Evidence-Based Proposal And Annotated Bibliography On Technology In Nursing

Evidence-Based Proposal and Annotated Bibliography on Technology in Nursing

In cognizance of the shifting dynamics of healthcare and the intense quest for quality and safe patient care, healthcare sectors are increasingly embracing technology. The recently ravaging pandemic, Covid19, has also prompted the need for care that does not require frequent patient-care provider physical interaction.

This has increased the use of telemonitoring technologies, which, according to Pronovost et al. (2022), not only improves patient outcomes but also, when integrated into the electronic health record (EHR), increases efficiency, accuracy and reduces the burden of obtaining and documenting patients. Even though telemonitoring technologies have been around for decades, their use increased during the Covid19 period, so the disease was a blessing in disguise.

The purpose of this paper is to compile an annotated bibliography on a chosen technology-telemonitoring and its impact on nursing, taking into account patient safety and quality, fostering interdisciplinary collaboration, and lowering healthcare costs.

Selected Technology, Rationale, and the Research Process Employed

The use of telemonitoring technologies in nursing care is the subject of the following discussion. Telemonitoring is defined by Andrès et al. (2019) as the use of information technology to remotely monitor a client’s health status via electronic means. The components include telemonitoring devices such as gluco-telemeters, blood pressure machines, pulse oximeters, weighing scales, and telecommunication devices that relay the measurements taken to the care providers at the primary care facilities.

The rationale for using telemonitoring devices is to improve the management of long-term conditions such as diabetes mellitus, hypertension, and heart failure, implement non-physical treatment measures for highly infectious diseases such as Covid19, and reduce the cost of care.

Reliable medical databases were used to obtain the articles discussed in the annotated bibliography. I obtained the articles from the following search engines: Google Scholar, ProQuest, MEDLINE, Scopus, and the Cochrane Library. The keywords used in the article search include ‘telemonitoring, as well as telemonitoring and nursing care.’ Only peer-reviewed studies were considered, and the article search was restricted to studies published within the last five years (from 2018 to date).

I used the CRAAP mnemonic to assess the credibility of the articles chosen, which includes the currency (articles published within the last five years), relevance (information relating to the topic), authority (authors with credentials in the healthcare field), accuracy (peer-reviewed information), and finally, the purpose for which the articles were chosen, which was to inform or evaluate the use of telemonitoring technologies in healthcare.

Annotated Bibliography

Amante, D. J., Harlan, D. M., Lemon, S. C., McManus, D. D., Olaitan, O. O., Pagoto, S. L., Gerber, B. S., & Thompson, M. J. (2021). Evaluation of a diabetes remote monitoring program facilitated by connected glucose meters for patients with poorly controlled type 2 diabetes: Randomized crossover trial. JMIR Diabetes, 6(1), e25574. https://doi.org/10.2196/25574

As part of the ongoing wave of telemedical approaches to patients with chronic illnesses, Amante et al. (2021) conducted a randomized crossover trial to evaluate the impact of a diabetes remote monitoring program facilitated by glucose meters for patients with poorly controlled type 2 diabetes mellitus (T2DM). The two-arm, 12-month randomized crossover study included 119 patients receiving care at a diabetes center of excellence.

The intervention included a cellular-connected glucose meter and phone-based diabetes coaching provided by Livongo Health. One group received the intervention for six months before returning to usual care (IV/UC) while the other group received usual care before enrolling in the intervention (UC/IV) for six months. The primary outcome was a change in hemoglobin A1c (HbA1c). The findings show that both groups improved in Hemoglobin A1c (HbA1C) during the first six months, with the intervention group improving by 1.1% and the usual care group improving by 0.8%.

However, after the crossover, those who returned to their usual care had no significant change in HbA1C (p=0.41), whereas those who started receiving the intervention improved significantly (p=0.008). These results show that telemonitoring interventions had a significant impact on lowering HbA1C, a measure of average glycemic control over three months (ADA, 2020).

The study recommends that hospitals adopt a telemedical approach to treating chronically ill patients. Owing to the authors’ backgrounds in healthcare and informatics, the study’s recent publication, addressing a current issue, and serving its purpose, which is to evaluate the impact of telemonitoring in nursing, these findings are credible.

