NURS-FPX 4900 Assessment 3 Assessing the Problem
Assessing the Problem Part 1 Example Essay 1
The World Health Organization (WHO) considers hypertension a major risk factor for death and morbidity. They account for approximately nine million deaths annually. It is anticipated that by 2025, more than 1.5 billion people worldwide will suffer from hypertension. Patients with hypertension account for roughly 50% of the risk of heart disease and 75% of the risk of stroke (Himmelfarb et al., 2016). 73.6 million Americans suffer in silence from hypertension (Zhang & Moran, 2017 ). Hypertension is not only a severe chronic ailment, but it is also the leading risk factor for other comorbidities.
Hypertension is exacerbated by comorbidities such as cardiovascular disease, renal failure, stroke, and premature death. It can be difficult to treat hypertension, and many people battle with sickness management. Blood pressure management with lifestyle modifications and antihypertensive medication is beneficial in decreasing cardiovascular disease risk factors (Zhang & Moran, 2017).
Regardless of the clear benefits of blood pressure treatment, a sizable proportion of the diagnosed and undiagnosed populations get inadequate care. Traditional hypertension control measures, such as office visits, must be supplemented with a modern strategy. They rely on the development of technology that allows patients to self-manage their blood pressure to adequately handle the hypertension burden on the health system.
Impact of Healthcare Technology
E-Health is described as the use of digital or electronic technology applied in medicine, which includes electronic procedures and communication technologies (Omboni et al., 2016). E-Health improves treatment quality and provides efficient healthcare to patients (Omboni et al., 2016).
The rapid change in technology has been witnessed over the past two decades. The rapid technology improvement has increased the breadth of digital health treatments that involve using the internet to provide care from a distance (Silva et al., 2015). EHTs, grid technology, clinical decision support systems, remote diagnosis and teleconsultation, medical research, and telehealth are core aspects of e-Health. E-Health applications include online medical records, e-learning, medical imaging and diagnostics, interactive systems, wearables, and online prescriptions.
A commonly used tool for e-Health is the Electronic Health Records (EHRs), which comprises software created to store patients’ medical history, including tests, results, medications, and all general history, and share it with the healthcare team online support clinical actions. Telehealth and mobile health (m-health) are the most popular e-health services among service providers and customers (Milani et al., 2017). Telemedicine enables the transfer of medical information via electronic communication and patients’ remote diagnosis and treatment. Simultaneously, m-health employs mobile devices to facilitate communication between physicians and patients. Telemedicine and mobile health are often used to expand and improve patient care.
E-health and telemedicine integrate the doctor and the patient, facilitating the formation and maintenance of long-term partnerships for hypertensive patients who require ongoing medical treatment (Omboni et al., 2016). Long-term relationships between service providers and consumers may be established and sustained with health information technology support.
Besides, e-health and telehealth are crucial to empower hypertension patients’ wellness status (Omboni et al., 2016). Telemedicine facilitates the formation of a physician-patient connection and stresses individualization of treatment, which can ultimately enhance blood pressure readings and cardiovascular risk management. Telemedicine enables the spread of services and healthcare to people who are able to obtain medical attention. Telemedicine also helps to reduce the number of avoidable emergency department visits and the expenditures connected with them (Omboni et al., 2016).
Adopting both e-health and telemedicine in blood pressure control has various advantages. Telehealth allows hypertensive patients to speak with their doctors—health information technology aid in establishing and maintaining long-term connections between service consumers and providers. E-health and telehealth are important to empower hypertension patients and promote self-management with positive outcomes in patients’ well status (Omboni et al., 2016). By developing individualized physician-patient connections, digital treatments enhance blood pressure control and cardiovascular risk management.
Telemedicine enables patient-physician engagement across long distances while also improving the tracking and delivery of biometric data. Engagement with the patient and their care increases the patient’s likelihood of adhering to treatment regimens and lifestyle changes. The disadvantages of incorporating e-health and telehealth into current treatment systems include a lack of sufficient infrastructure, the cost of creating and executing the services, a lack of funding, and privacy and legal issues (Omboni et al., 2016). These impediments hamper the adaption and deployment of technological advances in hypertension control.
