Outcomes of acutely ill older hospitalized patients following implementation of tailored models of care: a repeated measures (pre- and post-intervention) design

Int J Nurs Stud. 2007 Sep;44(7):1079-92. doi: 10.1016/j.ijnurstu.2006.04.017. Epub 2007 Jan 30.

Abstract

Background: There is a lack of research investigating models of nursing care for older hospitalised patients that address the nursing needs of this group.

Objectives: The objective of this study is to evaluate the efficacy of models of care for acutely older patients tailored to two contexts: an aged care specific ward and a medical ward.

Design: This is a repeated measures design. Efficacy of the models was evaluated in terms of: patient and nurses' satisfaction with care provided; increased activities of daily living; reduced unplanned hospital readmissions; and medication knowledge.

Settings: An aged care specific ward and a medical ward in two Sydney teaching hospitals.

Participants: There were two groups of patients aged 65 years or older who were admitted to hospital for an acute illness: those admitted prior to model implementation (n=232) and those admitted during model implementation (n=116). Patients with moderate or severe dementia were excluded. The two groups of nurses were the pre-model group (n=90) who were working on the medical and aged care wards for the study prior to model implementation, and the post-model group (n=22), who were the nurses working on the wards during model implementation.

Methods: Action research was used to develop the models of care in two wards: one for an aged care specific ward and another for a general medical ward where older patients were admitted. The models developed were based on empirical data gathered in an earlier phase of this study.

Results: The models were successful in both wards in terms of increasing satisfaction levels in patients and nurses (p<0.001), increasing functional independence as measured by activities of daily living (p<0.01), and increasing medication knowledge (p<0.001).

Conclusions: Findings indicate that models of care developed by nurses using an evidence-based action research strategy can enhance both satisfaction and health outcomes in older patients.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Acute Disease / nursing*
  • Acute Disease / psychology
  • Aged / psychology
  • Aged, 80 and over
  • Analysis of Variance
  • Attitude of Health Personnel
  • Geriatric Assessment
  • Geriatric Nursing / organization & administration*
  • Health Services Needs and Demand
  • Hospital Units / organization & administration*
  • Humans
  • Job Satisfaction
  • Models, Nursing*
  • New South Wales
  • Nursing Evaluation Research
  • Nursing Staff, Hospital / organization & administration
  • Nursing Staff, Hospital / psychology
  • Outcome Assessment, Health Care
  • Patient Care Planning / organization & administration*
  • Patient Satisfaction
  • Patient-Centered Care / organization & administration*
  • Program Evaluation
  • Total Quality Management / organization & administration