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Ethical decisions in designing patient-centered health interventions.
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For this assessment, you will implement the preliminary care coordination plan you developed in Assessment 1. Present the plan to the patient in a face-to-face clinical learning session and collaborate with the patient in evaluating session outcomes and addressing possible revisions to the plan Ethical decisions in designing patient-centered health interventions..NOTE: You are required to complete this assessment after Assessment 1 is successfully completed.
Care coordination is the process of providing a smooth and seamless transition of care as part of the health continuum. Nurses must be aware of community resources, ethical considerations, policy issues, cultural norms, safety, and the physiological needs of patients Ethical decisions in designing patient-centered health interventions..
Nurses play a key role in providing the necessary knowledge and communication to ensure seamless transitions of care. They draw upon evidence-based practices to promote health and disease prevention to create a safe environment conducive to improving and maintaining the health of individuals, families, or aggregates within a community. When provided with a plan and the resources to achieve and maintain optimal health, patients benefit from a safe environment conducive to healing and a better quality of life.
This assessment provides an opportunity for you to apply communication, teaching, and learning best practices to the presentation of a care coordination plan to the patient Ethical decisions in designing patient-centered health interventions..
You are encouraged to complete the Vila Health: Cultural Competence activity prior to completing this assessment. Completing course activities before submitting your first attempt has been shown to make the difference between basic and proficient assessment.
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
In this assessment, you will implement the preliminary care coordination plan you developed in Assessment 1 and communicate the plan to the patient in a professional, culturally sensitive, and ethical manner.
To prepare for the assessment, consider the patient experience and how you will present the plan. Make sure you schedule time accordingly Ethical decisions in designing patient-centered health interventions..
Note: Remember that you can submit all, or a portion of, your plan to Smarthinking Tutoring for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.
Note: You are required to complete Assessment 1 before this assessment.
For this assessment:
Reminder: The time you spend presenting your final care coordination plan must be logged in the CORE ELMS system. The total time spent in securing individual participation in this activity in Assessment 1 and presenting your plan in this assessment must be at least three hours. The CORE ELMS link is located in the courseroom navigation menu Ethical decisions in designing patient-centered health interventions..
Please be advised that the Volunteer Experience form requires that you provide the name and contact information for at least one individual with whom you worked as part of your direct clinical activity. Your faculty may reach out to this individual to verify that you have accurately documented and completed your clinical hours Ethical decisions in designing patient-centered health interventions..
Build on the preliminary plan document you created in Assessment 1. Your final plan should be 5–7 pages in length.
Support your care coordination plan with peer-reviewed articles, course study resources, and Healthy People 2020 resources. Cite at least three credible sources.
The requirements, outlined below, correspond to the grading criteria in the Final Care Coordination Plan Scoring Guide, so be sure to address each point. Read the performance-level descriptions for each criterion to see how your work will be assessed.
Before submitting your assessment, proofread your final care coordination plan to minimize errors that could distract readers and make it more difficult for them to focus on the substance of your plan.
You must submit your hours to the CORE ELMS system before you can complete this assessment and course.
Portfolio Prompt: Save your presentation to your ePortfolio. Submissions to the ePortfolio will be part of your final Capstone course. Ethical decisions in designing patient-centered health interventions.
Jessica has been a nurse practitioner for nearly two decades. She has been providing primary care services to home bound and home limited patients since 2013 with an organization known as MD2U in Evansville, Indiana. In viewing the documentary, The Invisible Patient, Jessica presented herself as a disruptive innovator.
According to Hamric, Hanson, Tracy, & O’Grady, “disruptive innovation transforms an existing market or creates a new market by making processes simpler and improving access” (2014). Jessica took pride in carrying for individuals in the community that were faced with challenges Ethical Dilemma Case Study. In viewing the documentary, I was able to see many of them live in difficult situations.
Some are unable to travel to see a clinician at a doctor’s office for a lot of different reasons. They all had multiple chronic conditions, and all faced some form of poverty. Jessica mentioned several times that there are only a handful of people currently reviving primary health care in their homes. Jessica background was in renal and telemetry medicine at Yale New Haven hospital.
Prior to joining MD2U, she cared for the adult and geriatric population with dementia. She also spent a decade in traditional family practice prior to branching out. If Jessica did not provide her services many of her patients would have frequent admissions to the hospitals or require long term or skilled rehab services.
During the documentary, Jessica displayed respect and empathy to her patients while delivering high quality patient centered care Ethical Dilemma Case Study. Per Jessica, her services are also more cost efficient for the patients, especially since they were on a fix income.
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The ethical dilemma that stuck to to me the most while watching the documentary was the care Jessica provided to the 34-year male Roger Brown. He was diagnosed with muscular dystrophy at four years old. “Muscular dystrophy is a group of diseases that cause progressive weakness and loss of muscular mass” (“Muscular dystrophy”, 2018).
According to “Muscular dystrophy”, the genes are abnormal, and they mutate interfering with the production of proteins needed to form healthy muscle (2018). This disease is very common in young males Ethical Dilemma Case Study. There is no cure, but medications and therapy can try to help manage symptoms and slow the course of the disease.
The normal life expectancy is approximately twenty years, Roger exceeded this. Symptoms may include, “frequent falls, waddling gait, walking on the toes, large calf muscles, muscle pain/stiffness and respiratory complications” (“Muscular dystrophy”, 2018) Ethical Dilemma Case Study. The ethical dilemma faced here was informed consent, “Concerns that patients and their families have not been fully informed about there treatment or clinical prognosis is a common ethical concern for nurses” (“Muscular dystrophy”, 2018).
Often, patients feel more comfortable asking a nurse to decipher what their doctor say because of comprehension, especially with end life decision making. In one party of the documentary Jessica is faced to discuss end of life care with Roger and his mom due to the progression of his disease especially impacting his respiratory status Ethical Dilemma Case Study. Jessica conflict was Rogers age. Normally treating a person of his age, you would take aggressive measures.
But regarding Rogers health, his EF is 20%, fluid buildup, heart failure, kidney stones and generalized pain. He had multiple co-morbidities that Jessica knew if his heart stop beating, performing CPR to prolong his life would cause more harm to him. At first Roger wanted to continue aggressive measures so he could continue his life if he could Ethical Dilemma Case Study. Jessica had to find another approach to assist Roger and his mother to understand the progression of his disease. She helped him understand that he wasn’t getting better regardless of his treatment.
Aggressive measures and hospice/palliative care services are two different treatments. Jessica had a difficult time discussing this because she was fully aware Rogers time was near. She did a great job explaining to Roger and his mother what would happen once he starts to transition. Many people are faced with difficult decision regarding code status, hospice and palliative care services in their lifetime Ethical Dilemma Case Study. End of life should be a smooth transition, but it is often difficult because people find it hard to accept.
One important factor that affects ethical decision making is your personal belief system (Hamric, Hanson, Tracy, & O’Grady, 2014). Your life experiences over a period may change your personal values Hamric, Hanson, Tracy, & O’Grady, 2014). My personal beliefs are inline with Jessica with this ethical dilemma. I feel end of life patients should have pain and symptoms management.
I would also assist the patient and family through the dying and death process, so the anxiety and fear can be decreased like Jessica did Ethical Dilemma Case Study. Advocacy for the patient is key to me. For a person to give great end of life care appropriately, effective communication should take place.
Becoming an adult gerontology nurse practitioner, I will be the spokesperson for my patient and honor their rights and give them dignity. I will ensure my patients are informed on what advance directives and living wills are in case they ever are unable to make a sound decision and they wouldn’t want to put that burden on there love ones.
Everyone should honor a patient wishes as it is not causing any harm. Through education with end of life, DNR, palliative care services, hospice services and advance directives the tales will be eliminated, and anxiety/fear will be decreased (Hamric, Hanson, Tracy, & O’Grady, 2014) Ethical Dilemma Case Study.
One mechanism to overcome barriers is recognizing a patient needs and making patient and families aware of additional services such as palliative care Ethical Dilemma Case Study. It is for patient with life threatening illness. “Patient have better quality of life and live longer and cost the health system less”, with palliative care services (Perrin & Kazonowski, 2015). Barriers to palliative care consultation for patients in critical care include misunderstanding.
Palliative care undermines the focus of saving the patient life is what some feel. Providers often have difficult time determine when critically ill patients are approaching the end of life, often causing patients to die in pain. According to Perrin & Kazonowski, palliative care is an approach that improves the quality of life of patients and their families facing problems associated with life threatening illness (2015). APN can emphasize to families that symptom management care to the patient can improve a patient outcome.
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When the dying process is detected earlier, comfort focused treatment goals are initiated sooner. When appropriate, patients are moved to lower intensity care site (Perrin & Kazonowski, 2015) Ethical Dilemma Case Study. Length of stay in the intensive care unit is decreased (Perrin & Kazonowski, 2015).
Cost of care is reduced because realistic goals are established. Staff would receive support for patients and families. The need for repeat admission could be reduced because treatment goals have been clarified. And lastly, with palliative care the patient and families would have continuity of care with familiar faces because they would be followed from the hospital, to skilled/long term care or home.
Clinicians face ethical and professional dilemmas when they manage their clients who cannot financially afford their care. Actions taken during these situations determine patient’s satisfaction and care quality. Determinants of such actions include the organization’s billing policies, admission policies, and hospital organization among other factors. The case presented is of a young man, 27 years, who requires emergency attention for acute flare-ups of his Crohn’s disease.
However, he is concerned about the costs of the present care because he has not been able to afford the cost of previous prescription medications. The nurse leader has a responsibility to oversee the overall process of nursing care in the department and make critical decisions (Kiwanuka et al., 2020). This patient requires urgent care and my decisions as an advanced nurse practitioner are essential.
