Two Nurse Managed Wellness Clinics, Challenges of Identifying Health Care Needs in an Ethically Diverse Elderly Client Sample

2.50
Hdl Handle:
http://hdl.handle.net/10755/151786
Type:
Presentation
Title:
Two Nurse Managed Wellness Clinics, Challenges of Identifying Health Care Needs in an Ethically Diverse Elderly Client Sample
Abstract:
Two Nurse Managed Wellness Clinics, Challenges of Identifying Health Care Needs in an Ethically Diverse Elderly Client Sample
Conference Sponsor:Sigma Theta Tau International
Conference Year:1997
Conference Date:June 20 - 21, 1997
Author:Carroll, Theresa, PhD
P.I. Institution Name:University of Texas Health Science Center at Houston
Title:Professor and Associate Dean
Purpose and Setting: This study describes and compares the health care needs of elderly resident of HUD subsidized assisted living low income high rise apartment buildings where advanced practice nurse faculty had established nurse managed wellness clinics. One facility houses 110 mostly Caucasian elderly persons while the other provides apartments for 200 African American mostly elderly persons. Specifically, this study attempts to: 1) document demographic characteristics, past morbidity experience, prior use of health resources; and 2) assess current level of functional independence, health status and quality of life in this ethnically disparate sample of elderly people. These variables were chosen to: provide information for customizing the wellness program to the needs of the elderly persons living in the respective settings, describe and compare the samples and establish baseline data that would provide the foundation for measuring outcomes of the wellness program initiated at the clinic.



Significance of the Research Problem: One goal expressed in Health People 2000 is to increase the years of healthy life to age 65 and beyond. A strategy proposed for accomplishing healthy aging is participation by elderly people in health promotion programs (National Center for Health Statistics, 1994). Implicit in this recommendation is the assumption that wellness programming may delay decline and promote independence among seniors. The cost benefit value and outcomes of health promotion programs remain yet to be systematically and objectively determined. In addition to outcomes, Donabedien (1988) suggests that such an evaluation also needs to include measures of structure and process. Based on this recommendation, the current study documents the first step in measuring outcomes of one wellness program by reporting on the process and results of baseline data collection.



Data Collection and Analysis: A descriptive survey design using both qualitative (focus groups, participant observation, formal and informal individualized discussions) and quantitative methods (printed surveys, questionnaires and systematic geriatric assessment) were used to conduct the health needs analysis. Content analysis was used to analyze qualitative data. Descriptive statistics were used to analyze and aggregate results from questionnaires and the systematic geriatric assessment which included a health history, review of systems, MiniMental State Examination (Folstein, Folstein & McHugh, 1975), Activities of Daily Living (Mahoney & Barthel, 1965), Instrumental Activities of Daily Living (Lawton & Brody, 1969), Nutritional Assessment (Lipschitz, Ham & White, 1992), Geriatric Depression Scale (Yesavage & Brink, 1983), and the Social Resource Scale (Duke University Center on Aging, 1978). Data collection was conducted as part of the one day per week that the advanced practice nurse, graduate and undergraduate nursing students staffed the clinic.



Selected Findings: In the high rise with predominately Caucasian elderly people, 85% (n=94) participated in some aspect of wellness programming. Of the residents who participated, 46 (49%) were evaluated via the systemic geriatric assessment. Fifty percent (n=100) of the residents in the African American high rise participated in the activities of the wellness clinic but due to difficulty with the requirement of a signed consent, only four individuals were evaluated by the systematic geriatric assessment. In this setting, a chart audit was performed to identify prevalent health needs. Elders in both settings expressed desire for blood pressure monitoring, medication information and chair exercises. Results of chart audit and systematic geriatric assessment indicated major health problems were cardiovascular-hypertension, poly-pharmacy (68% were on 2-6 prescribed medications; 50% used at least two home remedies), and weight management (over & under). Difficulties with data collection included inability to remember specific even recent events, fear that identified health problems would necessitate move from setting, desire to please the data collector, past negative experiences with health care personnel, lack of trust, and inability to read, see or hear. Advanced practice nurses in both settings agreed that the processes that were used to collect data were as important to the acceptance of and participation in the wellness program as the results. Continuously reporting and using data to plan the programs served to reinforce the importance of active participation and contributed to "buy-in" by the residents.



