Self-Care Problems in Elderly Patients

Introduction

According to Koç (2015), elderly patients are typically presented with a myriad of self-care issues. These issues have been found to affect their health outcomes to a huge extent. On this basis, the proposed evidence-based practice (EBP) entails exploring the factors that influence self-care issues among elderly patients. The following PICOT question is formulated

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In elderly patients from 60 to 80 years old (P), does social and environmental factors like motivation and family support (I), compared to genetic factors (C), associate more with self-care problems (O)?

Taking this into consideration, the first part of this paper presents a review of the literature exploring factors that influence self-care issues among elderly patients. The second part describes the proposed research approach and design for this study. The third section seeks to outline the sampling techniques used in this study. The last part of this paper offers the implementation of the EBP project with a change model.

Research Literature

A plethora of past studies has tried to explore various factors that influence self-care issues among elderly patients. In this view, Amelia, Lelo, Lindarto, and Mutiara (2018) analyzed various factors that affect self-care behaviors among patients suffering from type 2 diabetes. This study utilizes a descriptive quantitative research paradigm, where all patients with type two diabetes in eight public health centers were taken into account.

One hundred fifteen respondents were issued with questionnaires, where relevant data related to the study phenomenon were asked. From this study, it was revealed that the main factors that influence self-care particularly among elderly patients included efficacy, motivation, family support, and attitude. The main strength of this weakness is that it applied quantitative data in coming up with a solid conclusion regarding the factors affecting self-care among the elderly. However, the use of only 115 participants was limited to a huge extent.

A study by Chang and Lee (2015) explored factors that affect self-care in elderly patients with hypertension. This was a descriptive quantitative study aiming at identifying the level of self-care as well as predictors of self-care in elderly patients suffering from hypertension. The survey was conducted on 306 patients with hypertension. Statistical Package for the Social Sciences (SPSS) software was used in analyzing the quantitative data collected from the study.

Besides, an independent t-test, as well as analysis of variance (ANOVA), was used in the examination of the differences between the factors affecting self-care among elderly patients suffering from hypertension. From the study, it was revealed that the four main factors influencing self-care are empowerment, social support, depression, as well as perceived severity. The main strength of this study was the use of Connelly’s model, which is considered fundamental in research. However, the main limitation of the study is that interpretation of the causal relationships between predictors required a lot of caution.

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A study by Çiftçi, Yıldırım, Altun, and Avşar (2015) focused on evaluating self-care agency as well as the factors that affect self-care agency among patients with psychiatric disorders. The sample population in this study comprises patients diagnosed with mental disorders.

Patient information forms, as well as the Self-Care Agency Scale, were used in the collection of data of 155 patients. The findings of the results showed that sex, social-economic status, and educational status are the primary determinants of self-care among elderly patients. The strength of this article is that it provided useful insights related to factors affecting self-care among patients with mental illnesses. However, the use of 155 participants was not adequate to come up with a comprehensive conclusion.

A study by Kamrani et al. (2014) focused on self-care behaviors among elderly patients with chronic heart failure as well as other related factors. This was a cross-sectional study, where 184 elderly patients were used as the subject. Independent t-test and ANOVA were used for data analysis. This study found out that some clinical-related characteristics had a negative impact on the self-care behaviors of patients. As such, interventions for improving self-care behaviors among elderly patients should consider targeting both clinical together with age-related characteristics. The primary strength of this study is that it was able to analyze a wide range of self-care behaviors among the elderly. However, the use of interviews in this study was limited, as the researchers obtained subjective data, which was based on opinions.

A study by Koç (2015) investigated a wide range of factors that influence self-care agency and daily life activities among elderly patients. Taking this into consideration, 372 elderly patients were used as the subjects in this study. Data was collected through questionnaires. Descriptive statistics, one-way analysis variance, student’s t-test, and multiple regression analysis were used in analyzing the acquired data.

Analysis of the data in this study revealed that the majority of elderly patients were independent. This is due to the fact their levels of self-care were determined as falling within the middle range. The main strength of this study is that it used the Katz Basic Activities of Daily Living (ADL) Scale which is considered effective in evaluating the ability of patients to perform their daily activities independently. The main weakness of this work is that the study is conducted within a small scope.

