Risk Factors For Gestational Diabetes Discussion

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Risk Factors For Gestational Diabetes Discussion

Problem Statement

Need Statement

The COVID-19 pandemic has changed how healthcare delivery of outpatient care and telehealth has increased. The PICOT question- 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.

 

Population and Setting

The setting targeted by the current research study is an outpatient clinic in San Diego, California. The target populations are pregnant women with gestational diabetes. The condition occurs among pregnant women and specifically implies high blood sugar levels. This happens because the body fails to produce enough insulin, a hormone that controls the amount of blood sugar. Often, gestational diabetes occurs during the second and third trimesters but disappears shortly after birth. Giannakou et al. (2019) have identified a list of risks of gestational diabetes and the need for appropriate and timely intervention. Some of these risks are a higher-than-normal growth of the fetus, excessive amniotic fluid, and premature birth. Risk Factors For Gestational Diabetes Discussion

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Intervention

The proposed intervention is telehealth. This is in recognition that while there is a sufficient supply of health care clinics in the San Diego area, not all patients can attend the periodic clinic visits due to their condition and the distance between their residences and the hospital. In addition, telehealth is intended to supplement physical visits because digital tools allow for examinations to take place virtually. The fact that the target population visits the clinics for checkups and treatment implies that the caregivers cannot afford sufficient observation. This means they could miss out on identifying changes in vitals such as blood sugar. Intervention through telehealth enables caregivers to have more time to observe pregnant women and guide them on ways to assess their blood sugar levels.

 

Comparison

Most healthcare organizations commonly use approaches are issuing test kits to at-risk pregnant mothers and having them conduct their tests at home. In addition, they are then required to monitor their diet to ensure that the possibility of an increase in blood sugar is suppressed. While this approach has been helpful, it preempts the one-on-one observation a caregiver takes on their patients virtually through telehealth. The fact is that patients are expected to follow the guidelines as issued during their last visit. With telehealth, day-to-day follow-ups are likely made possible, with it, better patient outcomes. Vora et al. (2020) have stated that high blood sugar levels are reduced and managed with a proper diet and physical exercises. Caregivers are challenged with making these verifications when they are done away from the health care settings, like with outpatients visiting clinics periodically. A benefit that telehealth would be able to create is a daily check and monitoring of the individual patients without having them visit the clinic. Risk Factors For Gestational Diabetes Discussion

 

 

Outcome

The use of telehealth on gestational diabetes patients yields improved patient outcomes at a lesser cost. The patients can access valuable and high-quality care in the comfort of their homes, saving a lot of time and financial resources. Zork (2022) has discussed the issues of convenience for patients and caregivers and addressed the plight of people with mobility challenges. Telehealth increases the provider’s reach to pregnant mothers who are limited in their movement to and from one place to the other, perhaps due to distance from the hospital or other physical challenges. Alleviating patients’ safety by giving them the best quality care, telehealth helps achieve this goal. Many others further justify its importance and adoption in helping address gestation diabetes patients.

 

Time

Since gestational diabetes has become a common condition in pregnant women in the San Diego area and California at large, the proposed timeframe for the telehealth intervention is ten months. The rationale for this timeframe is to allow sufficient time for providers to purchase and install the necessary equipment and technology to support the intervention. In addition, the staff members who frequently use these technologies internally and remotely will be trained within this set timeframe.

Literature Review

While there has been an increase in the number of pregnant women experiencing gestational diabetes in recent years, the emergence of Covid-19 perhaps illuminated the degree of unpreparedness of the healthcare system in the country. 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. Risk Factors For Gestational Diabetes Discussion

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. Risk Factors For Gestational Diabetes Discussion

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. Risk Factors For Gestational Diabetes Discussion

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 the 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.

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. Risk Factors For Gestational Diabetes Discussion

 

 

References

Appuswamy, A. V., & Desimone, M. E. (2020). Managing Diabetes in Hard to Reach Populations: A Review of Telehealth Interventions. Curr Diab Rep, 20(7), 1-10.

Aziz, A., Zork, N., Aubey, J. J., Baptiste, C. D., D’alton, M. E., Emeruwa, U. N., … & Friedman, A. M. (2020). Telehealth for High-Risk Pregnancies in the Setting of the COVID-19 Pandemic. American journal of perinatology, 37(08), 800-808. https://doi.org/10.1055/s-0040-171212

Döğer, E., Bozbulut, R., Acar, A. Ş. S., Ercan, Ş., Uğurlu, A. K., Akbaş, E. D., … & Cinaz, P. (2019). Effect of Telehealth System on Glycemic Control in Children and Adolescents with Type 1 Diabetes. Journal of Clinical Research in Pediatric Endocrinology, 11(1), 70. https://doi.org/10.4274/jcrpe.galenos.2018.2018.0017

Giannakou, K., Evangelou, E., Yiallouros, P., Christophi, C. A., Middleton, N., Papatheodorou, E., & Papatheodorou, S. I. (2019). Risk factors for gestational diabetes: An umbrella review of meta-analyses of observational studies. PLoS One, 14(4), e0215372. https://doi.org/10.1371/journal.pone.0215372

May, S., Jonas, K., Fehler, G. V., Zahn, T., Heinze, M., & Muehlensiepen, F. (2021). Challenges in Current Nursing Home Care in Rural Germany and How They Can Be Reduced by Telehealth-an Exploratory Qualitative Pre-Post Study. BMC health services research, 21(1), 1-10.