The health assessment information required for the diagnosis of this patient includes a subjective assessment of his symptoms and an objective analysis of the signs. Evaluation of symptoms such as pain, rectal bleeding, and vomiting (Burg & Riccoboni, 2017) should be elicited from the patient’s history. Assessment of his sociocultural background would be necessary but after the stabilization of the patient.
An objective analysis of the patient such as vital signs especially temperature and blood pressure, bowel movements, and focused abdominal exam is also required. Investigation of the patient’s electrolytes and electrocardiography would be vital in the emergency setting. Management of pain and administration of corticosteroids would be highly indicated in the patient.
The remaining issues about billing and costs for the care provided would be discussed when the patient is stable and cannot be considered an emergency case. In managing the case, the intervening nurse should consider the need to make a referral for further affordable care, health promotion and patient education, and understanding of the organization’s billing regulations. To promote ethical justice to the patient, consultation with the organization administration may be effective in this case. As Milliken (2018) observe, nurses have an ethical responsibility to be advocates for the patient. To promote affordable care, I would advise the patient about healthcare insurance and assurance policies that would take care of his medical needs at affordable costs.
Evaluation and Management E/M NRNP 6675
WAlden University, LLCStudent NameCollege of Nursing-PMHNP, Walden UniversityNRNP 6675: PMHNP Care Across the Lifespan II
Faculty Name
Assignment Due Date
Pathways Mental Health
Psychiatric Patient Evaluation
Client denied past episodes of hypomania, hyperactivity, erratic/excessive spending, involvement in dangerous activities, self-inflated ego, grandiosity, or promiscuity. Client reports increased irritability and easily frustrated, loses things easily, makes mistakes, and has a hard time focusing and concentrating, affecting her job.
Has low frustration tolerance, sleeping 5–6 hrs/24hrs reports nightmares of a previous rape, isolates, fearful of going outside, has missed several days of work, appetite decreased. She has somatic concerns with GI upset and headaches. Client denied any current binging/purging behaviors, denied withholding food from self, or engaging in anorexic behaviors. No self-mutilation behaviors.
GAD 7= 2 with symptoms rated as no difficulty in functioning
Interpreting the Total Score:
Total Score Interpretation ?10 Possible diagnosis of GAD; confirm by further evaluation 5 Mild Anxiety 10 Moderate anxiety 15 Severe anxiety
MDQ screen negative
PCL-5 Screen 32
· Previous Detox/Residential treatments: one for abuse of stimulants and cocaine in 2015
· Previous psychotropic medication trials: sertraline (became suicidal), trazodone (worsened nightmares), bupropion (became suicidal), Adderall (began abusing)
· Previous mental health diagnosis per client/medical record: GAD, Unspecified Trauma, PTSD, Stimulant use disorder, ADHD confirmed by school records
Any history of substance-related:
· Blackouts: +
· Tremors: –
· DUI: –
· D/T’s: –
· Seizures: –
Longest sobriety reported since 2015—stayed sober maintaining sponsor, sober friends, and meetings
.
Education: High School Diploma
Denied current legal issues.
· Suicide gestures in past – no
· Psychiatric diagnosis – yes
· Physical Illness (chronic, medical) – no
· Childhood trauma – yes
· Cognition not intact – no
· Support system – yes
· Unemployment – no
· Stressful life events – yes
· Physical abuse – yes
· Sexual abuse – yes
· Family history of suicide – unknown
· Family history of mental illness – unknown
· Hopelessness – no
· Gender – female
· Marital status – single
· White race
· Access to means
· Substance abuse – in remission
PROTECTIVE FACTORS FOR SUICIDE:
· Absence of psychosis – yes
· Access to adequate health care – yes
· Advice & help seeking – yes
· Resourcefulness/Survival skills – yes
· Children – no
· Sense of responsibility – yes
· Pregnancy – no; last menses one week ago, has Norplant
· Spirituality – yes
· Life satisfaction – “fair amount.”
· Positive coping skills – yes
· Positive social support – yes
· Positive therapeutic relationship – yes
· Future oriented – yes
Suicide Inquiry: Denies active suicidal ideations, intentions, or plans. Denies recent self-harm behavior. Talks futuristically. Denied history of suicidal/homicidal ideation/gestures; denied a history of self-mutilation behaviors
Global Suicide Risk Assessment: The client is found to be at low risk of suicide or violence. However, the risk of lethality increased under the context of drugs/alcohol.
No required SAFETY PLAN related to low risk
She denies any current suicidal or homicidal ideation. Cognitively, She is alert and oriented to all spheres. Her recent and remote memory is intact. Her concentration is fair. Her insight is good.
She denied vegetative symptoms of depression, no evident mania/hypomania, no psychosis, denied anxiety symptoms. Denied current cravings for drugs/alcohol, exhibits no withdrawal symptoms, has somatic concerns of GI upset and headaches.
At the time of disposition, the client adamantly denies SI/HI ideations, plans, or intent and has the ability to determine right from wrong and can anticipate the potential consequences of behaviors and actions. She is at low risk for self-harm based on her current clinical presentation and her risk and protective factors.
Double click inside this text box to add/edit text. Delete placeholder text when you add your answers.
· Continue with atomoxetine 80mg PO daily for ADHD. #30 1 RF
Instructed to call and report any adverse reactions.
Future Plan: monitor for decreased re-experiencing, hyperarousal, and avoidance symptoms; monitor for improved concentration, less mistakes, less forgetful
2) Education: Risks and benefits of medications are discussed, including non-treatment. Potential side effects of medications discussed. Verbal informed consent was obtained.
Not to drive or operate dangerous machinery if feeling sedated.
Not to stop the medication abruptly without discussing it with providers.
Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Praised and Encouraged ongoing abstinence. Maintain support system, sponsors, and meetings.
Discussed how drugs/ETOH affects mental health, physical health, sleep architecture.
3) Patient was educated about therapy and services of the MHC, including emergent care. Referral was sent via email to the therapy team for PET treatment.
4) Patient has emergency numbers: Emergency Services 911, the national Crisis Line 800-273-TALK, the MHC Crisis Clinic. Patient was instructed to go to the nearest ER or call 911 if they become actively suicidal and/or homicidal.
5) Time allowed for questions and answers provided. Provided supportive listening. Patient appeared to understand the discussion and appears to have the capacity for decision making via verbal conversation.
6) RTC in 30 days
7) Follow up with PCP for GI upset and headaches, reviewed PCP history and physical dated one week ago, and include lab results
Patient is amenable with this plan and agrees to follow treatment regimen as discussed.
Information Required in Documentation to Support DSM-5 and ICD-10 Coding
The documentation includes the symptoms of the condition the patient is suffering. The DSM-5 criteria have an 11 items checklist where the severity of patient symptoms is measured. The DSM includes descriptions, symptoms, and other diagnostic criteria for mental disorders (American Psychiatric Association, 2020). It generates consistent and trustworthy diagnoses used in mental disorder research and gives a common vocabulary for physicians to talk about their patients. These documents also allow the physicians to document any behavioral changes. The important aspect is that DSM-V aids doctors in diagnosing behavioral health conditions more precisely (Stewart & DeNisco, 2019). ICD-10, on the other hand, aids billing personnel in accurately coding and billing. Because of these distinctions, an EHR system for a behavioral health provider should have both types of coding.
Missing Information and How It Can Be Helpful to Narrow down Billing and Coding Options
There should be more information about the patient’s strategies to cope with stress and triggers. This information will ensure that if the strategy needs physicians or medication, they are documented for billing (Buppert, 2021). It is also essential to measure whether the patients’ support needs are. Suppose the patient needs more than a 30-day interval between support. It can be accounted for in billing. It will ensure that the patient appointments are appropriately supported. There should also be information on where the failed medication trial occurred and the adherence plan.
Explain How To Improve Documentation To Support Coding And Billing For Maximum Reimbursement
The use of technology will allow physicians to have accurate data collection methods. It is also essential to provide training to the physicians on the key coding compliances and ensure maximization of the reimbursement issues (Pohontsch et al., 2018). There also needs to be a clinical documentation improvement to enhance adequacy and accuracy.
American Psychiatric Association. (2020). Updates to DSM–5 criteria, text, and ICD-10 codes. https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5
Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.
Pohontsch, N. J., Zimmermann, T., Jonas, C., Lehmann, M., Löwe, B., & Scherer, M. (2018). Coding of medically unexplained symptoms and somatoform disorders by general practitioners–an exploratory focus group study. BMC family practice, 19(1), 1-11.
Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.). Jones & Bartlett Learning.
Insurance coding and billing is complex, but it boils down to how to accurately apply a code, or CPT (current procedural terminology), to the service that you provided. The payer then reimburses the service at a certain rate. As a provider, you will have to understand what codes to use and what documentation is necessary to support coding.
For this Assignment, you will review evaluation and management (E/M) documentation for a patient and perform a crosswalk of codes from DSM-5 to ICD-10
Review this week’s Learning Resources on coding, billing, reimbursement.
Review the E/M patient case scenario provided.
Assign DSM-5 and ICD-10 codes to services based upon the patient case scenario.
Then, in 1 – 2 pages address the following. You may add your narrative answers to these questions to the bottom of the case scenario document and submit altogether as one document.
Explain what pertinent information, generally, is required in documentation to support DSM-5 and ICD-10 coding.
Explain what pertinent documentation is missing from the case scenario, and what other information would be helpful to narrow your coding and billing options.
Finally, explain how to improve documentation to support coding and billing for maximum reimbursement.
Reimbursement and the appropriate coding to support it are of paramount importance to the business side of the medical field. When a service is provided, a code is used to extract billable information from the medical documentation, which results in insurance reimbursements to the provider. Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses, and you will need to understand how to accurately code services for documentation, billing, and reimbursement.
This week, you analyze the relationships among documentation, coding, and billing in advanced practice nursing as you practice applying diagnostic criteria and service codes to a case study. You will also evaluate the progress you made on the study plan that you created in NRNP 6665 and develop additional goals to help you prepare for your nurse practitioner national certification exam.
