Nursing the Acutely Ill Person

Introduction to Older Patients Acute Illness Rehabilitation Plans

Acute illness is a traumatic experience for the patient and caregivers as well. Older patients with acute illness remain at risk of self-care abilities which results in geriatric rehabilitation hospitalizations. The acute care centers for older persons are a carefully designed model that provides continuous quality improvement interventions (Gwyther,2011). The caregivers focus on principles of the arranged care environment that helps the patient to achieve self-care lost due to acute illness. It also aims to prevent patient disability by planning for transitions of medical care (Stratakou & Plerou,2017). The essay will reflect the importance of nurses in care planning based on evidence-based interventions for rehabilitation to improve patient safety and quality of life.

Improving Quality Care

Rehabilitation can be defined as the set of procedures that support older patients to maintain normal functioning and interaction with their environment. Patients with neurological and cardiovascular problems fall in the same patient caseload, often in the same patient (Cunliffe et al.,2011). The older patients often turn susceptible to various illnesses like diabetes, arthritis, dementia which greatly impact their independence. Physiotherapy is a major nurse skill that can plan a biopsychosocial model to provide holistic and patient-centered care admitted in the geriatric rehabilitation ward (Alanko et a;.,2019). The nature of physiotherapy focus on the physical behavior of a person's condition. The everyday activities in older patients is an essential point to initiate treatment and physiotherapy focus to assess barriers in performing activities and general motilities. Moreover, physiotherapy will tend to improve various risk factors related to aging and include strength, coordination, balance, and pain management (Cunliffe et al.,2011). It means physiotherapy plays an essential role in improving patient health, wellbeing, and independence.

Providing care to older patients is a skillful practice as patients with acute illness are often diagnosed with multiple disorders. Proper knowledge of nurses regarding best care practices including physiotherapy is important for patient satisfaction and management. The nurse must be proficient in three major categories and include assessment, treatment, and patient outcome which focus on the care of the older patient(Alanko et a;.,2019). Nurses will associate with multidisciplinary teams to plan arranged care. and decide interventions on how the older patient can remain independent after discharging from the care center. Mobility and exercise are essential to improve bone complications in older patients which can maximize the incidence of falls in older patients. Supported care for mobility should remain an integral part of nursing concerning everyday actions like getting up and walking to the toilet. The mobility intervention should be started early before shifting to a geriatric ward to reduce the chances of dependency on others due to impaired mobility. Sherrington (2011) suggests that mobilization intervention showed improved results when given for around 6 months. Mobilization must be reintroduced in everyday activities for improving patient falls which may result in head injuries increasing harm to the patient. It will support the patient to improve muscle strength which will further reduce dependency on others for everyday activities like washing, bathing, and even more difficult work meal preparation (Rickard,2012). Nurses must engage the patient in rehabilitation plans of the patient with an acute illness like mucosal damage and share information regarding the risk of future falls by providing necessary training. The timely application of these interventions will improve patient quality and wellbeing.

Effective rehabilitation goals can be provided by proficient caregivers having qualities like communication, effective collaboration, and good quality assessment skills. It is to ensure the patient and family members that well co-ordinate care is being provided to the patient. Nurses must be familiar with the new and advanced physiotherapies and best practice strategies that ensure the individual patient will receive possible best care interventions (Xie., 2017). Nurses can educate themselves by reading journals related to advanced care mobilization strategies, attending seminars, and maintaining certification in physiotherapy goals. Life quality of patients can be improved by engaging multidisciplinary teams including a team of a physiotherapist and other decision-making stakeholders to standardize care and address care gaps. Besides, opinion leaders are marked at every step of therapy, and physical exercise including nursing management, physician leads, and rehabilitation leads to identify stepwise health improvement which will also help to identify the barriers and needs of the patient (Xie., 2017). This model of clinical care in advance and combine concepts of clinical care pathways, clinical networks, and knowledge sharing strategies to provide quality care reasonably.

