Nursing concepts and applications

Nursing

Improving nursing care requires a consideration of the basics which can improve outcomes for patients and nursing care staff. In the present organization, nursing care staff is required to provide care to elderly patients with dementia. Although this type of care requires consistent monitoring, a review of nursing practice in the organization also indicates that nursing practice requires considerable physical involvement with the patient. Because a majority of the patients are elderly, nursing staff are required to facilitate moving the patient, often requiring them to assist in basic activities such as helping the patient out of bed and providing assistance for walking and other daily activities.

With the realization that patients in the current care setting require so much assistance with physical mobility and meeting basic physical requirements for daily needs, there is a direct impetus to consider what methods could be employed to improve outcomes in this area. Using this as a basis for investigation, this research considers the development of an exercise/mobility program for patients. The central argument is that by providing patients with this type of program, healthcare providers will be able to improve the mobility of patients and improve the overall level of care provided. Further, regular exercise/mobility may have mental health benefits for elderly patients, improving overall quality of life.

Review of the Proposed Program

Overview of the Program

The proposed program for this investigation is an exercise/mobility program that should provide elderly nursing home patients with improved quality of life. A critical review of the current literature on the utilization of exercise programs for the elderly suggests that these programs can have a number of notable benefits for this population. For instance, Chen, Li, Lin, et al., (2007) report that exercise programs for the elderly can improve physical stamina and facilitate greater movement. In terms of physical results, exercise programs can exhaust patients and improve quality and quantity of sleep. Improving sleep can have marked implications for both physical and cognitive functioning. Additionally, Luukinen, Lehtola, Jokelainen, et al., (2006) report that physical exercise for the elderly can improve strength and flexibility, decreasing the impact of chronic health conditions which can limit physical mobility. These authors report that this can result in greater independence and quality of life for the patient.

Kato (2006) has also considered the benefits of an exercise program for elderly nursing home residents. According to this author, research on the impact of institutionalization on the elderly individual demonstrates that "The muscle strength of the institutionalized individuals was 50% lower than that of the community-dwelling persons" (p. 108). Further, balance of institutionalized nursing home residents was significantly lower than that reported in a community sample. Deteriorations in muscle strength and balance can increase the incidence of falls and bone fractures for the elderly. Kato insists however that the application of a regular exercise program in this setting can improve health outcomes and reduce the number of falls associated with institutional care.

Finally, research on exercise programs for elderly nursing care residents suggests that these programs can have a number of psychological and mental health benefits as well. For instance, regular exercise for elderly individuals has been associated with a decrease in depressive symptoms for the elderly patient (Tsang, Fung, Chan, et al., 2006). Further, research in this area suggests that regular exercise in the elderly can help promote cognitive function and reduce some of the negative impacts of dementia (Exercise..., 2006). Based on this data, it becomes evident that the development of exercise programs for the elderly patient suffering with dementia can have a number of physical and mental health benefits that can markedly improve overall quality of life.

Generalizability of the Findings

Based on the data provided above, it seems reasonable to argue that, in theory, the development and implementation of an exercise program for elderly nursing home patients suffering with dementia would be a feasible undertaking. Research that has been conducted in this area has considered: elderly individuals, elderly individuals that have been institutionalized and elderly individuals suffering from dementia. In all instances, the research indicates that there are positive physical and mental health benefits that could improve the overall quality of life for the current population. Thus, in theory, there is a direct impetus to consider the further development of the program.

Implementing the Research in Full

While the theoretical development of the program appears to have notable salience, it is important to consider the practical issues involved with program development and implementation. In order to effectively create an exercise program, consultation with exercise professionals working with elderly patients would need to be considered. Although the organization currently employs an occupational therapy staff that could realistically conduct the exercise program, consultation for program development would be needed to ensure that the program provides benefits without causing harm to the patient.