Students will:
Apply DSM-5 diagnosis criteria and ICD-10 codes to patient service documentation
Analyze the relationships among documentation, coding, and billing in advanced practice nursing
Required Readings (click to expand/reduce)
American Psychiatric Association. (2020). Updates to DSM-5 criteria, text and ICD-10 codes. https://www.psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm-5
American Psychiatric Association. (2013). Insurance implications of DSM-5. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM_Insurance-Implications-of-DSM-5.pdf
Clicking on this link will initiate the download of the PDF.
American Psychiatric Association. (2020). Coding and reimbursement.
https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-medicare-and-medicaid/coding-and-reimbursement
American Psychiatric Association. (2013). Numerical listing of DSM-5 diagnoses and codes (ICD-10-CM). In Diagnostic and statistical manual of mental disorders (5th ed.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/10.1176/appi.books.9780890425596.ICD10Num_list
Buppert, C. (2021). Nurse practitioner’s business practice and legal guide (7th ed.). Jones & Bartlett Learning.
Chapter 9, Reimbursement for Nurse Practitioner Services
Centers for Medicare & Medicaid Services. (2020). Your billing responsibilities. https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/ProviderServices/Your-Billing-Responsibilities
Stewart, J. G., & DeNisco, S. M. (2019). Role development for the nurse practitioner (2nd ed.). Jones & Bartlett Learning.
Chapter 15, Reimbursement for Nurse Practitioner Services
Walden University Academic Skills Center. (2017). Developing SMART goals. https://academicguides.waldenu.edu/ld.php?content_id=51901492
Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.
Chapter 4 Neuroanatomy, Physiology, and Mental Illness
Document: E/M Patient Case Study
Also Read: Controversy Associated with Dissociative Disorders NRNP 6665
LOE
Strengths/Weaknesses
Feasibility
Conclusion
Recommendation
Huygens, M. W., Vermeulen, J., Swinkels, I. C., Friele, R. D., Van Schayck, O. C., & De Witte, L. P. (2016). Expectations and needs of patients with a chronic disease toward self-management and eHealth for self-management purposes. BMC health services research, 16(1), 1-11. DOI 10.1186/s12913-016-1484-5To evaluate how eHealth is used to support patients in self-management especially in chronic care. Chronic patients need round the clock monitoring due to their chronic condition. eHealth has the capability of monitoring and sending timely messages to nurses and doctors concerning the condition of each patient that use the technology.Investigating the expectations of patients with chronic ailments and their willingness to use eHealth for self-management purposes.Five focus groups comprising individuals with diabetes (n=14) and heart disease (n=9) were used. The researchers also used a separate focus group from patients with chronic conditions. The researchers examined chronic disease impacts on life, patient opinion regarding self-management, and needs and expectations regarding the use of eHealth. The researchers adopted conventional content analysis to understand the data.Groups of people suffering from COPD (n=9), diabetes (n=14), were recruited from four primary care centers around Netherlands. All patients were adults (18 years and above)eHealth- the technology used in monitoring the health of patients with chronic conditions. COPD- Chronic obstructive pulmonary disease-an inflammatory disease that affects the lungs and obstructs air flow to the organ. Measuring of symptoms and the effects of the condition on daily lifeA verbatim transcription of was done for all focus groups. The verbatim transcription was checked against the audio recordings for discrepancies. Researchers independently evaluated each transcript from COPD, diabetes, and heart disease.30 participants between 50 and 80 years old participated in the focus group. Two groups evaluated people with diabetes, another 2 groups analyzed COPD. Most COPD participants had mild to severe case of COPD. 4 participants had high cholesterol and high blood pressureThere were different expectations from different patient groups concerning eHealth and self-management. The use of eHealth greatly depended on the willingness of the participants to use it.The researchers found that there were big differences in the needs and the expectations of patients meaning that the implementation of eHealth technology should be tailored for each group. Based on these differences, there cannot be a ‘fits-all’ solution for everyone hence the need to tailor the eHealth for each group.
Bashir, A., & Bastola, D. R. (2018). Perspectives of nurses toward telehealth efficacy and quality of health care: Pilot study. JMIR Medical Informatics, 6(2), e35. https://doi.org/10.2196/medinform.9080The purpose of this study is to evaluate the effect of telehealth technology on the quality of service delivered by nurses. The study seeks to analyze the evolving roles of nurses as they assume new responsibilities occasioned by the use of information technology.A survey was conducted from nurses through a survey instrument to evaluate the quality of service when telehealth is used.This study is important because it highlights the role that telehealth plays in the provision of quality care for patients.
Data was collected from nurses from a home care agency using interview questions. The researchers did follow-up interviews to ascertain and validate the interview questions.The Visiting Nurse Association-VNA of Omaha was the study site. 13 members of VNA telehealth nursing staff participated in the study.Positive facilitators of telehealth were the major variables in the study. The key variables include; responsiveness, reliability, assurance, and empathy. Measuring these parameters helped the researchers to evaluate the link between the quality of telehealth.Measurement of the variables was scored on the level of responsiveness of the participants.The perceived services and consumer expectations is the major component of the study and is measured by the willingness of consumers to use telehealth.
The study provided weblink for the survey which was given through email to all the VNA participant nurses. 13 nurses took part in the survey.The survey was generated using a Web-based software tool; Survey Monkey was used to generate a web-based software tool for the study. . The data were processed through SPSS version 22. The gaps, expectations, and perceptions, were calculated.
The results of the study were positive based on the mean differences between perception and expectation.In the past, SERVQUAL tools have been found as a reliable and valid measure of SQ. This is because of factors such as the dimensionality, item compositions, validity, and disconfirmation paradigm used in its measurement. The “type of technology” has a direct effect on barrier reduction, attitudes, and quality and quantity of communication.
SERVQUAL instrument proved to be the best criterion for assessing TNSQ. This tool not only estimated the level of satisfaction but also identified situations where perceptions exceeded expectations.Shea, S., Weinstock, R. S., Teresi, J. A., Palmas, W., Starren, J., Cimino, J. J., Lai, A. M., Field, L., Morin, P. C., Goland, R., Izquierdo, R. E., Ebner, S., Silver, S., Petkova, E., Kong, J., & Eimicke, J. P. (2009). A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus: 5 Year Results of the IDEATel Study. Journal of American Medical Information Association, 16(4), 446–456. doi:10.1197/jamia.m3157 To find out if telemedicine technology can offer chronic patients with an effective case management service.Today, patients have an array of hospital-based technology from which they can get information on health matters. Through telemedicine and other technologies, patients have access to personal health records that they can directly access and utilize.The researchers performed a randomized and controlled test that compares telemedicine to the usual care services. A total of 1,665 recipients of medicare suffering from diabetes participated in the study. The participant chosen for the study were all aged 55 years and above. They were drawn from the federally designated areas of New York that are underserved medically.Diabetes was chosen as the ideal clinical target for the IDEATEL. The results would be determined by the consumption of the technology and how much it contributed to the health of the patients.Measuring the variable depended on how much information the participants gathered about their condition. The more information a participant had, the better the outcome of their health improvement.Covariance was used to determine and adjust appropriately the baseline values used in the clustering process. The heterogeneity of groups and all other residual variances were modeled to accommodate model assumptions. The researchers found that the usual care groups together with the intervention did not bear much difference to the baseline demographic. The researchers found that case management of diabetes delivered through telemedicine greatly improved the hemoglobin level.
The study took into consideration the comparison between treatments delivered through telemedicine and in-person delivery of diabetes treatment. The design of the study allowed it to be feasible given the expansive geographic span of New York.
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Clinical practice guidelines have numerous advantages for practicing nurses. Practice guidelines offer practicing nurses the opportunity to focus on the provision of quality healthcare. Besides, practice guidelines promote rational use of resources by clinical staff. Evidence-Based Practice Guidelines-CPG are unique statements created to help nursing practitioners to make effective decisions concerning the healthcare provided to patients. Today, EBP is a critical part of nursing practice because it impacts the provision of quality healthcare to patients.
CPGS not only reduce costs to patients but also impact patient outcomes (Brook, R., & Rajagopalan, 2018). This paper is a critique of the journal article Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association obtained from clinical practice guidelines and the National Guideline Clearinghouse
The purpose of this study was to create a clinical guideline for the assessment, control, and monitoring of factors that contribute to the severity of High blood pressure. The study also aimed at developing the appropriate pharmacologic treatment plan for the disease. Being the most common respiratory disease in the US, High blood pressure remains a dangerous chronic inflammatory disease that affects millions of people across America and Canada. This study contains a comprehensive description of what cancer is, its causes, and the best pharmacology treatment for the disease.
The study was conducted in Canada based on the Canadian Community Health Survey that revealed that close to 10% of Canadians suffer from some form of High blood pressure. The study was conducted among young and old Canadians to find out the prevalence of the disease in these demographic groups. The epidemiological evidence from the study showed that young people below 19 years and old people above 60 years are the most affected by this respiratory problem.
The study was conducted in Canada to evaluate the number of deaths caused by High blood pressure annually. Up to 10% of the Canadian population is affected by High blood pressure. A recent cohort study done in Ontario revealed that the prevalence of High blood pressure has increased to 55% from a low of 8.5% in 2003. High blood pressure is a respiratory problem that affects the airways causing difficulty in breathing. T helper cells are associated with High blood pressure and affect immune responses. There are many triggers for High blood pressure such as dust, dander from animals, cockroach residue, pollen from plants, and cold air in some people.
The research question is presented in the study. The authors pose the question, “do the prenatal risk factors increase the chance of High blood pressure attack in children”. To answer this question, the research identifies up to 5 clinical High blood pressure phenotypes that differ distinctly from a lung infection. There is the non-atopic phenotype that represents the groups of children that experience wheezing episodes.
