Skip to content 
NURS FPX 6030 Assessment 2
Problem Statement (PICOT)
Among the existing call structures, the simplest framework to generate research questions and analysis plans for research questions used in nursing studies is the known PICOT matrix. The selected PICOT question is: This question entails three elements of the research question:
-
Outcome, Time, and Population:
What is the impact of implementing an actual daily exercise program of mobility and strength training on the physical function (O) within six months (T) among geriatric patients in a skilled nursing facility (P) compared to the standard ADLs (C)?
P: Long-term care facility inhabitants comprised of the elderly population
I: An exercise program to strengthen and mobilize yourself and something that you should do on a daily basis
Class C: and Aristocrat health care special products DA’s, or Daily Activities.
O: Effects in Relation to the Functioning of Musculoskeletal System
T: Half a year
Problem Statement
-
Need Statement
Weakness, impaired mobility and health are some of the impacts resulting from the perceived high prevalence of physical inactivity and poor nutrition of elderly in the skilled care homes. Enhancing physical health and quality of life in this at-risk population might be possible through the incorporation of health promotion activities specializing on exercise and nutrition. This need statement contrasts the outcome of a 6-month strength and mobility-training exercise on elderly patients in skilled nursing facilities (SNFs), and routine ADLs (Merchant et al. , 2021).
-
Underlying Assumptions
Enhancing the current methods of treatment and management may be made from the effects it has on functions of body. Appropriate comparison with normal Activities of Daily Living are drawn in the studies which in turn assumes that normal strength training, mobility has considerable impact on the elderly population’s functional capacity.
If such time period is enough to observe enhancement in the scores, then 6-month implementation consistency is required (Merchant et al. , 2021). This is why awareness of these assumptions is critical when it comes to the design of the research and the interpretation of the results.
-
Population and Setting
In fact the physical mobility of the elderly person may be enhanced significantly by supervised exercise regime offered by a skilled nursing facility. Since the goal of this kind of intervention program is to improve overall health and basic functioning the exercise components of the individualized plan emphasise strength training and movement (Merchant et al. , 2021).
In the program, the assessment of six months is done in relation with the basic activities of daily living. With this form of assessment we can have enough time to monitor the desirable changes in strength, and mobility, and the level of functional independence.
Issues emerge when one is in the process of attempting to use a quality improvement strategy to the elderly people. In the case of this population, communication issues, fatigue, and physical limitations might hinder motivation and adherence (Collado-Mateo et al. , 2021). Izquierdo et al. (2021) reveal that exercise prescription must incorporate a health status aspect to help in the development of proper exercise programs.
Budgeting and proper management of resources as well as the manner in which information is disseminated are among the greatest predictors of sustainability (Damery et al. , 2021). Another reason individuals should keep an eye on things is to avoid likely incidents of being harmed (Denfeld et al. , 2022). However, there are barriers that have to be addressed for the daily exercise program benefiting elderly patent in a skilled nursing facility to be effective regardless the positive outcomes that the program holds.
-
Intervention Overview
A particular form of daily exercising will be carried out regularly in order to meet the indicated need of improving physical function of elders residing in a skilled nursing home. Mobility and strength training for physical function for the elderly; the target of this intervention is to try to maintain or even enhance their flexibility, balance, muscle strength and at the same time reduce chances of falling. In the view of Pinheiro et al. (2023), exercise patients could be expensive to manage as other therapies such as medicinal drugs for enhancing physical function.
Are you Looking for guidance for NURS FPX 6030 Assessment 2? Our experts are here to assist you. Reach out to us for support today.
Nevertheless, due to a lack of resource, SNFs may face issues in developing such exercise programs that would have a positive impact. Additionally, owing to the variability in response related to; fitness and health status, it is challenging to develop exercise regimens catering to various patients’ needs in this group (Merchant et al. , 2021). This aspect of the therapy’s unpredictability must be considered when developing the interventions because its impact would complicate the consistency of the outcomes.
