Patient Problem Solution
The successful management of health problems facing different patient populations requires the use of evidence-based interventions or solutions. Nurses and other healthcare providers play an essential role in determining the most effective and efficient treatment interventions for their patients. They utilize evidence-based interventions to ensure that optimum outcomes of care are achieved in the care given to their patients. Therefore, this project examines the proposed solution that will be utilized in addressing the issue of hypertension and pre-diabetes affecting the selected patient for the project.
Part 1
Solution/Intervention
The proposed solution or intervention that will be used in managing hypertension and pre-diabetes is the use of web-based self-management interventions. Web-based self-management entails empowering patients on the effective interventions that can be used to improve their outcomes of treatment. The interventions are delivered virtually via health technologies such as m-health and telehealth. Self-management interventions in hypertension and pre-diabetes entail the education of the patient on the importance of lifestyle and behavioral modifications alongside medication adherence. Patients should be educated about the self-m
anagement interventions to increase their level of awareness about the ways in which the adverse outcomes associated with their conditions can be minimized. Patients also require coaching on the ways in which the interventions are implemented in practice. The effective use of self-management interventions in hypertension and pre-diabetes contribute to care outcomes such as patient satisfaction, empowerment, and cost-efficiency in care (Alessa et al., 2019).
Studies have been conducted to examine the effectiveness of web-based self-management interventions in hypertension and pre-diabetes. One of the studies is the research by Li et al., (2020) that investigated the effectiveness of self-management of hypertension in adults using the mobile health technology. The results obtained from a systematic review of quantitative and qualitative studies showed that self-management using mobile health technology led to effective blood pressure control, improvement in self-management behaviors and adherence to medication among the participants. The study showed that the use of tailored messages, multifaceted functions, and interactive communication were the most effective features of the technology in promoting the desired behavioral change (Li et al., 2020). A study by Morrissey et al., (2018) sought to obtain the perspectives of the general practitioners on the effectiveness of health technologies for hypertension and diabetes self-monitoring. The data of the study showed that the use of health technologies for self-management of hypertension was cost-effective and provided accurate data on blood pressure and glucose monitoring. The consequence was that general practitioners were able to identify and manage potential adverse events earlier, promoting safety and quality of health (Morrissey et al., 2018). The research by (Aminuddin et al., 2019) showed that the use of smartphone-based self-management interventions in patients with diabetes improved self-care, self-efficacy activities, and health outcomes. The technology also contributed to improved glycemic control in patients with diabetes mellitus type 2 (Aminuddin et al., 2019). Therefore, the use of web-based self-monitoring interventions may prove effective for the patient in this case study.
Leadership
Effective leadership is important for the management of hypertension and pre-diabetes using web-based self-management interventions. Nurses and other healthcare providers involved in the implementation of the solution should demonstrate effective leadership styles such as active listening, promotion of patient-participation, and respect for diversity. There is also the need to coach and mentor the client to embrace the desired interventions delivered via the web-based health solutions. The healthcare providers should also encourage innovation in the identification and implementation of best practices for the optimum management of hypertension and pre-diabetes.
Collaboration
Effective collaboration is required for the realization of the desired outcomes of care using web-based self-management interventions for hypertension and pre-diabetes. Collaboration entails ensuring that the patient and other stakeholders are actively involved in the assessment, planning, implementation, monitoring, and evaluating the effectiveness of the selected interventions. Collaboration contributes to the realization of care outcomes such as patient satisfaction, empowerment, lifestyle and behavioral modification, and ownership of the self-management interventions that are used in hypertension and pre-diabetes management. Therefore, active collaboration will be promoted in the use of the web-based self-management interventions in addressing the health needs of the patient in the case study.
Communication
Communication is an essential component that will determine the realization of lifestyle and behavioral change by the patient. Effective communication skills such as open communication, active listening, and use of non-verbal cues are needed to be embraced in working with the patient in the case study. The communication should foster positive consultation between the stakeholders involved in the care process. The values, needs and preferences of the patient should be prioritized for the realization of the optimum goals of care. Therefore, open and transparent communication will be embraced to promote patient outcomes in the case delivered to the patient.