In a research study, a population is defined as a set of elements (People or objects) that have similar characteristics as quantified by a researcher. On the other hand, the word sample in research refers to selected objects or elements chosen to participate in a study. This study sought to capture the experiences of older men and young children working in Ontario Canada. The study was conducted among 150 old adults and children in Ontario and the West South Central region of the United States of America.
This region is 443,501 square miles in size with a combined population of about forty-five million inhabitants. Owing to its huge size, it would be impossible to interview all the women in the oil and gas industry in the entire West South Central States. A total of 150 old people and children were randomly selected to participate in the study by way of an interview to collect and capture their lived and personal experiences with High blood pressure.
According to the American College of Cardiology-ACC and American Heart Association-AHA., the best methods for measuring the impact of Evidence-based practice Clinical guidelines is through scientific measurement of patient outcomes. The authors assert that the implementation of EBPCG can only work when it is practiced by nurses and patients. The impact factor, in this case, is measured based on the number of citations present in the research or paper. In this work, such metrics provide a reliable and effective method of measuring the impact that clinical guidelines have on scientific research on evidence-based practice.
However, the AHA and ACC point out that the growth of analytical tools used in harvesting information from online databases has helped the research on Evidence-based practice Clinical guidelines to take a multi-disciplinary approach such as sociological approach, scientific approach, structural approach, and technological approach. The two institutions continue to assert that “most importantly, discoveries in the basic science of AD would be entirely impotent without close collaborations with investigators in translational, clinical, and public health disciplines.’ (American College of Cardiology-ACC and American Heart Association, 2017). This statement is conclusive and takes into consideration the work of individual researchers as critical additions to research on EVPCG.
According to Victoria and her fellow researchers, this research is the first RCT-based test done to find out the efficacy usefulness of web-based online intervention programs for caregivers compared to face-to-face interventions. According to the authors, the results of the test were a great success because control implementation error was taken care of. The authors assert that by controlling the information viewed by caregivers in a specific schedule. Victoria and her fellow researchers further assert that the contents of the website continued to remain static for the period of the test which further eliminated any errors. According to Garity (2006), the stress in caregivers of people living with Evidence-based practice Clinical guidelines is the same irrespective of the approach used to educate them. Based on this argument, it is not acceptable for Victoria and her fellow researchers to conclude that their research is 100% fault-free.
According to Creswell (2009), the best research methods which should be used in qualitative research include observations, interviews, and review of existing literature (Creswell, 2017). Accordingly, this research used a combination of the three methods mentioned above to come up with comprehensive and valid research. Interviews by far are the most used method to capture data in qualitative studies. This study entailed the researcher going to the field to conduct interviews with the chosen participants.
Another source of data that this research relied on to a big extent is observation. Observation is important to this research as it accorded the researcher the opportunity to observe first-hand the subjects as well as their natural environment which in this case was their workplaces. The observation was done via watching and taking down notes and also video recording the interviews as well as the environment of the participants to get a feel of the environment.
The observation was important to this study because it helped to reduce any biases that may have been formed before interaction with the participants. Apart from interviews and observation, a review of existing documents or literature played a pivotal role in shaping the direction of this research. A review of the literature gave the researcher a deep understanding of the phenomena and giving the researcher the much-needed background information for the study.
In this article, the American College of Cardiology-ACC and American Heart Association asserts that the continued use of the evolved format to present guidelines contributes a chunk of knowledge to EBPCG. The authors provided that each modular presentation is effectively represented through a combination of tools such as tables and flow diagrams where appropriate. To become more valid, the presentation contains a table of associated recommendations, a synopsis of the problem, and recommendations that are specific to the case study.
Interviews, observation, and review of existing documents were chosen as the most appropriate for this study because of the numerous benefits they presented to the researcher. Top of the benefits list that made these methods the best fit for this research is the fact that the researcher was able to get first-hand information from the respondents themselves. The researcher got the opportunity to immerse themselves in the world of the women being interviewed and was able to observe both the subject as well as the environment within which the respondents operated from.
The observation was particularly pivotal for this research because it allowed the researcher to observe what was going on rather than just relying on what one has been told by the respondents which may be biased in opinion (Reboussin et al., 2018). These sources also allowed the researcher to be able to narrow down the research to be more specific which in turn helped the researcher to decide the direction of the research and be able to make amendments as necessary before final data could be gathered for analysis. Additionally, these methods were chosen over other methods because they come with a high degree of reliability. They are deemed reliable because the researcher relies on what he has observed and recorded.
The calculation of descriptive statistics was done from a pool of co-publications which also contained the total number of publications every year. The data obtained from the co-publication networks were then fed to a linear regression line of 0.9567 being the value of R2. Investigators lying within a certain ADC network were then linked to other researchers or investigators who published a book together with another investigator (Quirt et al., 2018). The researchers then observed the percent of all nodes connected to the largest network or cluster which according to them had recorded growth compared to individual researchers. Based on this metric, Hughes and his teammates concluded that the level of connectivity interaction between ADC co-authors publications has tremendously increased.
For this study, participants were put in two randomized offline parallel groups using a computer-generated list which uses blocking as well as stratification i.e. categorizing the caregivers as either being relatives on non-relatives of the people with Evidence-based practice Clinical guidelines. Each group was given ten-minute training on how to operate the website. Every week, each participant read through an entire session before printing out a questionnaire to indicate how satisfied they were with both the training and the website.
The study was used stress and coping theory by Lazarus and Folkman as well Bandura’s self-efficacy model to ascertain the stress levels, self-efficacy, burden, and health issues in such caregivers (Cristancho-Lacroix, et al, 2015). The findings did not reveal any significant difference in PSS-14 (self-perceived stress) which means that it still needs further research to bring it to acceptable levels. This pilot research aimed to evaluate what impact the Diapason program would have on caregivers as far as helping them to deal with stress is concerned. The program was meant to offer skills, information, training, and a forum for caregivers to find a valuable platform to help them reduce their stress and burden.
Intention-to-treat analysis was the method used to analyze all available data. Calculations for means and percentages or descriptive data were also calculated for each caregiver as the characteristics found in PWADS. Besides, Victoria and fellow researchers relied heavily on Mann-Whitney tests (popularly called t-tests) as well as Spearman correlations were the main method used for identifying correlations between the variables. Face-to-face interventions allow researchers to control the level of bias which is something Victoria and her co-researchers did not achieve with success in their online-based intervention (Whelton et al., 2015). Furthermore, due to the heterogeneous nature of caregivers, future studies must limit the criteria of inclusion.
The researchers concluded that as the number of High blood pressure rises in America, so does the number of collaborating researchers on Evidence-based practice Clinical guidelines. According to Hughes and his fellow researchers, the number of nodes linked to each cluster especially the major cluster is proof of collaboration between researchers. The researchers do agree that their research lacks adequately in the area of statistical power which could pose problems of efficacy to the research. This notwithstanding, the researchers believe that this research has been largely successful in providing an alternative method for providing information and education to caregivers of people suffering from Evidence-based practice Clinical guidelines, especially the informal caregivers.
The researchers believe that they have demonstrated with a success that online facilitation of caregivers can help them to acquire functionalities such as personalization, flexibility, socialization, and dynamism which are all important qualities in a caregiver given the stress levels associated with Evidence-based practice Clinical guidelines. Furthermore, the researchers conclude that there was a very limited acceptance of the online Diapason program by caregivers which is a pointer to the fact that the program needs to be rolled out in a structural manner that allows the caregivers to be able to interact with other professionals as well as the broader online community.
Caring for people using Evidence-based practice Clinical guidelines -EVPCG is cost-effective and increases patient outcomes. Over five million Americans and thirty-five million people worldwide suffer from High blood pressure meaning that these people require some form of caring whether formally or informally. Caring for people through Evidence-based practice Clinical guidelines -EVPCG is the best way to combat High blood pressure since people do not even have basic information on how to take care of people suffering from the disease.
Caring for people with High blood pressure people takes two approaches; formal and informal care. Authors Victoria Cristancho-Lacroix, Jeremy Wrobel, Inge Cantegreil-Kallen, Timothee Dub, Alexandra Rouquette, and Anne-Sophie Rigaud analyze the efficacy and acceptability of web-based educational programs intended for informal caregivers to people with Evidence-based practice Clinical guidelines using methods of research analysis.
According to Victoria Cristancho and her fellow researchers, the world has seen substantial growth in the number of High blood pressure which presents problems to nations. All of these people require round-the-clock care just to get by. By the year 2017 AHA indicated that over 12 million caregivers gave more than 17.5 billion hours of care (unpaid) which was equivalent to USD 216 billion. Presently, a majority of people with High blood pressure are cared for at home by their relatives which has also seen the emergence of chronic stress in such caregivers. Based on this, Victoria and fellow researchers researched to find out if a web-based intervention program for caregivers is just as good as face-to-face interventions.
Evidence-Based Practice-Clinical Guidelines is a critical tool used by nurses to assess patients and offer the best treatment plans that capture their problems. For ultimate results, both nurses and patients must practice EBPCG. Evidence-Based Practice-Clinical Guidelines guide practicing nurses to offer quality healthcare to patients. Besides, nurses that use Evidence-Based clinical guidelines have a better grasp of their duties and responsibilities meaning that they have a great impact on patient outcomes.
Intravenous line is an easy procedure which nurses encounter daily in practice. This occurs either during administration of medications or during fixing of intravenous lines. However, nurses are vulnerable to inappropriately preparing and pushing medications. This can be due to lack of knowledge and skills of IV drug preparation and safe use of IV lines. Also, lack of standards of IV-line insertion and usage and miscommunication between health care professionals is a contributing factor. This can lead to harm of the patients which is against the ethics of practice (Pezeshkmehr, 2021). As identified by Boström et al. (2020), some of the complications of IV lines include thrombophlebitis, limb ischemia due to a retained tourniquet in the arm of the patient and misconnection due to poor communication and documentation. Despite the presence of multiple guidelines on IV lines insertion and maintenance, nurses and other health care professionals still experience IV-line related complication which can bring in the individual factor in rates of IV-line related complications. Peripheral venous line complications account for up to 69% of premature access failure in hospitals (Ray-Barruel et al., 2019).
