Running head: CHALLENGES IN TRANSITIONAL CARE Challenges in Transitional Care Frank Calderon Florida National University Dr. Jorge Hirigoyen 2/1/2019 1 CHALLENGES IN TRANSITIONAL CARE 2 Challenges in Transitional Care Introduction to the Problem The case of failure in transitional care for the elderly and the chronically ill patients shows the challenges in transitional care. Transitional nursing is the continuity of treatment of the patients during the movement from one health center to another or home. The incidence rehospitalization of people who have been released from the medical facilities to go home for recovery is high. According to Ortiz research, in 2015, 35.6% of hospital readmission within 30days of discharge is of elderly patients of age 75- 84. The authors indicate that this is due to the patients worsening instead of getting better. Caregivers report that they do not know how to handle the patients that are left in their care. Storm and Aase (2014) elaborate that physicians say that elderly patients who have acute conditions are in vulnerable positions of breakdown if the proper transition is absent. This is after evaluating that some of the deaths reported of elderly patients in home-based and community- based care be caused by poor. Ye and Quan (2016) point out that in 2012, China had the practice of the medical practitioners discontinuing patient's care once the patient is discharged. The recovery care task was left with caregivers. This practice led to 30 percent of patient declining in their well-being and regular functioning after been released from the hospital especially the elderly. In the homebased care, they lacked professional monitoring. In addition to the issue in the transition of the elderly from the hospital to their home, the other failure is the transitional care within the medical setting. Ortiz (2019) explains that the main case identified is medication mix-up and CHALLENGES IN TRANSITIONAL CARE 3 error during the movement of the patient emergency department to the intensive care unit. It also includes the surgical unit setting. Problem Statement Lack of specialized nursing intervention is the cause of the challenges in transitional care. It causes the readmission of elderly patients with acute illness. The handoff of patients with no clear communication to the caregivers on how to take of them cause mishandling of the patient (Morphet & Williams, 2014). Most caregivers as well not trained on how to provide primary care to their patient. As a result, they develop other conditions, or their case elevates and hence the need to go back to the hospital. In some case, the patient may lack friends or family members to look after him or her. In such a situation, the patient requires a transitional nurse to fulfill his/her medical needs. The absence of one threatens the life and well-being of the patient. The difficulties of transitional care within the medical setting are as a result of lack of specialized nurses who are skilled and knowledgeable about providing professional care. Storm and Aase (2014) illustrate that the issue of delay in the provision of therapy places the patient at risk. This is a challenge that results because of unprofessional nurse handling the transfer of the patient from unit to another. A specialized nurse is aware of the importance of timely and complete communication. Poor transitional care in chronically ill people exists due to improper coordination between the emergency department nurse and the one in the ICU. Ortiz (2019) asserts that lack of organization confuses the right therapy for the patient which in turn causes the delay in the recovery of the patient or the development of complications. Furthermore, unlike a regular nurse, a specialized nurse provides quality transitional care. They are experienced, well-trained and knowledgeable in giving transitional care. A CHALLENGES IN TRANSITIONAL CARE 4 general nurse will administer primary care for an ill person who is hospitalized. It is evident that the provision of transitional care by ordinary medical practitioners is the cause of low-quality care. This creates patient and caregiver dissatisfaction. The significance of the problem to Nursing The research problem is significant to nursing. The problem is; lack of specialized nursing is the cause for the challenges in transition care. It directly concerns the nursing profession. It raises awareness of the weakness of nursing in transitional care. It identifies that nursing service in transitional care is poor. Patients are sent off without continuity care from professionals till they fully recover. Moreover, the wrong care is given to the patients when they are moved within hospitals from one setting to entity as nurses commonly provide the wrong medication. The problem also informs the nurses their weakness in communication. It implies that unspecialized nurse is not keen in providing timely and complete information to facilitate continuity care. It mainly raises concerns in nurses in units where that transfer takes place. The problem as well illuminates to nurses that poor professional coordination between them is resulting in transitional care challenges since it hinders consultation and provision of information. It similarly notifies the nurses their shortfall in performing specific crucial nursing roles. The first one is ensuring the patient with no caregiver receives transitional care from them. Secondly, it is educating the caregivers on how to handle the patients. In addition to informing the nurses on the weak areas, it is enlightening them how to improve the nursing job. It is asserted that specializing in transition care