Functional Role in Nursing

The health care practitioners owe a duty of providing high quality and safe patient care. To guide them in achieving this, the following core competencies are issued;

1. Provide patient-centered care; this competencies requires nurses to recognize, respect, and be concerned with the patients’ unique values, belief, preferences and expressed needs. This competencies implies that the nurse has to establish a personal relationship with each patient and offer personalized health care as the health needs for each patient differs.
2. Work in interdisciplinary teams; in offering healthcare the nurses do not work in isolation and for this reason they should be open to cooperation, coloration, communication and integration of care in teams. This helps the nurses help each out in providing care that in continuous and reliable.
3. Use of evidence-based practice; this competence requires the nurse to integrate in the best research best research in offering optimum care. The nurses are also urged to continue engaging in learning and research activities.
4. Quality improvement; this competence urges the health care providers to consider quality as a continuous process. They are required to be always on the look-out for errors and hazards in care and seeking ways of avoiding and mitigating them.
5. Use of informatics; the healthcare practitioners are encouraged to make use of information technology in offering their services. This is essential in enhancing better communication, reduce medical error and support decision making process.

Barriers to working in Interdisciplinary team

Provision of quality healthcare requires the collaboration of several providers each with varying levels of education and training. This collaboration is however inhibited by poor communication amongst the interdisciplinary team. Poor communication creates scenarios of medical errors occurring which may escalate the injury or lead to death (O’Daniel & Rosenstein, 2008).

This communication barrier can be solved through promoting a culture that supports communication and team collaboration, adoption of health information technologies. The management should also set up measures and means for encouraging group interaction either formal or informal.

Initiatives to promote adoption of the Five Core Competencies

Adoption of advanced systems

These decision support system are effective in ensuring safe care. In choosing these systems, the nurse managers should be part of the team carrying out the system selection, and designing process. The system adopted should be simple, efficient and easy to use (Davish et al, 2014).

Continuous education

The health care providers should be exposed to continuous learning programs. This helps the nurses in identification of the best research finding about effective clinical practice. They should be a forum for sharing this best evidence-based practice among the practitioners to ensure the adoption of this core competencies is widespread.

Question Two, Clinical Issue in a Functional Role

Similarities and Differences between Data Gathered and Generated Data

Similarities

From both the data generated and data gathered there seems to be a consensus on the rating of the health services received by the elderly persons. Only 38.1% of elderly persons viewed the services offered to them as excellent or very good. From the focus group , it was revealed that the elderly person were not satisfied with the health services as they only seemed to add more pill with no explanation of their condition. 

There was a similarity between the data gathered and that data generated in terms of the foot clinic in terms of the time taken for an elderly person to see a nurse. From the data gathered, this was found to be even a month. From the focus group, it was indicated their concern on the length of time it takes to be seen by the nurse.

Health Conditions

National/ State Data	Local Data
The major health conditions facing the elderly person were indicated to be hypertension, arthritis, heart disease, cancer and diabetes.	Only a foot clinic is available for the elderly persons where the nurse assesses vital signs, trims toenails and offers education to the elderly persons.

Interpretation

The foot clinic that is available for the older persons at the community that offers a 30-minute appointment does not cover the major health conditions that have found to face most elderly persons in the community.

Conclusion

 Programs more focus on the leading causes of deaths among the older persons such as heart disease, cancer, stroke, and chronic pulmonary disease need to be addressed.

Congregate Meals

National/State Data	Local Data
Statistics show that about 30 older persons attend the meal for each data with approximately 100 people attending the meals at least monthly.The number of people attending the meals has not changed much for over a decade.	From the focus group, it was evident that those who attended the congregate meals could either drive or had a reliable means of transport. A concern was raised about other elderly persons within the community who could not manage to get to the community center.

Interpretation 

This service of congregate meal was ineffective by not being inclusive. From a population of 1500 elderly persons, only 100 (6%) managed to access the center. Only those with means of getting to the center were served there which left out many other who would have liked to join in having the congregate meals.

Conclusion 

The congregate meal offered a chance for the elderly persons to interact with one another. However, a means of getting to the center should be availed for all willing members. Lack of means of transport to the community center may be the reason why the number of those attending the congregate meals have increased for over a decade.

Foot Clinic

National/State Data	Local Data
The foot clinic is operated by a nurse every Thursday between 9am to 11 am. The 30-minute appointment is booked through the Area Agency on Aging. It may take more than a month in waiting for see the nurse. The program is state funded and offers services for free	The location for the foot clinic was found not to be convenient The wait period which may be a month is not appealing to the elderly persons.  This is a general concern of the limitation caused by offering the service only once per week.

Interpretation

The foot clinic does not offer services with satisfaction. It not structured in a manner that caters for the needs of the elderly population that it intends to serve. The service is a popular service amongst the elderly population but has limited access.

Conclusion

The foot clinic is one of the most popular service offered to the elderly persons. The resources allocated to it are not enough as it can only be offered once a week and in limited time period on 2hrs. This creates congestion which increase the wait period to almost a month.