A study by Mair, Quiñones, and Pasha (2015) explored care preferences among middle-aged as well as elderly patients with chronic illnesses. A total of 6469 adults aged 50 years and above were used in this study. The authors utilize the qualitative research design supported by a survey to assess preferences for personal care in the elderly and collect information about their attitudes (Mair et al., 2015). Through the use of multilevel modeling, the study analyzed the links between individual-level health care needs and the national-level infrastructure of healthcare.

This study found out those middle-aged and elderly patients with chronic disease who did not receive personal care, are usually less likely to prefer family-based care. The main strength of this study is that it leveraged a large sample size, which enhanced the validity and reliability of the study. Nevertheless, the main limitation of this study is that it only took into account chronic illnesses in general without any specification. This was limiting given that different chronic diseases are influenced by various factors.

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A study by Paterson, Thorne, and Russell (2016) investigated the everyday self-care decision-making of individuals with chronic illnesses. As such, a sample of 21 individuals with HIV/AIDS, Type II diabetes, or multiple sclerosis was used. They conducted a descriptive qualitative study focused on the investigation of the choices and preferences of the selected group (Paterson et al., 2016). The clinicians recorded their decisions regarding daily self-care over a period of one week.

The findings of the study showed that despite the fact that the participants shared similar aspects in regards to their self-care decision-making, they differed significantly in perceived meaning together with the significance of their problems. The main strength of this study is that it provided insights regarding factors affecting decision-making in self-care among the elderly. However, the limitation of this study is that the one-week period was too short to come up with solid conclusions.

A study by Rajpura and Nayak (2014) focused on medication adherence in elderly patients suffering from hypertension. Medication adherence has been found to be one of the major components of self-care among elderly patients. In this study, a cross-sectional questionnaire survey research design was adopted with 117 participants. From work, it was revealed that adherence to medication is necessary for enhancing self-care.

However, it is determined by a wide range of factors including the perception of illness, beliefs regarding medication, as well as perceived illness burden. One of the main strengths of this study is that the use of various data analysis tools made it possible for the researcher to come up with a solid conclusion. Nevertheless, the main limitation of this study is that the study participants were recruited from a small geographical location within New York City. This implies that the generalizability of the research sample may be limited to a huge extent.

A study by Uchmanowicz, Wleklik, and Gobbens (2015) evaluated frailty syndrome as well as self-care ability in elderly patients suffering from heart failure. In this consideration, this was quantitative data where 110 patients with chronic heart failure were used as the subjects. Frailty syndrome was assessed through the use of the Tilburg Frailty Indicator. Self-care behavior was evaluated through the use of the European Heart Failure Self-Care Behavior Scale.

From the study, it was established that the social components of frailty syndrome typically affect the ability of self-care in elderly patients suffering from heart failure. As such, it is critical to use a multidimensional measurement of frailty. The main strength of this study is the application of the European Heart Failure Self-Care Behavior Scale which is regarded in evaluating various metrics. However, this study was limited by the use of only 110 participants. This affected the reliability of the study considerably.

Lastly, a study by Woda, Belknap, Haglund, Sebern, and Lawrence (2015) explored various factors that influence self-care behaviors among African Americans with heart failure. Through the use of the photovoice method, participants in this study related critical lifestyle factors through photography. On this, the researcher and participants met for reflection as well as discussion two hours per week for six weeks. In such a way, the descriptive qualitative study design was selected to analyze the current factors and the way they impact patients with heart failure (HF). The findings of this study revealed that the environment usually has an inherent and direct influence on HF self-care.

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As such, having friends and care managers played a substantial role in promoting self-care among these patients. The main strength of this study is that findings may play a profound role in assisting policymakers, patients, healthcare professionals, as well as support systems in understanding the complexity of engaging in self-care. One limitation of the study is that the final collective analysis of all photographs did not occur with all participants. This implies that the discussion may have led to an alteration of themes.

Research Approach and Design

According to Maltby, Williams, Mcgarry, and Day (2014), a research approach may either be qualitative or quantitative. The qualitative research approach usually entails working with subjective data. This includes data that cannot be expressed in numerical forms such as anger, attitude, and happiness. On the other hand, quantitative research design entails working with data that can be presented in numerical forms such as distance, speed, and height. On this understanding, this particular study will use quantitative data. This is due to the fact that the data obtained will be numerical.

