Practicum Project: Suggesting Interventional Solution to the Problem
Patient Health Problem Solution
This practicum project was about a health issue involving a 12-year-old female who was admitted with acute asthmatic exacerbation. The patient also had childhood obesity and chronic GERD. The last session with the patient and the mother evaluated how technology would impact their healthcare. An intervention of choice to improve their health promotion and maintenance was a health educational brochure.
The purpose of this paper is to summarize and substantiate this patient’s health problem; elaborate on the impact of nursing leadership and change management on the problem; explain how the quality of care, cost, and patient safety impacted the intervention; explain the role of the state board of nursing standards in improving the management of the problem; and explain the potential role of technology, utilization of community resources, and care coordination in developing the educational brochure.
Problem Summary and Justification
The patient was Annie (not her actual name), a 12-year-old black female patient accompanied by her mother on a brief inpatient hospital admission due to acute asthmatic exacerbation. However, during this admission, she was diagnosed with chronic GERD and childhood obesity.
Annie has been using her Ventolin inhaler whenever needed for asthma attacks. However, this time, the inhaler did not control her symptoms even after half an hour of treatment. This was her second admission due to asthma. The first admission was four years ago when she was being evaluated for symptoms of GERD.
Recently, asthma attacks have increased in frequency and are triggered not only by cold weather but also by certain body sprays and strong smells from foods and fresh paints. Annie lives with her parents and is the only child in her family. I selected this patient because her case represents a patient health problem with various socioeconomic determinants, a need for care coordination, and nursing care and patient exudation.
At the first point of our interaction, I desired to learn more in-depth about the reasons for her recent increase in attacks and offer care where possible and necessary. Therefore, her care would offer me the opportunity to exercise my quality improvement skills and nursing care coordination skills.
Role of Leadership and Change Management in Addressing the Health Problem
Good nursing leadership qualities and skills enable a nurse leader to inspire, influence, and motivate patients, care stakeholders, and other healthcare professionals in the nursing process. Nursing leadership helped inspire the patient and her family to take the initiatives to prevent future attacks through knowledge empowerment by using the educational brochure.
The educational brochure contained self-explanatory information that informed the patient’s caregiver about emergency awareness and prevention strategies for future attacks. According to van Diggele et al. (2020), effective nursing leadership influences patient education through attitude and behavior change. Nursing leadership ensured that the resource was influential by keeping it simple, direct to the point, and only including the need-to-know elements that would enhance understanding and health literacy.
Change management concepts learned from undergraduate education influenced the development of the intervention. This patient’s health problem was not an ordinary case of pediatric asthma. It was complicated by comorbidities and socioeconomic issues. One key change management concept applied in this intervention’s development was stakeholder involvement (Harrison et al., 2021).
Key stakeholders in this patient health problem were family caregivers, doctors, and community resource managers. This intervention aimed at engaging these stakeholders by promoting awareness in the patient and her family caregiver (the mother) in seeking these services by providing necessary contacts and links to essential community resources
The role of nursing ethics was not overlooked in the development of this intervention. Patient privacy, confidentiality, and data security ethics ensured that no direct patient identifiers were included in the interventions. The need to promote justice and equity in resource allocation, utilization, and access ensured that sample community resources for social and material support were included in the intervention.
This intervention also attempted to ensure that the patient’s caregiver makes informed decisions in future health-related endeavors regarding the child’s health. Therefore, the information included in the brochure was evidence-based and adapted from current guidelines and reputable sources.
Strategies for Communicating and Collaborating with The Patient and the Family
Patient collaboration and communication improved collaboration. To enhance collaboration with this patient and her family, patient and family-centered communication is an evidence-based strategy that ensures their engagement and quality outcomes (Park et al., 2018).
Patient- and family-centered communication will include a discussion of factors specific to this patient and their relevant determinants of health, such as income and health insurance in healthcare resource utilization. Communicating strategies that promote self-management and behavior improvement will improve their engagement and self-care. Change communication is another strategy that enhances cooperation and engagement of the patient’s family and their effective self-planning in the process of enhancing self-management.
Effective collaboration with the patient and her family could be enhanced through shared decision-making. In this process, the patient and the nurse collaborate to make patient-specific decisions. The selection of community resources will enhance the uptake and utilization of these resources. Patient engagement is vital in promoting compliance to care interventions and adherence to treatment plans.
