Question

1. As people age it is more likely that they will enter and exit a health care system at different points in their lifetime. Please identify two (2) health care settings that an older adult might enter and the services that are offered in those settings.

2. Describe two factors that contribute to poor transitional care outcomes. Describe nursing interventions to improve transitional care outcomes.

Answer 1

1.As people grow older they are at risk for chronic diseases and need for frequent visit to health care professional there are many clinical setting a older patient can visit like hospital,general practitioner office,Rehab center,home care nursing,geriatric homes ,community homes for sick,palliative care centres.

General practitioner clinic:Is a small Healthcare clinic which has essential services provided for all kinds of diseases like first aid,medication,symptomatic care,fewer diagnostic facilities like a laboratory,imaging like x-ray,ABG,to give a fair idea of a person's disease condition.in case the disease is very acute and severe the GP can refer the patient to a teritiary care hospital

Care at home setting:This is another setting which is widely used by older patients when a patient has some chronic disease and needs mostly nursing care and no active medical intervention the patients are shifted to care at home setting where trained medical professionals like nurses,physician assistant come home and provide care to the patients .This care is at home setting encouraging the involvement of relatives in care or a transitional care till the relatives manage the patients alone .in this setting a home is converted to a hospital bed by use of beds,pressure area care mattresses,oxygen cylinders emergency medication.

2.older clients when they are transfered from one setting to another there are chances of errors which can lead to poor transitional care outcome .A continuity in care is very important to have a positive outcome .the reasons for poor outcome is discontinuing of care caused due to improper handover during transfer ,improper communication between the healthcare staffs of a particular setting with the other,incomplete documentation of the carried at a particular setting,lack of devices or equipments to provide care to patients,lack of patient and family education regarding the continuity of care.

This transitional care outcome can be improved by the following

1.hands off communication:A checklist should be used by nurses during handover of patient from one setting to other it should consist of medical components,nursing care,medications,diet,any special instructions,investigations,follow up.

2.use of transfer checklist: A comprehensive transfer checklist or document should be prepared while shifting a patient from one setting to other which should have in detail the medical care given to the patient in the hospital .

3 effective communication:The nurse should communicate to the patient and relatives about the various aspects of continuity of care.The nurse should also communicate effectively to other health care workers

4.patient and family education:This consist of clinical education done by the nurse during the stay of the patient .the nurse should teach the patients and relatives on simple procedures like rules tube feeding,suctiong,care of Foley's,bedsore prevention ,use of pressure area care mattress

5.Medication chart :Nurses in the hospital can prepare a medication chart which comprehensively consist of medication orders,side effects,interactions,monitoring post medication and special interactions.the chart should be nearly prepared and counter checked by two nursing staffs and a doctor for accuracy this can be handed over and explained to the transition care setting,patient,and relatives this can reduce medication errors at transition which causes highest rate of mortality and morbidity in geriatric patients .