will enhance their task of providing care to patients. Therefore, it is recommended that nurses who deal with transitional care get additional education CHALLENGES IN TRANSITIONAL CARE 5 to gain skill. Finally, the problem cautions the nurses on the impact of lack of knowledge and expertise. It shows that the implications are detrimental to the patients whose health are already vulnerable. Purpose of the Research The purpose of the research is to improve the quality of transitional care. There is a lot of research about the quality of the general health in the hospital. Therefore, various stakeholders have invested in facilitating quality treatment. Nevertheless, the issue of transitional care has not little study and as a result their no broad awareness of the matter concerning transitional care, its challenges, and importance. This, in return, has led to little attention from the government, physicians and donor, individuals who can contribute to promoting good transitional care. This prompted my research on challenges in transitional care to implore the health stakeholders to look into the issue and promote quality transitional care. Furthermore, I considered research into the challenges of transitional care would be a way to inform the nurses on the areas of their weakness and as a result, encourage them to improve. It will eventually translate to quality transitional care. My research exposes the challenges faced in transitional care and the problem which is lack of specialized nurses. In addition to the nurses, it also creates awareness for the caregiver and relevance of seeking help from transitional nurses. My study likewise enlightens the medical trainers on the significance of including transitional care in the nursing curriculum. Consequently, all nurses will have basic knowledge of rendering such care Finally, through researching the subject on transitional care, I offer a platform for further research into the area. Therefore, it will promote a better understanding of the issues facing transitional care. This helps the stakeholders to see the severity of the issue and provide CHALLENGES IN TRANSITIONAL CARE 6 assistance. Further research will likewise suggest better solutions to address the problem facing transitional care. Research Questions What is the impact of unspecialized nursing in transitional care? Why do unspecialized nurses promote low-quality transitional care? What are the pros and cons of specialized nursing versus general nursing? Master’s Essentials Alignment with My Topic Master's essentials align with my topic. It concurs with what my topic implies. The second essential indicates that organizational and system leadership is crucial in quality and safe patient care. My topic, on the other hand, illuminates on the importance of leadership in patient care as some of the challenges like communication and corporation are due to lack of leadership. Master's essential III as well support the topic problem which suggests that lack of specialized nurses is the cause of challenges. The essential state that master-level nurses are aware that quality care goes hand in hand with the methods and tools used. Similarly, the topic indicates that the use of unspecialized nurses who have no master is the cause of the low-quality transitional care. Essential VII, interprofessional collaboration asserts that masters prepared nurse is a leader and member of the team who can communicate, cooperate and consult with other professionals. Similarly, the topic agrees as it suggests that the challenges of lack of communication, coordination, and consultation. It adds that this due to the use of unspecialized nurses implying that nurses with maser can overcome the challenges. CHALLENGES IN TRANSITIONAL CARE 7 The topic as well matches with essential IX. It is concerned with master-level practice. It states that nurses with master's level have scientific knowledge and the capability to apply it into practice. My topic suggests that unspecialized nurses are not as competent as the specialized ones who have a master’s degree. Therefore, they pose challenges in transitional care which wouldn't have been the case if specialized nurses conducted the care. This essential as well claim that master's prepared nurses can influence positive healthcare result. The topic echoes that specialized nurses perform transitional care better compared to general nurses. CHALLENGES IN TRANSITIONAL CARE 8 References Morphet, J., Griffiths, D. L., Innes, K., Crawford, K., Crow, S., & Williams, A. (2014). Shortfalls in residents’ transfer documentation: Challenges for emergency department staff. Australasian Emergency Nursing Journal, 17(3), 98-105. Ortiz, M. R. (2019). Transitional Care: Nursing Knowledge and Policy Implications. Nursing Science Quarterly, 32(1), 73-77. Storm, M., Siemsen, I. M., Laugaland, K., Dyrstad, D., & Aase, K. (2014). Quality in transitional care of the elderly: Key challenges and relevant improvement measures. International Journal of Integrated Care, 14(2). Ye, Z. J., Liu, M. L., Cai, R. Q., Zhong, M. X., Huang, H., Liang, M. Z., & Quan, X. M. (2016). Development of the Transitional Care Model for nursing care in Mainland China: a literature review. International journal of nursing sciences, 3(1), 113-130. Running Head: DESIGN PHASE 2 1 Design Phase 2 Frank Calderon Florida National University 2/27/2019 DESIGN PHASE 2 2 Design Phase 2 Methodology and Design of the Study The study of transitions included the acute admissions of elderly individuals to the hospitals up to the nursing homes of from the home to a home with a home-based care services. Additionally, it included the discharge transitions