The quantitative research design that will be adopted in this study is descriptive research. As posited by LoBiondo-Wood and Haber (2014), descriptive research is a study that is designed to depict the participants accurately. This implies that the descriptive approach typically presupposes describing the people who take part in the study. Creswell and Clark (2017) stress that descriptive research design is a scientific method that involves observing as well as describing the behavior of a subjective without influencing it in any way. There are three ways that can be considered when conducting descriptive research. These are observational, case studies, and surveys.

The survey will be used in this particular study, where the participants will be issued with questionnaires to fill. This will help the researcher in obtaining data easily related to the factors that influence self-care issues among elderly patients. This is not possible to achieve through the use of quantitative research designs such as experimental or quasi-experimental.

The use of descriptive research design, as argued by Maltby et al. (2014) has its own advantages and disadvantages. In relation to advantages, participants are normally observed in the unchanged and natural environment. This helps in ensuring that the data collected is valid and reliable. Data collection in descriptive research design allows the researcher to gather in-depth information, which enhances the quality of the study. Descriptive research design has also been found to result in a collection of rich data that is collected in large amounts (LoBiondo-Wood & Haber, 2014). This, as a result, enhances data accuracy and reliability.

When it comes to the disadvantages of descriptive research design, one of them is that the study cannot be replicated. Additionally, participants in the descriptive research design may fail to behave naturally when they know that they are being studied. Lastly, findings in descriptive research design may be open to interpretation. This, as a result, may compromise the quality of the study to a considerable extent.

Sampling

The target population of this study includes elderly patients suffering from chronic illnesses such as diabetes and heart failure. When it comes to sampling, LoBiondo-Wood and Haber (2014) have argued that it is a technique of selecting subjects to present the entire population. Sampling may either be probability or non-probability depending largely on the nature of the study. Probability sampling will be adopted in this study. This technique, as articulated by Creswell and Clark (2017) involves selecting samples where every member of the population gets a fair chance of selection. Through the use of this technique, convenience sampling will be used, which entails selecting participants on the basis of their availability and willingness to participate.

In relation to the sampling procedure, 100 participants will be used in this study. Precisely, the participants will be elderly patients with chronic illnesses. Therefore, as regards inclusion criteria, patients who are more than 60 years will be included in the study. Additionally, participants must be patients suffering from chronic illnesses. On the contrary, as regards to exclude criteria, patients who are below 60 years will be excluded from the study. Besides, patients with no-chronic illnesses will also be excluded from the study.

The selected participants will be issued with a questionnaire, where they will fill in information related to their self-care. One of the main advantages of this sampling procedure is that it will ensure that only the most appropriate subjects take part in the study. This, as a result, will play a pertinent role in guaranteeing that the research aim and objectives are achieved. One of the disadvantages of this sampling procedure is the limited number of participants. As such, 100 participants may not provide the information needed to come up with a comprehensive conclusion on the factors affecting self-care issues among elderly patients.

In relation to confidentially, a wide range of scholars has affirmed that it is critical in ensuring that the rights of the participants are not violated. Additionally, enhancing the confidentiality of participants typically help in preventing possible threats and victimization. Therefore, in this particular study, the anonymity of the participants will be improved in various ways. Firstly, the participants of the study will be requested not to indicate their names on the questionnaires. This implies that they will remain anonymous. Confidentiality can also be enhanced by ensuring that the personal information of the participants is not shared with third parties, which may, in turn, invade their privacy and confidentiality.

Proposed Implementation with a Change Model

The Plan-Do-Study-Act (PDSA) change model will be used in the implementation of this EBP project. Taking this into account, the PDSA is a model used in testing a change that is implemented. This is usually through going through the prescribed four steps, which helps in breaking down the tasks into steps, evaluating the outcome, as well as testing again (Okafor, Ede, Kinuthia, & Satcher, 2018).

Therefore, in relation to this particular project, in the planning phase, concise statements on what to be done will be noted down. Background information related to self-care will also be made ready in this phase. In the second phase, the implementation of the project will be done. This will entail collecting data by issuing questionnaires to 100 elderly patients with chronic illnesses. The next stage will be studying the results of the data collected.

This will help in making a useful conclusion regarding the factors that affect self-care issues among elderly patients. The last phase will be acting, where the findings of the study will influence practice. Precisely, understanding factors influencing self-care issues will provide insights into how these issues can be solved to enhance patient outcomes.

One possible barrier to the implementation of the results of this EBP is inadequate stakeholder support. On this, despite the fact that the project may lead to improved patient outcomes, multiple stakeholders including nurses, physicians, as well as other medical practitioners may fail to support it. However, overcoming this barrier be possible through training various stakeholders on the significance of the results in ensuring that the needs of the patients are taken into consideration.