Change Management
The successful implementation of the proposed solution will require the adoption of new lifestyle and behaviors by the client. The client will therefore require support in ensuring successful implementation of change. Interventions such as active patient participation, patient education, and aligning the interventions with the aims of disease management will be embraced. Responsive strategies to address any potential resistance to change by the patient will also be embraced.
Policy
Nurses play a critical role in shaping policies that relate to the use of technologies in providing patient care. Nurses advocate for the utilization of care technologies that promote safety, efficiency, and quality of patient care. The technologies used should also align with policy provisions such as the protection of data integrity and continuous quality improvement in nursing. Therefore, the existing evidence will be reviewed to ensure that the selected web-based self-management interventions promote the provision of value-based care to the patient.
Quality of Care
Nurses strive to promote high quality care provision to their diverse patient populations. The care given should be patient-centered and evidence-based to ensure that the quality outcomes are achieved. Healthcare technologies for self-management of hypertension and pre-diabetes promote quality of care by ensuring reduction of adverse events, minimization of hospitalization rates and lifestyle and behavioral modification. Therefore, the effectiveness of the technologies informs their selection for use in the case study.
Patient Safety
The aim of any intervention in nursing is to promote patient safety in care. The care given to patients should predispose them to minimal harm and optimize its benefits in disease management and promotion of recovery. Evidence-based technologies used in self-management of chronic conditions promote patient safety by increasing the accuracy of disease monitoring and management. Therefore, the proposed solution is anticipated to contribute to positive outcomes of treatment and patient safety in hypertension and pre-diabetes management.
Costs to the System and Individual
The care provided to the patient should be cost-effective in nature. The costs incurred by the healthcare system should also be minimal. The use of web-based self-management interventions for hypertension and pre-diabetes are cost effective for the patient and system. The interventions minimize the need for unnecessary hospital visits and hospitalization rate. They also facilitate the early identification and management of potential adverse events in the care process. Patients are also empowered to take responsibility for their health. Cumulatively, the above benefits reduce healthcare spending by the patient and the utilization of healthcare resources.
Technology
Nurses and other healthcare providers have the responsibility of selecting healthcare technologies that will promote value-based care in the management of the disease. The healthcare technology should promote safety, quality, efficiency, and patient-centeredness in care. Web-based interventions for self-management of hypertension and pre-diabetes promote safety, quality, and efficiency in disease management. As a result, they are desirable for use in addressing the health concern of the patient.
Care Coordination
Care coordination entails the utilization of carefully planned inter-professional interventions to provide care to the patient. Web-based interventions for self-management of hypertension and pre-diabetes incorporate the concepts and principles of care coordination. The web-based interventions incorporate the inputs from different healthcare providers on the management of the health problems affecting the patient. The interventions also seek to ensure optimum participant involvement in the provision of the care needed by the patient for the promotion of the effective management of the health problems.
Community Resources
The available community resources should be utilized optimally to promote the effective management of hypertension and pre-diabetes. Besides the web-based interventions, the patient should be linked to the existing community resources such as social support groups for patients with hypertension and other chronic illnesses. Social support from the community members will promote the coping of the client with his health problems.
Part 2
Summary of the Patient Problem
The selected patient problem for the project is a 42-year-old male who has hypertension and is pre-diabetic. The patient has been hypertensive for the last two years. He has been managing hypertension by taking anti-hypertensive medication. The patient is also pre-diabetic. He has been using lifestyle and behavioral modifications to manage it. Some of the interventions that he uses to manage pre-diabetes include engaging in active physical activity on a regular basis and dietary modification. Despite the above interventions, hypertension has been poorly controlled, hence, the use of the patient for the project.
Reason for Selecting the Problem and Its Relevance
The health problems of hypertension and pre-diabetes were selected for the project because of a number of reasons. Firstly, hypertension and diabetes are among the health problems with increasing prevalence in the modern world. According to the Center for Disease Control and Prevention (CDC), about half of the adults in the US have hypertension with 24% of them having controlled hypertension. About 37 million adults in the US also have uncontrolled hypertension. Hypertension was also ranked as the primary cause of death of at least 494873 people in the US in the year 2018. Hypertension accounts for a significant proportion of the budget of the US. For example, about $131 billion is used on a yearly basis to treat the condition (CDC, 2020b). Similar statistics are seen in pre-diabetes and diabetes. The CDC also reports that about 88 million adults in America were pre-diabetic in 2018. The rate of pre-diabetes was found to be higher in males than in females (37.4% v. 29.2% respectively) (CDC, 2020a). Poor management of pre-diabetes can lead to disease progression to diabetes. Consequently, population awareness on the effective management of diabetes and pre-diabetes is important.