of elderly from hospitals to a nursing home or home also to home-based care services. Therefore, the methodology included participant observation of admission and discharge transition process. This involved an open-ended conversation with the patients and also with the patient's next of kin’s while involving the health care personnel (Design and Methodology of a Mixed Methods Follow-up Study to the 2014 Ghana Demographic and Health Survey, 2017). The observation also entails a collection of data which is guided by a thematic guide which is adapted to the admission and discharge transition in the health facilities. During the observation, the admission includes observing the patient being handed over from the ambulance to the paramedics and healthcare professionals in the emergency departments so that the patient can be observed until he is handed over to the medical ward for further treatments. During this research, the observation covers the data on interaction, coordination as well as dialogue between the health practitioners and the patient. The observation ends when the researcher has a short conversation with the patient and also with the healthcare personnel on the admission day so as to help in clarification of some aspects pertaining to the current admission as well as the entire process of admission. DESIGN PHASE 2 3 Additionally, the observation of transitions of discharge commenced at the hospital ward on the expected day of discharge. It involved the conversation between the researcher and the healthcare practitioner and the person who is going to be discharged. The interaction also with the coordination and dialogue taking place between the healthcare practitioner and the patient is observed. Such a conversation is very helpful since it helps in understanding the discharge processes and discharge transition. Short follow of up conversation also helps in understanding more the processes and the bases of decisions made before a patient is discharged (Design and Methodology of a Mixed Methods Follow-up Study to the 2014 Ghana Demographic and Health Survey, 2017). Sampling Methodology The sampling method used in the research was sampling which was utilized in the recruitment of the participants to take part in the study. Additionally, the homecare offices in various municipalities of the country were contacted and informed on the project and the need for the nursing leaders to participate in interviews which will enable the researches to get the necessary information which will also enhance their research. From these interviews, data is collected which also shed light on the nursing leaders role and experience in the process of transition especially for the older patients from the hospital to home. This implies that the interviews are conducted only for data collection (Sahu & Singh, 2016). In essence, the semi-structured interview guide dictated what the interviews should cover and how it should be carried out. It starts with the general, discussion of transition processes and the patients experienced pertaining to transitions received at homecare. The participants in this regards will focus on all the experiences on the transition from the hospital to their homes, and DESIGN PHASE 2 4 then researchers will decide on what next (Johnson, Pennell, Stoop, & Dorer, 2018). The guide for the interview also entails themes which include the organization of the internal and external cooperation, the personal resources together with values which guide the quality of the care services. Necessary tools Various technologies and tools are used in the research process. However, the primary consideration if the health information technology tools which help to smoothen the transition processes of the patients. It is worth noting that health IT involves numerous technologies such as electronic health records. The electronic health records entail saving of patient’s information electronically on computers which will enable retrieving exercise to be very easy. Additionally, it includes clinical decision support which also enables the health care personnel to make an effective decision which ensures that the patients are handled very well and the decisions made helps them to regain their good health. In essence, the health IT performs very significant tasks in various aspects of transitions. It helps in capturing the information pertaining to the patient which helps in informing the transition processes as well as the clinical history of the patients and what needs to be done during the transition process. It is coherent that the design of the health IT has the ability to support the transition process especially in supporting the individuals who are involved in the transition processes (Riba, Parikh, & Greden, 2019). With the information technology as well, the healthcare professionals will be able to connect to the home care services where the elderly have been taken so that they can be taken care of until they get well or improve on their health before they are being taken to their respective homes. DESIGN PHASE 2 5 Any algorithms or flow maps created The various algorithms created during the research include the Fourier transform which helps in enhancing the senses of individuals. This is because the Fourier transform has been dubbed to be one of the most significant algorithms in the healthcare sector. This transformation is a mathematical technique which is used in breaking the complex signals which in turn will enable the healthcare personnel to see the variation in their activities and what needs to be attained. This helps in ensuring that they attain the objective of the organization. It is