Core Nursing Theories And Principles Discussion Paper

Abstract

The primary objective of the project is to justify the implementation and subsequent use of telehealth to improve patient care outcomes among pregnant women with gestational diabetes in an outpatient clinic in San Diego, California. Because of the increase in communicable diseases in the general public including the highly contagious COVID-19, the use of technology in healthcare has become a visible tool that is used not only to compart the spread of such diseases but also improve access to healthcare by vulnerable groups in the society such as pregnant mothers.  The most important finding is that the implementation of telehealth in outpatient clinics is essential in improving care outcomes because it helps to bridge the gap between the healthcare provider and patients hence, the provision of healthcare services becomes seamless. In addition, telehealth helps to improve the quality of care and patient satisfaction while reducing cost.

Introduction

The capstone project is anchored on the health outcomes of implementing telehealth in outpatient clinics in San Diego, California. The target patient population are pregnant women with gestational diabetes which is a health concern among expectant women because it can lead to life threatening events such as stillbirths, preterm birth, excessive birth weight as well as obesity later in life. The essence of implementing telehealth in the said outpatient clinic is to supplement the physical and periodic clinics that are established for antenatal care. While physical clinics are critical for pregnant women, telehealth as an emerging technology is essential because it helps to compliment physical clinics by empowering women to take care of and manage their health conditions at points when there is an emerging issue that can be addressed while at home. Telehealth also helps to incorporate the patient (pregnant women) into their care plan and this helps to improve outcomes, creates a sense of confidence and trust towards the healthcare providers. With the widespread nurse shortage, that has ravaged the whole world, the use of technology has become a vital ingredient averting negative outcomes that are associated with the shortage. Core Nursing Theories And Principles Discussion Paper

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In essence, with the implementation of telehealth, it is possible for a small number of healthcare providers to manage a relatively large number of patients. The implementation of the telehealth will require inputs from the health informaticists as well as the clinical staff. The implementation plan will encompass interprofessional collaboration among stakeholders as well as setting goals that will facilitate the implementation matrix.

Problem Statement

Need Statement

Healthcare has evolved over the decades to meet the increasing patient needs. Some of the changes that have been experienced in healthcare include change in practice to adopt evidence based practices that have been scientifically proven to solve specific healthcare issues. In addition, technology has been implemented in healthcare to facilitate the provision of evidence based practices. There are several technologies that have been implemented in healthcare and they include electronic helath records, robotic surgery, cancer immunotherapy among others. One of the most prevalent healthcare technologies that has gained popularity in healthcare is telehealth which has improved patient outcomes as well as healthcare efficiencies among care providers. For this assignment the PICOT question is; In outpatient clinics, how does telehealth visits compared to office visits result in improved patient care outcomes and satisfaction rate within ten months of implementation? A growing body of evidence shows that telehealth can improve health outcomes. Telehealth can also improve access to care by increasing patients’ ability to see a provider from home or other locations. Telehealth can improve access to care, continuity of care, engagement in care, and self-management of chronic conditions. The ability of telehealth to easily serve most of the vulnerable populations has been a major milestone in quality healthcare delivery. Core Nursing Theories And Principles Discussion Paper

Population and Setting

The target population for this capstone project are pregnant women with gestational diabetes which is a helath condition characterized by elevated blood sugar levels among expectant women and goes away shortly after deliver. The setting is in an outpatient clinic in San Diego, California. Gestational diabetes is a form of insulin independent diabetes in that the body produces insulin but the insulin is rendered ineffective by the mothers system elevating blood sugar levels. In a study by Giannakou et al. (2019), the authors highlighted that increased BMI and hypothyroidism were the common risk factors for the development of gestational diabetes. The condition is also a matter of interest in healthcare because of the associated effects such as premature birth, excessive growth of the fetus and excess amniotic fluid.

Intervention

The proposed intervention for the practicum project is telehealth. The use of telehealth for the identified population is justified by the fact that pregnancy is associated with several complications that require frequent monitoring that may not be practical in terms of physical visits. In addition, some of the pregnant women miss scheduled appointments or the antenatal clinics because of the distance between their homes and the clinic. It is however important to note that the use of telehealth does not replace the physical visits but rather helps to compliment them by addressing emerging issues. Telehealth helps to connect the pregnant women and the caregivers remotely and hence this can be an important time for educational purposes on management of blood sugar levels.

