Grand Canyon University
July 18, 2018
Literature Review
Taking care of the elderly population can be a challenge for nurses and other medical populations because of the vulnerability of this population group. People above the age of 65 tend to be susceptible to main healthcare issues while in the primary care setting. For instance, they experience many health issues because of their decreasing immunity and their cognitive functioning might deterotiated. While receiving care, these patients are also susceptible to medication allergies and falls among other problems. This makes working with these populations relatively challenging. To guarantee quality and safety in elderly patients’ care it is important to improve nurses’ workflow issues and use of health information technologies. This literature review analyses articles on improving workflow in primary care settings.
Comparison of Research Questions
The studies that have been selected for this research mostly help to answer the question of the relationship between workflow and quality of care. The research question in Isono et al. (2017) is “How can time be reduced for nursing assistants who spend time on the referral tasks?” This study aims to understand the strategies that can be used to optimize the referral processes for nurses so that they can maximize efficiency in the provision of care. This question contributes to understand how nursing workflow can be improved to enhance quality of care. Brady et al. (2017) tried to determine if timely patient flow is a priority to all healthcare organizations. Similarly, Holeman et al. (2016) seeks to understand how workflow influences the quality of care. These questions helps to answer the issue of the relationship between workflow and quality of care. Sing et al. (2013) investigates whether the six competencies of Accreditation Council for Graduate Medical (ACGME) has been helpful in improving workflow. This study has established that workflow is an important factor in care quality; hence, it aims to understand if the ACGME strategies in place are effective in ensuring an effective workflow for medical professionals. Joling et al. (2018), Ferass, Pessôa and Ferla (2015), and Fliss et al. (2017) focused their researches specifically on the elderly population. Joling et al. (2018) asks the quality indicators for quality elderly care. Ferass, Pessôa and Ferla (2015) investigates how nurses’ attention networks can affect care for nurses. Lastly, Fliss et al (2017) evaluates the effect of healthcare utilization among the elderly populations. However, Renolen et al. (2018) aims to understand “What are the challenges nurses encounter in integrating evidence-based practice into their work?” This study aims at determining the issues that affect nurses as they try to implement evidence-based practice. This research takes a different like from the others but it is important in showing that time and workflow are issues that affect evidence-based practice.
Comparison of Sample Populations
Joling et al. (2018) and Ferass, Pessôa and Ferla (2015) are the only research among the analyzed articles who do not follow an experimental study design. The studies were systematic reviews that evaluated articles collected from online databases. The study by Isono et al. (2017) was done using 25 nursing assistants as the sample. Renolen et al. (2018) conducted their study using 54 RNs and (nursing assistants from two wards in a Norwegian hospital. Brady et al. (2017) performed their study at a 500 bed tertiary hospital in Ireland with 52 participants. Singh et al. conducted plot tests in institutions in Colorado and New York. Holeman (2015) used 10 primary care physicians from 10 different Midwestern hospitals in the U.S. Fliss et al. Studied 8 general hospitals in Israel. One common factor with these sample selections is that the researchers have used too small of samples. This decreases the applicability of the results they collect.
Comparison of Limitations
One common limitation in all the studies is in their sampling, which affects the applicability of the collected results. For the experimental studies in this review, most of the samples are too small. None of the studies has a sample size that is more than 100 participants. Additionally, they are too centralized either to one or two medical institutions in a specific geographical location. The risk of having a small sample is that the results may fail to be representative of the occurrences in the entire population. This makes it hard to apply the results to other settings. The limitation with the systematic review articles by Joling et al. (2018) and Ferass, Pessôa and Ferla (2015) is that they bear the biases and limitations transferred from the analyzed articles. However, each of the studies’ limitations is manageable and does not have an impact that is too big to compromise the credibility of the registered results.
Conclusion
The studies that have been evaluated above are helpful in showing that it is important to improve nursing workflow to help improve the quality of care for elderly people, which is the study topic for this research. A majority of the studies help to answer the question of the relationship between workflow and the quality of care. There is also an investigation of the barriers to evidence based practice and the recommendations for strategies to improve care. However, future studies need to conduct their researches with larger sample groups. A larger sample will help to diversify the results to get more accurate representations of the entire population.
References
Brady, A. M., Byrne, G., Quirke, M. B., Lynch, A., Ennis, S., Bhangu, J., & Prendergast, M. (2017). Barriers to effective, safe communication and workflow between nurses and non-consultant hospital doctors during out-of-hours. International Journal for Quality in Health Care, 29(7), 929-934.
Ferass, Pessôa and Ferla (2015). Improving Healthcare Quality to Elderly by Organizing of Attention Networks. Journal of Community Medicine and Health Education, 5(332)
Fliss, E., Weinstein, O., Sherf, M., & Dreiher, J. (2017). Healthcare services utilization following admission for hip fracture in elderly patients. International Journal for Quality in Health Care, 30(2), 104-109.
Holman, G. T., Beasley, J. W., Karsh, B. T., Stone, J. A., Smith, P. D., & Wetterneck, T. B. (2015). The myth of standardized workflow in primary care. Journal of the American Medical Informatics Association, 23(1), 29-37.
Isono, H., Suzuki, S., Ogura, J., Haruta, J., & Maeno, T. (2017). Improving the workflow of nursing assistants at a general hospital in Japan. BMJ Open Qual, 6(2), e000106.
Joling, K. J., Van Eenoo, L., Vetrano, D. L., Smaardijk, V. R., Declercq, A., Onder, G., ... & Van Der Roest, H. G. (2018). Quality indicators for community care for older people: A systematic review. PloS one, 13(1), e0190298.
Renolen, Å., Høye, S., Hjälmhult, E., Danbolt, L. J., & Kirkevold, M. (2018). “Keeping on track”—Hospital nurses’ struggles with maintaining workflow while seeking to integrate evidence-based practice into their daily work: A grounded theory study. International journal of nursing studies, 77, 179-188.
Singh, R., Singh, A., Singh, D. R., & Singh, G. (2013). Improvement of workflow and processes to ease and enrich meaningful use of health information technology. Advances in medical education and practice, 4, 231.
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