also used in medical imaging which helps in creating date to check whether the patients who had undergone imaging are fit to be discharged to be taken care of at homes. There is also a Mumps algorithm which is a healthcare operating system which was developed in the 1960s but has been improved lately to reflect on the current needs of the patients and the medical sector. Therefore, it can be denoted as a computer program which is used in the healthcare today to run multiple programs and enable the healthcare personnel to understand the status of numerous patients and decide on the next course of action. This operating system is currently used in the powering of the entire hospital departments which helps in the management of clinical records to enable the healthcare facilities to save a lot of time in assessing the health care records for patients and improve the workplace efficiency (Morr & AliHassan, 2019). Consequently, the probabilistic data matching is another algorithm which enables numerous computer searches which are deterministic to be carried out. This is because it carried DESIGN PHASE 2 6 out byte by byte comparison which can mainly be used for typographical or data entry processes. Such probabilistic algorithms are depicted to look for a various bit of information especially in the medical records while ranking them according to the likelihood of the patients adopting very well to the medication and estimate the time which the patient can remain within the hospital before they are discharged to home care through a transition which will see them gain good health. This probabilistic data help in retrieving of useful information which helps in research. Further, the medical algorithms as well as aids for decision making which will help in promoting safe healthcare as it also helps the healthcare personnel to enable them not to make mistakes when carrying out their tasks. It is worth noting that with the increase in awareness of the medical errors recently, it is also believed that the health professionals are using these techniques into guiding them to offer quality care services and understand the patients and those who need to go to various homecare homes when they need specialized care. A medical algorithm in this regard can be a low tech as a lookup or a decision tree which helps in carrying out complex decision making through the help of programming (Morr & Ali-Hassan, 2019). Therefore, the medical algorithms remove some of the medical uncertainty decision which in turn will help in improving the efficiency and most importantly the accuracy of the teams provided. Notably, the health score which helps in quantifying illness also is another algorithm which helps in evaluating the health status of the patients and deciding whether they should be discharged to their homes to homecare homes which will be looked on by the professional nurses. The nurse wills the physicians in monitoring as well as predicting the patient prognosis basing on the multitude factors. It is, therefore, a system which helps in handling the patients DESIGN PHASE 2 7 holistically on wellness matter and ensuring that the transition process is carried out following the correct and effective procedure. Literature Review According to Benten and Spalding (2018), it is depicted that the older people's experience regarding their transfer from the hospital to their immediate care homes were not informed. In essence, few of the older people felt that they were engaged and participated in the d4ecision making process pertaining to their transfer from the hospitals to the homes where they also are well taken care of. Therefore, most of the patients thought that there are various reasons for the transfer and the main reason for it all entails the bed blockers. Most of them, however, did not know when they were enrolled in the active rehabilitative programs as they just found themselves in. Additionally, Perry et al. (2011) showed that there was no shared decision when it comes to the physicians deciding on the patients going home and the dependence of the family to feel confident. Most of the patients explained they view that they were not willing to leave the hospitals unless they were assured of formal or even informal care arranged for them. In this regards, it is coherent that the elderly patients trusted so much the health services system. It was also noted that these patients followed everything they were told by the doctors and never complained at all. This, therefore, implied that the patients could not take part actively in the decision making since they were not so much aware of the formal discharge plans made. Notably, Gibbon (2004) explained that many patients were found to have a desire of going back to their homes as soon as possible but were always worried on the way they would DESIGN PHASE 2 8 cope since they still needed care. Therefore, the staff held a weekly conference which the patients were never invited as they were also not aware of. References Benten J, Spalding NJ (2008) Intermediate care: what are service users’ experiences of rehabilitation? Qual Aging 9(3):4–14 Design and Methodology of a Mixed Methods Follow-up Study to the 2014 Ghana Demographic and Health Survey. (2017). Gibbon B (2004) Service user involvement: key contributors, goal setting and discharge home. JARNA 7(3):8–12 Johnson, T. P., Pennell, B., Stoop, I. A., & Dorer, B. (2018). Advances in Comparative Survey Methods: Multinational, Multiregional, and Multicultural Contexts (3MC). Hoboken, NJ: Wiley. Morr, C. E., & Ali-Hassan, H. (2019). Analytics in Healthcare: A Practical Introduction. Basingstoke, England: Springer. Perry MAC, Hudson