Hypertension and pre-diabetes are relevant to nursing practice because of a number of reasons. Firstly, hypertension is one of the health issues that contribute to considerable complications if left untreated or poorly controlled. Accordingly, patients with poor controlled or untreated hypertension are predisposed to complications that include stroke, renal failure, heart failure, and aneurism among other complications. The cost of treating hypertension and its complications is also high. For example, evidence shows that individuals with hypertension face approximately $2000 higher annual expenditure in health when compared to people without hypertension. In addition, the annual expenditure attributed to hypertensive patients in the US is estimated to be $9089 (Kirkland Elizabeth B. et al., 2018). The high cost of treatment is attributed to increased utilization of healthcare services, hospital admissions, emergency visits, loss of productivity, and purchase of the essential medications needed for the management of the disease. Similar effects of pre-diabetes may be experienced if poorly managed (Li et al., 2020). Nurses and other healthcare providers have a crucial role to play in promoting the effective management of hypertension and pre-diabetes. They embrace interventions that promote the health of the patients and minimize their risk of developing complications. Based on the above, it was essential to use this patient to inform the role of the nurse in promoting health and wellbeing of patients affected by chronic conditions.
Role of Leadership and Change Management in Addressing the Problem
Leadership and change management have critical roles to play in addressing the health problems of hypertension and pre-diabetes. Effective leadership is needed to ensure the implementation of interventions that promote the health of the patient. The leadership should promote patient empowerment to play a proactive role in the management of his health problems. The leadership styles embraced should also facilitate the adoption of care interventions that align with the diverse needs, values and preferences of the patients (Spies, Gray, et al., 2018). The effective management of hypertension and pre-diabetes requires the adoption of healthy lifestyle and behavioral interventions by the patient. As a result, change management should be enhanced through the provision of opportunities that increase the adoption of healthy lifestyles and behaviors. In addition, forces that pull the patient away from embracing the desired behaviors should be limited to increase the implementation of interventions that optimize the management of hypertension and pre-diabetes (Spies, Bader, et al., 2018). Therefore, leadership and change management informed the selection of the intervention for use in addressing the patient problem in the case study.
Influence of Leadership and Change Management Strategies on the Development of the Proposed Intervention
Leadership and change management strategies influenced the development of the proposed solution. The influence of leadership can be seen from the fact that the intervention seeks to strengthen inter-professional collaboration in the provision of care to the patient. The use of web-based interventions for self-management incorporates inputs from different healthcare stakeholders to achieve the desired outcomes of care. The other way in which leadership influenced the development of the intervention is its role in shaping the patient-centered initiatives that will be used in the provision of care. The technology will promote safety, high quality and continuity in nursing care, hence, excellence in service provision. Change management strategies also influenced the development of the intervention. The selection of the intervention took into consideration the need for behavioral modification by the patient (Harvin et al., 2020). The use of the web-based interventions is likely to promote the adoption of healthy behaviors by the patient, for effective management of his health problem.
How Nursing Ethics Informed Development of the Proposed Intervention
Nursing ethics also informed the development of the proposed intervention. The development of the proposed solution took into consideration the safety needs of the patient. It was important to ensure that the selected web-based interventions do not predispose the patient to any form of harm. As a result, evidence-based interventions will be used to promote the effective management of hypertension and pre-diabetes. The development of the intervention also took into consideration the need for the promotion of data integrity. The selected intervention should safeguard the privacy and confidentiality of the patient’s data. The intervention should also empower the patient to play a proactive role in promoting the sustainability of the effective management strategies for his health problem (Zhu et al., 2018). The ethical aspect of promoting the autonomy of the patient was also considered in the development. Technologies that are familiar to the patient will be used to increase their usability and ease of use. Lastly, the ethical aspect of informed consent was considered. Informed consent will be obtained from the patient prior to his utilization of the selected web-based technologies. Informed consent will imply the understanding of the patient about the aims and benefits of the different web-based interventions for self-management of hypertension and pre-diabetes (Hailu et al., 2018).
