 2/27/2019 DESIGN PHASE 2 2 Design Phase 2 Methodology and Design of the Study The study of transitions included the acute admissions of elderly individuals to the hospitals up to the nursing homes of from the home to a home with a home-based care services. Additionally, it included the discharge transitions of elderly from hospitals to a nursing home or home also to home-based care services. Therefore, the methodology included participant observation of admission and discharge transition process. This involved an open-ended conversation with the patients and also with the patient’s next of kin’s while involving the health care personnel (Design and Methodology of a Mixed Methods Follow-up Study to the 2014 Ghana Demographic and Health Survey, 2017).

The observation also entails a collection of data which is guided by a thematic guide which is adapted to the admission and discharge transition in the health facilities. During the observation, the admission includes observing the patient being handed over from the ambulance to the paramedics and healthcare professionals in the emergency departments so that the patient can be observed until he is handed over to the medical ward for further treatments. During this research, the observation covers the data on interaction, coordination as well as dialogue between the health practitioners and the patient. The observation ends when the researcher has a short conversation with the patient and also with the healthcare personnel on the admission day so as to help in clarification of some aspects pertaining to the current admission as well as the entire process of admission. DESIGN PHASE 2 3 Additionally, the observation of transitions of discharge commenced at the hospital ward on the expected day of discharge. It involved the conversation between the researcher and the healthcare practitioner and the person who is going to be discharged. The interaction also with the coordination and dialogue taking place between the healthcare practitioner and the patient is observed. Such a conversation is very helpful since it helps in understanding the discharge processes and discharge transition. Short follow of up conversation also helps in understanding more the processes and the bases of decisions made before a patient is discharged (Design and Methodology of a Mixed Methods Follow-up Study to the 2014 Ghana Demographic and Health Survey, 2017).

Sampling Methodology The sampling method used in the research was sampling which was utilized in the recruitment of the participants to take part in the study. Additionally, the homecare offices in various municipalities of the country were contacted and informed on the project and the need for the nursing leaders to participate in interviews which will enable the researches to get the necessary information which will also enhance their research. From these interviews, data is collected which also shed light on the nursing leaders role and experience in the process of transition especially for the older patients from the hospital to home. This implies that the interviews are conducted only for data collection (Sahu & Singh, 2016). In essence, the semi-structured interview guide dictated what the interviews should cover and how it should be carried out. It starts with the general, discussion of transition processes and the patients experienced pertaining to transitions received at homecare.

The participants in this regards will focus on all the experiences on the transition from the hospital to their homes, and DESIGN PHASE 2 4 then researchers will decide on what next (Johnson, Pennell, Stoop, & Dorer, 2018). The guide for the interview also entails themes which include the organization of the internal and external cooperation, the personal resources together with values which guide the quality of the care services. Necessary tools Various technologies and tools are used in the research process. However, the primary consideration if the health information technology tools which help to smoothen the transition processes of the patients. It is worth noting that health IT involves numerous technologies such as electronic health records. The electronic health records entail saving of patient’s information electronically on computers which will enable retrieving exercise to be very easy. Additionally, it includes clinical decision support which also enables the health care personnel to make an effective decision which ensures that the patients are handled very well and the decisions made helps them to regain their good health. In essence, the health IT performs very significant tasks in various aspects of transitions. It helps in capturing the information pertaining to the patient which helps in informing the transition processes as well as the clinical history of the patients and what needs to be done during the transition process. It is coherent that the design of the health IT has the ability to support the transition process especially in supporting the individuals who are involved in the transition processes (Riba, Parikh, & Greden, 2019). With the information technology as well, the healthcare professionals will be able to connect to the home care services where the elderly have been taken so that they can be taken care of until they get well or improve on their health before they are being taken to their respective homes. DESIGN PHASE 2 5 Any algorithms or flow maps created

The various algorithms created during the research include the Fourier transform which helps in enhancing the senses of individuals. This is because the Fourier transform has been dubbed to be one of the most significant algorithms in the healthcare sector. This transformation is a mathematical technique which is used in breaking the complex signals which in turn will enable the healthcare personnel to see the variation in their activities and what needs to be attained. This helps in ensuring that they attain the objective of the organization. It is also used in medical imaging which helps in creating date to check whether the patients who had undergone imaging are fit to be discharged to be taken care of at homes. There is also a Mumps algorithm which is a healthcare operating system which was developed in the 1960s but has been improved lately to reflect on the current needs of the patients and the medical sector. Therefore, it can be denoted as a computer program which is used in the healthcare today to run multiple programs and enable the healthcare personnel to understand the status of numerous patients and decide on the next course of action. This operating system is currently used in the powering of the entire hospital departments which helps in the management of clinical records to enable the healthcare facilities to save a lot of time in assessing the health care records for patients and improve the workplace efficiency (Morr & AliHassan, 2019). Consequently, the probabilistic data matching is another algorithm which enables numerous computer searches which are deterministic to be carried out. This is because it carried DESIGN PHASE 2 6 out byte by byte comparison which can mainly be used for typographical or data entry processes. Such probabilistic algorithms are depicted to look for a various bit of information especially in the medical records while ranking them according to the likelihood of the patients adopting very well to the medication and estimate the time which the patient can remain within the hospital before they are discharged to home care through a transition which will see them gain good health. This probabilistic data help in retrieving of useful information which helps in research. Nursing Research: Challenges In Transitional Care Implementation Phase

Further, the medical algorithms as well as aids for decision making which will help in promoting safe healthcare as it also helps the healthcare personnel to enable them not to make mistakes when carrying out their tasks. It is worth noting that with the increase in awareness of the medical errors recently, it is also believed that the health professionals are using these techniques into guiding them to offer quality care services and understand the patients and those who need to go to various homecare homes when they need specialized care. A medical algorithm in this regard can be a low tech as a lookup or a decision tree which helps in carrying out complex decision making through the help of programming (Morr & Ali-Hassan, 2019). Therefore, the medical algorithms remove some of the medical uncertainty decision which in turn will help in improving the efficiency and most importantly the accuracy of the teams provided. Notably, the health score which helps in quantifying illness also is another algorithm which helps in evaluating the health status of the patients and deciding whether they should be discharged to the… Nursing Research: Challenges In Transitional Care Implementation Phase