Casariego-Vales, E., Blanco-López, R., Rosón-Calvo, B., Suárez-Gil, R., Santos-Guerra, F., Dobao-Feijoo, M. J., Ares-Rico, R., Bal-Alvaredo, M., & On Behalf Of The Telea-Covid Lugo Comanagement Team. (2021). Efficacy of telemedicine and telemonitoring in at-home monitoring of patients with COVID-19. Journal of Clinical Medicine, 10(13), 2893. https://doi.org/10.3390/jcm10132893

During the Covid19 pandemic, most hospital beds were occupied, prompting the healthcare sector to devise interventions that would allow patients to receive care even at home. Casariego-Vales et al. (2021) investigate whether telemedicine and telemonitoring are clinically useful for Covid19 patient monitoring at home.

The methods included the use of a Telemonitorizacion Asistencial (TELEA), which provided all Covid19 patients in Galicia with a virtual ward (Northwestern Spain). TELEA interventions were given to high-risk patients in the Lugo, A Marina, and Monforte Healthcare Area (ASLAM), which was then compared to other models of care given to other patients in Galicia. According to the findings, 4384 (9.3%) of the total 47,053 COVID-19 patients in Galicia were in ASLAM. TELEA was used by 1187 (27.1%) of them, while the rest (3197 in ASLAM and 42,669 in the rest of Galicia) were monitored using other methods.

Patients monitored in ASLAM via TELEA had fewer emergency department visits (p = 0.05), were hospitalized less frequently (p = 0.01), had shorter hospital stays (p = 0.0001), and had a lower mortality rate in their first hospitalization (p = 0.03). These were favorable results compared to the other Covid19 patients in Galicia who were monitored using different methods.

Finally, Casariego-Vales et al. (2021) assert that the care model involving proactive at-home monitoring of Covid19 patients is associated with reduced pressure on hospital services, lower patient mortality rates, and lower costs of care, thus recommending increased implementation of such programs. The article met the CRAAP criteria, making the information credible and applicable in real-world nursing practice.

Farooqi, M. H., Abdelmannan, D. K., Al Buflasa, M. M., Abbas Hamed, M. A., Xavier, M., Santos Cadiz, T. J., & Nawaz, F. A. (2022). The impact of telemonitoring on improving glycemic and metabolic control in previously lost-to-follow-up patients with type 2 diabetes mellitus: A single-center interventional study in the United Arab Emirates. International Journal of Clinical Practice, 2022, 6286574. https://doi.org/10.1155/2022/6286574

In this study, Farooqi et al. (2022) evaluate the impact of telemonitoring devices on glycemic control and compliance in 38 T2DM patients who were previously lost to follow-up in this study. This was a single-center intervention study that randomized lost-to-follow-up patients at Dubai Diabetes Center.

Following the randomization, the patients went to the center for the first time, where they were given home-based telemonitoring devices and were followed up after three months. The outcomes were as follows: Baseline HbA1C was 10.3 ± 1.9%, but after three months, it was 7.4 ± 1.5%, and the percentage of patients with HbA1c <7% was 50%.

This finding indicates that a home-based telemonitoring approach to T2DM patients who were previously lost to follow-up is significantly associated with a reduction in HbA1C, indicating the need to expand the intervention’s use in healthcare.

Warren, R., Carlisle, K., Mihala, G., & Scuffham, P. A. (2018). Effects of telemonitoring on glycaemic control and healthcare costs in type 2 diabetes: A randomized controlled trial. Journal of Telemedicine and Telecare, 24(9), 586–595. https://doi.org/10.1177/1357633X17723943

Many researchers, including Warren et al. (2018), discovered a pressing need to design a cost-effective intervention for diabetic patients through the American Diabetes Association’s (2018) analysis of the cost implications of diabetes treatment. Warren et al. (2018) investigated the effects of Telehealth intervention on T2DM control and the potential cost savings to the healthcare system.