The proposal will aim to first identify how confident the nurses are that they have the required knowledge and skills to safely fix and use IV lines without causing adverse complications to the patient. The skills, according to Osti et al. (2018), include site identification, cleaning of the site, proper insertion technique, management of the line after insertion and possible complications of poor line insertion. In addition, it will identify the percentage of nurses who at one point in practice have experienced an infection at the site of line insertion and how they managed it. It will also assess the possible misconnections which they have experienced in their lifetime during practice. In addition, it will evaluate the importance of having a care plan in each hospital for IV lines.
The care plan includes assessing the patient which involves looking at the patient clinical status and educating the patient on care for IV line. The second part of the care plan is choosing correct IV line and site for insertion. Large IV lines have a possibility of rupturing small veins hence causing irritation while small IV lines are not best to give fast infusion or even blood due to the possibility of breakdown of blood products termed as hemolysis (Morgaonkar et al., 2017). Next is the intervention which involves cleaning IV lines before use, ensuring they are patent, and assessing them daily for signs of infections. The last part is evaluating whether the patient has understood the instructions and whether the site is developing infections.
Even though most nurses have knowledge of IV-line use and complications, some lack the necessary skills to insert and maintain an IV line without complications. Also, patient consent is sometimes neglected. In addition, nurses have at one time or another experienced insertion site infection and thrombophlebitis which can be avoided. It is an expectation that nurses should have the necessary knowledge and skills to fix IV lines and take care of them as it is central to evidence based nursing practice. In case some lack the required skills, measures can be made to help train them to better nurses who are competent.
The most appropriate data collection tool for this proposal will be interviews and checklist. Other tools which may be appropriate during the study will be questionnaires and reports and existing data. Interviews with a checklist is appropriate because it is simple and able to get the relevant information from the participants. Also, it is cheap and less time is required. From the data collected in the checklist during interviews, analysis can be done to come up with a conclusion hence leading a better and well-informed evidence-based practice. Interviews are reliable because you get the information directly from participant hence no second party information.
The statistical test of choice is multiple regression test. This is especially essential for quantitative data helping to know the effect of lack of enough knowledge and skills on the number of IV-line related complications amongst the nurses. This will help in coming into conclusion whether there is need for more training on IV lines protocols and the need for development of a standardized guidelines for IV-line use in all health care facilities (Feinsmith, et al., 2018). A chi square test can also be used to compare rates of IV-line related complications amongst those who feel they have enough knowledge and skills on IV lines and those who do not.
Using the checklist as the data collection tool, the methods which are planned to be used include using open or closed ended questions in interviews, observation by volunteer groups, following up patients on IV lines for possible complications and using online methods to reach clients. This will help reach a high number of nurses hence increasing the success rate and quality of the results collected. In addition, consent will be taken from the nurses so as to participate in the project with confidentiality maintained.
One will be the evaluation for the cause of the unexpected outcome including conflict of interests. This will then be reported early and possible plan for correcting it made. Also, it will involve evaluating the whole process taken in the project to identify reasons for the lack of expected outcomes hence mitigation measures to avoid it. Overall in case of lack of expected outcome, a recommendation for further research on the field to be done to help come up with better guidelines which are evidence based.
The proposed solutions to fixing the problem including developing a training schedule for nurses about IV lines and this include both during trainings in nursing training institutions and during practice. In addition, a proposed protocol for improving IV access include evaluation of the patient, intervention and reevaluation. When this process is used, less complications of IV lines will be experienced and if they happen, they will be recognized early. The plans will involve making policies in consultation with hospital managers to develop a standard guideline for IV drug use. This will help build a better plan which will last for future generations.
Additionaly, further research and evidence will help revise the guidelines and incase the recommendation needs to be stopped, it will be based on the evidence provided. The proposed solution can be discontinued in case a better proposal guiding IV-line insertion and usage is developed. To help extend the proposed solutions, changes can be made based on research to make it more applicable, affordable and easy to implement hence better patient outcome.
The underlying clinical question for the proposed study is that for children aged between 5 and 15 years, in severe acute asthma refractory to nebulization by SABA/LAMA combination, how effective is using IV methylprednisolone alone versus IV methylprednisolone and heliox at reducing respiratory difficulties over a period of one hour of admission? Severe acute asthma is a clinical condition that can easily be managed using various therapies.
Nonetheless, poor management of severe acute asthma in children can also cause death upon cardiorespiratory collapse. When managing severe acute asthma in children, the therapies often target to increase air passage through oxygen supplementation and bronchodilators dilation. As per Batabyal & O’Connell (2018), the different therapies for severe acute asthma in children of aged 5-15 years should enable the patient to achieve a stable breathing condition.
There are only limited treatment therapies for acute severe asthma refractory to SAA/LAMA combination because the other ones are either prohibitively expensive or unsafe. But because the patients must be treated, physicians are often left with the choice of either IV steroids with or without heliox. This explains why many pieces of research have focused on IV methylprednisolone and heliox as the two most feasible options for treating acute severe asthma in children of age between 5-15 years old.
Using corticosteroids as a treatment option for severe acute asthma in children has however been well-established. Several clinical trials have investigated the benefits of corticosteroids and have provided indications of early improvement in peak expiration flow rates, reduced hospital admission, reduced morbidity, and decreased use of beta agonists (Fishe et al. 2019a). Some practitioners strongly believe that when presented with acute asthma exacerbations, intravenous corticosteroids should be a number one option for achieving the desired pharmacologic effect. However, other piece literature has revealed that this should not be the case (Ferrante & La Grutta 2018, Kenyon et al. 2020).
Specifically, according to Doymaz et al. (2020), corticosteroids should not be a top of the list option for acuter severe asthma exacerbation because their early onset of pharmacologic effects have not been confirmed. Specifically, corticosteroids have been suspected to alter leukocyte function, decrease vascular permeability and inhibition of arachadon acid pathway (Fishe et al. 2019b). Henderson et al. (2018) observed that corticosteroids cause a leukocyte response peak effect within 4-6 hours after administration, which is a delayed pharmacologic response.
Published guidelines and expert opinion on the treatment of acute asthma exacerbations recommend the use of oral corticosteroids within the first 48 hours of treatment (Tesse et al. 2018). However, according to Indinnimeo et al. (2018), some practitioners are hesitant on using oral therapy. Ideally, this hesitation is attributable to a perceived delay in the action onset, a longer duration of hospitalization associated with the use of oral corticosteroids, and potentially decreased potency of the therapy (Leung, 2021).
Some other trials (Ferrante & La Grutta 2018, Kenyon et al. 2020) have demonstrated a few therapeutic equivalencies of intravenous and oral corticosteroids, demonstrating similar improvements in peak expiratory flow rates, and forced expiratory volumes within one second (FEV1) between intravenous and oral groups. However, only a few of the studies have assessed the clinical outcomes of these therapies such as length of hospital stay.
There is an established threshold in the management of acute severe asthma in children of age 5-15 years, that any therapy must be able to achieve. First, early treatment of asthma exacerbations is the best treatment strategy, and there are various important elements of early treatment that any therapeutic intervention must observe. For example, the therapy must be able to relieve hypoxemia when the patient is experiencing mild to severe exacerbations (Leung, 2021).
Similarly, according to Seliem & Sultan (2018), SABA must be able to reverse airflow obstruction, especially during severe exacerbations where additional inhaled ipratropium bromide is used. The corticosteroids must be able to reduce airway inflammation, especially in patients who fail to respond to SABA (Ferrante & La Grutta 2018, Kenyon et al. 2020). more importantly, the therapy must be able to prevent the relapse of exacerbation through follow-up care.
Since the 1940s, corticosteroids have been the widely used treatment of acute severe asthma. However, the long-term systemic use of corticosteroids such as IV methylprednisolone have been associated with adverse events such as adrenal suppression, and even cardiovascular disease (Ferrante & La Grutta 2018). As a result, clinicians have often questioned the mechanism of action of as well as their side effects to refute or support the use of IV methylprednisolone or heliox.
Typically, corticosteroids are synthetic analogue of the natural steroid hormones produced in the body within the adrenal cortex. Their synthetic compounds are like those of natural hormones and may have mineralocorticoid or glucocorticoid properties (Seliem & Sultan, 2018). According to Batabyal & O’Connell (2018), Mineralocorticoids affect ion transportation in the renal tubule’s epithelial cells and are majorly involve water balance and electrolyte regulation. On the other hand, glucocorticoids are primarily involved in protein and fat metabolism, with anti-proliferative, immunosuppressive, and anti-inflammatory properties.
Most of the immunosuppressive and anti-inflammatory actions of glucocorticoids are either directly or indirectly attributable to the interaction with the cytosolic glucocorticoid receptors, which changes the gene transcription to either repress or indue gene transcription in both structural cells and inflammatory leukocytes (Seliem & Sultan, 2018). Therefore, glucocorticoid have a clinical effect on asthma primarily by upregulating the transcription of anti-inflammatory genes to cause a downstream reduction in the number of pro-inflammatory chemokine and cytokine proteins, cell adhesion molecules and other important enzymes that initiate or maintain the host’s inflammatory response.
There are several side effects of systemic corticosteroids in children and adolescents that must be examined to evaluate whether IV methylprednisolone and/or heliox is effective in respiratory difficulties in children of age 5-15 years. For instance, the paediatric population receiving IV glucocorticoids such as IV methylprednisolone have been associated with growth suppression, which manifests in delay in growth among children with asthma as well as those with other diseases such as nephrotic syndrome (Leung, 2021). Evidence by Lew et al. (2021) also suggest that the final height of children with a history of glucocorticoid may have compromised final height.