-
Comparison of Approaches
That means that a broad range of therapies is currently utilized in Skilled Nursing to enhance nursing outcomes in elderly patients based on target patients’ specific needs, where each type of therapy present its own benefits and drawbacks. Programs that have each patient’s customized exercise regime and follow practices based on the scientific literature are clearly discernible (Palmgren et al. , 2020).
While these programs offer several benefits for medication users and the health care systems, for instance, improvements in physical health, pain management, and general wellbeing, the programs’ implementation is not devoid of challenges. At the same time, it is necessary to recognize the high costs, the requirement to rely on the patient’s compliance, and the restrictions when it comes to an extension of the observed effects to interaction with the environment for other tasks beyond the process of treatment sessions if such interventions are used in a skilled care setting (Yamagami et al. , 2022).
According to Inoue et al. (2022), nutritional intervention is probably more feasible and sustainable if compared to the intricate physical rehabilitation programs to enhance the global physical performance, energy expenditure, and muscle strength. Like in the case of requirement of physical therapy, it is stringent and relies on the patient’s commitment (Endris et al. , 2022). However, it is ideal for preventing ailments that affect motor functions of the body thus leading to disability.
-
Initial Outcome Draft
In six months’ time, the plan of implementing the daily exercise regime focused on strength training and mobilization in the SNF for the elderly residents is to improve their level of functioning. This supply an improved health of the body to the elderly by exercising regularly. Precipitation is familiar in such facilities because nursing homes do not set severe standard of fitness.
Thus, to enhance an extended group of deconditioned patients’ physical outcomes and create the effectiveness of regular skilled nursing care, a plan should be provided on how to incorporate organized mobility and strength training to the usual care. In another case, for the results were out then the quality improvement strategy was effective in the sense that it brought the change that enhanced the physical functioning of the elderly nursing home residents for the six months’ duration this strategy was implemented (Welch et al. , 2021).
-
Evaluation Criteria
The objective of the intervention is to get the elderly in the nursing homes to move more around and also gain strength. The Short Physical Performance Battery (SPPB) can be applied to evaluate the impact of the intervention looking into the physical function scores (Welch et al. , 2021).
It is therefore possible to conclude that the SPPB is a valid tool for assessing the function of the lower limbs among elderly persons. The probes contain chair stand, gait speed, and standing balance inspections. A significant difference in the results of the SPPB scores among the total physical function of the intervention group and the control group will reveal an effectiveness of the intervention mobility and strength gain.
Time Estimate
A daily exercise for elderly patients admitted to SNFs is also eased systematically within the six months’ plan. Exploratory interactions with the health care providers, review of published literature and interviews form part of the activities that make up the first two months of the program design and needs assessment phase. While in the third and fourth month, then the program becomes refined, inputs for the program are gathered and pilot testing is made.
For issues in the fifth month, you will contain them through personnel training and planning. The last month six involves the total implementation, monitoring and further adjustments of the plan. The strategy also considers the unknowns and the knowledge gaps through the call for continuous research monitoring, sustainability planning, identification of limitations and cost/resource efficiency determination. This methodically planned strategy ensures efficiency, along with the responsiveness to new data and comments (Welch et al. , 2021).
Quality Improvement Initiative
Regarding the type of QI project, the suggested quality improvement project would be the daily exercise program for the SNF residents operating in a geriatric skilled nursing facility to enhance residents’ functional status based on the PDSA cycle. The planning phase in this case includes requirements assessment, literature analysis and consultation with experts to come up with a six-month program focusing on strength and mobility training after admission.
During do phase, the specified workout interventional plan will be implemented, receive feedback and modify according to the results obtained. Thus, the aim of this study is to evaluate descrete improvement in physical function in order to identify ways of maximizing that function based on pilot data as well as findings within the Short Physical Performance Battery.
