D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

Advocacy plays a significant role in the building of robust health systems. In today’s complex and rapidly changing healthcare system, advocacy is among the strategies that can be used to achieve population health. It gives people a voice in the decisions that affect their health while holding authorities accountable for their responsibilities. Advocates identify problems and raise awareness of those problems. As advocates of the patients and communities, nurses are responsible for identifying health problems and pushing for new reforms to address these problems. For example, falls among the elderly aged 65 and above affect individuals who stay at home in Minnesota. This discussion uses a collaborative approach to advocate for a policy change to address falls among the affected population in the state.

Advanced Professional Nurse as Advocate

Becoming social policy advocates is how advanced practice nurses navigate upstream to achieve positive population health outcomes. These nurses advocate for the health of individuals both in the community and hospital settings using different strategies. In the community setting, the nurse might advocate for an at-risk population through educational approaches. For example, the advanced professional nurse can engage with educational institutions to ensure students are adequately prepared to handle the diverse needs of populations in the community (Williams et al., 2018). Advocacy plans at this level might include calling for more teachers or the addition of training institutions to accommodate more students. This plan ensures that graduating nurses have enough knowledge and expertise to address the specific needs of at-risk populations.

The second strategy for advocacy at the community level involves advocacy in economic matters. It is long established that most at-risk populations cannot access healthcare or purchase necessary drugs for their treatment. Advanced practice nurses can advocate for economic policies, like funding of community healthcare systems, to improve healthcare access among populations (Williams et al., 2018). For instance, evidence demonstrates the reduction of drug costs as a result of advocacy programs. Sharing this information with community members can help patients receive necessary medications when needed.

Advocacy for at-risk populations in the community can be different when done in the hospital setting. In hospitals, advocacy involves working with physicians and administrators to propose alternatives for improving patient care. The first aspect that advanced nurses can advocate for at-risk populations is mediating tasks between patients and physicians or other healthcare providers. The nurse fights for the patient when a wrong diagnosis is made, wrong medication is administered, or improper discharge is given to a patient. The advanced nurse practitioner functions to fight for the patients’ rights even when they do not know them.

The second approach to advocacy in healthcare institutions involves engaging in legal aspects of patient care. For instance, healthcare policies exist to guide the medical care of patients and families. Therefore, the nurse can advocate for new policies to address the specific needs of the at-risk population. An example is advocacy for using evidence-based strategies to minimize elderly patient falls in medical/surgical units. The advanced practice nurse engages in research to identify solutions and propose to the administration for proper change. Based on the advocacy plans in the hospital and community setting, one can conclude that hospital-based advocacy focuses on specific health problems of individuals while community-based advocacy addresses broad changes for the safety of populations.

Interprofessional Collaboration

Interprofessional collaboration involves the working together of multiple workers from diverse professional backgrounds with patients/families and communities to deliver high-quality care. Advanced practice nurses can promote interprofessional collaboration through understanding professional roles. It is established that collaboration becomes easier if providers understand each others’ roles (Schot et al., 2019). Conflict or differences often arise when professional teams take over each others’ roles. Advanced practice nurses should ensure adequate orientation for new employees and in-service education for staff to promote role clarity. Additionally, the nurse should encourage staff to communicate when performing one’s duty, which potentially leads to overstepping other professionals’ activities.

Collaboration in healthcare can sometimes become challenging due to power differences among professionals. Power and autonomy disparities are often attributed to the different levels of education, status, and prestige unique to each profession (Schot et al., 2019). To address this challenge, advanced practice nurses should encourage other nurses to advance their education levels and empower them to assume higher positions that can promote collaborative practices. For example, nurses are not regularly invited to crucial meetings involving problem-sharing and decision-making due to power differences. Perhaps, advancing education, taking leadership courses, and practicing with autonomy can help promote interprofessional collaboration.

Data-Driven Health Issue

Falls are one of the most observed mechanisms of injury that cause significant mortality and morbidity across all ages worldwide. The risk of falls can be attributed to several factors, including alcohol intoxication, frailty, and comorbidities in elderly populations, among many others. However, unintentional falls, sometimes called accidents, are the leading cause of death among adults aged 65 and older in Minnesota and the United States. According to recent data from the Centers for Disease Control and Prevention (CDC) (2021), the age-adjusted fall rate for older adults is 64 deaths per 100,000 individuals. Additionally, it is observed that the death rates have increased by about 30% from 2009 to 2018. Based on this data, one can only imagine the future mortality rate as the American population continues to age.