Care Coordination and the Utilization of Community Resources to Address Hypertension
The Agency for Healthcare Research and Quality Care Coordination defines it as “the purposeful planning of patient care activities between two or more individuals (including the patient) participating in the patient’s care to support the proper delivery of health care services” (Bower, 2016). Care coordination is an essential component in providing adequate care. Care coordination seeks to enhance patient outcomes and well-being by directing resources to a specific patient or group of patients via a coordinated care plan.
A new diagnosis can leave a patient feeling unsure and overwhelmed, and it is common for the patient to be excluded from the essential resources, resulting in decreased adherence to illness care. When a practitioner and care team create a clear care plan, appropriate resources are made more easily accessible, allowing the patient to get better treatment. Adoption of care coordination has resulted in better care quality.
Careful management must begin as soon as a diagnosis is made; careful management can improve care quality by providing appropriate clinical preventative services, safety, and efficiency. Reviewing mediation and medication reconciliation to avoid duplicate and prescription errors are an example of patient safety. Understanding that these variables may help design supports to assist the patient in achieving their individual goals. When the risk factors do not appear to be modifiable, coordination of services can often benefit patients and their families. Coordination of care can help clarify roles and eliminate duplication of services.
Self-management support is significant for patients with chronic diseases and emerging modifiable risks. Understanding an individual’s readiness to change can help in the patient care plan. A care manager with is part of the care team can help motivate the patient, set goals, track progress towards goals, and foster individuals’ self-management of their medical condition.
In the broadest terms, modifying risk include improving health outcomes, positively influencing psychosocial concerns, as well as helping patients achieve goals that produce better health outcomes (Care Management: Implications for Medical Practice, Health Policy, and Health Services Research | Agency for Healthcare Research & Quality, 2010).
The limitations to fully utilizing community services for optimal blood pressure control result in a decreased use of community resources for blood pressure management. A lack of frequent medical follow-up and a lack of financial means to access relevant community resources are two examples of roadblocks (Khatib et al., 2014). Poor medication adherence is caused by a lack of proper fiscal incentives to encourage medication adherence to improve the treatment of chronic ailments like hypertension.
According to survey participants, financial restrictions impede their health-seeking routines (Khatib et al., 2014 ). Another consideration is the patient’s willingness to change. The federal and state governments collaborate to enhance access to healthcare services and resources to improve the overall outcome of illness management strategies. Poor drug adherence, hypertension control, and general quality of life result from insufficient reinforcement assessments. As a result, policies that address these unfulfilled expectations must be created and executed to elevate and improve the quality of care offered.
Analyzing Policies Associated with Health Care Technologies
The federal and state governments have made significant progress in achieving universal health outcomes and improving service quality and efficacy using evidence-based methods. The Health Insurance Portability and Accountability Act (HIPPA) and the Affordable Care Act (ACA) have significantly influenced healthcare technology, care coordination, and community services. In 2010, the ACA was improved, resulting in a model of healthcare that reduces costs while increasing access to treatment. The Affordable Care Act (ACA) expanded access to healthcare for people suffering from chronic diseases such as hypertension. As healthcare becomes more accessible, patients have better access to resources.
Following the ACA’s incentives, the healthcare system prioritized care coordination, resulting in lower healthcare costs, more patient satisfaction, and improved patient outcomes (Bartels et al., 2015). The Health Insurance Portability and Accountability Act (HIPPA) policy has been reinforced to prohibit the disclosure of private health information about individuals without their knowledge or agreement (U.S. Department of Health & Human Services, 2015). There were no uniform standards in health care for protecting health information prior to HIPPA. During this time, new technologies were emerging.
The healthcare industry began to shift away from paper processes and toward a greater reliance on electronic information, systems to pay claims, answer eligibility questions, provide health information, and perform various other administrative and clinical duties functions (U.S. Department of Health & Human Services, 2015). HIPAA’s primary purpose is to protect a patient’s private health information, significantly influencing technology, care coordination, and community resources (U.S. Department of Health & Human Services, 2015). Patients’ privacy must be respected while coordinating treatment, sharing protected health information (PHI), and gaining access to community services, since this legislation applies to all healthcare staff (U.S. Department of Health & Human Services, 2015).
Nursing practice standards, such as the Nursing Code of Ethics, and state nursing boards, such as the Wisconsin Board of Nursing, establish firm principles and processes to guarantee that nurses collaborate to provide safe and high-quality patient care. “Ethics, human rights, and nursing concierge as a potent vehicle for social justice and health diplomacy that may be reinforced by collaboration with other health professions,” according to the Nursing Code of Ethics (Find High Blood Pressure Tools and Resources, 2020).