Last of all, it is done in the act phase if the program has certain aspects that require full-scale implementation changes while the majority of the aspects of the program are already working effectively. With the help of this PDSA approach, the goal of enhancing the mobility and strength of patients may be methodically optimized, adjusting to emerging evidence (Valenzuela et al. , 2023).
-
Potential Challenges
The elderly person may not be able to adhere to an exercise schedule since they can easily get sad, have chronic pain, become tired, or get other ailments. During the six months, the patients might lose the motivation to stick to the treatment plan and stick to their new diets. Some elderly patients have frailty or mobility problems, which require them to be closely monitored all the time when exercising, thus a big risk of a fall.
In staff sufficient personnel and staff training necessary to ensure patient safety should be available. In most cases, skilled nursing institutions incur challenges such as personnel, supplies, as well as financing. The main problem with the general fitness regimens might be in securing the right resources for the several routines being implemented. Exercise may be considered as a secondary or less strenuous responsibility compared to other care obligations (Merchant et al. , 2021).
Literature Review
As identified in a systematic review and network meta-analysis by Valenzuela et al. (2023) with 11,609 participants in residential care, exercise therapies significantly enhance total physical function in older people. The study revealed that as far as physical function was concerned, it was raised by 0. 13 standard deviations on average, and the highest improvements were obtained for individuals with 110-225 minutes of exercise per week, with the Optimal amount being 170 minutes (Valenzuela et al. , 2023).
In line with the relevance and the practicality of the formation of daily exercise program for the geriatric patents in SNFs, the findings endorse the regular chirping crusade of exercise intervention in the SNFs as well as other long term care facilities in order to discourage the progressive deterioration of health as a result of aging among the elderly.
As recommended by Merchant et al. (2021), therapies for elderly patients in Skilled Nursing Facilities should be supported by statistical papers. By pointing out that the risk of further decline in the older adults’ function and strength must be managed through individual exercise schedules after four weeks of participating in the Vivifrail multicomponent program that has been proven to have stopped functional decline and strength loss, the study supports the idea of individual trainings.
Strength training and consistent mobility are less hazardous than ADLs as they are administered at present (Merchant et al. , 2021). Merchant, F, Nilsen, L, Conti-Ramsden, H & Rydén, A 2021, In this study, it is agreed that activity programs that are tailor made are very important in the sustainably of frail oldest old dementia patients. The article also conducts a six-month review of the chosen data, further stressing that exercise treatments are appropriate to enhance physical functioning in the mentioned demographic and circumstance based on the relevancy, adequacy, and accuracy of the study.
The comparison of the benefits of the IG that involves a specific exercise program and CG that included routine mobility exercises for elders in care homes was conducted with the help of a 12-week trial and the results are presented in López-López et al. , 2023. Some kinds of tests that evaluate mobility and fitness like the walking tests, total physical performance were improved in the training group than the control group.
NURS FPX 6030 Assessment 2 Problem Statement (PICOT)
The outcome of the intervention was effective in improving the clients’ functional mobility as well as their fitness level, however, the degrees of independence of the clients was not significantly affected by the intervention. This aerobic exercise program for improving selected domains of physical performance in institutionalised older persons utilises the principle of muscular power and interval endurance. Specifically, the research established that the intervention is safe and effective, which may point to the use of the approaches mentioned above for this population.
Zou et al (2022) conducted a study in which physical function and the risk of falling among nursing home residents in China increased and how a 12 week Otago fitness played a role to get rid of it. The results that were obtained from measures of strength, balance, and activity were far much better among the intervention group than among the control group, supporting Otago’s efficiency in improving physical performance among SNF residents.
Furthermore, Zou et al. (2022) provided a systematic review of 23 clinical trials on physical exercise programs for nursing home residents, with components that are constructed based on functional abilities. In the case with walking and functional exercise programs, it was found that for the physical results, there is a hint that it is helpful, but for the psychological results, it is not helpful at all. A number of cognitive benefits of walking regimens were noted but they fluctuating. There were no adverse outcomes reported within the elderly subjects living in the nursing homes, regardless of any signs of dementia they might have.