Comparison of approaches

Several approaches are available and are being utilized by various healthcare organizations to manage gestational diabetes among pregnant women. Despite the application of various approaches that are currently available, none has achieved that which that can be met by the implementation of telehealth. One approach is issuing of test kits to at-risk pregnant mothers and having them conduct their tests at home. The at risk pregnant women are advised to monitor their diet to prevent elevation of blood sugar levels. One major limitation of this approach is that it does not accommodate the day to day conversations with the healthcare providers as is the case of telehealth. Besides, the approach of giving at-risk pregnant mothers and having them conduct their tests at home is a primitive approach because pregnant mothers only follow a schedule that has been issues during their last visit. According to Vora et al. (2020), gestational diabetes can be managed at home by managing ones diet and physical exercises hence, empowering pregnant mothers can help them in managing this condition while at home using natural remedies. With the implementation of telehealth, it bis therefore possible to monitor patients even when they are far from their facilities. Core Nursing Theories And Principles Discussion Paper

Outcome draft

The main outcome for the implementation of telehealth is to improve patient outcomes while minimizing on cost. With telehealth, it is possible for patients to access quality healthcare services remotely without necessarily traveling to healthcare facilities which helps to save on cost and time. Telehealth can help in managing patients who have challenges in mobility and other financial challenges that can prevent form accessing quality healthcare services during pregnancy. During the outbreak of the novel coronavirus, it became extremely difficult for pregnant women and other special population of patients to access healthcare services due to safety concerns of possibility of contracting the virus. As such, the use of telehealth will help overcome some of the barriers to accessing healthcare services. According to Vasilevski et al., (2022), the scheduling of face to face visits and postnatal visits was greatly impacted during the COVID-1 period. These restrictions and challenges to accessing healthcare services can be alleviated through the implementation of telehealth.

Time estimate

The timeframe for implementing the proposed intervention is ten months, a duration sufficient enough to allow for the implementation of the necessary infrastructure which includes technological input as well as equipment that can support the system and meet the required outcomes. besides, the timeframe has been suggested in a manner that is sufficient to accommodate a relatively large number of users given the increasing number of pregnant women presenting gestational diabetes in the San Diego area and California at large. Training of staff will form part of the implementation program because the staff members who will handle and manage the operation of the system needs appropriate training. Core Nursing Theories And Principles Discussion Paper

Literature Review

The various disparities that exist in healthcare have played a significant role in increasing the burden of disease among the population as some minor disease conditions develop into complex processes that are difficult to treat and manage as many people do not have equitable access to healthcare. Some of the disparities in healthcare were vividly illuminated during the COVID-19 pandemic. One prominent issue that arose during the pandemic is that of challenges affecting pregnant women in all aspects of pregnancy from the time of antenatal care to postnatal care. Commenting on the challenges women with gestational diabetes faced during the pandemic, Aziz et al. (2020) mentioned that the inability of many of them to access health care facilities increased their risks of gestational diabetes. Drawing from this, the researcher has suggested the need for the federal government to liaise with private and public health providers to embrace the use of telehealth and telemedicine. The contemporary common approach and methods used are for pregnant mothers to make physical visits to hospitals where their vitals are checked, and this reveals whether they are at risk of gestational diabetes (May et al., 2021). Since collecting self-monitoring data in the case of gestational diabetes is not complicated, the intervention of telemedicine and telehealth would come in handy for caregivers and patients. As noted by Uecker and Kinnaman (2021), this would mean that the need for frequent physical visits would be unnecessary. Proper training on gathering the much-needed self-monitoring data using the toolkits provided by the healthcare providers and submitting the same virtually through digital forms such as mobile phones has had positive impacts. Döğer et al. (2019) have noted that clinicians follow up with the visiting patients to determine whether treatment is needed. The challenge of the physical visits is that they are time-consuming, cumbersome, and leave out a material proportion of pregnant women who otherwise need similar care. With the emergence and rise in popularity of telehealth and telemedicine, clinicians have found a much-needed intervention for gestational diabetes and other ailments pregnant, and nursing mothers face.

Appuswamy and Desimone (2020) argue that it makes no logical sense for pregnant women to visit clinics just to check their glucose levels and spend a lot of time and financial resources. Notably, most of them do this as a precaution to safeguard their plight and that of the unborn child. However, using digital technologies such as telehealth has enabled more women who are otherwise limited by the lack of mobility and resources to collect their records and share them using simple applications on their smartphones. The benefit that this has on these women is that their risks of gestational diabetes and related adverse outcomes are reduced. In addition, the healthcare provider can handle more patients at a time as they only advise those who need treatment based on the data collected to visit them. A different view presented by Appuswamy and Desimone (2020) points to the importance of clinics holding large volumes of data. The researchers have discussed the issue of using telehealth from a holistic point of view, where they argue that with larger volumes of data from patients, these providers can engage in more analysis on the prevalence of gestational diabetes and other illnesses and hence determine the various interventions required for the entire population.