S, Ardis K (2011) If I didn’t have anybody, what would I have done? Experiences of older adults and their discharge home after lower limb orthopaedic surgery. J Rehabil Med 43:916–922 Riba, M. B., Parikh, S. V., & Greden, J. F. (2019). Mental Health in the Workplace: Strategies and Tools to Optimize Outcomes. Springer. Sahu, S. K., & Singh, T. J. (2016). Research Methodology: Latest Edition. SBPD Publications. Running Head: CHALLENGES IN TRANSITIONAL CARE Challenges in Transitional Care: Implementation Phase 3 Frank Calderon Florida National University Dr. Jorge Hirigoyen 3/10/2019 1 IMPLEMENTATION PHASE 2 Implementation Phase 1. Introduction The research project will be focused on investigating whether extra training of nurses in transitional care regarding medication reconciliation, communication with the patient in transitional care, and evaluation of the need for follow up test enhance the outcome in transitional caregiving. Given that the research design to be used will be a mixed method design where data will be collected and narratives recorded, there is need to have a proper plan before the implementation phase to ensure that all the resources are available, and relevant ethical and legal concerns are brought into consideration. Important to consider is that the study will be engaging human participants who make it extremely relevant to have ethical concerns looked into keenly (McKenney, & Reeves, 2018). The plan and the protocols and activities to be carried during the implementation of this project are discussed in this paper. 2. Creating a plan A. Activities to be carried and a timeline The activities to be carried include seeking relevant permissions. This will be done in person where the researcher will visit the offices of the relevant authorities to seek permission to conduct the study. This will be the first milestone to complete before doing anything. It will take at most first three days after the project work commences. The second activity will be inviting participants into the study. This will take 5 more days after the permission to speak with the nurses and the patients are granted by the relevant authorities. After the potential respondents have accepted our invitation to participate, they will be visited for data collection. Each visit will IMPLEMENTATION PHASE 3 see the researcher interview both the transitional care patient and their nurse per visit (McKenney, & Reeves, 2018). This is also supposed to take approximately 7 days after commencement. The fourth step will be data analysis for the statistical data collected, which is supposed to take at most 3 days. After the data has been analyzed, it will also be matched with the relevant narratives from the qualitative conducted through tape recording. This will take a day. Finally, the compilation of the final report will be easy, considering that all the prior work is ready. The compilation of the report, therefore, will take at most 3 days. This project is projected to follow the timelines in appendix 1. Appendix 1: Project timeline Deliverable Time scope Seeking Relevant permissions 12/3/2019 – 15/3/2019 Inviting participants to the study 16/3/2019 – 20/3/2019 Data collection 21/3/2019 -30/3/2019 Data Analysis 1/4/2019 – 3/4/2019 Report Compilation 4/4/2019 – 7/4/2019 B. Create a budget The budget will include all the relevant costs that include traveling allowance, purchase of materials necessary for the questionnaire, purchase for software relevant for data analysis, and also a lunch allowance for the researchers who will be working from morning to the afternoon. These items are projected to cost the researchers as described by the budget in appendix 2. IMPLEMENTATION PHASE 4 Appendix 2: Project budget item Cost Traveling allowance $400 Cost of questionnaire materials $20 Data analysis tools (software purchase) $35 Total Estimated Cost $455 3. Implementation a. Seek permissions from relevant authorities The project will include human participants. In the United States, the Institutes Review Board (IRB) looks into any study that will engage human participants, identifies the ethical consideration of the study, and only grants permission to studies that are seen to be ethical (Wolf, Walden, & Lo, 2005). The researchers will visit the nearest IRB to get approval for the study. Prior to the visit, there will be need to describe the ethical considerations of the study to the participants. One of the ethical considerations is that the researchers will keep the personal details of the participants anonymous (Mullarkey, & Hevner, 2019). Secondly, the researchers will also prove that the study, if successfully completed will be presented to the participants, and they will surely benefit from it (the cost-benefit ration should be below one) (Safapour, Kermanshachi, Habibi, & Shane, 2018, April). After getting permission from the IRB, the researchers will then visit the institutions they wish to get respondents from. This will be nursing homes since they have a higher number of transitional care patients and transitional care nurses. The researchers will speak to the IMPLEMENTATION PHASE 5 authorities to grant them permission to speak to their patients and nurses and also seek to get the physicians and patients’ emails (Mullarkey, & Hevner, 2019). This will be easy to accomplish after showing the institutional leaders an IRB certificate. 