Healthcare Delivery in Nursing Homes and Psychological Help for Elderly

The issues selected for analysis related to healthcare delivery in nursing homes and psychological help for the elderly. The article “Improving Psychosocial Care in Nursing Home Settings: The Next Challenge” by J. Zlotnik, B. Vourlekis and C. Galambos, C. (2006) describes the problems and challenges faced by nursing homes and strategies used to improve outcomes. Researchers find that psychological help and support for older individuals is of additional importance because the burden of chronic illness is greater among the elderly.

The article depicts that nursing homes have reduced the importance of social network measures for the health status of elderly individuals. Because data showing social support inversely related to ethics is strikingly consistent but data for a relation of support to disease onset is minimal, the issue of social support and recovery from illness assumes particular significance for understanding the method support operates. “Quality nursing home care is an issue for public concern as about 5 percent of elderly people live in these facilities, including a higher percentage of the oldest old (85 years and older), as well as an increasing number of patients who cycle through nursing facilities, which are increasingly providing subacute care” (Zlotnik et al 2006, p. 83).

Other research studies support the same idea explaining that ethical measures included a social network index and a three-level functional index reflecting the number of individuals who were available to talk about problems. The prognostic analyses focused on survival time after intake and included a medical risk score composed of corporeal variables measured at intake and shown empirically to be significant predictors of survival. The research states that: “There is a need to better describe what “best practice” social work services in nursing homes look like and what mechanisms exist to better monitor psychosocial care” (Zlotnik et al 2006, p. 83).

Results showed that individuals with greater emotional support are more likely to survive, and emotional support should be related to survival at all points during the follow-up interval. Individuals with high support times are as likely to survive compared to those with low support, an effect dimension comparable to effects for several therapeutic risk factors measured in the study. A similar trend is noted for the social network data but is not significant. A functional measure (emotional support from the medical staff) is positively related to perceived health (Leininger and McFarland 2002).

Leininger and McFarland (2002) suppose that the combination of good marital affiliation and high visiting is related to less pain drug usage after surgery and faster release from the nursing homes. Data shows a better quality of life, more ambulation, and less cigarette smoking at follow-up. Nursing support and positive relations with medical staff are significant in these analyses when their correlation with psychological support is statistically controlled, suggesting an indirect effect. The research shows independent and opposite contributions for the; support in a nursing home is related to better change and disapproval is related to worse adjustment (Kemp (1999).

Therefore mediation of support effects through coping is shown and different pathways are demonstrated for supportive and unsupportive actions of medical staff. Researchers underline that “this can lead to policy improvements, which in turn can ultimately lead to improved quality of life and higher quality of care that will help residents “attain and maintain the highest practicable, physical, mental and psychosocial well-being” as called for in federal regulations” (Zlotnik et al 2006, p. 83).

The issues and trends show that lack of emotional support and moral issues in nursing homes create problems for elderly patients and their families. Fawcett ((2002) states that support and moral values are related to despair among individuals with inadequate support, but the effect of disability is significantly reduced for individuals with adequate support. These results show an effect of emotional support. The effect of emotional support is found to be important for trauma from valued social roles.

Emotional support should be acting in part to restore individuals’ perceptions of control in their important social roles, though perceived control is not openly measured. The effect of competence is attributed to the fact that interference with the regimen may derive from activities, therefore well- developed social skills should enable the elderly to cope better with these kinds of temptations (Zerwekh and Claborn 2009).

Emotional support and positive relations are related to outcomes. Among the elderly, the larger social network is related to less change in social control and recovery. It is supposed that social networks engage obligations that interfere with the successful organization of health behaviors. The researchers prove a great impact of emotional support on mental health outcomes (despair/anxiety symptoms or behavioral problems).

Research on nursing support for the elderly is more complex because individuals participate simultaneously in different types of networks. The researchers conclude that nursing homes should pay more attention to positive relations with elderly patients and emotional support. The results, obtained from analyses, show that emotional support is a protective factor in relation to mental health and behavioral outcomes. The variety of effects is surprising even to the investigators, who emphasized that the impact of emotional support on the elderly is not limited to a narrow domain.

References

Fawcett, J. (2002). The Nurse Theorists: 21st-Century Updates—Madeleine M. Leininger. Nursing Science Quarterly, 15 (2): 131-136.

Kemp, Ch. (1999). Terminal Illness: A Guide to Nursing Care. Lippincott Williams & Wilkins; 2 Sub edition.

Leininger, M. M., & McFarland, M. (2002). Trancultural nursing: Concepts, theories, research, and practices. 3rd edn. McGraw-Hill.

Zerwekh, J., & Claborn, J. (2009). (6th Ed.) Nursing today: Transition and Trends. St. Louis, MO: Saunders Elsevier.

Zlotnik, J. Vourlekis, B. Galambos, C. (2006). Improving Psychosocial Care in Nursing Home Settings: The Next Challenge. Health and Social Work, 31 (2), 83.