Implications: Documentation of outcomes of wellness programming is important in measuring the effectiveness of this much talked about but largely financially unsupported concept. But outcomes cannot be measured unless valid and reliable baseline data are available. Baseline data in community based, primary care settings are particularly difficult to obtain. Careful planning for collecting, analyzing and using these data are important to the acceptance of the wellness program by the recipients.
Repository Posting Date:
26-Oct-2011
Date of Publication:
20-Jun-1997
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleTwo Nurse Managed Wellness Clinics, Challenges of Identifying Health Care Needs in an Ethically Diverse Elderly Client Sampleen_GB
dc.identifier.urihttp://hdl.handle.net/10755/151786-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Two Nurse Managed Wellness Clinics, Challenges of Identifying Health Care Needs in an Ethically Diverse Elderly Client Sample</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1997</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">June 20 - 21, 1997</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Carroll, Theresa, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Texas Health Science Center at Houston</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Professor and Associate Dean</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">theresa.l.carroll@uth.tmc.edu</td></tr><tr><td colspan="2" class="item-abstract">Purpose and Setting: This study describes and compares the health care needs of elderly resident of HUD subsidized assisted living low income high rise apartment buildings where advanced practice nurse faculty had established nurse managed wellness clinics. One facility houses 110 mostly Caucasian elderly persons while the other provides apartments for 200 African American mostly elderly persons. Specifically, this study attempts to: 1) document demographic characteristics, past morbidity experience, prior use of health resources; and 2) assess current level of functional independence, health status and quality of life in this ethnically disparate sample of elderly people. These variables were chosen to: provide information for customizing the wellness program to the needs of the elderly persons living in the respective settings, describe and compare the samples and establish baseline data that would provide the foundation for measuring outcomes of the wellness program initiated at the clinic.<br/><br/><br/><br/>Significance of the Research Problem: One goal expressed in Health People 2000 is to increase the years of healthy life to age 65 and beyond. A strategy proposed for accomplishing healthy aging is participation by elderly people in health promotion programs (National Center for Health Statistics, 1994). Implicit in this recommendation is the assumption that wellness programming may delay decline and promote independence among seniors. The cost benefit value and outcomes of health promotion programs remain yet to be systematically and objectively determined. In addition to outcomes, Donabedien (1988) suggests that such an evaluation also needs to include measures of structure and process. Based on this recommendation, the current study documents the first step in measuring outcomes of one wellness program by reporting on the process and results of baseline data collection.<br/><br/><br/><br/>Data Collection and Analysis: A descriptive survey design using both qualitative (focus groups, participant observation, formal and informal individualized discussions) and quantitative methods (printed surveys, questionnaires and systematic geriatric assessment) were used to conduct the health needs analysis. Content analysis was used to analyze qualitative data. Descriptive statistics were used to analyze and aggregate results from questionnaires and the systematic geriatric assessment which included a health history, review of systems, MiniMental State Examination (Folstein, Folstein &amp; McHugh, 1975), Activities of Daily Living (Mahoney &amp; Barthel, 1965), Instrumental Activities of Daily Living (Lawton &amp; Brody, 1969), Nutritional Assessment (Lipschitz, Ham &amp; White, 1992), Geriatric Depression Scale (Yesavage &amp; Brink, 1983), and the Social Resource Scale (Duke University Center on Aging, 1978). Data collection was conducted as part of the one day per week that the advanced practice nurse, graduate and undergraduate nursing students staffed the clinic.<br/><br/><br/><br/>Selected Findings: In the high rise with predominately Caucasian elderly people, 85% (n=94) participated in some aspect of wellness programming. Of the residents who participated, 46 (49%) were evaluated via the systemic geriatric assessment. Fifty percent (n=100) of the residents in the African American high rise participated in the activities of the wellness clinic but due to difficulty with the requirement of a signed consent, only four individuals were evaluated by the systematic geriatric assessment. In this setting, a chart audit was performed to identify prevalent health needs. Elders in both settings expressed desire for blood pressure monitoring, medication information and chair exercises. Results of chart audit and systematic geriatric assessment indicated major health problems were cardiovascular-hypertension, poly-pharmacy (68% were on 2-6 prescribed medications; 50% used at least two home remedies), and weight management (over &amp; under). Difficulties with data collection included inability to remember specific even recent events, fear that identified health problems would necessitate move from setting, desire to please the data collector, past negative experiences with health care personnel, lack of trust, and inability to read, see or hear. Advanced practice nurses in both settings agreed that the processes that were used to collect data were as important to the acceptance of and participation in the wellness program as the results. Continuously reporting and using data to plan the programs served to reinforce the importance of active participation and contributed to &quot;buy-in&quot; by the residents.<br/><br/><br/><br/>Implications: Documentation of outcomes of wellness programming is important in measuring the effectiveness of this much talked about but largely financially unsupported concept. But outcomes cannot be measured unless valid and reliable baseline data are available. Baseline data in community based, primary care settings are particularly difficult to obtain. Careful planning for collecting, analyzing and using these data are important to the acceptance of the wellness program by the recipients.</td></tr></table>en_GB
dc.date.available2011-10-26T11:13:39Z-
dc.date.issued1997-06-20en_GB
dc.date.accessioned2011-10-26T11:13:39Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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