Minnesota is a healthy state placing consistently near the top national rankings for many years. However, the rate of unintentional falls continues to rise, making the state the leading in terms of deaths resulting from unintentional falls in the country. The state health statistics demonstrate that one in three adults falls each year, translating to over 7000 senior falls in the Benton, Sherburne, and Stearns counties yearly (Minnesota Department of Health, 2012). In St. Cloud, the fire department performs about 1 to 2 assist daily of older adults due to falls and sometimes multiple lifts of the same person weekly. On average, it is observed that 1900 Minnesotans die yearly due to unintentional injuries, and over 300,000 seek medical care due to unintentional injuries.

Various groups are at risk of unintentional injuries, including older adults and young children. Focusing on the elderly falls usually result from osteoporosis that weakens the bone structure, osteopenia, or medications like anticoagulants or antiplatelets. In Minnesota, falls are the leading cause of relocation to nursing homes among older adults (Minnesota Department of Health, 2012). Apart from the medical conditions of these patients, common fall hazards include scattering rugs, slippery surfaces, uneven flooring, clutter on the floor, low lighting, and the absence of sturdy handrails. Regarding gender disparities in fall rates, the male from mid-teens has significantly higher rates than their counterparts. However, older adults tend to display even rates for unintentional injuries, especially from 70 years and above. Racially, the American Indians display higher rates in Minnesota, accounting for 85.0% of all falls. These statistics portray the burden of unintentional injuries in the state and the need for policy change.

Characteristics of At-Risk Population

The first characteristic involves the age of affected individuals whereby older adults 65 years and above are greatly affected. For instance, Minnesota had the third-highest death rate from falls in 2016 among people aged 65 and older, behind Wisconsin and Vermont. The state also has the highest incidence rate regarding unintentional falls yearly. The second characteristic is gender, where both men and women are at more significant risks of falls in the state. According to the Minnesota department of health (2012), the rate of falls among men and women is apart from higher rates for mid-teens. Among these elderly individuals, the American Indians account for 85% of all falls, followed by African Americans with 37.3% and Whites with 34.8%. Identifying these is a crucial step towards coming up with focused solutions for unintentional falls in Minnesota.

Social Determinant of Health (SDOH)

Falls are a marker of frailty, immobility, and acute and chronic health impairment in older persons. Preventing these falls requires an understanding of the factors behind the increased rates and how they can be modified. Social determinants of health represent conditions in which people are born, grow, live, work, and age that shape health. The factors can broadly be grouped into the community social context, physical environment, economic stability, healthcare system factors, and access to food. The increased fall rates among older adults in Minnesota are contributed by lack of resource availability due to low income, poor access to home health services, and deficiencies in home modification.

The context where older adults live and get involved in activities dramatically determines the observed fall rates. Studies have demonstrated that the neighborhood context determines whether the elderly leave their communities, including physical activities performed (Lee et al., 2017). In Minnesota, concentrated disadvantages, including poverty, residential instability, and poor neighborhoods, increase unintentional injuries. For instance, neighborhoods with low socioeconomic status have poorly maintained buildings, surrounding structures, and environments that increase the risk of falls. Older adults with visual or balance impairments might find it challenging to move around these environments leading to unintentional falls.

The specific SDOH influencing falls among the elderly in Minnesota is poverty. Poverty is the single largest determinant of health that influences the conditions that people live in alongside other economic factors. Regarding the issue of falls, many older adults in Minnesota lack enough capital to modify their homes to prevent falls. For instance, evidence-based guidelines recommend the installation of grab bars on walls around tubs and the bedside to provide support for the elderly (Wollesen et al., 2016). Additionally, the use of nonskid mats, padded shower seats, and modification of floors all require capital for installation and maintenance. Modifying homes so that seniors can perform daily activities as safely and comfortably as possible is the best solution, but impossible for many due to financial problems (Wollesen et al., 2016). Knowing what can be done around the house and the provision of required resources for home modification can greatly improve older adults’ health and quality of life through fall prevention.

Current Policy

Falls are not an inevitable part of aging and are primarily preventable using appropriate strategies. The state of Minnesota provides various strategies to prevent falls for older adults at home and those hospitalized in-home care facilities. One of the programs for fall prevention was developed by Minnesota State Fire Chiefs Association in 2017 to address the issue of falls and fire among older adults. This initiative focuses on individuals aged 65 years and above and addresses critical areas focused on reducing falls (Minnesota State Fire Chiefs Association, 2017). The first part of the program addresses staying active for older adults. The department recommends regular exercise to build and maintain strength, endurance, and balance. Older adults are also encouraged to wear sturdy shoes with non-slip soles for fall prevention.

