Nursing Homes: Caring for Aging, Chronically Ill Patients - Paper Example

Introduction

Nursing homes offer care services to people who are well enough to be out of the hospital but require special care that is not available in their homes. In addition to medical care, nursing homes offer physical, speech, and memory therapy. Most nursing home patients suffer from chronic diseases such as dementia, diabetes, and heart diseases. An increase in old population numbers corresponds with an increase in nursing home patients. The Centers for Diseases and Infections Control (CDC) estimates that more than four million Americans check into nursing homes annually (Kapoor et al., 2019. However, nursing homes report some of the highest infection rates among health facilities. According to CDC data, nursing homes account for more than three million annual infections, with the most common being pneumonia, soft tissue injuries and sores, urinary tract infections, and anti-bacterial resistant infections (Giannella et al., 2016). The causes of these infections include pre-existing medical conditions, hospital transitions, contact with many people, and medical equipment such as catheters. These statistics call for the need to establish suitable antidotes. Furthermore, nursing homes have to reduce operating costs as health insurers implement the pay for quality policy. This policy ensures that facilities with minimal infections and the best quality service have higher earnings than other facilities.

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Problem Statement

As stated earlier, more than four million people seek services of nursing homes annually in the United States. Furthermore, nursing homes report more than three million infections annually, 350,000 of which turn out to be fatal and lead to death (Giannella et al., 2016). Urinary tract infections account for six percent of new infections in nursing homes, while pneumonia accounts for two percent. Pneumonia accounts for fifteen percent of hospital admissions from nursing homes.

Infections in nursing homes lower the patients' quality of life while increasing the cost of running the shelters. Therefore, if the problem persists, hospital readmissions and deaths will increase. Besides, patients will spend more time in hospitals and develop resistance to anti-bacteria medication. Furthermore, infections lead to financial losses for the patients, health providers, and insurers. It is imperative to find suitable means of reducing infections in nursing homes.

This project aims to explore the significance of washing hands in minimizing infections. The research will identify the effectiveness of hand hygiene in reducing infections both in the short and long term, the impact of palliative care on patients above sixty-five years, and assess the effect of diseases to patients over sixty years.

Purpose of the Change Proposal

The proposal seeks to find a cost-effective strategy to reduce infections in nursing homes and improve patients' quality of care. The older generation is susceptible to these infections due to a weak immune system and pre-existing conditions. Common diseases include influenza and pneumonia. Furthermore, SNF patients have indwelling devices such as catheters. These devices predispose them to UTI infections. Recurrent infections raise the possibility of patients developing resistance to drugs. Hence, the research seeks a suitable means of deterring diseases.

SNF has to make profits and offer quality services. Therefore, this research seeks to assess the impact of competition on the quality of service. Besides, it looks into cost-efficient strategies of reducing infections while ensuring maximum utilization of the available resources. These include maximizing the effectiveness of doctors' visits, the role of contact in spreading germs, and how hygiene contributes to reducing the spread of diseases.

Picot

PICOT Question: "For patients resident in SNF (P), how does improving hand hygiene and infection prevention (I), as compared to poor hand hygiene and inadequate infection prevention (C), help reduce SNF infections transmission (O) during the time of patients' residency (T)?"

Ninety percent of patients in nursing homes are over sixty years of age, while forty-five percent of these patients are over eighty-five years old (Phelps, 2016). By 2030, nursing home patients will be more than five million in the United States. To minimize infections, the intervention focuses on the hygiene of visitors, patients, and medical staff. All parties have to wash their hands with either sanitizers or soaps under running water. Visitors should clean up before interacting with the SNF residents, while staff should do so before cleaning wounds and relating with patients. In addition, patients should desist from dressing their wounds and sharing personal equipment such as toothbrushes.

The population sample will consist of residents over sixty-five years. Twenty patients and five medical staff will act as the test group. Volunteers will make-up the sample population. Probable outcomes of the research include a drop in infection rates due to adequate hygiene and hand washing. In addition, nurse to patient infections will reduce due to appropriate attire, proper sanitation, and suitable cleaning and dressing of wounds. Furthermore, all parties will be more aware of the importance of hygiene in combating infections. It will take three months to carry out the study. The success of the first test group will determine the creation of a subsequent study group.

Literature Search Strategy Employed

The literature search had the aim of discovering relevant results while ensuring the search is consistent and structured. To meet these conditions, the study follows a Boolean search strategy. Defining the research question was the initial step. Research questions define the limits and relevance of the articles. Subsequently, keywords and phrases were developed. Some of the keywords include nursing homes, infections, hygiene, hand washing, and antibiotic resistance. Moreover, the emphasis was on articles published in the last five years. This factor was critical in ensuring that the data was relevant. Medline, Web of Science, and class notes are the primary sources of the articles in the study.