Additional Services

National/State Data	Local Data
Bingo is a game held at the community center every Wednesday and attended by approximately 40 people. The community center runs an exercise program every Tuesday morning that is attended by approximately 25 people	Data generated from the focus group indicate that the elderly persons would like to have new opportunities to break the monotonous weekly programs

Interpretation

The Bingo game and exercise program help bring the elderly persons for socialization keeping fit. The repetitive program is in a way boring to the elderly persons and they wish for an expansion of opportunities to keep them engaged.

Conclusion 

The elderly persons are appreciative for the opportunity to meeting and socializing at the community center every week for the Bingo game and exercise program. Following the same program every week is boring to them and they recommend an expansion of opportunities.

Strengths of the Community

The community center is a great opportunity to bring the elderly persons on the community in one place to interact and share their experiences. The meals offered in the community center were found to be good. The running of the foot clinic is very helpful in ensuring the wellbeing of the elderly persons within the community is catered for.

Areas of Improvement

The community center seems to only cater for a small portion of the elderly persons in the community of the 1500 person. Only those who can drive or with access to a reliable transport attends the programs. There should a provision of means of transport for those without reliable means.

Coverage of health conditions is another area that can be improved. The foot clinic should be offered for more days and wait period shortened. The location of this clinic should be situated in more convenient location that is easily accessible to the elderly person. 

Recommendations

1. Establish a full-pledged geriatric care center that would cover a wide range of activities including daily clinic, doctor’s checkup and additional services in a wider scope.
2. Develop a means of transport for those elderly persons who cannot drive and have no reliable  means of transport
3. Initiate home visits program.

Question Three: Article Critique

Research problem/purpose

The purpose for this research was to establish the impact of intervention of improve the living standards for grandparents who take care of their grandchildren in situation where the parents are absent from. Nursing is concerned with the welfare of the care givers as their welfare affects the welfare of the family. 

Literature review 

The literature provides is effective in creating a picture of the magnitude of the problem by providing the statistics of grandparents in the country and identifying the proportion that acts as caregivers. The literature goes further and looks into the health issues affecting these grandparents which supports why the current research should be carried out.

Study Framework

The study is based on a clear model of family stress, adjustment, and adaption. This model is related to nursing knowledge as considers how different issues affect the health of grandparents acting as caregivers for their grandchildren.

Research Objectives and Questions

For this research article, the research questions are not clearly indicated on their own but embedded within the section for purpose. They are however well connected with the general purpose of the study as they aim to find out the health attributes that can enhanced positively through the use of home-based intervention.

Variables

The variables are not explicitly indicated nor are they categorized as operational or conceptual.

Design

The design adopted for this study is longitudinal. The design adopted for the study was appropriate for this is offered a means of answering the research questions. Since the study aimed at measuring the impact, it important to establish before the intervention and after the intervention. For this study a pre-test and post-test were carried out. This implies that changed due to intervention could be easily identified.

Sample, population and setting

A sample of 529 participants were chosen using convenience sampling method. With this sampling method, it may not be easy to ensure the representativeness of the sample selected. This makes is hard to state for sure whether the type II error can be avoided.

Measurement

Baseline data was first collected before the intervention was rolled out. The measurement tool used was the Short Form-36 General Health Survey which is well described on the attributes and how to use it.

Data collection 

The process of data collection for this research article was done by trained research assistants. The research followed ethical consideration as the participants were required to sign letter to indicate informed consent. The research has also been approved by the university board. 

Data analysis

The data analysis procedures used in this research have been clearly identified and explained. The explanation indicates how data from the SF-36 form was analyzed (Kelley, Whitley, & Campos, 2010). The results have been presented in a narration format and later summarized on a table thereby making them to easily understandable.

Interpretation of findings

The discussions of this research article focuses on how the results offer insight to the research question on impacts of an impact to the vulnerable population being the grandparents. The biased does not appear to be biased as in one instance notes it is not possible to determine sustainability of the changes. This implies that the study interprets the advantages and disadvantages as observed.

References

Darvish, A., Bahramnezhad, F., Keyhanian, S., & Navidhamidi, M. (2014). The Role of Nursing Informatics on Promoting Quality of Health Care and the Need for Appropriate Education. Global Journal of Health Science, 6(6), 11–18. 

Institute of Medicine (US) Committee on the Health Professions Education Summit; Greiner AC, Knebel E, editors. Health Professions Education: A Bridge to Quality. Washington (DC): National Academies Press (US); 2003. Chapter 3, The Core Competencies Needed for Health Care Professionals

Kelley, S., Whitley, D., & Campos, P. (2010). Grandmothers Raising Grandchildren: Results of an Intervention to Improve Health Outcomes. Journal of Nursing Scholarship, 379-386.O’Daniel, M., & Rosenstein, A. (2008). Professional Communication and Team Collaboration. In An Evidence -Based Handbook for Nurses. Rockville: Agency for Healthcare Research and Quality.