There are different types of diseases, especially chronic conditions that require self-care. This is true for elderly patients suffering from chronic pain. However, a range of factors affects their ability to provide self-care in an appropriate manner, the most essential of which include social, environmental, and genetic ones. From the view of nursing, it is critical to explore the issue of self-care in elderly patients, since the mentioned services play an important role in the effectiveness of nursing care and the expected outcomes.
According to Sözeri-Varma (2012), only openness and collaboration between a nurse and a patient may bring the most beneficial health improvements. Understanding the needs of the older patients and accurately estimating their ability to provide self-care is paramount to determine the type and extent of the services required to treat them. It should also be noted that at an old age there is a change in personality saturated with a diverse set of qualities (Stanik-Hutt et al., 2013).
Therefore, there is a need to consider various classifications of social and environmental factors and those factors that affect lifestyle and age. In this regard, this paper will focus on the identification of how the selected MSN program of a Nurse Practitioner aligns with the issue supported with the detailed presentation of its aspects and evidence. Nurses play a major role in promoting self-care and reducing the social barriers that prevent elderly patients from enjoying the benefits of self-care.
Identification and Clarification of Selected Nursing Issue
The nursing issue that requires further study is the role that nurses play when it comes to promoting self-care and reducing the social barriers that prevent the elderly from enjoying the benefits of self-care. This issue was considered because millions of patients prefer self-care especially when it comes to the treatment requirements of chronic conditions and the cost of health care. However, there are serious impediments for patients preferring to apply self-care methods.
One can argue that nurses can be empowered and trained to help bridge the gap. In other words, nurses can promote the viability of self-care especially in treating certain types of medical conditions. Nurses are going to provide the educational aspect so that the patient and the family members will have a deeper understanding and appreciation of the self-care method.
Application to Selected MSN Program Specialty Track
Speaking of the application of such MSN program specialty as Nurse Practitioner, it should be stated that special attention is to be paid to the specific needs of elderly patients. Stanik-Hutt et al. (2013) consider that a nurse should perceive an elderly patient as a human being requiring not only medical care but also compassion and sensitivity to his or her needs. This should help in the search and development of the internal resources of a patient, contributing to his or her self-realization, self-support, and self-protection.
A special role in this is played by the professionalism of a specialist in promoting health care, his or her knowledge of the gerontological and psychological characteristics of age, and the ability to determine the belonging of patients to a particular social group. This is the reason for the need to empower nurses. They are the specialists that must possess the correct knowledge and skills to promote the importance of effective self-care methods. Nurses are in a unique position that allows them to get personal with the patients while at the same time maintain an air of authority that ensures their ability to educate both the patients and their respective family members regarding the important concepts and principles related to self-care.
The main thesis of this paper is that the essence of self-care has been gradually lost or distorted over time. It is rather important to return this original essence and develop it based on various strategies related to caring for a person.
At the same time, Sözeri-Varma (2012) argues that a specific area of competence is to be highlighted. This remains unclear about nursing but should be clarified through reflection and the development of the science of nursing. In this regard, the prospect of providing nursing health care services to people of old age should be aimed at improving the quality and expanding the availability of services. In particular, in terms of prevention along with social and medical provision: to create such conditions in society, so that older people retain their social status, remain active, and be capable of self-care as long as possible.
Nursing Issue and Supportive Evidence
The identified nursing problem for this research is the influence of social and environmental factors on self-care in elderly patients, in comparison to genetic predispositions. As it stands, over 8,300,000 elderly patients require long-term care, with over 6,000,000 patients receiving help at home (Baumann & Dang, 2012). This makes a total of over 14 million patients, and this number continues to grow.
All of these patients are practicing self-care in one form or another, as the vast majority of them cannot be assisted by nurses at all times. The degree to which the elders can implement self-care is limited by their physical and mental aptitude, competence, and mobility. Social and environmental factors play a great role in enabling the elders to perform self-maintenance and self-care or preventing them from doing so.
Enablers, such as the availability of equipment that allows the elders to perform certain actions, often motivate self-care. This can be seen in patients with limited mobility – the availability of ramps, handles, and specialized bathrooms enable them to perform these actions with little to no outside help. This is one example of how the environment could improve self-care. Lack of these specialized options and tools, on the other hand, disables the elders from administering self-care forcing them to rely on others (Baumann & Dang, 2012).