Self-Care and Management

Cardiovascular disease is one of the major health issues encountered by the older population worldwide. Physical activity like an exercise in older patients can improve patient quality by reducing cardiac disabilities. A cardiac rehabilitation program, a medically supervised initiative to help patients having a history of cardiovascular strokes. The main goal of the program is to reduce the risk of heart strokes in the future in which the cardiac specialist will design the care plan and will educate the nurses regarding the exercise training for improved patient outcomes (Crotty,2014). This intervention is important to improve cardiac illness before shifting to the geriatric care ward. Obesity, high cholesterol, diabetes, and depression are risk factors for heart stroke also, lack of adequate exercise contributes to the heart diseases at an extended level (Taylor,2011). Apart from improving cardiac health, physical activity will also help the patients to walk without any support and focus to minimize fall incidences as well. Although, it has been observed that physical activities reduce the fall incidences by 40%in older patients (Taylor,2011). The physical activities will reduce the overall in-hospitalization cost which is beneficial to the patient and family members as well.

Age is the elemental risk factor in the geriatric population leading to cardiovascular diseases. Age-related changes can increase fat deposition in arteries which restricts the blood supply to cardiac muscles, leading to a heart attack. The other clinical change with age is atherosclerosis, causing stiffness in heart muscles leading to high blood pressure. Lack of physical exercise, wrong eating habits can increase the damage to the arteries, which can easily be controlled by following a proper cardiac rehabilitation plan (Weerahandi,2019). The plan will focus on a diet plan which must include fruits and vegetables, containing a higher proportion of minerals, ions, antioxidants, reducing the harm to the arteries and heart muscles as well. A healthy diet will provide help the patient to achieve self-care which cannot be achieved without engaging and understanding the individual patient. Moreover, nurses must be aware of the food-related allergies which can be achieved by improving technical skills. Also, regular physical exercise including brisk walking and gardening will help the patient to manage heart strokes by reducing blood cholesterol levels and maintaining blood pressure (Weerahandi,2019). The cardiac rehabilitation program will aid to improve patient lipid profiles by weight management, diet counseling, and exercise (Gwyther,2011). However, the pharmaceutical way of lipid management is also included in the lifestyle management changes to attain cholesterol goals. The patients having cardiac problems are more susceptible to psychological and social problems affecting the mortality and morbidity as well(Gwyther,2011). The cardiac rehabilitation plan will screen all these associated problems and rehabilitation nurses will plan all the necessary interventions for their return to normal life before shifting to the geriatric care center.

 Nurses play an essential role in providing cardiac rehabilitation therapy by improved educational training which will cover the cardiac pathology, medication management, and stress management factors. Nurses should be aware of the risk factors creating space for cardiac strokes to timely start the best intervention plan. The training was provided to individual nurse practitioners covering all the important chapters (Machado et al.,2014). This will enhance the practical and theoretical knowledge of nurses which will help to achieve rehabilitation goals in future clinical practices. The self-assessment tool is further used and includes three main processes like self-reinforcement, self-evaluation, and self-monitoring followed by setting behavioral goals per day for medication and diet adherence. The arrangement of practical and theoretical knowledge can be applied for better application of theoretical knowledge, using simulation (Handley et al.,2015). The use of simulation helps nurses to upgrade their practical knowledge by improving the decision-making capabilities and clinical reasoning with the changing healthcare systems. Active participation staff in advanced care training by the nursing lead to effective learning and growth in their profession (Machado et al.,2014). The significance of shifting theoretical knowledge into practice is the standard for clinical credibility. One of the important modes is by simulation and practice which sets the broader path for deeper education and practice.