The Nursing Code of Ethics is broken into nine sections that outline how a nurse should act ethically. Provisions 1–4 emphasize the nurse’s primary responsibility to the patient; the nurse should prioritize their commitment to the patient and support and advocate for the patient (Find High Blood Pressure Tools and Resources, 2020). Provisions 5 and 6 address the nurse’s ethical and moral responsibilities to herself, coworkers, and patients.
These standards emphasize the necessity for nurses to perform ethically since it establishes, preserve and enhance the work environment and, ultimately, patient care (Find High Blood Pressure Tools and Resources, 2020). Provisions seven through nine emphasize the need to cooperate to preserve other patients’ rights. The Nursing Code of Ethics encourages harmonious teamwork among members of the healthcare team in order to improve patient satisfaction and service quality. Nurses’ advocacy for patient rights, health diplomacy, and initiatives are critical for the continuum of care and coordination (Find High Blood Pressure Tools and Resources, 2020).
Assessing the Problem Part 2
I spoke with K.M., a 42-year-old female that I picked for this practicum, about the influence of hypertension on quality of treatment, cost consideration, and safety. When asked about the quality of her therapy, she stated that she had faced some of the highlighted barriers to hypertension management. According to Khatib et al. article, one of the most common issues reported by patients and clinicians and one of the main reasons patients did not comply with the treatment regimen was a lack of ability. According to the article, several patients were unaware of the lifestyle changes and risk factors for hypertension (Khatib et al., 2014).
While discussing and reviewing this material with K.M., she remarked that she could sympathize with it because she, too, lacked awareness about what lifestyle changes were required to keep his hypertension under control. Furthermore, she noted that further education and counseling during her treatment would be ideal because things in her life are constantly changing, and an adjusted care mode would benefit her lifestyle.
When we looked at the motivational barrier, she stated that she did not have the energy or time to exercise and occasionally forgot to take her meds. She did not experience signs and symptoms of missing medicine such as headache, dizziness, or palpitation; nevertheless, she did state that there are occasions when she does not take her prescription and that she is in denial that the meds function to help regulate her blood pressure problems. She claims that taking her drugs lengthens the therapy since her body grows reliant on them.
While addressing patient safety concerns with her family physician regarding symptoms, she mentioned that one of the physician assistants she visited when her primary care doctor was out of town changed her medication regimen. As instructed, K.M. began taking the new drug since the physician assistant wanted to adjust his blood pressure meds.
During her one-month follow-up appointment, her primary care doctor was unaware of the change in blood pressure medication, and K.M. said that the doctor was dissatisfied with the new adjustments, so she reverted to the previous prescriptions. K.M. was furious after the following appointment, and she claimed that it is as if no one understands what they are doing or whether it even matters what medication is taken. “Doesn’t everyone do the same thing?”
We also spoke about money and her incurred costs during her disease management thus far and last year. K.M. claimed that she had many medical visits and was requested to view various departments. She started going at first, but she did not understand the point because it only added to her monthly costs. At each appointment, her blood pressure appeared to be expected. She added that because she had normal blood pressure, she did not see the significance of all of the appointments and continued with the meds, believing that the problem had been resolved. K.M. said that it was only a detour.
After meeting with K.M., I noticed that a higher emphasis on self-management may be attributable to the lack of a team-based approach with her suggested consulting team. I saw that self-reporting, education, and self-awareness might help support K.M. in sustaining her hypertension control. I spoke on the necessity of a team-based approach and how medication adherence is critical to maintaining control. K.M. said, “I did not grasp the rationale before, but now it makes sense.” “Because I felt my blood pressures were normal, I stopped taking medicine,” K.M said that there was much material offered, but it was not articulated adequately. I have to do this, and I have to go to this individual without understanding why.
Conclusion
Care coordination at a high level is vital to the patient’s well-being. Unmet needs and inadequate hypertension management are more likely when care coordination is lacking. Despite efforts to manage hypertension and reduce mortality and morbidity, the vast majority of hypertensive patients, both diagnosed and undiagnosed, do not receive adequate treatment (Himmelfarb et al., 2016). Healthcare practitioners must be aware of the risks associated with inadequate care coordination for hypertensive patients.
