NR505-61331 Week 7 Evidence-Based Practice Project Proposal Outline LT

NR505-61331 Week 7 Evidence-Based Practice Project Proposal Outline LT

Nursing Practice Concern/Problem

The COVID-19 has shown discrepancies and problems in health care systems as patients failed to access health care, nurses failed to provide home-based care, and organizations failed to address the issue quickly. Patients who are diagnosed with CHF require continuous health monitoring as it helps in detecting any irregularities in health. Failing to provide the care will result in patients visiting health care services and delayed care. This increases health care cost, hospital readmission rate, and delay in care. Further, nurses visiting homes to provide care has its own issues such as travelling, increased stress, attending patients every time even when there is a minor issue, and still, it does not allow them to monitor them 24×7 (Kumar et al., 2020). However, telehealth monitors allows nurses to monitor the patients remotely. 

PICOT Question

In-patient diagnosed with CHF (Population) what is the effect of implementing of telehealth monitor (TM) in the home (Intervention) in comparison to on-site visitations from the home healthcare nurses (Comparison) on in the prevention of re-hospitalizations (Outcome) to be measure over a 2-month period (Time).

Key Stakeholders

The key stakeholders identified include both internal and the external stakeholders. When it comes to internal stakeholders, there are nurses, executives or administrators, physicians, nurse leaders and managers, technical nurses, nurse informaticists, and pharmacists. Internal stakeholders such as nurses, pharmacists, and physicians will help in understanding the current healthcare problems, skill required, competency needed, and knowledge levels to select and implement the telehealth service and evaluate the outcome (Kumar et al., 2020). These stakeholders play an important role in implementing the change by collaborating with each other. Furthermore, they can create barriers and challenges and may lead to resistance to the change. Thus, the internal stakeholders including manager and leader will motivate and promote the telehealth implementation, which positively impacts the acquisition, sustainability of project, cost-benefit assessment, and analyzing benefits of telehealth in bettering healthcare access, quality, equity and technological interventions.

NR505-61331 Week 7 Evidence-Based Practice Project Proposal Outline LT

The external stakeholders might consider aspects such as economy, government regulations, and organizational development and these might affect the acquisition of telehealth technology. As a result, policymakers, government and licensing agencies are considered external stakeholders. Patients are the primary stakeholders as their needs will determine whether the hospital acquires telehealth to improve overall care (Ekanoye, 2017).

Theoretical Framework

Unified Theory of Acceptance and Use of Technology (UTAUT) highlights how health care professionals, organizations, and the public is ready to understand and adopt the telehealth technology to increase quality of care (Van Dyk, 2014). Likert scale helps in analyzing this concept and prepares plans to train and educate health care professionals and patients. Diffusion of telemedicine is another major aspect as despite the increased benefits of the telehealth, its diffusion level is very low (Ekanoye, 2017). The Comprehensive Model for the Evaluation of Telemedicine helps in determining the importance of integrating telehealth services such as telepsychiatry, teledermatology, teleradiology, tele-pharmacy, and remote patient monitoring (Van Dyk, 2014). 

Diffusion of Innovation theory helps in evaluating and analyzing technical, behavioral, organizational, and economical barriers to implement the technology (Ekanoye, 2017). Lewin’s Three Phase Model will help in training and preparing the employees, implementing the change, and evaluating the change to implement the change on a permanent basis based on its effectiveness (Van Dyk, 2014). Further, theory of self-efficacy, concept of burnout, and resistance to change aid in developing a framework and methodology that addresses barriers from nurses (Van Dyk, 2014). 

NR505-61331 Week 7 Evidence-Based Practice Project Proposal Outline LT

Literature Review

Based on the literature, it is found that telehealth services are beneficial in increasing health care access, quality of care, patient satisfaction, and decreased time taken to provide care and health care cost overall (Lin et al, 2017). Telehealth reduced CHF-related hospital stay, hospital readmission, and mortality rate concluded that telehealth increased quality of life of CHF patients (Koehler et al, 2019). According to Hale, in their study that telehealth is very beneficial in monitoring heart functionality, which helps in early diagnosis. In their study, Isaranuwatchai et al. (2018) concluded that telemonitor (TM) not only improves CF, but it is beneficial in treating COPD. Pekmezaris et al. (2016) highlighted the need to educate people from different cultures by providing language support to increase its versatility and ease of use. Jiang et al. (2020) concluded that TMs a cost-effective system, which increases patient satisfaction and nurse satisfaction. Studies by Frederix et al. (2018) and Williams et al. (2016) indicated that TF reduced hospital readmission compared to on-site visits. 

NR505-61331 Week 7 Evidence-Based Practice Project Proposal Outline LT

Data Collection Methods

Questionnaires will be used to collect the data regarding health care professionals’ knowledge, satisfaction levels, and perceptions and before and after the implementation of TF to identify key aspects. Another set of questionnaires will be used to understand perception and satisfaction levels of patients before and after the TM implementation (Frederix et al., 2018). Further, a cloud-based database will be used to collect data regarding patient visits, health care cost, mortality rate, morbidity, death due to other issues (Williams et al., 2016), time taken to provide care, number of hospital readmission, and ER visits. These data will be compared to pre-implementation data (Kumar et al., 2020). 