This engagement also promotes self-management and positive behavior change. Therefore, working closely with the patient through the above communication and collaboration strategies will prevent future unplanned hospitalizations and complications of her health problem.
Patient engagement in their care will also prevent ethical problems related to decision-making (Lantos, 2020). An example is a situation where the clinician requests interventions and the patient or family declines, or the patient suggests intervention, but the clinician declines it as inappropriate without communicating.
The Role Played by Practice Standards and Policies in the Intervention Development
The state boards of nursing standards regulate my scope of intervention. Therefore, it determent what I could legally perform or explain as a baccalaureate nurse. This scope included assessment, diagnosis, planning, implementation, evaluation, and coordination of care.
Therefore, the contents of this intervention were limited to health problem assessment, diagnosis of complications, planning interventions, implementing prevention strategies, evaluation of outcomes, and coordinating care between different stakeholders. Therefore, the intervention was within the boundaries of the practice authority of a baccalaureate nurse.
Effective policies such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA) ensured that no protected health information (PHI) of the patient was included I n this intervention. This upheld the privacy and confidentiality between the patient and the care coordinator. This intervention also borrowed concepts from another influential policy – the affordable care act (ACA).
As part of mitigating the health disparities that affected this patient, the provision of ACA that allows pediatric patients to be eligible to use their parents’ insurance covers was used as the basis of influencing the patient family to use available insurance to plan for their future health activities and expenditures.
According to Suri et al. (2022), ACA improved outcomes for patients from low socioeconomic status at the individual level. However, this credible research still reported the existence of cost barriers even in those individuals who used insurance.
The Quality of Care, Patient Safety, and Cost Outcomes of the Intervention
Educational brochures have been used in health care to communicate health risks and interventions and educate patients to improve health literacy (Malliarou et al., 2022). The reforms by recent policies such as ACA have shifted patient care from hospital-based care to patient and family-based care to save care costs and improve the quality of care. Using this intervention would improve the quality of care, enhance safety, and minimize the costs of care.
Quality of care has six domains: safety, equity, timeliness, effectiveness, efficacy, and patient-centered care (Harrison et al., 2021). This intervention incorporated patient-centered communication, planning, and collaboration that included specific social determinants of health, such as income and health insurance, to propose specific preventive interventions.
This intervention used evidence-based information from scholarly sources to recommend health prevention and monitoring. Prevention of hospitalization was a key theme discussed in this intervention. This strategy would improve patient safety. By enhancing the use of community resources and coordinated communication through technology, this intervention would ensure that the patient’s family spends less on hospitalizations due to emergencies.
Technology, Care Coordination, and The Utilization of Community in Addressing the Patient Health Problem
Potentially useful technologies impacting this patient’s health problem are smartphone application technologies, digitally-enabled technologies, phone message service technologies, and social media. These technologies would connect the patient remotely with her primary doctor and nurse, enhance remote monitoring, improve the doctor-patient relationship, improve patient satisfaction, and prevent emergency hospitalizations (Poowuttikul & Seth, 2020).
Smart inhalers will enhance self-management and self-monitoring. According to a study by Homaira et al. (2022), care coordination for asthma patients integrates acute care and primary care. This coordination also enables these families with resources that have the potential to prevent emergency hospitalizations. Community resources such as community pharmacies, online support groups, and respiratory rehabilitation facilities ensure care continuity, restore health, and reduce the risk of hospitalizations.
The educational brochure has the potential to positively impact the quality of care, care costs, and patient safety. Nursing leadership, change management, and nursing ethics determined the scope and contents of the intervention. State board of nursing standards were applied to ensure the intervention’s scope did not go beyond the level of practice and education.
National policies such as ACA and HIPAA formed the basis of patient education and outline of information in the intervention. These policies also ensured ethics of care, such as data safety, community resource utilization and equity, and patient confidentiality.
Patient-centered communication, shared decision-making, and change communication is strategies to enhance patient and family communication and collaboration by promoting patient engagement and involvement in their care. The potential role of various technologies, care coordination, and community resources cannot be overlooked in this patient’s health problem.
- Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where do models for change management, improvement, and implementation meet? A systematic review of the applications of change management models in healthcare. Journal of Healthcare Leadership, 13, 85–108. https://doi.org/10.2147/JHL.S289176
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