References
Bartels, S. J., Gill, L., & Naslund, J. A. (2015). The Affordable Care Act, Accountable Care Organizations, and Mental Health Care for Older Adults. Harvard Review of Psychiatry, 23(5), 304–319. https://doi.org/10.1097/hrp.0000000000000086
Bower, K. A. (2016). Nursing Leadership and Care Coordination. Nursing Administration Quarterly, 40(2), 98–102. https://doi.org/10.1097/naq.0000000000000162
Care Management: Implications for Medical Practice, Health Policy, and Health Services Research | Agency for Healthcare Research & Quality. (2010). Ahrq.gov. https://www.ahrq.gov/ncepcr/care/coordination/mgmt.html
Find High Blood Pressure Tools and Resources. (2020). Www.heart.org. https://www.heart.org/en/health-topics/high-blood-pressure/find-high-blood-pressure-tools–resources
Himmelfarb, C. R. D., Commodore-Mensah, Y., & Hill, M. N. (2016). Expanding the Role of Nurses to Improve Hypertension Care and Control Globally. Annals of Global Health, 82(2), 243. https://doi.org/10.1016/j.aogh.2016.02.003
Khatib, R., Schwalm, J.-D., Yusuf, S., Haynes, R. B., McKee, M., Khan, M., & Nieuwlaat, R. (2014). Patient and Healthcare Provider Barriers to Hypertension Awareness, Treatment and Follow Up: A Systematic Review and Meta-Analysis of Qualitative and Quantitative Studies. PLoS ONE, 9(1), e84238. https://doi.org/10.1371/journal.pone.0084238
Milani, R. V., Lavie, C. J., Bober, R. M., Milani, A. R., & Ventura, H. O. (2017). Improving Hypertension Control and Patient Engagement Using Digital Tools. The American Journal of Medicine, 130(1), 14–20. https://doi.org/10.1016/j.amjmed.2016.07.029
Omboni, S., Caserini, M., & Coronetti, C. (2016). Telemedicine and M-Health in Hypertension Management: Technologies, Applications and Clinical Evidence. High Blood Pressure & Cardiovascular Prevention, 23(3), 187–196. https://doi.org/10.1007/s40292-016-0143-6
Silva, B. M. C., Rodrigues, J. J. P. C., de la Torre Díez, I., López-Coronado, M., & Saleem, K. (2015). Mobile-health: A review of current state in 2015. Journal of Biomedical Informatics, 56, 265–272. https://doi.org/10.1016/j.jbi.2015.06.003
U.S. Department of Health & Human Services. (2015, April 16). Privacy. HHS.gov. https://www.hhs.gov/hipaa/for-professionals/privacy/index.html
Zhang, Y., & Moran, A. E. (2017). Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension Among Young Adults in the United States, 1999 to 2014. Hypertension, 70(4), 736–742. https://doi.org/10.1161/hypertensionaha.117.09801
Intervention Presentation and Capstone Reflection Video Example
This reflection focuses on the processes and lessons from activities in my capstone project. The prime of the capstone project was presenting it to the target population, senior students at Beverly Hills high school. We had a two-hour interaction where we discussed the proposed intervention: an online adolescent mental health program. The students were very receptive and excited because teens are more engaged in current technology such as smartphones and are excited to interact on social platforms (Odgers & Jensen, 2020).
The students suggested the program would be most appropriate when carried out on the weekends on Saturday from ten in the morning to noon, with a 2-hour follow-up session on Wednesdays from seven to nine at night. These follow-up sessions are special classes for those adolescents with special needs, such as diagnosed mental health issues and ongoing background issues such as violence at home.
The online program will integrate students from all over the community. These platforms will help adolescents’ healthy socialization, protecting them from online bullying and other adverse social media effects (Patterson & Edwards, 2018). Adolescents will also speak their emotions freely and get help without exposing their details.
The programs will entail mental wellness education to enable adolescents to make healthy decisions to promote their mental health. They will also provide follow-up services for adolescents recovering from mental health problems. Adolescents face significant problems with autonomy, violent backgrounds, and poor decision-making. They will adequately take care of their health with proper guidance, producing productive, happy students and a safer, conducive learning environment.