The randomized outcomes indicate that simple strength training in Vivifrail is effective for the elderly patients with sarcopenia in SNFs. Courel-Ibáñez et al. , 2022 also confirms that short-term therapy and strength performance improves significantly after four weeks and also more longer term therapy of twenty-four weeks. To preserve or even enhance frailty status in institutionalized older persons, intermittent exercise, featuring a measure of training schedules, i. e. , four weeks of training thrice yearly, is found to be practical.
The involvement is recommended since strength as well as functional ability are declined during detraining intervals that can range from two to fourteen weeks. Moreover, the authors Bertoncello et al. (2021) observe that elderly patients must have a daily exercise programme, which they studied 221 nursing home patients for one year. Analysis underlines the effectiveness of personal physical exercise, for non-participants mobility decrease probability was five times higher than the participants. Since even patients with dementia showed no changes in mobility, it is possible and rational to rule out the physical decline in this particular group through regular exercise.
Health Policy and Technology Impact on Addressing Needs
Exercise programs are one of several therapies that under the umbrella of the National Institute on Aging (NIA) want to encourage for people of the third age. NIA will be established as a valuable asset on generating solutions that address identified issues using evidence through such a partnership (NIH, 2022). In formulating the application of exercise programs, the institute supports the research of the exercise program to provide the knowledge base for the methods to fulfill the identified requirements to serve its overall mission of enhancing the physical function in elderly patients.
Also, there are incentives encouraging SNFs to deliver quality care through the CMS with exercising potentially comprising a part of this care. Since CMS has a huge influence on SNF operations, this involvement introduces a critical policy asset (National Academies of Sciences & Medicine, 2022).
Enhancing the physical function in elderly people is one of the goals of CMS and to meet this objective, the agency intends to use financial incentives that may encompass exercise promotions among other quality care services. This synthesis clarifies how the emphasis of policies has to be beneficial for it to be effective at implementation.
Some forms of exercise regimens might be provided and conducted, remotely, through a range of technologies such as wearable technology, and virtual reality. Following the same source by Vargemidis et al, this method enhances the workout regimens’ accessibility and personalization.
They may all enhance as a total with the improvements in technological that enhance treatment’s access and customization. Physical activity is also mentioned in the communication of the American Geriatrics Society where the body released its clinical practice guidelines (Baldwin et al. , 2020). While Falls Free and other similar projects insist on exercising for falls prevention and elderly mobility on the other hand . Taken as a single unit these programs assists enhance on the elderly people’s health and promote healthy aging.
-
Missing Information
High quality and safe exercises for SNFs depend on adequate staffing, adequate staff training in exercising the frail and increased resources. Areas such as training of competent personnel for these programs remain critical since they determine the success of these programs (Damery et al. , 2021).
The best strategy that has to be adopted by health programs for encouraging exercise in SNFs is to ensure detailed information and resources. SNFs exercise programs have to be incorporated with other care services. Therefore, it is vital to ensure that exercise is synchronized with the strategies of preventing falls and medication management (Ojo & Thiamwong, 2022). In this case, holistic integration makes it possible to ensure that while exercise is being conducted, it does not have to be carried out independently but as a joint plan put in place alongside other health facets.
Conclusion
The evidence is overwhelming to support personalised exercise interventions for enhancing physical functioning of community dwelling older people in nursing homes. This claim is evidenced by existing research conducted on Vivifrail, the Otago, and other kinds of therapies alongside the long-term effects of constant engagement. NIA and CMS supported policy alignment reveal how important it is. Altogether, the evidence and policy matters underline the potential of definite exercise interventions in enhancing the functional status of elderly people living in nursing homes.
