Nursing Innovations Forge New Paths
Nurses enable health through both clinical judgment and technical knowledge. Yet their immeasurable skills such as the ability to support and comfort produce measurable results. For example,
Nurses are teachers of theirs peers and patients. Good nurses look at the whole person or patient. Nurses communicate, execute, and innovate, all with an attitude of caring. Nurses are the most trusted of the health care professionals. Nurses apply their knowledge with compassion to a positive measurable end.
These immeasurable skills that nurses possess will bring the solution to the next great challenge the US health care system faces: the aging of the baby boomers. Around 2030 there will be over 70 million people 65 or older. The fastest growing segment of the population is the oldest at 85+ years. Although people are living longer it’s not necessarily better. As they age they usually need more health care. Half of hospital patients are 65 or older. Two thirds of the elderly will need long term care at some point in their life. The average 75 year old has three chronic conditions and 4 or more prescriptions. 42% of people age 85 or older have Alzheimer’s disease. It’s so easy to list statistics but how to make those later years truly golden? It is nurses who will lead the way. Why? There are reasons other than those already listed. First of all there are more nurses than any other health care professional. Secondly, nurses are aging along with the baby boomers. Half of all nurses will be 50 or older by 2020. This will enable them to empathize with the possible challenges baby boomers face as they age.
The present health care system is unprepared for the aging of the baby boomers. They are not alone in their assessment. Reform is necessary. The foundation of that reform will be a change in attitude towards the elderly and a change in attitude in provision of care. Research by the RAND Group and UCLA shows the elderly gradually receive less care than they actually need. Resident clinics utilizing the Assessing Care of Vulnerable Elders (ACOVE) initiative shows that even the basic assessments for preventive measures are lacking in many of these clinics. The evaluation of the performance of resident MDs at over 2000 patients in 52 clinics showed that screening for at risk medical or physical conditions, for example mobility function status, or memory was at unacceptably low percentages. There was also few electronic medical records or reminder systems in place.
Current Medicare payment guidelines do not include long term care services, coordination or collaboration of providers, ongoing monitoring of chronic conditions, or any service provided by non MDs.
Nurse led innovations are changing how the elderly receive care. The goal is to maintain independence and dignity while ensuring the perils of aging are taken in stride. This change in perspective towards the care of the elderly will also include an active participation of both patient and caregiver. It is a fact that patient and caregiver engagement leads to better medical outcomes and greater patient satisfaction.
A number of nurse led innovations from the Raise the Voice initiative of the American Academy of Nursing are directed at the elderly population using strategies to prevent hospitalization for acute episodes or to keep seniors in their homes and communities as long as safely possible. These nurses, called Edge Runners are enablers and facilitators. For instance, in the Caregiver Skill Building Intervention caregivers are taught coping skills to deal with their patient’s behavior. The goal is to ward off caregiver burnout and depression. If successful, nursing home placement for the patient is delayed by 1-5 years.
In the SeniorWise program the focus is to keep seniors with MCI or Alzheimer’s mentally fit and happy for as long as possible, by the modification of risk factors, improving memory and other interventions.
The success of the Senior ASSIST Program(Assisting Seniors to Stay Independent through Services and Teaching) is measure in how long their clients stay in the program which is often many years. A geriatric trained RN makes home visits and teaches the senior to manage their health. The RN also coordinates with the senior’s doctor and helps them access other health services. This program is an important bridge to the time when an elderly person would qualify for Medicare services.
Health care worker roles will need to be changed. Change includes expansion such as allowing NPs to practice to the full extent of their licenses and revamping roles of many health care workers. Ways also need to be explored to broaden the responsibility of workers at different levels of training.
One common factor of successful innovations in delivery of health care to the elderly is interdisciplinary teams and coordination of care. Again nurses have led the way here.
So far we have seen that a shift in attitude towards care of the elderly must include their input. Any interventions, strategies, or care must focus on prevention and maintenance of good health or management of chronic conditions to avoid acute episodes that require emergency care or hospitalization. The development of interdisciplinary teams can ensure that seniors can remain in the community and stay independent as long as possible. The team must include the senior’s health goals as the center of their care plan.