Analysis

Paired t-test and one-way ANOVA analysis will be used to compare the pre and post implementation data. Further, IBM SPSS tool will be used to conduct statistical analysis. Likert scale will be used to analyze the perceptions, satisfaction level, and attitude of nurses and patients and statistically determine the interrelation between these concepts with the success rate of TF (Frederix et al., 2018). Demographic and descriptive analysis will be conducted. Data on patient visits, health care cost, mortality rate, morbidity, death due to other issues, time taken to provide care, number of hospital readmission, and ER visits will be analyzed in descriptive statistics (Williams et al., 2016). 

NR505-61331 Week 7 Evidence-Based Practice Project Proposal Outline LT

Expected Outcomes

Implementation of TM in health care will increase knowledge of HCP related to technology, aid in bettering collaboration between HCPs, and satisfaction levels. The TM will decrease health care cost, hospital readmission rate, unwanted ER visits, burnout in nurses due to on-site visits, and time taken to provide care. Further, the system will increase quality of care and patient safety. 

References

Ekanoye, F. (2017). Telemedicine diffusion in a developing country: a case of Ghana. Science Journal Of Public Health5(5), 383. https://doi.org/10.11648/j.sjph.20170505.14

Frederix, I., Vanderlinden, L., Verboven, A., Welten, M., Wouters, D., & De Keulenaer, G. et al. (2018). The long-term impact of a six-month telemedical care program on mortality, heart failure readmissions, and healthcare costs in patients with chronic heart failure. Journal Of Telemedicine And Telecare25(5), 286-293. https://doi.org/10.1177/1357633×18774632

Hale, T., Jethwani, K., Kandola, M., Saldana, F., & Kvedar, J. (2016). A remote medication monitoring system for chronic heart failure patients to reduce readmissions: a two-arm randomized pilot study. Journal Of Medical Internet Research18(4), e91. https://doi.org/10.2196/jmir.5256

Isaranuwatchai, W., Redwood, O., Schauer, A., Van Meer, T., Vallée, J., & Clifford, P. (2018). A remote patient monitoring intervention for patients with chronic obstructive pulmonary disease and chronic heart failure: a pre-post economic analysis of the smart program. JMIR Cardio2(2), e10319. https://doi.org/10.2196/10319

NR505-61331 Week 7 Evidence-Based Practice Project Proposal Outline LT

Jaana, M., & Sherrard, H. (2019). Rural-urban comparison of telehome monitoring for patients with chronic heart failure. Telemedicine And E-Health25(2), 101-108. https://doi.org/10.1089/tmj.2017.0303

Jiang, X., Yao, J., & You, J. (2020). Telemonitoring versus usual care for elderly patients with heart failure discharged from the hospital in the United States: a cost-effectiveness analysis. JMIR Mhealth And Uhealth8(7), e17846. https://doi.org/10.2196/17846

Koehler, J., Stengel, A., Hofmann, T., Wegscheider, K., Koehler, K., & Sehner, S. et al. (2020). Telemonitoring in patients with chronic heart failure and moderate depressed symptoms: results of the Telemedical Interventional Monitoring in Heart Failure (TIM‐HF) study. European Journal Of Heart Failure23(1), 186-194. https://doi.org/10.1002/ejhf.2025

Koulaouzidis, G., Barrett, D., Mohee, K., & Clark, A. (2018). Telemonitoring in subjects with newly diagnosed heart failure with reduced ejection fraction: From clinical research to everyday practice. Journal Of Telemedicine And Telecare25(3), 167-171. https://doi.org/10.1177/1357633×17751004

Kumar, A., Hung, N., Wu, Y., Baek, R., & Gupta, A. (2020). Predictive modeling for telemedicine service demand. Telehealth And Medicine Today5. https://doi.org/10.30953/tmt.v5.186

Lin, M., Yuan, W., Huang, T., Zhang, H., Mai, J., & Wang, J. (2017). Clinical effectiveness of telemedicine for chronic heart failure: a systematic review and meta-analysis. Journal Of Investigative Medicine65(5), 899-911. https://doi.org/10.1136/jim-2016-000199

NR505-61331 Week 7 Evidence-Based Practice Project Proposal Outline LT

Pekmezaris, R., Schwartz, R., Taylor, T., DiMarzio, P., Nouryan, C., & Murray, L. et al. (2016). A qualitative analysis to optimize a telemonitoring intervention for heart failure patients from disparity communities. BMC Medical Informatics And Decision Making16(1). https://doi.org/10.1186/s12911-016-0300-9

Van Dyk, L. (2014). A review of telehealth service implementation frameworks. International Journal Of Environmental Research And Public Health11(2), 1279-1298. https://doi.org/10.3390/ijerph110201279

Williams, C., & Wan, T. (2016). A cost analysis of remote monitoring in a heart failure program. Home Health Care Services Quarterly35(3-4), 112-122. https://doi.org/10.1080/01621424.2016.1227009

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