Environmental hazards are observed to cause significant trips, slips, and falls at home. The association highlights the importance of being aware of the surroundings while at home. Additionally, older adults should take time to answer the door or phone to prevent unnecessary falls (Minnesota State Fire Chiefs Association, 2017). The third aspect addresses uneven and slippery surfaces whereby removing items like rugs or securing them on the floor can help prevent falls. Older adults are required to install grab bars as a precaution to minimize falls. The last aspect identifies the use of railings on both sides to aid in walking while ensuring front doors have a visible address, straightforward steps, and lighting.

The above initiative fails to address the issue of poverty among the elderly in Minnesota for effective prevention of falls. The initiative only highlights what older adults need to do to minimize falls at home. For example, installation of grab bars and modification of doors is among the solutions provided. Without adequate capital, the elderly will not manage to purchase the necessary equipment for home modification. The policy does not address how the elderly are in a better position to achieve the required modifications in their homes.  New programs or policies are required to ensure the elderly have access to resources to implement the recommended guidelines for fall prevention.

Policy Proposal

Falls are a threat to the health of older adults and can reduce their ability to remain independent (CDC, 2021). They significantly cause injuries like broken bones and head injuries that cause prolonged hospitalization, morbidity, and death. Despite the increased number of elderly falls in Minnesota, current policies, initiatives, and programs have inadequately addressed this issue. Various studies have analyzed the importance of pulling resources to address patient falls among the elderly. One of those strategies includes using home health services that provide assessment, medication review, education, and management of hazards by qualified providers (Bamgbade & Dearmon, 2016). This approach ensures the delivery of care that is based on the individual needs of each patient. Additionally, direct care and education provision minimizes the impact of falls and, consequently, leads to minor or no injuries.

The proposed policy to address the challenge of falls will involve  the passing of a law that  will mandate the allocation of funds for implementing a community resource program that will ensure the mandatory provision of fall prevention services among all elderly patients in Minnesota. The new approach will avail a community resource program that will provide in-home nurse and safety assessments, recommendations, interventions, and access to fund adapted medical equipment, home modifications, and assistance with in-home services: nursing, home health aide, homemaking, and therapy if recommended. This policy will surpass the challenge of poverty that makes most elderly unable to access the identified resources and services for fall prevention. The fund-adapted approach of the policy will ensure safe the installation of grab bars, side rails, and non-skid floor mats  to those that are poor. Additionally, the policy will ensure regular assessment and maintenance of home installed structures for the elderly in an attempt to prevent falls.

D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

Health Issue Impact

The introduction of the new policy will positively impact fall prevention among older adults in Minnesota. Firstly, the intervention will enable access to necessary resources to the patient for fall prevention. For instance, the installation of side grabs in the patient’s home will prevent falls during walking. In the patient’s bathrooms, non-slip floors will ensure patients are comfortable, leading to minimization of falls. Secondly, the intervention will ensure the routine availability of home-based screening for elderly patients to identify risks for falls. Individuals with difficulties moving around will be assessed and transferred to nursing homes for specialized care. These interventions will ease the burden of emergency visits due to falls. Consequently, the interventions will reduce healthcare costs associated with managing patients with complications resulting from falls.

Equitable Distribution of Resources

Diversity in populations is measured in terms of variation in genetics and morphological features that define populations. In Minnesota, the burden of falls is observed more on elderly individuals than other age groups. Therefore, managing falls will be directed to the elderly population that seems to be vulnerable in the community. Secondly, the interventions aim to address falls among low-income communities that are unable to access specialized care. These populations cannot modify their environment to prevent falls, with some even unable to access healthcare upon sustaining injuries. Directing resources in these communities will demonstrate an even distribution of resources. Lastly, most of the affected individuals in Minnesota are of American Indian origin. As one of the vulnerable communities in the area, pulling resources to promote access to healthcare services will demonstrate the equitable distribution of resources in the community.

Ethical Provisions

The policy proposal addresses the health of the elderly population in Minnesota through interventions that can reduce fall rates. This intervention aligns with ANA provision two, which states that “The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population” (ANA, 2015). The intervention also uses nursing actions like assessment and recommendation of changes to authorities regarding population health needs. The proposed policy will ensure that necessary resources are allocated to cater for the needs f the elderly while mitigating the challenge of poverty among this special population.Through providing home health aid, the nurse will commit to addressing the health of populations and recommend changes that can positively impact the health of the elderly.