Improved Cognitive Abilities

Dementia is usually experienced from mild to moderate in the older population. Women are more susceptible to dementia as compared to men. Anxiety and depression and are the two common clinical symptoms related to dementia. The rising provenance of dementia in older persons will create a space for burden among caregivers (Dutzi et al.,2019). Cognitive-behavioral therapy (CBT) demonstrated improved results when given for a long duration. Cognitive behavior therapy should involve various interventions including emotional, social, and spiritual dimensions for interaction with the social environment (Dutzi et al.,2019). However, dementia in older patients has been minimized with increasing awareness, education, and lifestyle changes. Throughout the treatment process in healthcare systems, nurses will participate in the effective care implication of the clinical interventions (Clare et al.,2019). Cognitive-behavioral therapy will improve them and improve the quality of life by increasing social interaction with the social environment.

Nurses will educate the patients regarding their mental illness to improve their everyday activities and should be made compulsory for every nursing practitioner to minimize the associated risk like fall. In dementia patients, non-pharmaceutical approaches are measured as the best intervention compared to other conventional therapies like counseling. Nurses should identify early symptoms like anxiety and depression which will help to initiate the therapy program and also to reduce the progression of dementia. People with dementia lack social interaction and self-care management like timely medication which will increase the associated harm to the patient (Stratakou & Plerou,2017). Nurses can provide cognitive training including multidisciplinary teams like an occupational therapist, speech therapist, and physical therapist, and the sessions were conducted in a classroom (Clare et al.,2019). It will include meaningful task-specific training like one on one session followed by discussions in a group which aim to improve motor activities, improving the mental abilities like memory and decision making The alternative approach of cognitive therapy has proved beneficial for reducing pain and supporting the mental state of older patients(Stratakou & Plerou,2017). Cognitive therapy enhanced the mental ability of the patient while conventional cognitive therapy is considered cheap, non-expensive, thereby reducing hospitalization cost. Cognitive-behavioral therapy can bring a sense of positivity in their mind and support to deal with their mental disabilities and negative emotions for improving quality of life.

 Dementia is often linked with anxiety, pain, stress, and in some cases sleeping disorders as well. Cognitive impairment owing to dementia result in tiredness, fatigue, reduced mental abilities leading to confusion and impact daytime work. It has been studied that confusion slows down the treatment process in cancer patients. Cognitive therapy is always been an essential component for improving mental abilities by targeting the endocrine activity and parasympathetic nervous system. It also acts as a pseudo distracter, relaxes the mind, and consequently improves life quality for the improved outcome (Shibasaki et al.,2015). Improved mental ability and strong patient-nurse bind will help the nurses to involve the patient in advanced care planning. Therefore, the therapeutic relationship has changed from a patronizing to more advanced participating decision-making (Lee,2020). The caregivers are expected to support dementia patients during everyday care including medication and agree to take them on time. The caregivers must share knowledge and ensure that they understand all the treatment options before involving them in advanced decision making(Shibasaki et al.,2015). Legally and ethically it is always recommended to ascertain a patient's wishes, preferences, and choices for their healthcare decisions rather than to appoint a surrogate decision-maker. The ability of the patient to encourage decision consequences is a highly valued standard in dementia patients for decision making between healthcare systems and can only be achieved by making the patient competent to take decisions. Although, dementia patient lacks processing and remembering capacities, however, possess all the capabilities to make decisions for everyday self-care.

Conclusion on Older Patients Acute Illness Rehabilitation Plans

The rehabilitation interventions have been proved safe and effective in improving older patients with acute illnesses. These interventions will focus on developing new exercise and training plans that proved more effective compared to conventional methods. The caregivers focus on principles of the arranged care environment that helps the patient to achieve self-care lost due to acute illness. The rehabilitation plans will involve multidisciplinary teams to plan arranged care and discharge plans as well. It means rehabilitation plans by caregivers play an essential role in improving patient health, wellbeing, independence. and self-care.

References for Older Patients Acute Illness Rehabilitation Plans

Dutzi, I., Schwenk, M., Kirchner, M., Bauer, J. M., & Hauer, K. (2019). “What would you like to achieve?” Goal-setting in patients with dementia in geriatric rehabilitation. BMC Geriatrics, 19(1), 1-10.