In this research approach, the focus is on the social factors that affect the promotion and enjoyment of self-care methods. For example, in many US cities, the availability of self-care measures available to the populace both inside and outside of the hospital setting diminishes the further away one is located from the administrative and financial sectors. Hospitals located in the province show a tendency to have lesser quality and availability of equipment when compared to the facilities located in the capital or major state centers (Baumann & Dang, 2012). Thus, social factors, such as finances and the availability of health care professionals affect the promotion and delivery of self-care methods for elderly patients.
According to data from different epidemiological studies conducted recently, only one fifth can be regarded as healthy among older people, who suffer from various diseases. Almost every elderly patient has trouble in providing self-care, be it nutrition and physical activity or medical prescriptions and specific therapy. It is significant to note the characteristic multimorbidity of this group that implies the combination of several chronic diseases that are difficult to medicate (Holden, Schubert, & Mickelson 2015).
Old age is not a disease, yet it is considered that dealing with elderly patients poses the need for medical care and, what is also important, significantly increases the need for self-care with age. Self-care performance barriers are composed of various factors. The status of elderly people in modern society is directly related to their experience and depends on several factors, including the level of education, marital status, income, place of residence, occupied place in the social and professional structure before retirement, the former status, and prestige.
As the reasons for the self-care problems of elderly people in society, the following are highlighted in the scholarly literature: the termination of work, the low level of pensions, the absence of other sources of income, and assistance from relatives for the majority of elderly people. In their recent study, Siabani, Leeder, and Davidson (2013) discuss that “cultural beliefs and personal values might lead to a misguided conception of self-care processes such as difficulty with adherence to a healthy diet” (p. 325). At the same time, high expenses for housing and medical service, weak adaptation to new conditions of life, the inability to raise the level of education, the lack of demand in the labor market due to age, poor health, etc. create additional difficulties.
Different situations that a person experienced in the course of his or her life becomes meaningful in connection with other situations that were experienced earlier and are expected in the future. This is what helps a person to cope with a particular situation. It is the comparison of a concrete situation with others in the temporal plan that enables a person to judge which situations can be considered stressful and in what exactly this stress is concluded (Siabani, Leeder, & Davidson, 2013).
In addition, the correlation of a given situation with one’s life experience makes it possible to decide what are the best ways to handle the situation based on one’s life history and the general cultural context to which a person belongs, as stated by Dickson, McCarthy, Howe, Schipper, and Katz (2013). The social level of this person opens up opportunities and at the same time puts limits on what opportunities and ways of getting out of various stressful situations at different stages of life can be used.
As noted by Siabani, Leeder, and Davidson (2013), the life experience of each person composed of multiple social and environmental factors has a crucial influence on the decision making related to health, which is necessary and correct in this or that situation and context. In other words, health problems in elderly patients have a different impact on a person, namely, how he or she copes with the disease (Abreau, Barroso, Segadaes, & Teixeira, 2015). At this point, among the stakeholders impacted by the problem, one may note a nurse, a patient, relatives, and friends of the latter, the hospital the patient belongs to, and nursing associated with geriatrics in general.
The geriatrics discipline that has developed in the framework of gerontology is engaged in this direction. Along with medication and health care services, elderly patients need the increased attention and more careful care, since the incidence of the elderly generation is higher than that of the young. Holden et al. (2015) claim that “contextual or ‘environmental’ barriers have been studied with variable regularity and often reveal self-care difficulties due to lacking social, financial, and community resources (e.g., transportation, access to care)” (p. 134).
Most often, senior people suffer from a decrease in mental abilities, such as sclerosis, marasmus, etc. that explains the complexity of the problem of organizing a network of medical and social institutions for the elderly. This partially explains that diseases in the elderly are characterized by a chronic character with the atypical course and partial exacerbation of the pathological process as well as a long period of recovery and provision of self-care services.
Another important issue is the presence of ageism. In scholarly literature, the concept of ageism manifests itself in the older age group with the lowest social status. In this context, it is possible to draw a conclusion that ageism aggravates social and subsequently health care problems of elderly people. However, psychological peculiarities can also contribute to solving the life problems of an elderly client. This means that it is important for a nurse not only to know these particularities well but also to use them as a necessary potential for resolving difficulties related to self-care promotion in the elderly.