The policy proposal utilizes the advocacy strategy to promote the health of elderly populations in Minnesota. According to the ANA code of ethics provision three (2015), “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.” The policy serves to supplement other policies and programs that aim at preventing falls in Minnesota. The policy change initiative involves identifying vulnerable communities lacking adequate resources and providing alternatives to address their needs. The new policy will definitely involve the allocation of funds to support the proposed program for falls prevention and this will only be possible through advocacy.

Barriers

One of the barriers that are likely to face the new proposal is financial support issues from the state government. Falls among adults aged 65 years and older are very costly to individuals and healthcare institutions. According to healthcare expenditure related to falls, approximately 50 billion is spent yearly on non-fatal falls. These figures indicate that already the healthcare system is spending a lot to address this issue. The new policy will require more personnel, the purchase of equipment, and other structures to support the at-risk population. Mandatory installation of safety equipment like side grabs, bed rails and floor modifications will definitely require a lot of capital. Therefore, it will be challenging for the state government to accept the new policy due to financial issues.

The second challenge that is likely to face the implementation of the policy is poor enforcement (Tzeng et al., 2020). Just like other local policies, enforcement becomes a challenge when the relevant authorities become too reluctant to uphold the law. Issues like delayed allocation of funds to support the policy change can contribute to poor enforcement of the new strategy. Political interference and lack of routine monitoring and evaluations are also factors that could contribute to poor enforcement of the proposed policy.

Policymaker

The policy proposal will be presented to the Commissioner, Minnesota Department Health, Jan Malcolm.

Rationale

As the head of the state department of health, this individual has an interest in improving population health outcomes. The challenge of unintentional falls is the leading health concern in the county and state, making it a priority for healthcare leaders. The commissioner is best suited for this role of policy advocacy because her primary functions include protecting, maintaining, and improving the health of all Minnesotans. Additionally, Malcolm has been active in state and national healthcare, public health associations, and government commissions on health care access and quality. Her experiences in these fields put her in better a better position to receive and advocate for policy change.

Strategic next Steps

The first step that will strengthen this professional’s practice as an advocate is through continuing education programs that deal with policy matters. Enrolling in courses that deal with healthcare policy and advocacy plans will ensure more insight into healthcare policy matters. In addition, these courses will give the knowledge to identify influential stakeholders to involve during policy advocacy and influence lawmakers to accept new policies. The second approach will involve active participation in nursing politics and vying for leadership positions. This approach will allow making robust networks of leaders with power and influence on policy matters.

References

Bamgbade, S., & Dearmon, V. (2016). Fall prevention for older adults receiving home healthcare. Home Healthcare Now, 34(2), 68–75. https://doi.org/10.1097/nhh.0000000000000333

Centers for Disease Control and Prevention. (2021). Home and recreation safety: Deaths from older adult falls. https://www.cdc.gov/homeandrecreationalsafety/falls/data/deaths-from-falls.html

Lee, S., Lee, C., & Rodiek, S. (2017). Neighborhood factors and fall-related injuries among older adults seen by emergency medical service providers. International Journal of Environmental Research and Public Health, 14(2), 163. https://doi.org/10.3390/ijerph14020163

Minnesota Department of Health. (2012). Preventing unintentional injury in Minnesota: A working plan for 2020 [PDF]. https://www.health.state.mn.us/communities/injury/pubs/documents/UnintentionalInjuryPlan2020.pdf

Minnesota State Fire Chiefs Association. (2017). Fire and fall prevention for older adults: Program guide and talking points. [PDF]. http://dps.mn.gov/divisions/sfm/for-fire-departments/Documents/Fire-fall-prevention-toolkit.pdf

Schot, E., Tummers, L., & Noordegraaf, M. (2019). Working on working together. a systematic review on how healthcare professionals contribute to interprofessional collaboration. Journal of Interprofessional Care, 34(3), 332–342. https://doi.org/10.1080/13561820.2019.1636007

Tzeng, H.-M., Okpalauwaekwe, U., & Lyons, E. J. (2020). barriers and facilitators to older adults participating in fall-prevention strategies after transitioning home from acute hospitalization: A scoping review. Clinical Interventions in Aging, Volume 15, 971–989. https://doi.org/10.2147/cia.s256599

Williams, S., Phillips, J., & Koyama, K. (2018). Nurse advocacy: Adopting a health in all policies approach. Online Journal of Issues in Nursing, 23(3). https://doi.org/10.3912/OJIN.Vol23No03Man01

Wollesen, B., Bischoff, L., & Mattes, K. (2016, June). Influence of poverty on mobility and fall risks in older adults. Journal of Aging and Physical Activity, 24(2), S60-S60. https://www.researchgate.net/publication/304170754