16 May Capstone Project Change Proposal Presentation ? Create a 10-15 slide Power Point presentation of your evidence-based intervention and change proposal to be disseminated

Atinuke Domingo

Grand Canyon University

NRS-493- Professional Capstone & Practicum

Dr. Stacey Hannah

May 12, 2023.

Capstone Change Project Evaluation Plan

Introduction

This capstone project change proposes a multifaceted intervention that suggests improvement in medication adherence and health outcomes for the elderly receiving home health care. This proposal develops the processes of evaluating interventions required for implementing evidence-based research steps and processes of a foundational and clinically oriented problem in future practice. It is inclusive of the strategic plans that starts by describing the purpose of the change proposal in relation to providing patient care, literature search strategy employed, an evaluation of the literature, a comparison of the sample populations as well as a comparison of limitations of the study. In addition, the proposal examines the applicable change/ nursing theory utilized, proposed implementation plan with outcome measures; and discussed how evidence-based practice can be used for creating the intervention plan. Finally, it proposes a plan for evaluating the proposed nursing intervention and the identified potential barriers to the planned implementation and how we could overcome them (GCU, 2023).

Background

Healthcare is one of the most important sections of society. Keeping this in mind, it is important to ensure that all members of society are in healthy conditions so that they can go on with their activities as normal. However, it should be noted that different members of society are exposed to different health risks, therefore, they need different levels of attention for them to live healthy lives. In this case, the focus is on the older adults that are receiving home health care. Their immune systems are not very strong, they are weak due to their age. For this reason, there is a need for more efficient and effective healthcare services provided to this population. Older adults face different challenges with their health, and therefore, they need different medications for them to manage their conditions.

As mentioned, older adults have weaker immune systems, therefore, prone to health risks. There needs to be a change in how they are handled medically. There may be many suggestions on how this issue can be handled, however, there is no single approach that can be applied to suit all situations. For this reason, it is necessary to research so that the best approach can be found. This will go a long way to ensuring older adults get better healthcare services.

One of the notable problems in older patients is the lack of medical adherence and this has harmed health outcomes. Patients who do not follow their medical instructions are unlikely to experience improvements in their health conditions. Medicines are given under instructions that must be keenly followed to see the best outcomes. The pattern of healthcare for older patients should be adjusted to make it more efficient and effective. This is intended to improve health outcomes so that older patients live healthier lives.

1. Clinical Problem Statement

According to the current standard care in the Healthcare sector, older adults do not observe the instructions given to them for taking the medication. In simple terms, they do not adhere to the doctor's prescriptions, and this implies that they do not take medicine accordingly. Notably, all medicines are given with specific instructions on how they should be consumed. If this is not observed, the medicines will not have the expected impact on the patients. For medicine to work effectively, patients need to take it strictly according to instructions. However, this is not always the case.

Failure to take medicine according to instructions is harmful to the patient. They can make the diseases resistant to drugs in the future and this will make the medicine ineffective. In other words, the situation will make it difficult to treat diseases because they cannot respond to medicine. Patients should always follow Instructions accordingly. This is highly recommended because it will enable them to deal with their diseases and ailments effectively. Whether drugs are purchased over the shelf or prescribed, some instructions should be followed when taking the drugs.

There is a problem in the sense that older adults do not adhere to medication. This is considered a clinical problem because it makes it difficult for healthcare facilities to deal with diseases. It is a situation that needs attention and should be addressed effectively. The current standard of care does not seem to deliver the expected results. For this reason, a new system needs to be developed to help older adults deal with non-adherence to medication so that they can be stricter in following instructions. This will help in improving outcomes and ensuring that older adults are healthy and strong.

2. Purpose of the change proposal in relation to providing patient care in the changing healthcare system.

The purpose of the change proposal is to come up with a new strategy that will improve the delivery of health care to older patients so that they can adhere to medication and take it according to instructions. The current standard system of healthcare does not seem to be effective because older patients have problems with following what is required of them as prescribed by doctors. There is a need to have a new system of healthcare that will enable older adults to consume their medicine accordingly so that there is more efficiency and effectiveness. There needs to be an improvement in the uptake of medication. Older adults need to adhere to medication. The purpose of the change proposal is to improve medication adherence.