An underlying hypothesis is that both IV methylprednisolone alone and IV methylprednisolone and heliox can reduce respiratory difficulties over a period of one hour of admission. However, considering the evidence on the side effects associated with systemic corticosteroids, practitioners must have evidence-based recommendations on how they can safely use the therapies to treat paediatric asthma.
But before any long-term use of systemic corticosteroids, the physician must have a thorough physical and patient history evaluation to examine the pre-existing conditions or risk factors that may be exacerbated by corticosteroids therapies including osteoporosis, affective disorders, dyslipidemia, and diabetes (Seliem & Sultan, 2018). According to Batabyal & O’Connell (2018), the use of corticosteroids must be preceded with thorough baseline measures such as height, body weight as well as blood pressure, alongside other important information such as blood glucose levels, pubertal status and nutritional status, lipid profile and complete blood count.
It is also important to assess the children’s exposure or symptoms of serious infections before the use of corticosteroids because they are usually contraindicated in patients with untreated systemic infections. According to Serebrisky & Wiznia (2019), patients without a history of chicken pox should avoid close contact to those with shingles or chicken pox, with a caution to seek immediate medical attention in case they do. Physicians should also be keen on concomitant use of other medications before initiating any corticosteroids therapy because existing research has shown drug interactions between corticosteroids and various drug classes.
IV methylprednisolone alone and IV methylprednisolone and heliox seem to be effective at reducing respiratory difficulties during acute asthma exacerbation in children of age 5-15 and may therefore be a good adjunctive therapy in for paediatric asthma management. However, while either IV methylprednisolone alone or IV methylprednisolone and heliox may be a viable constructive treatment option for emergency asthma treatment in children of age 5 – 15, physicians must be cautious of the various side effects associated with these therapies.
For example, IV glucocorticoids have been associated with a delay in growth among children with asthma as well as those with other diseases such as nephrotic syndrome. Also, systemic corticosteroids have been associated with perceived delay in the action onset, a longer duration of hospitalization associated with the use of oral corticosteroids, and potentially decreased potency of the therapy. The proposed investigation will delve into the benefits and side effects of IV methylprednisolone alone or IV methylprednisolone and heliox for managing acute severe asthma in children of age 5 – 15, before coming up with a comprehensive and evidence-based conclusion on which one among the two treatment regimens is more effective.
Diabetes Mellitus (DM) is a common chronic metabolic condition that manifests majorly as hyperglycemia and results from insulin sensitivity or impaired production of insulin by the pancreatic beta cells. The risk factors for DM can be classified into both modifiable and non-modifiable. American Diabetes Association [ADA] (2019) lists the modifiable risk factors like tobacco, alcohol, physical inactivity, obesity/overweight, impaired fasting glucose/impaired glucose tolerance, and dyslipidemia. Contrarily, the non-modifiable risk factors include a family history of DM, ethnicity, hypertension, age >40 years, and previous gestational diabetes (ADA, 2019). Management of DM encompasses both lifestyle interventions and pharmacological therapy. In some cases, despite the recommended therapy, the blood sugar levels remain elevated, a condition referred to as uncontrolled diabetes. Various randomized controlled trial studies have, in an attempt to define uncontrolled diabetes, used hemoglobin A1C (HbA1C) levels as the rationale. Orozco-Beltran et al. (2017) define uncontrolled diabetes as HbA1C ?8%. However, in this paper, we will use a cutoff HbA1C of >9% to define uncontrolled diabetes.
Uncontrolled diabetes is a significant cause of worry to the public health due to the high risk of developing complications and increased health needs among the patients. According to the CDC (2020) reports on DM morbidity, 34.2 million Americans have diabetes, approximately 1 in 10. This is not different from the global prevalence where it is estimated that 1 in 11 adults have DM (CDC, 2020). Annually, over 1-million deaths are attributed to DM and have been ranked the 9th leading cause of mortality worldwide (CDC, 2020). Further, significant expenditures are incurred towards the management of DM and its related complications. In the United States, it is estimated that $327 billion is incurred annually to manage DM (CDC, 2020). Studies have not explored the epidemiology of uncontrolled DM; however, it is expected that uncontrolled DM burden surpasses that of well-controlled DM. Following the significant morbidity, mortality, and economic strain, DM is an important public health concern that must be addressed. Further, due to the admissions and increased demands for emergency care of patients with uncontrolled DM, and being conscious of the role of advanced practice nurses in care delivery, the condition increases the burden of advanced practice care.
The PICOT question is as follows: In primary care patients with uncontrolled diabetes (HbA1c>9%) how does virtual telemedicine outreach compared to a telephonic outreach with a case manager influence diabetes control over the next 6 months? The population (P) consists of primary care patients with uncontrolled diabetes (A1C>9. Such patients have increased risks for complications and comorbidities; therefore, appropriate interventions must be established to reduce morbidity and mortality. The intervention (I) proposed in this paper is the use of telemedicine. Wootton (2012) defines telemedicine as the use of information and communication technologies to provide care to patients in remote areas. It can be synchronous-the use of live videoconferencing or asynchronous where information, for example, vital signs are entered, stored into e-health portals, and transmitted from home to the hospital information system (Wootton, 2012). The primary objectives of telemedicine in supporting the care of chronic conditions include intervention teaching, health education, transfer of health data, and facilitating follow-up of patients (Wootton, 2012).
The comparative © intervention is telephonic outreach. This involves making telephone calls to reach distant patients who are unable to have in-person visits (Orozco-Beltran et al., 2017). HbA1C levels are the primary outcomes (O) in this case. HbA1C is used to determine glycemic control in the past 3 months and the risk for diabetes-related complications. Current assays consider HbA1C less than 5.7% as normal while above 6.4% used as a diagnostic criterion for DM (ADA, 2019). For most patients with Type 2 DM, evidence-based guidelines recommend clinicians maintain the HbA1C levels between 7% and 8% (ADA, 2019). Values above 8% despite the therapeutic interventions herald the diagnosis of uncontrolled diabetes (Orozco-Beltran et al., 2017). Watt et al. (2021) however define uncontrolled diabetes as HbA1C >9% (75mmol/l), the values adopted in this paper. Besides the HbA1C levels, quality of life, rates of admission, number of emergency unit visits, and mortality rates can be used to compare the productiveness of the two interventions. A period of 6 months (T) is set to determine the influence of telemedicine on HbA1C as compared to the telephonic approach. In this paper, data has been extracted and synthesized from 16 articles regarding the use of telemedicine in the management of uncontrolled diabetes.
Research methodology refers to the process of collecting data and analyzing the data. This process shows how data was collected, the methods used for collecting data, and how data is interpreted to give it meaning. For this particular research, data was obtained from secondary sources. To achieve this, I established the key words in the PICOT question and the supportive research questions, and run them through different databases, among the CINAHL, EBSCO, PubMed, Medline, and Google Scholar. I then filtered the results based on relevance, recency and accuracy. Across all platforms, the cumulative search results gave more than 200 resources, out of which 29 were eventually screened for relevance to this study. The research aims to find out if a virtual telemedicine outreach in comparison to a telephonic outreach with a case manager does influence diabetes control over 6 months period. Thus, the PICOT question is: In primary care patients with uncontrolled diabetes (A1c>9%) how does virtual telemedicine outreach compare to a telephonic outreach with case manager influence diabetes control over the next 6 months?
For the past 20-years, copious amounts of research have been done surrounding the use of telemedicine in the management of chronic conditions. The process has however been slow due to a group of scholars who think that close interaction with the patient (face-to-face) is superior to remote monitoring. Nevertheless, the evidence available shows that telemedicine contributes massively to the management of chronic conditions such as diabetes, COPD, and heart failure.
Orozco-Beltran et al. (2017) researched to determine the role of telemedicine in the management of primary care patients with chronic conditions (diabetes, COPD, heart failure, and hypertension). The impetus for this was the changing population demographics (increasing aging population), the rise in chronic conditions prevalence, and the increased need for care models that are compatible with home care. Commonly used interventions compatible with home care are telemedicine and telephonic support; however, their effectiveness is not equal. Before the intervention, essential telemedicine equipment was distributed to the participants for self-monitoring. Among them include glucometers, blood pressure monitors, pulse oximeters, and weight scales. In addition to videos that instructed them on the use of the instruments, the patients were fully equipped. The spectrum of telemedicine as regards the research included entering vital signs into the e-health portals, and an alarm system that detects any alteration in the data entered. The alarm would therefore prompt the care team’s reaction and in return, intervention and health education would ensue. For a seamless transfer of data and interpretation, each patient had a unique e-health record and an identifier. Following the receipt of the information by the care team, a nurse would decide whether to make a call, go to the patient’s house, scheduled for a face-to-face visit or consult their seniors.
During the 1-year intervention, 521 participants completed the study. The majority of them were elderly, averagely 70.4 years; this proves that chronic conditions have a predilection for the aged population. The post-program analysis found that the intervention had a significant impact on weight loss, blood pressures, heart rate, and HbA1C levels. At the end of the study, while leveraging telemedicine technologies, the number of people who had ?8% HbA1C levels had reduced by 44% (Orozco-Beltran et al., 2017). A similar study by Watt et al. (2021) underpins the reduction in patients’ HbA1C levels after a virtual diabetic program. The study by Watt et al. (2021) explores the significance of a sustainability transformation program (STP) in promoting foot care and reducing risks of amputation among diabetic patients. The STP consists of primary care, face-to-face multidisciplinary foot (MDFT) care, a virtual MDFT, and community podiatry. At the beginning of the study which took 6-months, the weight and HbA1C ranges were as follows: 99.4 ± 25 Kg and 59.3 ± 16 mmol/l respectively. At the end of the study, the weight and HbA1C ranges measured as follows: 95.5 ±24.2 Kg and 54.8 ±12.9 Mmol/l respectively. A different study by Meneghini et al. (1998) has almost the same findings; HbA1C decreased by 0.8% and 0.9% after a 6-month and a 12-month intervention respectively. From the study by Watt et al. (2021), it is evident that both weight and HbA1C levels decreased moderately after the 6-month duration of an STP program to diabetic patients. Cahn et al. (2018) underpin that virtual diabetic programs only cause a modest reduction in HbA1C but with increased patient satisfaction. Besides the virtual MDFT care, the community had a website and a Facebook page that facilitated interaction between the care team and the diabetic patients. Well-controlled diabetes, marked by a reduction in HbA1C levels decreases complications such as diabetic foot and therefore reduces the risks for amputation (Thomson et al., 2021; Watt et al., 2021). Even though specific statistics regarding the readmission rate and the mortality rates post the telemedicine projects are unavailable, Orozco-Beltran et al. (2017) estimate that Tele-monitoring has reduced readmission by 28% and mortality by 24 % among patients with chronic conditions. Contrarily, telephonic outreach has not caused a significant impact on the management of chronic conditions; however, studies report that it reduces mortality due to relapses in patients with heart failure and diabetes (Kelley et al., 2020; Orozco-Beltran et al., 2017).