Literature Search Strategy
It is imperative to look into academic sources that discussed the role of nurses when it comes to the promotion of self-care. The review of literature must focus on journal articles and related scientific publications that deal with the role of nurses as educators when it comes to the benefits of self-care and how elderly patients are going to overcome social barriers to incorporate self-care techniques and methods to deal with chronic conditions. Thus, based on the evidence provided in this section, PICOT question for further research can be posed in the following way: In the case of elderly patients requiring self-care, can the shift in nursing perspective with regards to this issue help in promoting self-care and educating elderly patients on how to enjoy the benefits of self-care?
One of the most important benefits in spearheading this project is to acquire a deeper appreciation of the role of nurses in the context of health care. In addition, the proponents of the research project will have a greater understanding of self-care. For example, it was discovered that self-care is affected by social factors and that there is a way to rectify this problem.
Research Literature Support
In the article entitled “Barriers to Self-management of Diabetes”, the proponents of the study identified the fact that self-care is a key factor when it comes to the effective management of diabetes. They also pointed out the importance of identifying the key barriers that made it difficult for diabetic patients to utilize and enjoy the benefits of self-care methods on their way to experiencing optimal health (Onwudiwe et al., 2011).
To discover the answers to their research questions, the proponents created four focus groups that were interviewed by researchers. There were only 31 participants in the group. Although care was made to ensure the appearance of random selection, the participants were predominantly of African American descent. It was discovered during the interviews that literacy in terms of health concepts was a primary barrier. The patients required reliable sources of information. The strengths of the study include the identification of the barriers to the effective use of self-care methods and the realization that social status also affects the quality of health care. The limitations of the study include the lack of diversity in the participants. There was also no clear discussion on the development and deployment of an effective intervention strategy.
In the article entitled “Addressing Barriers to Diabetes Care and Self-Care in General Practice”, the proponents of the study wanted to find out the effectiveness of the Barriers Framework in improving the promotion of self-care methods. They developed an intervention strategy that calls for the distribution of a questionnaire, and they followed-up with the deployment of nurses. The lead nurse answered the question and documented key aspects of the interview process.
It was discovered that the method that was implemented was effective in determining the key barriers to self-care. The strength of the study is in the identification of an effective strategy to promote self-care and the demonstration of the effectiveness of a nurse when it comes to information dissemination. The limitation of the study is in the absence of a deliberate strategy that can be used to motivate nurses to do an excellent job and how they can be prepared for this role.
In the article entitled “Promotion of Self-care in Clinical Practice”, the proponents of the study wanted to find out how to develop a systematic use of clinical supervision to promote self-care. They decided to analyze the data of patients that were admitted to a specific hospital.
Care was taken to create a random selection of participants. However, there was no specific intervention strategy and the change framework was simplified to analyzing the data from records that were left behind by health care workers. In the end, the researchers were able to discover the need to improve the definition of key terms and concepts related to healthcare. The strength of the study is in the discovery that terms and concepts can help improve the promotion of self-care. The weakness or limitation is in the absence of a practical intervention strategy that can be used to improve the promotion of the use of self-care methods.
In the article entitled “Barriers and Facilitators to Self-care in Chronic Heart Failure”, the proponents of the study wanted to find out the barriers and the facilitators that contribute to the effective promotion of self-care. However, no intervention strategy was identified. The proponents of the study simply synthesized available research findings using electronic databases. Nonetheless, they discovered that personal and social factors affect the promotion of self-care. The strength of the study is manifested in the way it obtained different results from different points of view. This includes information from different medical specialists. Nevertheless, there was no additional contribution to the study of self-care.
Aside from considering the research output of the four articles examined earlier, there is another way to enhance the effectiveness of the review of the literature. To improve the answer to the PICOT question, it is best to consider research findings from research frameworks that studied the impact of demographics and other social factors (Dickson et al., 2013). The information collected from reviewing this type of research output provides a greater appreciation of the impact of factors like poverty, education, and income. It is also important to look into a critical appreciation of the different change models, especially those related to nursing practice (Mitchell, 2013). In this study, three major change models were considered, and these are listed as Lewin’s Change Model; Roger’s Change Model; and Lippitt’s Change Model.
Theoretical Framework and Change Model
One can argue that for this exercise, the best course of action is to adopt Roger’s Change Model. Lewin’s Change Model was deemed beneficial when it comes to initiating a starting point for change within an organization, but it lacked the tools that can help leaders develop an effective framework that calls for collaboration. The Lippitt’s Change Model can be considered as more sophisticated when compared to the Lewin Model, however, Lippitt’s framework specializes in the implementation of changes that are short-lived due to limited resources.