If you need complete information about class 6030, click below to view a related sample:
NURS FPX 6030 Assessment 1 Conference Call Scheduling and Notes
NURS FPX 6030 Assessment 4 Implementation Plan Design
References
Baldwin, C. E., Phillips, A. C., Edney, S. M., & Lewis, L. K. (2020). Recommendations for older adults’ physical activity and sedentary behaviour during hospitalisation for an acute medical illness: An international Delphi study. The International Journal of Behavioral Nutrition and Physical Activity, 17, 69.
https://doi.org/10.1186/s12966-020-00970-3
Bertoncello, C., Sperotto, M., Bellio, S., Pistellato, I., Fonzo, M., Bigolaro, C., Ramon, R., Imoscopi, A., & Baldo, V. (2021). Effectiveness of individually tailored exercise on functional capacity and mobility in nursing home residents. British Journal of Community Nursing, 26(3), 144–149.
https://doi.org/10.12968/bjcn.2021.26.3.144
Collado-Mateo, D., Lavín-Pérez, A. M., Peñacoba, C., Del Coso, J., Leyton-Román, M., Luque-Casado, A., Gasque, P., Fernández-del-Olmo, M. Á., & Amado-Alonso, D. (2021). Key factors associated with adherence to physical exercise in patients with chronic diseases and older adults: An umbrella review. International Journal of Environmental Research and Public Health, 18(4), 2023.
https://doi.org/10.3390/ijerph18042023
Courel-Ibáñez, J., Buendía-Romero, Á., Pallarés, J. G., García-Conesa, S., Martínez-Cava, A., & Izquierdo, M. (2022). Impact of tailored multicomponent exercise for preventing weakness and falls on nursing home residents’ functional capacity. Journal of the American Medical Directors Association, 23(1), 98-104.e3.
https://doi.org/10.1016/j.jamda.2021.05.037
Damery, S., Flanagan, S., Jones, J., & Jolly, K. (2021). The effect of providing staff training and enhanced support to care homes on care processes, safety climate and avoidable harms: Evaluation of a care home quality improvement programme in England. International Journal of Environmental Research and Public Health, 18(14), 7581.
https://doi.org/10.3390/ijerph18147581
Denfeld, Q. E., Turrise, S., MacLaughlin, E. J., Chang, P.-S., Clair, W. K., Lewis, E. F., Forman, D. E., Goodlin, S. J., & null, null. (2022). Preventing and managing falls in adults with cardiovascular disease: A scientific statement from the American Heart Association. Circulation: Cardiovascular Quality and Outcomes, 15(6).
https://doi.org/10.1161/HCQ.0000000000000108
Endris, B. S., Fenta, E., Getnet, Y., Spigt, M., Dinant, G., & Gebreyesus, S. H. (2022). Barriers and facilitators to the implementation of nutrition interventions at primary health care units of Ethiopia: A consolidated framework for implementation research. Maternal & Child Nutrition, 19(1).
https://doi.org/10.1111/mcn.13433
Inoue, T., Iida, Y., Takahashi, K., Shirado, K., Nagano, F., Miyazaki, S., Takeuchi, I., Yoshimura, Y., Momosaki, R., Maeda, K., & Wakabayashi, H. (2022). Nutrition and physical therapy: A position paper by the physical therapist section of the japanese association of rehabilitation nutrition (Secondary Publication). Journal of Microbiology and Antimicrobials Journal, 5(2), 243–251.
https://doi.org/10.31662/jmaj.2021-0201
Izquierdo, M., Duque, G., & Morley, J. E. (2021). Physical activity guidelines for older people: Knowledge gaps and future directions. The Lancet Healthy Longevity, 2(6).
https://doi.org/10.1016/S2666-7568(21)00079-9
López-López, S., Abuín-Porras, V., Berlanga, L. A., Martos-Duarte, M., Perea-Unceta, L., Romero-Morales, C., & Pareja-Galeano, H. (2023). Functional mobility and physical fitness are improved through a multicomponent training program in institutionalized older adults. GeroScience.