To develop the capstone project, I looked up current healthcare issues from reputable organizations’ websites, particularly the WHO, CDC, and Healthy People 2020. I also researched current (published within five years) articles on best practices in managing the identified problem (adolescents’ mental health) from reputable databases such as CINAHL, Google Scholar, Medline, and Cochrane library. These databases also provided information on best change management practices, healthcare technology, community resources, leadership strategies, and communication strategies to present the problem to the various stakeholders and the patient population.
The capstone project is entirely based on healthcare technologies, specifically health information systems. The program will rely on healthcare technology for data collection analysis, dissemination, and decision making. The hospital, as mentioned, will fund and provide leadership. At the same time, JED Foundation will run the programs using their professionals, trained and accredited, to provide quality adolescent mental health education and management.
The care coordination will entirely use information systems, linking the healthcare institution to the JED foundation, faith-based organizations, and community groups. Adolescents will create anonymous profiles from their smartphones to interact with others and the facilitators. The program will entirely run using healthcare technology, healthcare information systems.
The program’s main shortfall is the unavailability of consultation during off-program hours. New technologies such as artificial intelligence and computer assistants have changed the practice by improving efficiencies. Having artificial intelligence systems to provide 24-hour patient support will help adolescents consult and seek mental health help when they need it without waiting for program hours.
Some foundations, such as the JED foundation and Health4us, have programs running 24hours a day to allow adolescents to seek help at any time (SAHM, n.d.). In addition, the hospital can integrate several technologies to improve efficiencies in all fields. They should also expand their online consultation programs to increase their client base and provide healthcare services to more clients who would otherwise not reach the healthcare institution.
The health policy is integral in controlling healthcare institutions, professionals, and quality improvement projects. The health policy delegated many aspects of the project, such as the scope of practice, health technology and patient information protection, social media use, and prioritization of care. From the data collected, adolescents would benefit more from online programs and school-mental health programs in promoting their mental well-being (O’Reiley et al., 2018). The data collected is a formidable tool in advocating for health policy changes and the implementation of policies that increase online adolescent mental health programs.
The evidence-based practices and the interaction with the interest population exceeded my expectations. The evidence-based practices from the literature were far more than expected. The discussed intervention was readily accepted by adolescents and is very promising. Its implementation has exceptional benefits that will significantly reduce the burden of adolescent mental health issues. The students collaborated well, unlike the expected resistance and failure to open up. They were more than ready to share. The intervention will be implemented as best practice because there is evidence of successful implementation (Sweeney et al., 2019).
The intervention is not limited to adolescents, and online mental health resources are available for veterans, drug and substance use patients, and other healthcare conditions. The intervention is integral to mental health issues due to the stigma and fear of consultation. The government and healthcare institutions should develop and implement good online programs to manage adolescent mental health issues across the nation.
The capstone project has led to professional growth and development. It has taught me the importance of collaborating with a population when developing interventions to improve their health. The communication and collaborative skills I have learned will help me interact healthily with clients of all ages, cultures, and backgrounds. In addition, I have increased my confidence that help will help in advocacy, interprofessional consultation, and decision-making.
I had low confidence when starting the project and had problems initiating conversations, and my confidence has increased. The project has also broadened my perception of quality improvement projects. I have learned to invest and carry out research from studies to determine the best practices rather than just assuming.
References
O’Reilly, M., Svirydzenka, N., Adams, S., & Dogra, N. (2018). Review of mental health promotion interventions in schools. Social psychiatry and psychiatric epidemiology, 53(7), 647-662. https://doi.org/10.1007/s00127-018-1530-1
Odgers, C. L., & Jensen, M. R. (2020). Annual Research Review: Adolescent mental health in the digital age: facts, fears, and future directions. Journal of Child Psychology and Psychiatry, 61(3), 336-348. https://doi.org/10.1111/jcpp.13190
Society for Adolescent Health Medicine (SAHM) (n.d.). Mental Health Resources For Adolescents and Young Adults. Retrieved 9th January 2022, from https://www.adolescenthealth.org/Resources/Clinical-Care-Resources/Mental-Health/Mental-Health-Resources-For-Adolesc.aspx
Sweeney, G. M., Donovan, C. L., March, S., & Forbes, Y. (2019). Logging into therapy: Adolescent perceptions of online therapies for mental health problems. Internet interventions, 15, 93-99. https://doi.org/10.1016/j.invent.2016.12.001
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