In order to hire an outside consultant, the organization would need to consider how funding for this process could be procured. It may be possible for the organization to secure funding through a government grant to provide innovation in healthcare. Further, the organization could seek the assistance of non-profit organizations to provide this type of service. Professionals working in the non-profit organization may be able to provide exercise consultation at no or low-cost. In either case, it would be possible to secure funding to develop the exercise program.

Once the program has been developed, implementation could occur though the current occupational therapy staff. Presently the occupational therapy staff consists of 4 full time employees, 3 part time employees and three volunteers. The organization could choose to promote one of its part time employees to full time, in order to provide daily staffing for the exercise program. If funding for this position could not be secured, volunteers under the supervision of one of the full-time employees could be charged with conducting the exercise program. What this data effectively demonstrates is that the program could be practically developed with minimal funding.

Although, there are a myriad of practical solutions for funding and developing the program, the most notable barrier that appears to exist is that of change. Efforts to create change in the organization would require the support of top leadership and management in the organization. Although many of these individuals are members of the healthcare community -- thus capable of understanding the importance of the issue and the projected benefits -- prompting change which required the utilization of a new exercise program may be a difficult proposition. In addition to securing permission from the organization's top managers, nurses will be required to ensure that patient's attend exercise therapy. Resistance may also result from the individual patient, as he or she may not feel obligated to engage in daily or routine exercise. Patients may not be able to understand the importance of the program. Even when compelling arguments are made in favor of exercise, the presence of dementia may impact patient response from one day to the next.

Additionally, the organization may face some challenges in terms of ensuring the safety of patients. A review of the organization's current insurance policy suggests that while the institution is insured to provide occupational therapy and other physical health programs for patients, it is unclear how an exercise program would be addressed in terms of the organization's insurance policy. Thus, if an exercise program is not covered under the organization's insurance policy, efforts to implement this program may be impacted by the costs associated with ensuring patient safety.

Risk Assessment

Risk assessment for the program would need to consider the specific physical impact of the program on individual participants. Consultation with a professional that provides exercise and mobility services for the elderly will provide a clear indication of the overall risks associated with program implementation. With appropriate consultation and the development of a program that is safe for all program participants, it is reasonable to assume that the risk posed by the proposed program will not be any greater than the risk posed for the patient engaged in occupational therapy. Additionally, the focus of the program is to improve health and quality of life outcomes for the patient such that risk in other areas -- i.e. falls related to getting out of bed, etc. -- are effectively reduced. Proposed benefits of the program must be considered when examining overall risk posed.

Engage with Stakeholders

Arguably, the development and implementation of a new exercise program to promote wellness among patients will required a coordinated effort on the part of the organization. Leaders and managers will need to engage occupational therapists and nursing staff to provide support for this program. In addition, nursing staff and therapists will need to engage patients to actively participate in the program. To achieve this goal, the organization may need to consider the development of the program as an integral component of service provided to all patients. Much like assisted living and healthcare care, the exercise program will be a regular component of service. Thus, patients will be required to engage in the program to the best of their ability. Although patient resistance may be high in some instances, the proposed benefits appear to far outweigh the unwillingness of the patient to participate.

Secure Funding

The proposed program can be carried out with minimal funding. If funding is required, it is possible that the organization could obtain funding from a government grant or through the assistance of a non-profit organization. The most challenging issue created in this context is that of insurance. Although the organization currently holds insurance for providing occupational therapy for patients, it is possible that the organization will need additional coverage to implement a regular exercise program. If the organization chooses to develop the program as an integral part of its service, the cost of the insurance could be passed to patients. Overall, this cost should be minimal, allowing the organization to provide this service and ensure that patient safety is protected.

Plan the Change

The proposed program will first require approval from top leaders and administrators in the organization. Once this approval has been granted, funding for the program must be secured and the specific exercise program must be developed. Concurrent with program development should be staff training to implement the new exercise program. This will include scheduling for the exercise program and a review of the specific role that each member of the staff will need to serve in implementing this program. Once the funding has been secured and the staff has been trained, it will then be possible to begin the program with patients.