https://doi.org/10.1007/s11357-023-00877-4
Merchant, R. A., Morley, J. E., & Izquierdo, M. (2021). Exercise, aging and frailty: Guidelines for increasing function. The Journal of Nutrition, Health & Aging, 25(4), 405–409.
https://doi.org/10.1007/s12603-021-1590-x
National Academies of Sciences & Medicine. (2022). Care Delivery. In The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. National Academies Press (US).
https://www.ncbi.nlm.nih.gov/books/NBK584646/
NIH. (2022). What do we know about healthy aging? National Institute on Aging.
https://www.nia.nih.gov/health/healthy-aging/what-do-we-know-about-healthy-aging
Ojo, E. O., & Thiamwong, L. (2022). Effects of nurse-led fall prevention programs for older adults: a Systematic Review. Pacific Rim International Journal of Nursing Research, 26(3), 417–431.
Palmgren, A., Ståhle, A., Skavberg Roaldsen, K., Dohrn, I.-M., & Halvarsson, A. (2020). “Stay balanced” – effectiveness of evidence-based balance training for older adults transferred into a physical therapy primary care setting – a pilot study. Disability and Rehabilitation, 42(13), 1797–1802.
https://doi.org/10.1080/09638288.2018.1535631
Pinheiro, M. B., Howard, K., Oliveira, J. S., Kwok, W. S., Tiedemann, A., Wang, B., Taylor, J., Bauman, A., & Sherrington, C. (2023). Cost-effectiveness of physical activity programs and services for older adults: A scoping review. Age and Ageing, 52(3).
https://doi.org/10.1093/ageing/afad023
Valenzuela, P. L., Saco-Ledo, G., Morales, J. S., Gallardo-Gómez, D., Morales-Palomo, F., López-Ortiz, S., Rivas-Baeza, B., Castillo-García, A., Jiménez-Pavón, D., Santos-Lozano, A., del Pozo Cruz, B., & Lucia, A. (2023). Effects of physical exercise on physical function in older adults in residential care: A systematic review and network meta-analysis of randomised controlled trials. The Lancet Healthy Longevity, 4(6).
https://doi.org/10.1016/S2666-7568(23)00057-0
Vargemidis, D., Gerling, K., Spiel, K., Abeele, V. V., & Geurts, L. (2020). Wearable physical activity tracking systems for older adults—A systematic review. Association for Computing Machinery Transactions on Computing for Healthcare, 1(4), 1–37.
https://doi.org/10.1145/3402523
Vincenzo, J. L., Hergott, C., Schrodt, L., Perera, S., Tripken, J., Shubert, T. E., & Brach, J. S. (2021). Physical Therapists as Partners for Community Fall Risk Screenings and Referrals to Community Programs. Frontiers in Public Health, 9.
https://doi.org/10.3389/fpubh.2021.672366
Welch, S. A., Ward, R. E., Beauchamp, M. K., Leveille, S. G., Travison, T., & Bean, J. F. (2021). The Short Physical Performance Battery (SPPB): A quick and useful tool for fall risk stratification among older primary care patients. Journal of the American Medical Directors Association, 22(8), 1646–1651.
https://doi.org/10.1016/j.jamda.2020.09.038
Yamagami, M., Mack, K., Mankoff, J., & Steele, K. M. (2022). “I’m just overwhelmed”: Investigating physical therapy accessibility and technology interventions for people with disabilities and/or chronic conditions. Association for Computing Machinery Transactions on Accessible Computing, 15(4), 35:1-35:22.
https://doi.org/10.1145/3563396
Zou, Z., Chen, Z., Ni, Z., Hou, Y., & Zhang, Q. (2022). The effect of group-based Otago exercise program on fear of falling and physical function among older adults living in nursing homes: A pilot trial. Geriatric Nursing, 43, 288–292.
