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.