4. Invite the participants into the study through email Even with the organization’s permission, human subjects have the liberty to reject participation in the study (Wolf, Walden, & Lo, 2005). This implies that the researchers will have to invite at least 80 participants, whether patients or nurses, so that if 30 declines to accept or assumes the email the researchers will be able to work with 50. The invitations will be done through emails. The first email will be sent on the first day, inviting participants and describing the purpose of the study, and how it will benefit their field if successfully completed. Follow up emails will also be sent twice to potential participants who will take longer to respond to the first email (Mullarkey, & Hevner, 2019). Plans to visit the potential participants who accept our invitation will be made. 5. Carry the investigation recording the findings in tape and questionnaires After visiting the participants, a brief introduction will be necessary to make every participant relaxed. The introduction will describe the benefits of the research, restate the ethical considerations in place, and have a mood relaxing element that will make the participants relate with the researcher and be honest and free with them. After relieving the tension and familiarizing with the participants, the researcher will let the transitional care nurse continue with their work on the patients while he asks questions and fills in the questionnaire in an interview. Questions will be directed to both the nurse and the patient receiving transitional care. For confidential questions, each participant will be approached at the absence of the other participant IMPLEMENTATION PHASE 6 to ensure that the respondents are able to describe the negative concerns about the transitional care, especially the patients in the absence of the nurses. Tape recorders will be used while recording narratives that will be used in the qualitative part of the mixed methods research report. 6. Analyze the data and match it with the relevant narratives After data is collected from the field with the help of questionnaires filled in during the interviews, the data will be analyzed. The best analysis tool for this case will be the IBM statistical package for the social sciences (IBM-SPSS). Depending on whether the results on both the dependent variable and the independent variable will have a linear or non-linear correlation, a Pearson’s or Spearman’s correlation coefficient will be to analyze the presence of a relationship and its strength if any exists between the variables (Babbie, Wagner III, & Zaino, 2018). After this data analysis process, the narratives in tapes will be transcribed and matched to the relevant statistical outcomes. 7. Compile a report After data analysis, the final product will be designed. A report of the study is essential as evidence of the research and it also provides the most usable form of the research findings. The final research report will include the information that has been completed in the previous papers such as the introduction, literature review, research question, a hypothesis, research design and methods, findings/results, discussion, and the conclusion. This will be the end product of the whole research process (Safapour, Kermanshachi, Habibi, & Shane, 2018, April). Copies will be presented to all participants, the IRB, and the organizations that gave permission to complete the research. The researchers and the school will also retain copies of the findings. With the approval IMPLEMENTATION PHASE 7 of the professor, the researchers will upload the research findings to nursing journals so it can be of help to the rest of the transitional care stakeholders. IMPLEMENTATION PHASE 8 References Babbie, E., Wagner III, W. E., & Zaino, J. (2018). Adventures in social research: Data analysis using IBM SPSS statistics. Sage Publications. McKenney, S., & Reeves, T. C. (2018). Conducting educational design research. Routledge. Mullarkey, M. T., & Hevner, A. R. (2019). An elaborated action design research process model. European Journal of Information Systems, 28(1), 6-20. Safapour, E., Kermanshachi, S., Habibi, M., & Shane, J. (2018, April). Resource-based exploratory analysis of project complexity impact on phase-based cost performance behavior. In Proceedings of Construction Research Congress(pp. 2-4). Wolf, L. E., Walden, J. F., & Lo, B. (2005). Human subjects issues and IRB review in practicebased research. The Annals of Family Medicine, 3(suppl 1), S30-S37. Running head: RESULTS PHASE 4 1 Results Phase 4 Frank Calderon Nursing Research Florida National University Professor Dr. Jorge Hirigoyen 3/23/2019 RESULTS PHASE 4 2 Results In every research project or study the end is always the reporting of the results obtained from the various activities done during the data collection process (Ganann, McAiney, & Johnson, 2018). The research project was focused on investigating whether extra training of nurses in transitional care regarding medication reconciliation, communication with the patient in transitional care, and evaluation of the need for follow up test enhances the outcome in transitional caregiving. After the collection of data, various conclusions were arrived at that showed that extra training of nurses through the different aspects of the medical profession enhances the nurses to adapt to transitional caregiving. This was achieved through the visiting of various medical facilities and the collection of different information and data from the nurses in the facilities. The entire research project involved the use of both qualitative and quantitative designs through mixed research methods. Some of these methods included the use of questionnaires, sampling, interviews, surveying, and documentation. After their completion, the results were obtained, and it is also important to also note that the project had some few limitations that if not looked into can lead to