One can argue that Lippitt’s model can be modified to deal with long-term goals. Nevertheless, the model was not selected because it is complicated and requires several stages. With regards to the need for simplicity and yet covering all the requirements for implementing a specific type of change, it is best to use Roger’s Change Model.
There are two major reasons for considering this particular model. First, it provides a simple and easy to understand framework. There are only three major levels: awareness, interest evaluation, and adoption. Second, the model satisfies the needs of those crafting an intervention strategy in the context of self-care. For example, the model answers the problem of motivation. Finally, the model provides a framework that allows for a sustainable implementation of a long-term strategy.
The proponents will identify the need, and then, they will proceed to find out if the nurses are motivated to embark on this journey of change. If they are not motivated, the proponents will inspire them and make them understand the benefit of promoting self-care. The use of this model will provide guidelines and keep the proponents on track.
The research design follows a qualitative framework. To be more specific, it is best to use phenomenological design. This approach was selected because the data gathering is mostly done through interviews. The nurses will conduct interviews and provide information. The nurses will also document the results of the interviews and the information dissemination process.
One advantage is that it allows patients to have the freedom to describe their experiences. The nurses are also not inhibited to acquire the necessary information needed for the study. However, one of the disadvantages is the biased nature of the interviews if the nurses are not trained to handle this type of approach.
With regards to the sampling requirements, the target population is those who were outpatients of a specific hospital. Thus, the common denominator of the participants in the struggle to deal with medical needs associated with chronic conditions like diabetes, back pain, and heart-related ailments. The project will require non-probability sampling due to constraints in resources and the need to complete the project at a specific deadline.
The researchers will work with the hospital administrators to secure the ethical requirements needed to invite and include the said patients in the project. These are outpatients who were once admitted to the said hospital for complications arising from diabetes, chronic pain, and heart ailments. Once they were identified, invitation letters will be sent to their respective residences.
The advantage of the sampling procedure is seen in the speed and efficiency of the project implementation process. It is easier to identify the target population and those that are going to benefit from the use of self-care methods. The disadvantage of the said sampling method is that it is not representative of the general population. For example, if the respondents belong to the upper-middle-class of society, it is not possible to see the impact of poverty. Nevertheless, one can acquire reliable and relevant research findings when it comes to barriers to promoting and adopting self-care methods especially when it comes to chronic medical conditions and old age.
It has been made clear that there is a great need to promote and apply self-care methods. The need for self-care techniques is evident when it comes to old age and chronic conditions. However, it was also revealed that there are several social barriers to promoting self-care. Nevertheless, the proposed intervention strategy is to empower nurses to take on the role of educators and primary educators when it comes to self-care methods. The use of the appropriate change model will lead to the creation of an intervention strategy that calls for nurses that are connecting and learning with patients suffering from the impact of chronic conditions to help them understand that there is a way to overcome the barriers for change.
Abreau, W., Barroso, C., Segadaes, M., & Teixeria, S. (2015). Promotion of self-care in clinical practices: Implications for clinical supervisions in nursing. International Journal of Information and Education Technology, 5(1), 6-9.
Baumann, L.C., & Dang, T.T.N. (2012). Helping patients with chronic conditions overcome barriers to self-care. Nurse Practitioner, 37(3), 32-38.
Dickson, V. V., McCarthy, M. M., Howe, A., Schipper, J., & Katz, S. M. (2013). Sociocultural influences on heart failure self-care among an ethnic minority black population. Journal of Cardiovascular Nursing, 28(2), 111-118.
Harwood, E., Bunn, C., Caton, S., Simmons, D. (2013). Addressing barriers to diabetes care and self-care in general practice: A new framework for practice nurses. Journal of Diabetes Nursing, 17(5), 186-191.
Holden, R. J., Schubert, C. C., & Mickelson, R. S. (2015). The patient work system: An analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers. Applied Ergonomics, 47(1), 133-150.
Mitchell, G (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37.
Onwudiwe, N., Mullins, D., Winston, R., Shaya, F., Pradel, F., Laird, A., & Saunders, E. (2011). Barriers to self-management of diabetes: A qualitative study among low-income minority diabetics. Ethnicity & Disease, 21(1), 27-33.
Siabani, S., Leeder, S. R., & Davidson, P. M. (2013). Barriers and facilitators to self-care in chronic heart failure: A meta-synthesis of qualitative studies. Springerplus, 2(1), 320-338.
