D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

Recent Advances in Managing Heart Diseases

Executive Summary

Heart disease is a leading cause of mortality nationally and within states. In New Jersey, the main form of heart disease is a coronary heart disease which predisposes the patient to angina, arrhythmias, heart failure, and heart attack. Whereas the main approach to heart diseases is the therapeutic intervention with pharmacotherapy, the role of lifestyle adjustment cannot be overemphasized. This paper looks at the policy of the current management of heart disease and proposes alternative policies that would result in more satisfying patient outcomes. The paper discusses the demographics of Bayonne residents, New Jersey, the ethical implications of the proposed policy, and the financial implications. A resourceful reflection and an appropriate implementation plan are also provided. D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

Summary of Context and Scope of the SDOH in My Community

New Jersey Health Report in 2020 identifies heart disease as the leading cause of mortality. Heart disease is similarly the leading cause of mortality nationally. The most common type of heart disease is coronary heart disease that predisposes the patient to angina, arrhythmias, heart failure, and heart attack. The U.S. target for 2020 was to reduce the deaths from coronary heart disease to 103.4 deaths per 100 000 of the population while New Jersey’s State target was to reduce the coronary heart disease mortality rate to 94.3 per 100 000 of the population (Data USA, 2020 D025 Essentials of Advanced Nursing Roles and Interprofessional Practice). The State’s target for individual races is 99.7, 105.7, 59.8, and 38.9 for Whites, Blacks, Hispanics, and Asians, respectively.D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

Bayonne has a population of 65 300 according to the 2018 Census Report. The median age is 38 years while the median household income is $ 59 924. Whereas the current population is a decrease from 66 719 in 2017, the median household income reflects a marked increase of 5.7 %, from % 56 701 (Data USA, 2020). By ethnicity, 47 % are non-Hispanic Whites, 17 % Hispanic Whites, 11 % other Hispanic, 10 % African American, 10 % non-Hispanic Asians, and 5 % Pacific Islanders.  Bayonne’s average car ownership is  2 cars for each household while the homeownership rate is 38 %.  90 % of Bayonne residents have health cover, of whom 46 % depend on employee plans; 22 % on Medicaid, 12 % Medicare, 9 % on non-group plans, and 1 % on military or VA plans. The patient to primary care physician ratio is 1923 to 1; a 3 % increase from 1880 to 1 in 2017. D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

Heart failure is a chronic condition in which the heart is unable to pump sufficient blood to meet the needs of other body organs. It is the commonest cause of hospitalization for individuals aged above 65 years, thus the impact on older individuals makes the burden of disease greater (Hartshore, 2019). Among persons hospitalized for heart failure, twenty-five percent are readmitted to the hospital within a month while thirty-three percent die within a year. The Heart Failure Policy Network is the primary policymaker involved, its main partakers being patient advocates, healthcare professionals, and decision-makers. The Network published a handbook in 2019 guiding on the prevention, diagnosis, clinical management, multidisciplinary approach, patient empowerment, comorbidities, self-care, and advanced care setting for heart failure patients. D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

Whereas guidelines for the management of heart failure and other heart illnesses are succinct, the role of telemedicine in dealing with the diseases is often overlooked. Benefits of telemedicine include timely access to primary care physicians, which circumnavigates the ratio of 1923 to 1; enabling consultation from remote areas, and simplification of the consultation procedure through the elimination of transport costs and the associated logistics (Data USA, 2020 D025 Essentials of Advanced Nursing Roles and Interprofessional Practice). Furthermore, while traditional consultation processes necessitated the physical presence of physicians, clinicians, nurses, and other health professionals, telemedicine enables the health professionals to offer primary care from the comfort of their own homes or offices.

Besides, the care providers are not required to move from one hospital to another while meeting the needs of different patients. One health personnel may attend to the needs of patients at homes, nursing homes, or several hospitals without moving his/her physical location. In this respect, this paper seeks to propose an update to the management of heart diseases to incorporate the wider application of telemedicine for improved patient outcomes. D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

The current management of heart failure includes taking medication, reducing dietary sodium intake, and reducing bodily fluid intake. In severe cases, heart failure is treated by heart transplants and other surgeries. Lifestyle adjustment is an additional approach that has proven to be effective in managing the disease. The individual is advised to exercise daily, to improve circulatory health. Heart failure is also associated with other conditions such as coronary artery disease, diabetes, obesity, high blood pressure, and valvular heart disease (NJSHAD, 2021 D025 Essentials of Advanced Nursing Roles and Interprofessional Practice). Thus, preventing the development of the related conditions would significantly reduce the risks for heart failure.

The existing policy entails the management of heart failure both by pharmacotherapy and lifestyle adjustment. Nonetheless, the role of telemedicine in managing the disease has been largely limited. With telemedicine, the physician could monitor the patient’s progress remotely. Also, the nurse and clinician may ascertain the patient’s compliance with medication by easily reminding them to take their dose at stipulated times. In times of adverse health during the treatment, the patient may readily access the care provider without being physically present in a health facility.  The symptoms of the exacerbated disease include shortness of breath during routine activities, difficulty breathing while in the supine or prone posture, and generalized body weakness.

Besides, weight gain and swelling in the legs, feet, ankles, and stomach are also markers of deteriorating health (NJSHAD, 2021). Telemedicine is resourceful such that the patient may report to the care provider the first instance he/she notices the mentioned symptoms. The clinician, nurse, or physician will weigh the benefit versus risk of management and provide appropriate intervention. Also, the high-speed internet that is present in major cities nationwide will contribute to the success of telemedicine and e-health. The expected resultant effect is a reduction in mortality rates of heart diseases. D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

The ethical implications of the policy governing the management of heart diseases cannot be ignored.  For starters, patient privacy will be protected through ramified e-health systems that make access to third parties impossible. The improved privacy will prevent harms that would arise from personal information getting into the hands of unintended parties.