some drawbacks to the future nursing studies. Demographics of the Population The population that was involved in the research project mostly involved the nurses who are the primary caregivers to the patients. After obtaining permission from the relevant authorities, different research methods were used, and the first method was that of interviews. A total of 40 nurses were interviewed from five different hospitals to find out whether transitional caregiving was improved by the application of the pieces of training on nurses. Among the 40 nurses, 32 of them had previously received training on transitional caregiving while eight were interested but RESULTS PHASE 4 3 had not yet gotten the chance to attend them. Some of the interview questions were about their feeling towards the transitional caregiving pieces of training and the question of whether they are effective or not. The questions involved the transitional aspects of medication reconciliation, communication with the patient in transitional care, and evaluation on the nurses. Questionnaires were the other type of data collection that was used during the entire research project to obtain the desired results. A total of 11 medical facilities were involved in the answering of the questionnaires while the total number of nurses that participated in the process was 115. This was the data collection method that brought a lot of feedback due to the demography of the population of the nurses involved. 103 nurses who participated in the filling of the questionnaires had received transitional caregiving pieces of training in the past and were the perfect audience to give feedback on the research topic. The other remaining 12 caregivers had an interest but had not yet involved themselves in the transitional caregiving training. The questionnaires were open-ended questionnaires that gave the respondents the opportunity to give feedback according to what they thought was right and did not give them some restrictions. Observations were the other method of data collection that was used, and it involved several hospitals which were assessed. There was a total of 11 medical facilities where the evaluation of how nurses who had received training in transitional caregiving behaved as compared to those who did not. From there different results were obtained and contributed significantly to the final results. The last method of data collection that was used was that of documentation. This involved the perusing and obtaining relevant information that could help bring some conclusion results to the research topic. It also involved the checking of previous studies that had been conducted in the past on transitional caregiving for the nurses and the results that were obtained RESULTS PHASE 4 4 from the studies. This was done from library worksheets and evaluation from documents from the 11 medical facilities that had been chosen. Descriptive Data Points After the evaluation of the questionnaires, the research was able to find out that being a nurse involves not just the primary role of providing healthcare services but also interact with the population living in the community. It is, therefore, to ensure that the characters one plays in the community fully respects the dignity of the people. 34 nurses were able to prove that authenticity during interactions as well as maintaining a positive attitude is vital to make them comfortable and more responsive when taking information or views from them. In a job that requires collaboration with the community, advocacy skills such as confidentiality and autonomy are of great importance (Kim & Park, 2017). Another role that the study identified that can help significantly in improving community health is the identifying of the cultural values in the community that promote health such as values, characteristics, and strengths that exist among the population and enhancing them through use of participatory practices. Identifying critical health issues in the community and determining the ones that require a high priority than the rest was found to be an essential skill that nurses can use as a community nurse to boost the healthcare of a community. In the population that was examined, it identified gaps that came with the need to improve healthcare overpower the resources available to achieve the same. Transitional caregiving involves being responsible and going beyond the nursing regular teachings as the study was able to find out through the results given by the interview. For example, the need to have clean and safe drinking and recreational water in the community that has been slowed down due to inadequate resources necessary for providing fluoridated water. Most people agree that prevention is better than cure, RESULTS PHASE 4 5 as expressed in the excerpt #@$%#@$, that states that allocating more resources to curb health problems is better than having to face the outcome of it. This stresses the need for allocating more resources aimed at improving community health for all by reducing these gaps. According to “The Healthy People 2020” which is a federal government strategic plan that provides science-based ten-year nation objectives for improving health equality for all Americans, some documentation towards the effectiveness of training on transitional caregiving to the nurses (Gibson, Kelly, & Kaplan, 2012). One of the several goals of this plan is to create social and physical environments that promote good health for all. This objective can be reached if specific steps are taken in the community. One of these steps is reducing outdoor air pollutants. The population should be guided and educated on the effects of air