Despite the significance of technology in the management of chronic conditions, its use is affected by the patients’ geographical location, access to the internet, education level, and patient knowledge regarding information communication technology (ICT). According to Itamura et al. (2020) research on the uptake of virtual visits in the otolaryngology department during the COVID-19 pandemic, patients report difficulty in communication with the care providers while using the telecommunication devices; others mentioned the audio-video lag and the server speed. To minimize the digital divide attributed to lack of knowledge on ICT, the project team educated the participants regarding the use of software applications and Tele-monitoring devices (Emerson et al., 2015; Orozco-Beltran et al., 2017; Watt et al., 2021; Wootton, 2012). Further, the patients received contact details from the companies where the hardware and the software were procured. Even though telemedicine benefits outweigh that of telephonic outreach in terms of HbA1C control, readmission rates and mortality, the Luddites and the majority of the elderly would prefer telephone calls due to ease of use and lack of complex technologies required (Huygens et al., 2016; Orozco-Beltran et al., 2017; Watt et al., 2021; Wootton, 2012).
The current increased use of telemedicine devices is attributed to the COVID-19 pandemic. Despite the guidelines established by the World Health Organization and various governments such as the restriction of movement, social distancing, and the stay at home, care must continue. This is therefore a timely opportunity to leverage technology in the care of vulnerable populations. Telemedicine interventions ensure care continuity even with the stay-at-home and social distancing initiatives. Horrell et al. (2020) conducted a study to determine the magnitude of Telemedicine use among patients with chronic diseases during the COVID-19 pandemic. Further, Horrell et al. (2020) examined the causal relationship between socio-demographic characteristics and telemedicine use. Participants of the study were patients with chronic conditions such as hypertension, COPD, asthma, hyperlipidemia, Type 2 DM, heart failure, HIV, and Alzheimer’s disease. The measure of the Telemedicine engagement was determined by asking the patients ‘yes’ or ‘no’ questions. For instance, have you received any virtual care from your doctor for the last 4-months? Further, the participants were asked how they obtain information regarding COVID-19, their main concerns during the pandemic, and the sources/platforms they use to learn more about the COVID-19 pandemic. The findings revealed that 49% of the 2210 participants had participated in virtual visits with their health care provider; 45% rescheduled or canceled their regular clinic visits and 37% rescheduled or postponed their routine medical check-up. The high number of people (49%) participating in virtual visits can be attributed to the COVID-19 pandemic restrictions which limit movement and encourages people to stay at home. Communication with the care providers occurred via phone (73%) and e-portals (43%); the statistics depict significant embracement of telemedicine.
The socio-demographics affected the telemedicine use in the following ways: more women participated in telemedicine than men; those with higher incomes >$100000/year engaged more than those with <$30000/year; the higher the level of education, the greater the telemedicine use; telemedicine use was more among those <55 years of age and decreased dramatically among people <56 years of age. From the study, there was reported improved quality of life among the patients who continued care via virtual visits as opposed to those who canceled or postponed care to later dates. Among the diabetic patients, improved quality of life was defined by better glycemic control which is determined by the HbA1C levels, and reduced symptoms such as polyuria, polydipsia, and acute complications, for instance, non-ketotic hyperglycemic coma. A similar study by Iyer et al. (2021) underpin that telemedicine improved quality of life, satisfaction, and reduced exposure to COVID-19 among geriatric patients who engaged in virtual visits during the pandemic. Embracement of technology is more among younger patients as compared to the elderly population (Horrell et al., 2020; Iyer et al., 2021; Jain et al., 2020). There is ambivalence towards the use of telemedicine technologies which is attributed to patients’ knowledge of ICT and personal qualities (Dugdale et al., 2020; Jain et al., 2020; Norden et al., 2020; Orozco-Beltran et al., 2017). All the studies, however, in one way or the other, provide enough evidence that telemedicine use in the management of chronic conditions is superior to telephonic outreach. Further, the studies underpin the increased implementation of telemedicine in the management of diabetes especially during the COVID-19 pandemic as this would decrease HbA1VC levels as well as reduce exposure to COVID-19.
Following an intensive literature search, the review provides adequate information regarding the influence of telemedicine on the management of diabetes. It differs from the majority of the reviews which explore the effect of telemedicine on chronic diseases in general without distinctiveness. Part of the limitation of the study is that each of the articles was regarded as having equal values. Further, it was difficult to synthesize data from several studies.
The use of technology in the management of chronic diseases has been intensively explored by varied researchers. According to Orozco-Beltran et al. (2017), after a 1-year telemedicine program, the number of people with HbA1C levels above 8% reduced significantly by 44%. A similar study conducted by Watt et al. (2021) underpins that a 6-month implementation of a virtual diabetic program moderately reduced HbA1C levels from a range of 59.3±16 to54.8±12.9. Telemedicine acceptance has even increased during the COVID-19 pandemic due to the guidelines on movement restrictions and stay-at-home initiatives (Horrell et al., 2020; Itamura et al., 2020; Iyer et al., 2021). Besides HbA1C levels reduction, other outcomes reported while using telemedicine devices include improved quality of life, patient satisfaction; readmission rates, and reduced mortality (Cahn et al., 2018; Dugdale et al., 2020; Emerson et al., 2015; Horrell et al., 2020). According to Iyer et al. (2021), telemedicine use is limited by a lack of basic ICT knowledge and the elderly population which recommends easier methods to communicate with the care providers. To increase the acceptability of telemedicine, patients and care providers are taught how to operate the telecommunication devices before the commencement of the project (Itamura et al., 2020; Jain et al., 2020; Kelley et al., 2020; Norden et al., 2020; Smart et al., 2021).
Based on the body of evidence extracted from the articles, it is recommended that hospitals should embrace telemedicine in care for patients with chronic conditions such as diabetes. Further, it is recommended that telemedicine use should continue even after the COVID-19 pandemic to minimize health disparities caused by geographical locations (proximity to care centers). Since fewer elderly people embraced telemedicine more than the younger population, a recommendation to the project implementation team includes intensive training on the use of the ICT devices and possible use of simpler technologies.
20 years ago, even though the technology was available, its maximal effects in healthcare had not been realized. For the past two decades, the healthcare sector has seen immense advancement in technology and increased implementation of healthcare informatics projects. The projects involving the use of telemedicine in the management of chronic diseases have been increasingly reported. Multiple studies have since then explored the influence telemedicine has in the management of chronic diseases such as diabetes hypertension, heart failure, and COPD. With regards to uncontrolled DM (HbA1C>9%), the studies have found a moderate reduction in the levels. Therefore, diabetic patients who engage in telemedicine interventions show improved glycemic control, reduced readmission rates, decreased mortality, and improved quality of life. The COVID-19 pandemic has been an impetus for patients to change their face-to-face appointments to virtual visits and a few express their willingness to continue with the telemedicine interventions even after the COVID-19 predicament cease.
THT- Telehealth Technology
HIPAA-The Health Insurance Portability and Accountability Act
Synthesis Statement
The studies focused largely on determining the efficacy of telehealth use in patient monitoring, particularly from the patient perspective. The results show that with effective and appropriate implementation, leveraging telehealth in patient monitoring not only improves patient interaction, communication, and experience with the caregiver, but also results in better patient health outcomes.
Technology in medicine has made it possible for healthcare providers to remotely diagnose and treat patients. Other factors such as reduced mobility due to diseases and chronic conditions have advanced the case for telemedicine. Evidence-Based Practice help nursing practitioners to make effective decisions concerning the healthcare services provided to patients. EBP is a critical part of nursing practice because it ensures the use of up-to-date information and technology to diagnose and treat patients within and outside the healthcare settings. There are numerous technologies used for diagnosing and dispensing medicine remotely such as remote patient monitoring video and technologies, and store and forward technologies. In America, up to 95% of Americans own cell phones while 77% have access to smartphones (Cristancho-Lacroix et al., 2017; Ng, Alexander & Frith, 2018). These devices are being leveraged to increase access to medical care and boost health outcomes. This paper is an evaluation of community-based clinic utilizing virtual telemedicine in helping diabetic patients with uncontrolled diabetes
The purpose of this study was to develop an assessment, control, and monitoring criterion for evaluating telemedicine outreach compared to a telephonic outreach. The study also aimed at developing the appropriate pharmacologic treatment plan for the remote monitoring of patients through telehealth technologies. Being the most common chronic disease in the US, diabetes remains a dangerous chronic disease that affects millions of people across America and Canada (Sipes, 2017). This study contains a comprehensive description of what diabetes is, its causes, and the best pharmacology treatment for the disease.
Research methodology refers to the process of collecting data and analyzing the data. This process shows how data was collected, the methods used for collecting data, and how data is interpreted to give it meaning. For this particular research, data was obtained from two sources, i.e. primary sources and secondary sources. The research aims to find out if a virtual telemedicine outreach in comparison to a telephonic outreach with a case manager does influence diabetes control over 6 months period. Thus, the PICOT question is: In primary care patients with uncontrolled diabetes (A1c>9%) how does virtual telemedicine outreach compare to a telephonic outreach with case manager influence diabetes control over the next 6 months?