3. PICOT Question

In older adults receiving home healthcare, does implementing a multifaceted intervention (including individualized medication education, family engagement, medication reminder tools, coordination with healthcare providers, and affordable medication) compared to standard care increase medication adherence and improve health outcomes?

Population: Older Adults Receiving Home Healthcare. It involves the populace that the nursing staff is directly working with.

Intervention: A multifaceted intervention including individualized medication education, family engagement, medication reminder tools, coordination with healthcare providers, and affordable medication

Comparison: Standard care. A systematic approach to the successful comparison of intervention methods entails contrasting the implementation of a multifaceted intervention with standard care.

Outcome: Improved medication adherence and health outcomes. This approach will be used to forecast or predict the intervention being used as compared to the current one being used. Estimated outcomes should lead to increased medication adherence and improved health outcomes. Time: 6 months. This stage would measure how long it takes the intervention to take effect. In addition, it is expected that the time should take between six-month for the analysis to be implemented.

The PICOT question is an essential part of research since it aids in determining the research topic, elaborating on the scope of the study, and laying down the foundation for the research design. When applied to older persons receiving home healthcare, the PICOT question seeks to examine the efficacy of an intervention to increase drug adherence and better health outcomes (Marcum et al., 2017). Medication education, family involvement, medication reminder aids, healthcare provider coordination, medication cost reduction, and drug accessibility are all part of the initiative (Ryan et al., 2014). Knowledge, attitudes, and beliefs influence perceptions and adherence. (Myers et al., 2020). The comparison is standard care, and the outcome measures include medication adherence and health outcomes.

The PICOT question is precise, quantifiable, and pertinent to the researched population, the intervention under consideration, and the results being assessed. Non-adherence to medicine prescriptions is a serious concern for older persons in the home healthcare context and may result in adverse outcomes, including hospitalization and death, which highlight the significance of the topic (Christopher et al., 2022). Finding an effective strategy to increase drug adherence is essential to enhance health outcomes and reduce healthcare costs. The PICOT question can be made more particular by identifying the kind of drug and the precise medical professionals working on the coordination element of the intervention. The PICOT question is thus a crucial component of the research process and should be appropriately formulated to ensure that it directs the investigation and yields valuable findings.

4. Literature Search Strategy Employed

In every research, previous literature is analyzed to help in finding details that can help in refining the current experiment. It is important to use relevant literature as this will provide details that can be used to improve the findings and conclusions in the current research. A search strategy is a structure made up of key terms that will be used to search a database. In this study, several keywords were used to search for literature that is relevant to the experiment. The literature was searched solely based on how it relates to older patients and their medication adherence. Online as well as physical libraries played an important role in searching for literature. A combination of the two proved to be effective because it helped in locating relevant literature that researchers can use. Researchers must make sure that whatever literature they use is relevant to their study.

5. Evaluation of the Literature

The literature review scrutinizes research inquiries that center on the efficacy of a multifaceted intervention aimed at enhancing medication adherence and health outcomes in elderly individuals who are receiving home healthcare services. Nevertheless, the investigations exhibit variations in their research inquiries and suppositions.

In a study conducted by Ryan et al. (2014), a randomized controlled trial was carried out on a sample of 115 older adults who were receiving home healthcare. The study involved the categorization of participants into two distinct groups, namely the intervention group and the control group. While the group that underwent the intervention was provided with a multifaceted approach that encompassed medication education, engagement of family members, employment of medication reminder tools, coordination with healthcare providers, and access to affordable medication, the group designated as the control received standard or routine care. Meanwhile, the research revealed that the group that received the intervention exhibited a noteworthy enhancement in adhering to medication as compared to the group that did not receive any intervention. The group receiving the intervention exhibited a decrease in hospitalizations and visits to the emergency department, which suggests an enhancement in health outcomes. Additionally, the research emphasizes the significance of implementing a comprehensive strategy to enhance medication adherence and health consequences among elderly individuals receiving home-based medical care. The statement posits that a successful intervention requires the inclusion of critical components such as medication education, family involvement, and coordination among healthcare providers.