While many benefits are discussed by researchers on the use of telemedicine as an important intervention in healthcare, there are a few limitations that emerge, and the key among them is the availability and access to technologies such as the internet and digital equipment needed to facilitate the intervention. In commenting on this, Natamba, Namara, and Nyirenda (2019) have raised the question of whether healthcare providers factor in the possible limitation in accessing and using digital technologies. Moreover, some patients may delay or misinterpret readings on the test kits available to them or mistype them while relaying the information to clinicians (Aziz et al., 2020). Challenges such as these are likely to have a slight negative impact on the use of telehealth in intervening in gestational diabetes in places like San Francisco and others. On their part, Natamba, Namara, and Nyirenda (2019) have considered that while providers profit from the increase in digital data for patients, as mentioned, enables the custodian to leverage the big data for research and analysis, there is one slight issue that needs to be factored in; that with the more significant amount of data, more workloads accrue for the healthcare organization. There need additional resources and staff for managing and handling this accumulation of medical and personal data, which could stretch the provider’s existing resources.

Despite the identified drawbacks of telehealth, Zork (2022) has argued that the benefits associated with this intervention, in the context of the United States at least, far outweigh the costs. Patient outcomes are improved because of the convenience that the use of telehealth creates. The existing policy on increasing coverage of patients in the country benefits from the use of technology as the providers can attend to more patients from across regions. Moreover, telehealth and its closely linked concept of telemedicine increase the efficiency of intervention over time. This means that as more people get accustomed to digital technology, their use, and the collection of their medical data using specified medical kits, they increase the efficiency in personal and healthcare, further adding to the success of intended interventions. A huge plus that Zork (2022) has discussed in her article on the revolution technology is causing in health care is communication. Today, more than ever before, the communication between clinicians and patients has improved. This has been partially boosted by increased digital communication such as emailing, video calling, texting, and other digital-based applications such as social media and in-house medical applications. Suffice it to say, an increase in communication between these parties harnesses the understanding of the needs of the patients, ultimately leading to better quality healthcare and patient outcomes.

The one crucial lesson that covid-19 perhaps benefited the healthcare system is increasing awareness and illuminating the importance of virtual healthcare. With providers and patients alike forced by the pandemic to seek alternative ways of medical care that required minimal physical interaction, the ideas of telehealth were popularized at this time, and people recognized the value provisions of the technology. That aside, since the pandemic is arguably diminished, telehealth and telemedicine will likely stay longer and will probably be industry standards over time. Rutledge et al. (2021) claim that sometimes infeasible and difficult in-patient visits are addressed with telehealth. Telehealth ensures that patients receiving or requiring continued medical care and faced with unavoidable challenges still have access to the care. Core Nursing Theories And Principles Discussion Paper

The details of the analyzed literature reveal two important issues. One is that the emergence and popularity of telehealth have many positive impacts and are likely to improve gestational diabetes patient outcomes over time. This is because more patients will be reached, and the convenience created. Two is that as providers and patients embrace this disruptive technology in healthcare, they will yield better results in the communication and care for patients. More importantly, disruptive technology should be regarded as an approach or alternative that supplements are existing physical and in-patient visits.

Intervention Plan

Intervention Plan Components

As outlined previously and with great emphasis on the PICOT question, the target population for the proposed intervention are pregnant women living in San Diego area of California, who ae at risk of gestational diabetes. The proposed outcome of the project is to improve patient care outcomes by improving accessibility to healthcare services despite of eminent challenges such as mobility issues and distance form healthcare facilities. Key components of the plan include the proposed remote patient monitoring and associated support such as ensuring its use is evidence-based, its performance meets standards of care as envisaged in the health care policy in the United States, and persistent communication to stakeholders such as patients, policymakers, and provider organizations. Throughout, the intervention plan is guided by core nursing theories and principles.

The first component is the adoption of an evidence-based action which in this case is remote patient monitoring. Remote patient monitoring is defined by Polsky et al. (2020) as a technological telehealth digital tool that reports, collects, and transmits patient data to healthcare providers who then evaluate it and determine interventions required. In this particular case, the proposed remote patient monitoring tools could come in the form of wearables, mobile devices, and smartphone-based applications (Malasinghe, Ramzan & Dahal, 2019). Pregnant women at risk of gestational diabetes will be constantly reminded through notification nudging to check important vital signs such as their weight and blood glucose levels and transfer them to their physicians for analysis.