The research aimed to get a first-hand account of how telemedicine changed the lives of patients particularly those who have reduced mobility. The best way to get this information was by conducting an extensive interview with the selected participants to find out their experiences (Ledford, 2018). From the research materials provided, some studies were conducted through online surveys, interviews, and others were done through quasi-experiments. The surveys and the experiments captured all the pertinent areas that the study sought to cover concerning telemedicine. Interviews were done in the participants’ natural environment which gave the researchers a good opportunity to observe how telemedicine works and its impacts on patients. The interview questions consisted of open-ended questions as well as some sections with multiple answers. A total of twenty women working in the oil and gas industry were interviewed in this research. This interaction with the participants was particularly helpful to the research because researchers were in a position to identify any biases on the part of the respondents as well as any weaknesses in the research. Apart from getting a first-hand account of the respondents, the researchers also got valuable opportunities to observe the participants in their natural living environment which helped in shaping the direction of this research work.
Apart from using primary sources of data, many of the research articles being studied also relied heavily on secondary sources of data. Secondary sources of data such as scholarly books, articles, journals, and periodicals were integral sources of information for providing background information on telemedicine (Fletcher, 2017, p. 181). Many of the works being studied relied on previous scholarly studies and experiments done in this area. The importance of relying on previous literary work on telemedicine is that these materials gave background information on telemedicine. By analyzing secondary sources, the researchers were able to identify the areas that have not been covered regarding the issue of telehealth/telemedicine use in patient treatment and management. By dwelling on areas that have not been covered in the available literature, the researchers were able to give a new and different perspective to the study of telemedicine that has not been explored before by other studies.
Research design is a detailed account of how the research is carried out. It entails how data was collected, the instruments used in the process of data collection, how these instruments will be deployed or put to use, and how the data collected was be analyzed. Since all the articles being studied are qualitative research, more than one research design method was used in the collection and analysis of data. The research design methods used in this study are ones that best captured the scope and goals of each study. From the articles, there are two fundamental questions that the studies seek to give solutions to through research design (Fletcher, 2017). The first question is about what is happening (descriptive research) and why is it happening (explanatory research) (Ledford, & Gast, 2018). The descriptive part of the research is concerned with what is going on, which in this case is the impact of telemedicine on health outcomes. This part gives an in-depth analysis of the situation by describing it in great detail. For example, this part seeks to find out if telemedicine has any impact on health/patient outcomes. To accurately and effectively capture the experiences of the participants, the phenomenology research method was employed. Phenomenology is the process of investigating and studying people’s personal experiences to get a detailed account of the issue being investigated (Department of Veterans Affairs, 2018). To give valid meaning and interpretation to the experiences of the participants, going out to the field to collect information was crucial to the process of data collection.
The other research design method employed in this research is the case study. The case study is a research method that uses an up-close and detailed study of the subject of discussion. Using a case study in research was important because it helped researchers narrow down the scope of the research. This research method was chosen for two major reasons. One of the advantages of this research design method is that it is comprehensive. This method offers a holistic review approach to the study, unlike stand-alone research methods which only give snapshots to a study. A case study allows researchers to use an array of tools in single studies, which means researchers have space and time to come up with a detailed background to a study (Marczyk, 2017). Secondly, a case study is critical because it reduces biases. Case studies allow researchers to approach a study from different perspectives rather than from a single view which limits the researcher’s options (Creswell, & Creswell, 2017). Approaching a research study from many perspectives gives researchers a deeper understanding of the subject matter. The research articles for this study were done through interviews, online surveys, and experiments. The answers received from the said respondents contained lived experiences as well as personal experiences which puts into perspective the phenomenon of telemedicine.
The overall finding from the sampled studies is that virtual visits and treatment were beneficial to people with mobility problems. Overall, virtual visits were less effective compared to in-person visits, however, virtual visits enabled more frequent patient engagement compared to in-person visits. Another advantage presented by the virtual visit is that there was a high level of patient satisfaction. Concerning providers, there was an overwhelming consensus that telemedicine is a critical tool in diagnosing and treating patients especially now that there is a need for social distancing and curfews on mobility due to the COVID-19 pandemic (Smart et al., 2021). Out of the 141 scheduled in-person visits, 120 were done through virtual AD visits. This is equivalent to a 74% retention rate for the diabetes patients being monitored.
Secondly, telemedicine leads to better patient outcomes. Patient monitoring, diagnoses, and treatment have a direct impact on a patient, the intervention method chosen, the treatment plan, the provision of quality care, and the overall outcome. Through CPRS, the chances of medical errors are very minimal because of the accuracy it confers in capturing patient data. Further, CPRS promotes interprofessional cooperation of different health professionals which improves the quality of care given to patients. This project (CPRS) can improve patient safety, precision in diagnosis, communication, and overall effectiveness of patient care. For example, in the past, the facility that I am proposing this project to has witnessed a few cases of patient misdiagnosis due to incorrect capture of information, or other factors. In one case, the hospital misdiagnosed a patient with Parkinson’s disease when the patient was suffering from a case of a traumatic head injury.
Diabetes patients require frequent observation because of the nature of the disease. There is a high level of efficacy and feasibility in using telehealth to monitor and treat diabetes patients. For example, through telemedicine, the majority of participants greatly improved in terms of taking medicine. The monitoring tools alerted them when to take medicine and when the situation changed so that immediate care is taken before things got out of hand. Out of the 17 particular diagnoses, no differences were observed in the labs ordered (Wang et al., 2020). However, two of the diagnoses indicated some differences in images ordered. Additionally, there were four recorded differences in the prescriptions (Jabour et al., 2017). The overall observation was that more labs were recorded (0.16 virtual, 0.33 in-person p<0.0001) as well as in the images ordered (0.07 virtual, 0.16 in-person, p<0.0001) for in-person visits (Lyer et al., 2021). These differences were major because of the general medical exam visits that the patients had to do physically. There was also the issue of repeat visits that became necessary after the initial in-person visits (19% virtual, 38% in-person, p<0.0001) (Horrell et al., 2020). From the experiment, 10 out of 17 diagnoses indicated differences in the frequency of visits modalities. Visits for both diabetes (5.3x, p<0.0001) and anxiety (5.1x, p<0.0001) were much more frequent in the virtual conditions.
From the reviewed studies, the major strength is that the researchers succeeded in proving the efficacy of telemedicine. Based on the findings, adequate evidence was adduced to prove that telemedicine plays a critical role in improving health outcomes especially for patients with mobility problems. However, the major weakness of telemedicine is that it is still less effective compared to in-person visits. This is because in-person examination and diagnoses of patients are still the best way of accurately assessing patients and prescribing treatment. However, the research shows that telemedicine is mostly effective for follow-up where an initial in-person visit had been done.
Another limitation of the review is that it does indicate the differences between labs ordered in virtual visits and in-person visits. For instance, the study by McGonigle (2017) showed that there are increased orders for in-person visits for tests and diagnoses among diabetes patients (McGonigle, 2017). Further, the research indicates that there were no differences between prescriptions, lab, and images produced in in-person visits and virtual visits. This is contradictory because, in the conclusion section, the researchers conclude that many patients still preferred in-person visits because it is more efficient compared to virtual visits. While it may be difficult to subjectively deduce the reason for the observe disparity, it is likely that preference for in-patient visits is a factor of access to telemedicine technology, doubts on the reliability of such technology or simply the need for physical interaction with the care provider.
Caring for people with diabetes disease is costly as one hundred percent of cases of advanced diabetes end up in death since there is no cure for the disease. Over five million Americans and thirty-five million people worldwide have diabetes disease which means that all of these people require some form of caring whether formally or informally. Caring for people with Diabetes is one of the difficult tasks and yet most people do not even have basic information on how to take care of people suffering from the disease.
While this study appears inadequate in the area of statistical power which could pose problems of efficacy to the research, I believe that this research has been successful in providing an alternative method for providing information and education to caregivers of people suffering from Diabetes, especially the informal caregivers. Drawing from previous findings, I believe this study has successfully demonstrated that online facilitation of caregivers can help them to acquire functionalities such as personalization, flexibility, socialization, and dynamism which are all important qualities in a caregiver given the stress levels associated with diabetic patient care. Furthermore, the researchers conclude that there was very limited acceptance of the online Diapason program by caregivers which is a pointer to the fact that the program needs to be rolled out in a structural manner that allows the caregivers to be able to interact with other professionals as well as the broader online community.
The articles analyze the efficacy and acceptability of web-based educational and telehealth programs intended for informal caregivers to people with diabetes using methods of research analysis. The studies asserts that there is a substantial growth in the aging population which has also seen cases of dementia and diabetes grow to the astronomical figure of 35.6 million people annually (Mosier, 2017). All of these people require round-the-clock care just to get by. By the year 2012, Diabetes Association indicated that over 12 million caregivers gave more than 17.5 billion hours of care (unpaid) which was equivalent to USD 216 billion (Mosier, 2017). Presently, majority of people with diabetes are cared for at home by their relatives which has also seen the emergence of chronic stress in such caregivers.
The best method for determining the impact of evidence-based practice clinical guidelines is through scientific measurement of patient outcomes. The implementation of EBPCG works best when it is practiced by both nurses and patients. The impact factor, in this case, is measured based on the number of citations present in the research or paper. In this work, such metrics provide a reliable and effective method of measuring the impact that clinical guidelines have on scientific research on evidence-based practice. However, the AHA and ACC point out that the growth of analytical tools used in harvesting information from online databases has helped the research on evidence-based practice clinical guidelines to take a multi-disciplinary approach such as sociological approach, scientific approach, structural approach, and technological approach.