pollutants and actions that can be taken to reduce exposure levels. Another step that the study found to be very crucial to achieving this goal is by teaching the nurses on the different methods on how to improve their transitional caregiving skills. This can be achieved by developing and promoting strategies that provide benefits of fluoridation and utilizing tools to conduct surveys to monitor health care quality at different medical facilities and information from those caregivers who have undergone extra and modern training and other recreational facilities. These are the significant steps that are needed to achieve the goal of improving the nurses and caregivers towards the achievement of transitional caregiving. Another finding from the research project on transitional caregiving was that on the distribution and development of outreach materials to primary audiences such as teachers, parents, students and the community at large who spend time with the patients after they are discharged from the hospitals. Transitional caregiving according to the study involves the passing of information from nurses to other people through mass education and other educational processes. RESULTS PHASE 4 6 Many of the nurses that were interviewed stated that they do give the necessary information on how to communicate and take care of patient once are released from the hospitals. Lastly, all the nurses and individuals involved in the entire process agreed that transitional caregiving training is an important aspect that should be introduced to the entire medical delivery facilities. Research Limitations and Recommendation for Future Studies Firstly, this research is classified as a non-experimental study because the survey's conditions were not tailor-made to discover any causation. One can only identify differences and linkages between the existing variables. One of the limitations is that the researchers chose convenience sampling to take care of the limited cost and time. Thus, the readers should be careful with the findings since they are not representative as required in such studies (Waldrop et al. 2015). There is also a need to worry about the defects associated with questionnaires since the participants might tend to manipulate the answers. Another possible limitation of the study is that only 80% of those interviewed in the different medical facilities had finalized their transitional caregiving training. Thus, since others had not received the training, they were unsure of the results or the advantages that are obtained from getting transitional caregiving training. Therefore, this is a possible cause of bias, which limits the results. The next limitation is that the survey only engaged nurses meaning that getting information regarding their doctors and other officials was overlooked. The doctors and other hospital officials could have been engaged too. To deal with the limitations highlighted, it is recommendable to conduct a more substantial investigation which would involve a representative sample to ascertain the outcomes. This will allow for generalization (Aneshensel et al. 2015). Additionally, there is a need to interview nurses RESULTS PHASE 4 7 from different hospitals in the country since they have different preferences and exposures. Moreover, while dealing with doctors and other professions, the researchers would engage them since they are sure of their occupations. This would, therefore, increase the reliability of the data. For future research, there is a need to know that protection and care are required when handling data and information during the survey such as demanding procedures. Future studies are essential because many of the health and medical resources and equipment are becoming technological as each day passes and this training on these aspects and elimination of the said limitations would work as a bonus. Therefore, different data collection methods that were used were in a way effective and contributed to the results that were reported. It was discovered that transitional caregiving training went beyond the nurses themselves and was supposed to be also done to the doctors and the members of the community. This is because all of them are also involved with the interaction with the patients hence making it necessary for them to be trained too. The research was an excellent exposure to interact with the caregivers and get to learn a lot on their views on transitional caregiving. The research also helped in realizing some of the limitations to the research topic and some of the recommendations that may be implemented in future similar studies. Some vast gaps are in existence with the current caregiving and hence the need for the implementation of the transitional caregiving training to address the gaps. RESULTS PHASE 4 8 References Aneshensel, C. S., Pearlin, L. I., Mullan, J. T., Zarit, S. H., & Whitlatch, C. J. (2015). Profiles in Caregiving: The fantastic career. Elsevier. Ganann, R., McAiney, C., & Johnson, W. (2018). Engaging older adults as partners in transitional care research. CMAJ, 190(Suppl), S40-S41. Gibson, M. J., Kelly, K. A., & Kaplan, A. K. (2012). Family caregiving and transitional care: A critical review. Family caregiver alliance, National Center on caregiving. Kim, M., & Park, L. (2017). The effect of family caregiving on the well-being of older adults as caregivers or care recipients. Innovation in aging, 1(suppl_1), 68-68. Waldrop, D. P., Kramer, B. J., Skretny, J. A., Milch, R. A., & Finn, W. (2015). Final transitions: Family caregiving at the end of life. Journal of Palliative Medicine, 8(3), 623-638.
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