It is evident that an environment that fosters EBP in a practice setting can enhance positive staff and patient outcomes. This is no different when it comes to my future practice setting. Precisely, cultivating such an environment would entail advocating for evidence-based practices in the treatment of nurses. However, constant communication should be established for different stakeholders to have an understanding of specific evidence-based practices.

Conclusion

Conclusively, it has been established from this paper that the proposed project entails evaluating the factors that influence self-care among elderly patients. This paper has stated that there exist positivist schools of thought on the various factors impacting self-care among elderly patients. To conduct this study, quantitative research designs were adopted, where the descriptive paradigm will be used. The sample size includes 100 elderly patients with chronic illnesses. Data will be collected through questionnaires, where the participants will be required to fill the questions provided. The PSDA model of change will be used in evaluating and testing the project.

This will determine the extent to which the results of the study can be applied in an ideal clinical setting. However, fostering an environment that supports the implementation of EBP results has been found to be pertinent in enhancing nursing practice. This can be possible by maintaining effective communication with all the involved stakeholders. Besides, this can be achieved by advocating the use of evidence-based practices in treating patients within a clinical setting.

References

Amelia, R. I. N. A., Lelo, A. Z. N. A. N., Lindarto, D. H. A. R. M. A., & Mutiara, E. R. N. A. (2018). Analysis of factors affecting the self-care behaviors of Diabetes Mellitus type 2 patients in Binjai, North Sumatera-Indonesia. Asian J Microbiol Biotechnol Environ Sci, 20(2), 361-7.

Chang, A. K., & Lee, E. J. (2015). Factors affecting self‐care in elderly patients with hypertension in Korea. International Journal of Nursing Practice, 21(5), 584-591.

Çiftçi, B., Yıldırım, N., Altun, Ö. Ş., & Avşar, G. (2015). What level of self-care agency in mental illness? The factors affecting self-care agency and self-care agency in patients with mental illness. Archives of Psychiatric Nursing, 29(6), 372-376.

Creswell, J. W., & Clark, V. L. P. (2017). Designing and conducting mixed methods research. Sage Publications.

Kamrani, A. A., Foroughan, M., Taraghi, Z., Yazdani, J., Kaldi, A. R., Ghanei, N., & Mokhtarpour, R. (2014). Self-care behaviors among elderly with chronic heart failure and related factors. Pak J Biol Sci, 17(11), 1161-9.

Koç, Z. (2015). The investigation of factors that influence self-care agency and daily life activities among the elderly in the northern region of Turkey. Collegian, 22(3), 251-258.

LoBiondo-Wood, G., & Haber, J. (2014). Nursing research-e-book: Methods and critical appraisal for evidence-based practice. Elsevier Health Sciences.

Mair, C. A., Quiñones, A. R., & Pasha, M. A. (2015). Care preferences among middle-aged and older adults with chronic disease in Europe: Individual health care needs and national health care infrastructure. The Gerontologist, 56(4), 687-701.

Maltby, J., Williams, G., Mcgarry, J., & Day, L. (2014). Research methods for nursing and healthcare. Routledge.

Okafor, M., Ede, V., Kinuthia, R., & Satcher, D. (2018). Explication of a behavioral health-primary care integration learning collaborative and its quality improvement implications. Community Mental Health Journal, 1-7.

Paterson, B., Thorne, S., & Russell, C. (2016). Disease-specific influences on meaning and significance in self-care decision-making in chronic illness. Canadian Journal of Nursing Research Archive, 34(3).

Rajpura, J., & Nayak, R. (2014). Medication adherence in a sample of elderly suffering from hypertension: evaluating the influence of illness perceptions, treatment beliefs, and illness burden. Journal of Managed Care Pharmacy, 20(1), 58-65.

Uchmanowicz, I., Wleklik, M., & Gobbens, R. J. (2015). Frailty syndrome and self-care ability in elderly patients with heart failure. Clinical Interventions in Aging, 10, 871.

Woda, A., Belknap, R. A., Haglund, K., Sebern, M., & Lawrence, A. (2015). Factors influencing self-care behaviors of African Americans with heart failure: A photovoice project. Heart & Lung: The Journal of Acute and Critical Care, 44(1), 33-38.

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