Clare, L., Kudlicka, A., Oyebode, J. R., Jones, R. W., Bayer, A., Leroi, I., Kopelman, M., James, I. A., Culverwell, A., Pool, J., Brand, A., Henderson, C., Hoare, Z., Knapp, M., & Woods, B. (2019). Individual goal-oriented cognitive rehabilitation to improve everyday functioning for people with early-stage dementia: A multicentre randomized controlled trial International Journal of Geriatric Psychiatry, 34(5), 709–721. https://doi.org/10.1002/gps.5076

Cunliffe, A.L., Gladman, J.R.F., Husbands, .SL., Miller, P., Dewey, M.E., & Harwood, R.H. (2011). Sooner and healthier: a randomized controlled trial and interview study of an early discharge rehabilitation service for older people. Age & Ageing, 33(3), 246–252.

Alanko, T., Karhula, M., Kröger, T., Piirainen, A., & Nikander, R. (2019). Rehabilitees' perspective on goal setting in rehabilitation: A phenomenological approach. Disability & Rehabilitation, 41(19), 2280–2288.

Rickard, N. (2012). The meaning of involvement for older people in their rehabilitation after an acute illness. In Meaning of involvement for older people in their rehabilitation after an acute illness, 11(9), 1-12.

Stratakou, G. D., & Plerou, A. (2017). Cognitive enhancement for the elderly facing dementia with the use of cognitive rehabilitation therapy techniques and psychological treatment. A case study. Advances in Experimental Medicine and Biology, 987, 89–98.

Xie, L. (2019). Design and research of intelligent motion intervention systems for infectious diseases. Journal of Infection and Public Health. 87, 80–92.

Shibasaki, K., Ogawa, S., Yamada, S., Iijima, K., Eto, M., Kozaki, K., Toba, K., Ouchi, Y., & Akishita, M. (2015). The favorable effect of sympathetic nervous activity on rehabilitation outcomes in frail elderly. Journal of the American Medical Directors Association, 16(9), 799-799.

Lee., K., Liddle, J., Mudge, A., Bennett, S., McRae, P., Barrimore, S.E. ( 2020). "You've got to keep moving, keep going": Understanding older patients' experiences and perceptions of delirium and nonpharmacological delirium prevention strategies in the acute. Journal of Clinical Nursing. 29(13-14),2363-2377.

Crotty, M., Killington, M., Berg, M., Morris, C., Taylor, A., Carati, C. (2014). Telerehabilitation for older people using off-the-shelf applications: Acceptability and feasibility. Journal of Telemed Telecare, (7),370-376.

Taylor, M. (2011). Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization: A retrospective cohort study. Journal of Clinical Nursing. 19(14),263-277.

Weerahandi, H., Li, L., Bao, H., Herrin, J., Dharmarajan, K., Ross, J.S., Kim, K.L., Jones, S., Horwitz, L.I. J. (2019). Rehabilitation goal in older patients. Journal of the American Medical Directors Association, 20(4), 432-437.

 Gwyther, L.P. (2011). The perspective of the person with Alzheimer's disease: Which outcomes matter in early to middle stages of dementia? Journal of Alzheimer Disease Association Disorder. 11( 6),18–24.

Sherrington, C., Whitney, J.C., Lord, S.R., Herbert, R.D., Cumming, R.G., Close, J.C. (2011) Effective exercise for the prevention of falls: A systematic review and meta-analysis. Journal of American Geriatric Society, 56(12), 2234–2243.

Handley, R., & Dodge, N. (2015). Can simulated practice learning improve clinical competence? The British Journal of Nursing, 22(9), 529-535.

Machado, J.P., Veiga, E.V., Ferreira, P.A., Martins, J.C., Daniel, A.C., Oliveira, S., &Silva, P.C. (2014). Theoretical and practical knowledge of nursing professionals on indirect blood pressure measurement at a coronary care unit. Einstein (Sao Paulo), 12(3),330-335..

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