Nevertheless, since telemedicine is principally information-technology-dependent, its integrity could be compromised by web-hackers. Such occurrences could be prevented by using multiple-layered databases with intricate coding that hackers would find challenging to penetrate. Furthermore, e-health systems could be designed to report any attempts of hacking or corrupting the codes to the support that would readily amend the systems. D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

The confidentiality of telemedicine in handling heart disease patients is not to be questioned. Since remote communication will be used, end-to-end encryption would ensure the information is solely between the provider and the patient. Besides, sharing of information between health providers would be easier with e-health, as compared to the traditional physical sharing of hospital files and other documents. D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

Demographics Table

(Place Title of SDOH here) Statistics/facts Summary of statistics/facts Source for statistics/facts
Demographic Information(Provide 2 or more  statistics/facts associated with demographics for SDOH in the column to the right) D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

 

 

 22 % of Bayonne residents have Medicaid A large proportion of Bayonne residents has a reliable health cover, which could be instrumental in the implementation of telemedicine. Data USA (2020)
12 % have Medicare
Risk Factors(Provide 2 or more statistics/facts regarding risk factors associated with SDOH in the column to the right).

 

 

  Dyslipidemia

 

 

 Risk factors to developing heart failure include dyslipidemias and obesity (CDC, 2020)
Obesity Factors such as dyslipidemia and obesity have a higher likelihood of developing hypertension that causes cardiac failure. (CDC, 2020) D025 Essentials of Advanced Nursing Roles and Interprofessional Practice
Trends in SDOH Over Recent Year(s)(Provide 2 or more statistics/facts associated with trends in SDOH over the recent year(s) in the column to the right.) 379 800 deaths in 2018 resulted from heart failure nationally. 

 

 

 

 Heart failure is the leading cause of mortality in the US. (CDC, 2020)
Approximately 6.2 million US adults suffer from heart failure. D025 Essentials of Advanced Nursing Roles and Interprofessional Practice The prevalence of heart failure is increasing owing to an increase in lifestyle disorders. (CDC, 2020)

Policy Proposal and Implementation Plan

The first policy alternative is incorporating applications on smartphones and personal computers that will directly link heart disease patients with primary care physicians, nurses, and clinicians. The applications could incorporate features of saving information from every consultation for future reference. The patient and care providers will be required to have an active internet connection.

The second alternative is to register newly diagnosed heart disease patients on a national database. Each patient would have a personal profile with details of demographics such as name, age, sex, weight; and health indices such as blood pressure, pulse rate, lipid profile, and blood glucose that would enable the clinician to monitor the patient’s prognosis. The patient would not be required to have a smartphone or computer unless he/she is logged in to the personal profile. D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

In my opinion, the first policy alternative would be most preferred. This observation stems from the fact that the majority of households in Bayonne have reliable access to smartphones, personal computers, and active internet communication. The observation is also supported by the median household income of $ 59 924, which is far above the poverty line.

The financial implications of applying telemedicine to manage heart diseases are equally important. An ideal portal should have varied attributes, including hosting patient consultation. Additional features include mobile medical device data and video conferencing. The cost per patient site averages between $ 1000 and $ 1500 whereas hardware could cost between $ 7 000 and $ 10 000 per patient (Horiachko, 2020 D025 Essentials of Advanced Nursing Roles and Interprofessional Practice).

The incorporation of remote providers would result in an additional increase in price.  Besides, modular packaging that would provide easy configuration across various specialties would require an all-in-one system, costing between $ 20 000 and $ 30 000. Training of medical staff to use telemedicine platforms would cost between $ 200 and $ 2 000 per site, depending on the complexity of equipment, the number of users, and such factors.

Nonetheless, the benefits that would be accrued from the installation would be cost-effective. The mortality of heart diseases is expected to reduce remarkably, owing to timely reporting of adverse health and swift intervention, regardless of the physical locality of the patient and provider. Furthermore, once the telemedicine services are running, the operational and maintenance costs would be significantly lower than their installation. D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

The ethical implications of telemedicine implementation are worth-noting. First, malicious individuals might spread malware that may cause system dysfunction, thus interfering with the delivery of health services. Also if the malware used is spyware, the patient’s and provider’s information could be leaked, resulting in breached confidentiality. Notwithstanding, the principles of autonomy, beneficence, and non-malfeasance would still be upheld. The patient would be free to select the manner of care and which provider.

The main barriers to implementing the proposed policy alternative would be the installation costs of telemedicine. As afore-mentioned, the installation has heavy financial implications. Also, training on the application of telemedicine would be mandatory for both care providers and patients, which would be another milestone. D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

The proposed policy could be communicated through print media such as newspapers, health magazines, and periodical journals; and mass media such as television commercials, radio broadcasts, and billboards. Additional advertisements could be made on social media platforms such as Twitter, Instagram, Facebook, and Telegram. A luncheon could be held with the policymakers, during which a PowerPoint presentation of the policy would be made.

Inaction regarding the policy would translate to non-improved mortality rates from heart diseases. However, with increasing incidences and prevalence of lifestyle disorders, mortality rates are expected to rise.

Reflection

The change in the proposed policy is to incorporate telemedicine to improving the health outcomes of patients with heart diseases. The knowledge and skills required to develop include, but are not limited to, application of information technology to healthcare settings, utilization of e-health platforms among providers and patients, and reliable communication skills in dealing with e-health. D025 Essentials of Advanced Nursing Roles and Interprofessional Practice

D025 Essentials of Advanced Nursing Roles and Interprofessional Practice References