Sözeri-Varma, G. (2012). Depression in the elderly: Clinical features and risk factors. Aging and Disease, 3(6), 465-471.
Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G.,… Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. The Journal for Nurse Practitioners, 9(8), 492-500.
PICOT/PICo Question: In the case of elderly patients requiring self-care, can the shift in nursing perspective with regards to this issue help in promoting self-care and educating elderly patients on how to enjoy the benefits of self-care?
|Author & Title||Purpose of the research||Research Design and Sample||Intervention||Results||Strengths (S)
|Onwudiwe et al. (2011). Barriers to self-management of diabetes.||Self-care is a key element in the overall management of diabetes. However, it is important to figure out the key barriers that prevent patients from experiencing optimal health outcomes.||Four focus groups became part of the study. The sample is comprised of 31 predominantly African American patients. All of them suffered from the effects of diabetes. Patients were randomly chosen regardless of gender, age, and marital status.||The proponents of the study interviewed the participants to determine the barriers to optimal health in the context of self-care.||One of the critical barriers to optimal health is the absence of reliable and easy to understand the source of health information.||Strength:
This study provides insights with regards to people affected by the lack of access to information. It was made clear that social factors play a significant part in preventing the application of self-care techniques. Health literacy was identified as a key barrier for certain patients.
This study applies only to the members of the minority and the result and conclusion may not apply to the general population.
There was no clear discussion on how to develop and deploy an effective intervention strategy.
|Harwood, E., Bunn, C., Caton, S., & Simmons, D. (2013). Addressing barriers to diabetes care and self-care in general practice.||There is a need to figure out the effectiveness of the Barriers Framework approach when it comes to identifying barriers and answer questions that can help those who need to deal with the said hurdles.||A questionnaire was created based on the Barriers Framework asking patients with diabetes regarding the difficulties they encountered in the context of self-care.
No deliberate action was taken to ensure the random selection of participants because the goal was to collect a broad array of data. The questionnaire was sent to all patients that are interested in learning more about the concept of self-care.
|The questionnaires were sent to patients with diabetes. However, in the follow-up, nurses were present to answer the questions that came up after the patients were able to identify specific barriers to effective self-care.||Nurses were able to use the Barriers Framework to promote the value of an integrated care initiative, that allows the patients to overcome social barriers to effective self-care.||Strengths:
A clear strategy for eliminating social barriers was identified and deployed.
There was no deliberate strategy to figure out how to motivate nurses to provide an excellent service to the patients.
|Abreau, W., Barroso, C., Segadaes, M., & Teixeira, S. (2015). Promotion of self-care in clinical practice.||The need to figure out how to develop a system of clinical supervision to encourage the use of self-care methods.||The participants were patients in a specific hospital. The sample is comprised of 42 women and 68 men aged between 25 and 95. Statistical methods were used to analyze two sets of data containing information related to self-care.||The proponents of the study uncovered a limited understanding of self-care. There was also limited understanding of the impact of dependency.||There is a need to improve the definition of the terminologies and concepts that health care workers use to communicate to patients because this affects the delivery of health care services and the improvement of self-care.||Strengths:
The development of a clear framework to identify barriers and how to rectify the problem while the patient is still in a primary care setting.
The study focuses only on the inputs of the health care workers. The points of view of the patients were not considered in a more significant manner.
|Siabani, S, Leeder, S., & Davidson, P. (2013). Barriers and facilitators to self-care in chronic heart failure.||There is a need to figure out the barriers as well as the facilitators when it comes to self-care.||The proponents of the study utilized a meta-synthesis of data taken from different qualitative studies to find answers to the aforementioned research questions. The information was gleaned from electronic databases, such as Embase, CINAHL, and Google Scholar.||No intervention was constructed or resulted after initiating the said study. The intervention strategy came out as a theoretical framework after considering the results of the meta-synthesis approach.||It was discovered that the common barriers to effective self-care include: personal characteristics; caregivers, and environmental factors. At the same time, the study revealed key facilitators, such as supportive relationships and the assistance of health care workers.||Strengths:
The study was able to get different points of view from different types of medical conditions requiring self-care. The study was able to identify the key barriers and facilitators in experiencing self-care.
There was no clear intervention strategy that was identified and promoted to improve the use of self-care. The role of nurses was not clearly defined especially in promoting the benefits of self-care.