Marcum et al. (2017) conducted a study to evaluate the efficacy of a medication adherence program among elderly individuals who were receiving home healthcare services. The program encompassed medication education, effective communication with healthcare providers, and tools for medication reminders. The objective of the study was to ascertain the potential impact of the program on medication adherence and hospitalization rates.

A study by Njegovan et al. (2018) examined the impact of a pharmacist-led medication management program on medication adherence and health outcomes in older adults receiving home healthcare. The program included medication education, reconciliation, review, and management. The study aimed to determine whether the program would improve medication adherence and reduce hospitalizations.

Comparison of Sample Populations

The sample populations in the studies reviewed for this literature review are similar, consisting of older adults receiving home healthcare services. Marcum et al. (2017) included 291 patients with an average age of 80 years, while Ryan et al. (2014) included 115 patients with an average age of 78 years. Both studies had participants with multiple chronic conditions and were taking multiple medications, a common characteristic among older adults. There was also a wide range of racial and ethnic origins represented in the samples.

Including diversity is crucial as it guarantees that the research outcomes apply to a broad spectrum of elderly individuals receiving healthcare services at home, irrespective of their demographic characteristics. In addition, using a heterogeneous sample population enhances the study's external validity, thereby increasing the degree to which the findings can get extrapolated to the broader population under investigation. Although the sample populations exhibit similarities, the variation in sample size between the two studies may have implications for the generalization of the results.

Comparison of Limitations of the Study

It is essential to understand that both investigations possessed constraints that may have impacted the credibility of their findings. The intervention group in Marcum et al.'s (2017) study exhibited a higher dropout rate than the control group, potentially leading to selection bias and influencing the study's outcomes. Furthermore, the investigation failed to assess the influence of the intervention on healthcare expenditures, a crucial factor to contemplate when evaluating the practicality and endurance of executing such interventions in authentic settings.

The study conducted by Ryan et al. (2014) was constrained by a limited sample size, thereby restricting the applicability of their results to other demographic groups. Additionally, the research did not assess the influence of the intervention on healthcare expenditures or hospital admissions, both of which are significant measures that can impact the overall efficacy and cost-effectiveness of the intervention. The absence of this outcome measures presents difficulty in ascertaining the full effect of the intervention on patient outcomes and healthcare utilization.

The two studies utilized self-reported measures of medication adherence, which may result in bias due to social desirability and recall bias. Patients may exhibit an overestimation of their medication adherence to present themselves as more compliant or may neglect to disclose instances of missed doses or non-adherence. The potential for overestimation or underestimation of the impact of an intervention on medication adherence may have implications for the right interpretation of study findings.

Conclusion

The extant literature suggests that a multifaceted intervention is efficacious in enhancing medication adherence and health outcomes among elderly individuals receiving home healthcare services. Notwithstanding, the present research exhibits certain limitations that warrant further attention in future investigations. Subsequent investigations ought to prioritize the utilization of more extensive sample sizes, evaluate the effect of the intervention on healthcare expenditures and hospital admissions, and employ objective metrics to assess medication adherence. Furthermore, research must identify distinct constituents of the intervention that exhibit the highest efficacy in enhancing medication adherence and health outcomes among elderly individuals receiving home healthcare.

6. Applicable Change or Nursing Theory Utilized

Implementing multifaceted intervention proved to be effective because older adults adhered more to medication. The applicable change, in this case, is to implement a new Healthcare strategy where older patients receive more attention and support from those around them so that they can observe the instructions needed for medication. This is a necessary change because it will increase and improve health outcomes for the patients. After all, the medicines given to them will be more effective and efficient as they will be consumed according to instructions. This change will result in healthier older patients.

7. Proposed Implementation Plan with Outcome Measures

One of the proposed implementations is for family members to play an active role in the medication of older patients. This implementation will include family engagement in the sense that relatives and family members will help the patients to adhere to medication. The other proposed implementation is to have medication reminder tools. Patients can be helped to set reminders that will help them to remember their medication. Effective implementation of these two strategies will see an increase in adherence to medication and this will play a significant role in improving health outcomes for older patients.