Evaluation of the Literature

An increase in the number of nursing homes and their residents reduces the efficiency of collaboration between medical practitioners (Fleischmann et al., 2016). According to Fleischmann et al., doctors have to tender to the nursing home residents whole, maintaining their private practices. Therefore, these interactions are likely to result in infections, especially among the older generations. Furthermore, staff shift changes result in patients interacting with several nurses hence predisposing them to infections. Moreover, education and administrative support ensure that medical personnel and patients wash their hands, resulting in lower infections (Gould et al., 2017). This study supports the use of handwashing as a cost-effective tool for reducing infections.

Transitions between hospitals and nursing homes expose patients to diseases (Kapoor et al., 2019). The authors use a cohort study to develop a link between transitions and infections. However, it is susceptible to referral bias due to its focus on patients over sixty-five years. To study the effectiveness of influenza shots, a study observes respondents over sixty years. The study concludes that the influenza vaccine has minimal impact on infections (Van Beek et al., 2017). Furthermore, education has minimal effect on the quality of palliative care, and nursing homes should emphasize maintaining a suitable quality of life for their residents (Bokberg et al., 2019)

Applicable Change or Nursing Theory Utilized

This study uses Roger's change theory. According to the theory, change occurs in five distinct steps. These are: becoming aware of your behavior, determining benefits, evaluating the current state, and determining a suitable state, making behavioral changes, and accepting the changes (Rahim, 2016). Furthermore, the theory is ideal for studying variation in a long term study and institution that suffers several challenges. The nursing home suffers from inadequate personnel and resources.

Proposed Implementation Plan with Outcome Measures

The initial step of the plan is determining the outcome. After implementation, hand washing and hygiene policies should result in fewer infections and hospital transitions. To ensure success, an implementation committee consisting of administrative, staff, and patient representatives will be in charge. The committee could also include an independent party. Consequently, the committee should ensure there are ample signs within the nursing home to remind and educate everyone to wash their hands. These signs should also offer information on suitable hand washing techniques. Furthermore, there should be adequate washing points with enough water and soap. Hand washing strategy is cost-effective, therefore, the committee will have a minimal budget for soap and water. The bulk of the budget will go into increasing washing points and putting up signs. Staff will keep track of each patient's washing habits and ensure there is adequate soap and water. Additionally, they will keep track of infection and hospital transition rates. The committee will assess the data weekly to determine the effectiveness of the plan and identify areas that are ripe for improvement.

Identification of Potential Barriers to Plan Implementation, And Possible Solutions

The plan is likely to suffer opposition from employees. Employees are likely, to view the extra responsibilities as a burden. Furthermore, some of the parties could be unaware of the policy change, especially visitors. Therefore, they might interact with patients before washing their hands. The initial cost of setting up the water points and signs could also be high.

To mitigate these challenges, it is appropriate for the implementation committee to educate the residents and staff on the upcoming changes and seek their input. During these interactions, emphasis should be on the benefits that will accrue to both patients and workers. There should be ample signs around the nursing home to remind visitors of the policy changes. To minimize the cost of setting up the water points and symbols, the nursing home should seek sponsors.

References

Bokberg, C., Behm, L., & Ahlstrom, G. (2019). Quality of life of older persons in nursing homes after the implementation of a knowledgebased palliative care intervention. International Journal of Older People Nursing, 14(4). https://doi.org/10.1111/opn.12258

Ellis, P., Abbott, J. (2018). Applying Lewin's change model in the kidney care unit: Movement. Journal of Kidney Care, 3(5), 331-333. Retrieved from https://doi.org/10.12968/jokc.2018.3.5.331

Fleischmann, N., Tetzlaff, B., Werle, J., Geister, C., Scherer, M., Weyerer, S., Hummers-Pradier, E., & Mueller, C. A. (2016). Interprofessional collaboration in nursing homes (interprof): A grounded theory study of general practitioner experiences and strategies to perform nursing home visits. BMC Family Practice, 17(1). https://doi.org/10.1186/s12875-016-0522-z

Giannella, M., Tedeschi, S., Bartoletti, M., & Viale, P. (2016). Prevention of infections in nursing homes: Antibiotic prophylaxis versus infection control and antimicrobial stewardship measures. Expert Review of Anti-infective Therapy, 14(2), 219-230. https://doi.org/10.1586/14787210.2016.1132161

Gould, D. J., Moralejo, D., Drey, N., Chudleigh, J. H., & Taljaard, M. (2017). Interventions to improve hand hygiene compliance with inpatient care. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd005186.pub4