Strategies for Communication and Collaboration
A number of communication and collaboration strategies will be utilized in the implementation of the intervention. One of the communication strategies that will be embraced in the implementation process is open communication. Open communication between the patient and healthcare providers will be promoted to improve the quality of care. The patient will be encouraged to express his concerns, views and fears on the aspects related to the care he will be receiving. Open communication will promote trust and honesty between the patient and the healthcare providers. The other strategy for open communication that will be utilized is being objective. A focus will be placed on ensuring the existence of alignment between the strategies being adopted and aims of the intervention. Active participation in the implementation of the intervention will be encouraged. The patient will be encouraged to play an active role in the assessment, planning, implementation, monitoring and evaluation of the effectiveness of the selected solutions for managing his health problems. The patient and his significant others will also be involved in making decisions related to the care that he needs. Shared and participative decision-making will empower the patient to implement solutions that align with his needs, values and preferences (Granheim et al., 2018). The consideration of the above strategies will promote sustainability in the use of the developed solutions.
Benefits of Gathering Their Inputs
Gathering inputs from the patient and significant others will be important in facilitating the effective management of hypertension and pre-diabetes. Gathering inputs from them will provide the healthcare team with insights into the values, preferences and beliefs of the patient and the family. The development of care plans will incorporate the identified values, preferences and beliefs, hence, the realization of optimum outcomes of care. Gathering inputs from the patient and his family will also encourage their active involvement in the care process. Accordingly, the patient and the family will develop a sense of ownership of the solution. The implication will be the empowerment of the patient and his family to explore the effective ways in which their care needs can be achieved further. Gathering the inputs of the patient and his family will also contribute to the sustainability of the interventions of the solution (Bishop & Macdonald, 2017). Through it, the patient and his family will be encouraged to embrace long-term use of the interventions to promote their health and wellbeing.
Influence of State Board Nursing Practice Standards and Organizational Policies
The state board nursing practice standards influenced the development of the intervention. Accordingly, the state board nursing standards identify that nurses have a critical role to play in the promotion of health of their populations. Nurses employ interventions such as health education, diagnosing, treating, case finding, and provision of supportive care to patients to promote recovery and alleviate suffering. State board of nursing such as the New York State Board of Nursing recognizes the fact that nurses have to utilize healthcare technologies to promote the health and wellbeing of their populations. Nurses should ensure that the selected healthcare technologies promote safety, quality, and efficiency in hypertension and pre-diabetes management. Organizational policies could have also influenced the selection of web-based intervention to promote the health and wellbeing of the patient (Morrissey et al., 2018).
How the Intervention Improves Quality of Care, Enhance Patient Safety and Reduce Costs to System and Individual
The proposed intervention improves the quality of care given to the patient in the case study. The use of web-based self-management interventions for hypertension and pre-diabetes minimize the risk of adverse events. The reduction in risk is attributed to blood pressure and glycemic control. The interventions also promote the provision of patient-centered care. The use of web-based interventions ensures that the patent is in constant interaction with the healthcare providers. The interaction ensures continuity in the care provision for the patient, hence, enhanced wellbeing and health outcomes. The proposed intervention also aims at promoting patient safety. The intervention promotes the safety of the patient by minimizing any harm due to complications of hypertension and pre-diabetes (Aminuddin et al., 2019). The intervention also promotes cost-effectiveness in care. As noted in the earlier analysis, web-based interventions minimize visits to the emergency department and hospital admission among patients with chronic illnesses. The use of the interventions also reduces healthcare spending due to the reduction in adverse events related to hypertension and pre-diabetes. The intervention also promotes efficiency in resource utilization in health organizations. The reduction in hospital re-admission rates and visits to the emergency department minimize the resources that could have been used in health organizations to provide care to patients with hypertension and pre-diabetes (Li et al., 2020).
Conclusion
Overall, web-based interventions are effective for the self-management of hypertension and pre-diabetes. Web-based interventions promote safety and quality in the care that would be given to the patient. The interventions minimize the risk of complications as well as the increased need for intensive utilization of healthcare services. The interventions also promote cost-effectiveness in care. Therefore, the implementation of the solution will be done with a consideration of the policies, guidelines and ethics that govern nursing practice.
References
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