The second component is performance management. Aziz et al. (2020) advised that any intervention plan should be checked for effective performance with minimized negative impacts on patients. Following this, performance management of the proposed intervention is done through rigorous monitoring and evaluations in a bid to ascertain that it is a model that can be relied on and achieve the objective of improving health outcomes for patients. In addition to this, the healthcare provider adopting the proposed plan should be guided by the philosophy of continuous and persistent improvement which in this case implies telehealth program improvement. Core Nursing Theories And Principles Discussion Paper

The third component is for the healthcare provider to make effective and constant communication to stakeholders on the intervention. The healthcare community and decision makers are keenly interested in changes taking place in the industry and they need to be kept abreast of new developments to keep them informed for one and secondly to ensure that the changes are in line with healthcare policy and standards of operation.

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Theoretical Foundations

The proposed intervention plan is advised or influenced by core nursing models and theories. One such model is the patient-centered model. Uecker and Kinnaman (2021) commented that the patient-centered model is based on the principle that all patients are unique and have different cultural backgrounds. What this means is that healthcare should not be based on a static set of routines but should rather be based on understanding the individual needs of patients. Patient-centered care is manifested through the demonstration of respect for the values needs and preferences of all patients. The implementation of the proposed RPM plan will be guided by the patient-centered theory where opinions and preferences for the type of device will be considered.

A second theory that offers insights to the proposed intervention model plan is the cultural care model. According to Lee, Greenfield and Pappas (2018), the effectiveness and efficiency of healthcare to patients is best achieved when the providers acknowledge that cultural differences exist in society and among patients and use this diversity to develop a care plan for each patient. What this simply means is that healthcare interventions and approaches to care that providers issue and develop should be congruent with different cultures. As a priority, therefore, the proposed implementation should be guided by the cultural care theory in the sense that the cultural and religious practices of the patients should be highly prioritized.

Since the proposed remote patient monitoring technology requires support resources, it is important to mention that access to digital gadgets, the internet, and computers will be a huge plus. In California metropolitan areas of San Diego, Los Angeles, Santa Barbara, and San Francisco have very high smartphone and personal computer ownership at 86% and 81% respectively. These support technologies will make it more convenient for remote patient monitoring to be rolled out to the general population. Core Nursing Theories And Principles Discussion Paper

One of the major components of the intervention plan is the introduction of remote patient monitoring. While its implementation will involve a lot of capital layout for providers and for patients, its long-term benefits are immense. Commenting on the proliferation of telehealth and telemedicine, Vora et al. (2020) have pointed out two important issues. Basing their findings during the height of the novel Covid-19, the researchers have mentioned that telehealth lessens the risk of disease transmission. When outpatient pregnant mothers adopt the use of RPM, they reduce the risks of being exposed to communicable diseases that are sometimes acquired in health care settings. The second issue that the researchers commented on is the freeing up of hospital resources. With an increase in the use of remote patient monitoring using the technologies mentioned, hospital resources are freed up enabling the providers to serve the neediest patients more and better. According to Malasinghe, Ramzan and Dahal (2019), the use of remote patient monitoring technology helps providers gain faster access to patient data and in effect respond to emerging trends and issues sooner.

Stakeholders, Policy, and Regulations

The implementation of any health promotion plan is impacted by external and internal elements. These elements are the stakeholders, healthcare policies, and regulations. To this end, there are a handful of stakeholder needs that prevail and the stakeholders that are referred to in the context of this implementation are patients, providers, and policymakers. Su et al. (2020) mentioned that while the patient’s need which in this case is pregnant women is to maintain good health and deliver babies with minimal health complications, care providers have a need to improve health outcomes for all their patient groups. For the policymakers, their interest is that healthcare resources and benefits be equitably distributed. Collectively looking at all these needs, they all point towards health practices that are modeled to address the different groups within the population. In the United States, provider organizations are compensated by third-party payers which in this case are private and public insurance companies. According to Zahmatkeshan et al. (2021), health policy in the country has been pushing towards increased coverage by insurance companies in an effort to provide care to as many people as possible including the less affluent. Drawing from this, regulations have been set for providers on all interventions intended at improving healthcare outcomes in the country. Suffice it to say, the promotion of remote patient monitoring as a component of telehealth will be analyzed from the perspective of meeting key standards of practice and use. Core Nursing Theories And Principles Discussion Paper