Natamba, B. K., Namara, A. A., & Nyirenda, M. J. (2019). Burden, risk factors and maternal and offspring outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa (SSA): a systematic review and meta-analysis. BMC pregnancy and childbirth, 19(1), 1-11. Risk Factors For Gestational Diabetes Discussion

Guiding Questions

Evaluation Plan Design

This document is designed to give you questions to consider and additional guidance to help you successfully complete the Evaluation Plan Design assessment. You may find it useful to use this document as a pre-writing exercise, an outlining tool, or as a final check to ensure that you have sufficiently addressed all the grading criteria for this assessment. This document is a resource to help you complete the assessment. Do not turn in this document as your assessment submission. Risk Factors For Gestational Diabetes Discussion

Part 1: Evaluation Plan

Define the outcomes that are the goal of an intervention plan.
  • What are the outcomes that you are attempting to achieve with your intervention and project?
    • How do the outcomes illustrate the purpose of your intervention and project?
    • How do the outcomes illustrate what you hope to accomplish your intervention and project?
    • How do the outcomes establish a framework that can be used to achieve an improvement in the quality, safety, and experience of care?
Create an evaluation plan to determine the impact of an intervention for a health promotion, quality improvement, prevention, education, or management need.
  • How are you going to measure and evaluate the degree to which you achieved your outcomes?
    • What data do you need to fully evaluate the outcomes?
      • How will you collect the needed data?
      • What tools or technology will you use to aid in data collection?
    • What strategies will you use to analyze and evaluate the collected data?
      • What tools or technology will you use to aid in data analysis?
    • How will the evaluation plan illustrate the impact that your intervention plan had, or will have? Risk Factors For Gestational Diabetes Discussion

Part 2: Discussion

Advocacy

Analyze the nurse’s role in leading change and driving improvements in the quality and experience of care.
  • How does the nurse help to lead change in professional practice and interprofessional teams?
  • How does the nurse help to drive improvements in the quality and experience of care in professional practice and interprofessional teams?
Explain how the intervention plan affects nursing and interprofessional collaboration, and how the health care field gains from the plan.
  • How does your intervention plan affect the nursing profession and role?
    • In other words, how does your intervention plan improve the nursing profession and practices?
  • How does your intervention plan affect interprofessional collaboration related to improving outcomes for the target population and setting of your intervention plan?
  • What are other gains and benefits to the health care field in general from your intervention plan and project?

Future Steps

Explain how the current project could be improved upon to create a bigger impact in the target population as well as to take advantage of emerging technology and care models to improve outcomes and safety. Risk Factors For Gestational Diabetes Discussion
  • How could your intervention plan and project be revised to create improved or broader-reaching impacts for your target population?
  • How could your intervention plan and project better take advantage of emerging technology to improve performance related to the outcomes of the intervention plan?
  • How could your intervention plan and project better take advantage of emerging care models to improve achievement of the project’s outcomes, as well as to improve patient safety?

Reflection on Leading Change and Improvement

Reflect on how the project has impacted your ability to lead change in personal practice and future leadership positions.
  • How has your work on your capstone project impacted your ability to lead change in your personal practice and current care setting?
  • How has your work on your capstone project impacted your ability to lead change in any future leadership positions you may have?

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Reflect on the ways in which the completed intervention, implementation, and evaluation plans can be transferred into your personal practice to drive quality improvement in other contexts.
  • How can the work you have undertaken with your capstone project be transferred into your current practice and care setting?
  • How can the work you have undertaken with your capstone project be transferred into other care settings and contexts? Risk Factors For Gestational Diabetes Discussion

Address Generally Throughout

Integrate resources from diverse sources that illustrate support for all aspects of an evaluation plan for an intervention, as well as for professional discussion about the plan.
  • Do the resources cited support all aspects of your evaluation plan?
  • Do the resources cited support your professional discussion of the plan and your practice?
  • Do your resources come from a diversity of sources?
    • For example: the literature, professional standards, existing health care policy, relevant health care laws, et cetera.
  • Do you cite a minimum of 3–6 resources?
Communicate evaluation plan and discussion of the project in a professional way that helps the audience to understand how the outcomes will be evaluated, as well as what was learned through the project process.
  • Is your writing clear and professional?
  • Does your writing effectively communicate your proposed evaluation plan?
  • Does your writing effectively communicate what was learned throughout the project process?
  • Is your writing free from errors?
  • Is your submission 4–6 pages?
  • Does your submission conform to current APA style standards? Risk Factors For Gestational Diabetes Discussion