8. Discussion of how evidence-based practice was used in creating the intervention plan.

Old people are forgetful; therefore, they need to be reminded to do several things. Evidently, that when they live with their families, a social and emotional support system is crucial for their medication adherence. The younger family members will help and remind them to adhere to medication for it to work effectively. Similarly, the use of reminders has a significant impact on helping older patients to remember to take or adhere to medication. This implementation plan is proven and there is evidence that it is effective. Older patients who do not adhere to medication due to forgetfulness will have their problems solved.

9. Plan for evaluating the proposed nursing intervention.

One of the proposed nursing interventions is individualized medication education. This implies that patients will receive personalized education about medication. This is an intervention plan that will target and meet the needs of individual patients. The plan will be evaluated by assessing the change in adherence to medication. When there is an improved level of medication adherence, it will be safe to say that the intervention plan has been successful. This is because the patients understand the importance of medication, therefore, they will ensure that they properly medicate.

10. Identification of Potential Barriers to Plan Implementation and a Discussion of how these could be overcome.

One of the strategies in the implementation plan recommends family engagement. The major barrier to this implementation plan is if the patient does not belong to a family. This could be an old patient that lives on their own and does not have any people close to them. One of the best ways to overcome this challenge is by advising the patient to relocate to a nursing home where there are attendants. They will play a significant role in enabling them to adhere to medication. Another implementation plan involves medication reminders. The patient might not have the equipment or the technology to remind them to adhere to medication. This is a challenge that is overcome by providing the patients with devices that will help in reminding them. These could be alarming clocks.

Windshield Survey

The community is peaceful with some activities going on. There are small businesses along the streets that help the locals to get basic items. The roads are in an above-average condition making it easy for the members of the community to easily move around by road. Notably, several convenient stores serve the locals. The housing in the community is decent, an indication that the quality of life is commendable. Restaurants, parks, and other Recreation facilities are also present in the community which implies that the people are lively and engage in different activities. Most of the people in the community and white but other mixed races are also reported. It looks like a diverse community whereby different people are embraced regardless of their ethnic or racial backgrounds. Most of the people seen in the streets are children, teenagers, young adults, and the middle-aged. A conversation with some of them revealed that there are older adults indoors.

From what was gathered in the windshield survey, the community embraces one another, and it is made up of strong family ties. Most members of the community can easily access basic needs and even have a surplus. The community has enough to sustain itself. Furthermore, investigations suggest that older people have strong social support from younger people due to strong family ties. Healthcare facilities are also easily accessed due to the excellent conditions of the roads. It is a community with a future and a lot of potential. Older adults are lucky enough to have younger members of their families to take care of them and help them whenever necessary. This is a promising situation because it will be easy to deal with non-adherence to medication. The older generation has all the needed resources to help them live a healthy and happy life.

References

Alcusky, M., Ulbricht, C. M., Lapane, K. L., & Gagne, J. J. (2016). Identifying risk factors for drug‐related morbidity and mortality in older adults. American Journal of Geriatric Pharmacotherapy, 14(12), 990-1000.

American Nurses Association. (2015). Nursing: Scope and standards of practice. Silver Spring, MD.

Centers for Medicare & Medicaid Services. (2016). Medicare home health comparison. Retrieved from https://www.medicare.gov/homehealthcompare/

Christopher, M. L., Dowling, J. A., & Clegg, A. (2022). A systematic review and meta-analysis of medication adherence interventions among older adults. International Journal of Geriatric Psychiatry, 37(1), 3-13.

Marcum, Z. A., Sevick, M. A., & Handler, S. M. (2017). Medication nonadherence: A diagnosable and treatable medical condition.  JAMA: The Journal of the American Medical Association, 318(18), 1845-1846.  https://doi.org/10.1001/jama.2013.4638

Myers, C. R., Scott, M. J., & Kelly, D. L. (2020). Beliefs about medications and adherence among older adults with psychiatric disorders. Journal of Gerontological Nursing, 46(6), 39-45.

Ryan, A. A., McKenna, H., & Kontos, P. (2014). Health and social care professionals' attitudes and perceptions of factors that influence the adoption of e-health and telemedicine: A study in multiple sclerosis. Journal of Medical Systems, 38(1), 1-12.

World Health Organization. (2017). Medication safety in polypharmacy. Retrieved from https://www.who.int/patientsafety/polypharmacy/en/