Nursing Practice in Long Term Health Care

Stacy - Ann L. Ross 

Introduction

This paper seeks to analyze two research articles by identifying their purpose, type of framework, methods and findings relation to limitations, barriers/implications for the nursing practice. The first article Exploring Faecal Incontinence (FI) in Nursing Home (NH) Patients was researched because over 50% of patients in nursing homes are at risk for a decline in the quality of their life and their morbidity. This was a pilot study to test a new instrument interRAI LTCF with the prevalence and association of FI. The second article Nurse Assessment of residents' pain in a long-term care facility, was investigated to identify the at-risk residents for chronic pain and bring to our awareness the desperate need for nursing assessment, nursing diagnosis and management of pain. It was noted that perception of the elderly has a direct effect on intention to perform pain assessment and makes recommendation no how organizations can rectify this phenomenon. I will then relate the findings and how I can use them to guide my practice as a nursing student in the long-term care.

Description of Articles     

According, to Blekken, et al. (2016) the aim of the research was to "explore prevalence and associations of FI among NH patients, to examine the effect of clustering of observations and variation of NH units and individual patients" (p. 1579). Ethical guidelines were met and a cross-sectional design was used for collection of data from a sample of 261 patients in 20 different NH. Findings showed that differences in patient's comorbidities explained most of the variations in quantity of fecal incontinence.

Possible limitations related to the small sample size therefore, correlation between new medical diagnosis and FI were not identified. Data collection was delegated to the nurses who were trained, this limited the patient perspective and further the generalization of the study (cognitive impairment would have limited use of the tool). This research had validity and reliability for the patients who needed help with ADLs'. This pilot study was effective in proving that is was feasible and the interRAI LTFC instrument is useful for exploring and tracking FI in NH patients. Finally, it was stressed that there is need for increased fecal incontinence awareness among nurses as being potentially avoidable and treatable condition and recommended further studies on individualized continence care plans.
Identifying factors predicting nurses' performance of pain assessment among LTC residents, examining the relationship between ageist attitudes and practices and attitudes about pain assessment was the purpose of this research (Natan, Ataneli, Admenko & Har Noy, 2013). A descriptive correlational method was used to positively identify that nurse assessment is correlated with pre-service knowledge and positive non-ageist attitudes indicates an understanding of performing pain assessments. Implications for practice was identified as more need for pre-service training and a keen awareness for pain assessment.

Preferred Paper

Both subjects are equally important for promoting and maintain quality of life for the elderly resident in a nursing home; and both speak to maintaining human dignity of the resident. My preferred article is Nurse Assessment of pain in the Elderly. My choice was based on readability and relatability; the presentation of the research was key to this, the researcher referenced ageism frequently to point out importance of their theory "Nurses with a positive, non-ageist attitude towards older adults more likely have higher levels of awareness to perform pain assessment". (Natan, et al., 2013). The strength of the article lies in the cited words and were more effective than the actual numbers showing the correlation between the two variables. Being able to recognize my belief in the literature is important to me; I identify as being positively biased in relation to ageism and this is a direct influence from being raised in a household that believed in treating everyone with respect and dignity. Furthermore, this personal belief translates. Furthermore, this personal belief translates into my professional belief as nurse to provide care with respect and human dignity.

Guiding my Practice

Being able to approach my resident in a non-biased way allows me to have an empathetic dialogue and effectively do a thorough assessment and specifically ask of the existence of pain. According toKostas, Paquin, and Rudolph (2013), "The most important screening question is about the presence of pain and intensity of the pain " ( p. 582). Reaching a nursing diagnosis related to pain can be done with the use of tools for assessing pain such as numeric rating, verbal descriptor, facial and visual analog scales to help me bring to forefront the true intensity and location of the pain. Using these tools will along with a positive attitude will guide my effectively in my practice in relation to pain management.

Implementation

As a front-line worker, I am unable to implement departmental changes and the recommendations for pre-service nursing education to improve nursing attitudes towards the elder residents; this must be recognized as a mandatory part of training by management. However, can I identify nurses with a negative bias of ageism through observation of their behaviors when interacting with the resident. Knowing who they are I can informally share my positive bias of ageism and the importance for assessing pain in the elderly. I can also lead by example and let my practice reflect my belief by finding tools to share that are evidence based that will help the elder patient assess their pain. Additionally, I can directly effect change through practice by documenting and verbally notifying other nurses of my findings, treatment and follow up plan. This will again give me an opportunity to share my knowledge on pain management.

Conclusion

As a nursing community, we need to find and implement way to protect the dignity, morbidity, and quality of life of our elderly population in nursing homes. Many researches were done and the effectiveness of nurse's perception of their patients and how it affects their quality of care of that patient. The time has come for implementation. We cannot wait for organizations to implement new policy and procedures we must begin at the front lines using researches like the ones discussed to guide our practice.

References  

Blekken, L. E., Vinsnes, A. G., Gjeilo, K. H., Norton, C., Mørkved, S., Salvesen, Ø., & Nakrem, S. (2016). Exploring fecal incontinence in nursing home patients: a crossâ€Âsectional study of prevalence and associations derived from the Residents Assessment Instrument for Longâ€ÂTerm Care Facilities. Journal of Advanced Nursing, 72(7), 1579-1591. doi: 10.1111/jan.12932

Ben Natan, M., Ataneli, M., Admenko, A., & Har Noy, R. (2013). Nurse assessment of residents' pain in a longâ€Âterm care facility. International Nursing Review, 60(2), 251-257.

Kostas, T., Paquin, A., & Rudolph, J. L. (2013). Practical geriatric assessment. Aging Health, 9(6), 579-591. doi:http://dx.doi.org.proxy.bib.uottawa.ca/10.2217/ahe.13.51