This was a prospective study in which patients were randomly assigned to one of two groups: intervention (received usual care plus additional diabetes care from a diabetes care coordinator via a home monitor that captured clinical measures) or control (received usual care). While HbA1C was the primary outcome, the healthcare system was taken into account, and the incremental cost per percentage point reduction in HbA1C was calculated. At the 6-month endpoint, the intervention group’s HbA1C decreased from a median of 8.4% to 7.5%, whereas the control group’s HbA1C remained unchanged at a median of 8.1% (p=0.04).

The intervention group’s total healthcare costs were lower (mean $3781) than the control group’s (mean $4662), a statistically significant finding (p=0.01). The study concludes that the intervention is clinically and statistically meaningful in terms of providing a cost-effective solution to lowering HbA1C in T2DM patients, and the authors advocate for its increased use in health care. The article meets the CRAAP criteria, making it credible. It also contains relevant findings that can be used in practice to provide a cost-effective solution to managing T2DM in middle-to-low-income populations.

Summary of Recommendations

Three of the four publications evaluate the use of telemonitoring in the management of T2DM patients, with the impact on lowering HbA1C, increasing patient self-efficacy, and lowering healthcare costs being the common thread. One study examines the impact of telemonitoring on Covid19 patients and discovers that it is associated with shorter hospital stays and lower mortality rates.

Financial and human resources are two major organizational factors influencing the implementation of telemonitoring interventions. Although the initial implementation may be costly, it is cost-effective in the long run, thus justifying its use in healthcare. Human factors include staffing—the World Health Organization (2022) declares an ongoing nursing shortage, with 9 million more nurses needed to fill the gap by 2030–and attitude toward interventions, as some care providers or patients may vehemently oppose the change. Overall, the findings of the synthesized articles support the need for telemonitoring in patient care approaches.

Conclusion

As much as the Covid19 pandemic ravaged almost every industry, the healthcare sector was the most affected. Despite the negative impact on healthcare, it presented a challenge in the form of increased innovations aimed at continuing care without regular patient-care provider physical interaction. Most scholars agree that this period experienced an increase in the use of telemonitoring interventions in the approach to managing Covid19 and chronically ill patients.

The benefits of telemonitoring interventions revolve around quality and safe patient care, as well as cost savings. While the interventions have demonstrated effectiveness in patient care, an initial implementation may face challenges such as costly technologies and resistance from the quaint care providers. Despite the difficulties in the initial implementation, multiple evidence-based studies show that the benefits outweigh the risks.

References

American Diabetes Association. (2018). Economic costs of diabetes in the U.s. in 2017. Diabetes Care, 41(5), 917–928. https://doi.org/10.2337/dci18-0007

American Diabetes Association. (2020). 8. Obesity management for the treatment of type 2 diabetes: Standards of Medical Care in diabetes-2020. Diabetes Care, 43(Suppl 1), S89–S97. https://doi.org/10.2337/dc20-S008

Andrès, E., Meyer, L., Zulfiqar, A.-A., Hajjam, M., Talha, S., Bahougne, T., Ervé, S., Hajjam, J., Doucet, J., Jeandidier, N., & Hajjam El Hassani, A. (2019). Telemonitoring in diabetes: evolution of concepts and technologies, with a focus on results of the more recent studies. Journal of Medicine and Life, 12(3), 203–214. https://doi.org/10.25122/jml-2019-0006

Pronovost, P. J., Cole, M. D., & Hughes, R. M. (2022). Remote patient monitoring during COVID-19: An unexpected patient safety benefit: An unexpected patient safety benefit. JAMA: The Journal of the American Medical Association, 327(12), 1125–1126. https://doi.org/10.1001/jama.2022.2040

Warren, R., Carlisle, K., Mihala, G., & Scuffham, P. A. (2018). Effects of telemonitoring on glycaemic control and healthcare costs in type 2 diabetes: A randomised controlled trial. Journal of Telemedicine and Telecare, 24(9), 586–595. https://doi.org/10.1177/1357633X17723943

World Health Organization. (2022). Nursing and midwifery. Who.int. https://www.who.int/news-room/fact-sheets/detail/nursing-and-midwifery

Assessment 3 Instructions: Evidence-Based Proposal and Annotated Bibliography on Technology in Nursing

Write a 4-6 page annotated bibliography where you identify peer-reviewed publications that promote the use of a selected technology to enhance quality and safety standards in nursing.