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NURS FPX 4900 Assessment 3 Assessing the Problem Technology Care Coordination and Community Resources Considerations

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    NURS FPX 4900 Assessment 3 Assessing the Problem Technology Care Coordination and Community Resources Considerations

    Student Name

    Capella University

    NURS FPX 4900 Capstone Project for Nursing

    Prof. Name

    Date

    Assessing the Problem: Technology, Care Coordination, and Community Resources Considerations

    Introduction

    Type II Diabetes Mellitus (DM) is one of the chronic health diseases that are common worldwide. There are various complications of this disease, which may lead to several challenges for the patients. One such patient has been observed in my healthcare facility, as discussed in Assessment 1. John, a 50-year-old, male patient, has been receiving DM treatment and care for a long period of time at our hospital. Recently, he has been suffering from extreme fatigue and blurry vision which are some of the complications of diabetes.

    Multiple lifestyle and medicinal changes have been implemented on John but his blood sugar levels remain high as he has acquired the disease hereditary from his parents. This assessment is another part of the previous one where I will be discussing some of the healthcare technologies that John has been using for the management of his disease and we will further dig into how coordination of care and community resources can be useful for improving John’s health. 

    Impact of Healthcare Technologies on Type II DM

    Recently, several technologies have become a part of the healthcare industry, and healthcare providers, as well as patients, are benefitted from their use. Technological advancements have proven to have multiple benefits improving patient safety by programming risks and it eases the process of diagnosis and consultation. Moreover, it facilitates information sharing, assists in deriving clinical decisions, reduces medical errors, improves healthcare practices, and most importantly manages human shortages (Astier et al., 2020). 

    Similarly, there are some of the technologies that have been innovated for the monitoring and management of diabetes. These are; glucose monitoring devices and insulin administration machines (pens and pumps). John used a blood glucose monitoring device previously when a new technology which is a Continous Glucose monitoring device has been introduced for better management of his condition. Although the plan of action for both CGM and blood glucose monitoring is the same, CGM has various other benefits as it provides both immediate as well as predictive glycemic data. This information will enable healthcare providers and John to monitor his glucose trends, identify hypo/hyperglycemia events with no symptoms, and review inconsistency over a period (Miller, 2020). Food and Drug Administration (FDA) have approved eight CGM systems worldwide and many of them are planned for future approval in years ahead (Aleppo & Webb, 2018). 

    Despite having several benefits, CGM has certain disadvantages too. One of the basic drawbacks is the alarm system in the device.  John has been recently introduced to this so he hasn’t shown any complaints however research finds various negative reports of CGM. Some patients have reported that these alarms can be disturbing while they are at work or school. Additionally, these alarms have resulted in increased anxiety and stress for various users.

    NURS FPX 4900 Assessment 3 Assessing the Problem

    An example of such a case is excessive night-time alarms which might cause anxiety-induced seizures and sleep deprivation in individuals (Alcántara-Aragón, 2019). This issue can be resolved by programming individualized alarms. Another disadvantage of CGM is it can sense the glucose present in interstitial fluid. There is always a difference between the glucose in the blood and interstitial spaces. Thus, the machines should be manually calibrated as BGM and patients must be educated about expected differences and should be instructed about performing BGM as needed (Alcántara-Aragón, 2019). 

    Continuous Glucose Monitoring Devices (CGM) in professional practices impose positive impacts on diabetic patients’ health but also have some potential barriers to implementation.  Cost and coverage by healthcare systems are two basic challenges faced by hospitals in terms of CGM implementation. With the advancements in technologies, cost-effectiveness has been an important aspect that most hospitals consider before introducing any digital devices in practice.

    Similarly, a study on the cost-effectiveness of CGM applications recommended that cost-benefit analysis is an important tool for decision-makers to have healthy gains and minimize the negative impact on the healthcare budget (Jiao et al., 2022). Another challenge is professional and personal education about CGM. Appropriate training of providers and patients is essential to the successful use of CGM in clinical practice. This training requires extensive development of curriculum and evidence-based practices which is a challenge for hospitals under this global burden of diseases (Aleppo & Webb, 2018). 

    NURS FPX 4900 Assessment 3 Assessing the Problem

    Lastly, accessibility and health disparities are further challenges of using advanced technologies. To combat this challenge, telehealth and the use of mobile apps can be a beneficial option in managing diabetes for chronic patients. Advances in digital technologies, especially the evolution of smartphone apps have largely impacted patients’ self-management skills related to diabetes, assist in improvising lifestyle and bringing modifications, enhance patient-provider connection through telemedicine, and motivates patients to be compliant with their medication regimen.

    In terms of managing type II diabetes, as our concerned patient, John, it will enable him to effectively manage his type II DM by recording his glucose trends, medicine intake, carbohydrate intake, physical activity, and hypoglycemia events. Moreover, through smartphone apps he can be given direct coaching and nursing care through telecommunication. Research shows that these technologies have proven to improve patients’ health and reduce the risk of complications (Doupis et al., 2020). 

    Use of Care Coordination and Community Resources

    The Agency for Healthcare Research and Quality (AHRQ) explains care coordination as the methodical planning of patients’ care activities and sharing of protected information only among required healthcare providers. This process results in effective, safe, and useful care according to patients’ needs and preferences (AHRQ, 2018). Management of diabetes can be costly, time-consuming, and is a complex process. Appropriate coordination of care by healthcare providers impacts positively these aspects of diabetes management thus improving patients’ outcomes. Since John is a chronic type II diabetes patient, he has been receiving various home health care services like home nursing, physical rehabilitation, and nutrition and dietary management. These services are accessible only due to care coordination among healthcare professionals. 

    A systematic approach and direct involvement of interprofessional team members to ensure that every physical and mental aspect of the patient is provided with optimal care is the main purpose of care coordination. The process of care coordination includes certain elements; 1) holistic needs assessment of patients’ needs which include their medical history, operative, and community assessment, 2) considering the needs, an individualized care plan is developed in collaboration with the patients, their caregivers, and the healthcare team, 3) making the care and services accessible to the patients using community-based resources, and 4) constant communication and monitoring of the effectiveness of the care (Northwood et al., 2022).

    Care coordination has been reported to enhance patients’ experiences, improve their satisfaction with healthcare, increase health accessibility, improve health outcomes, and assist healthcare providers to provide patient-centered and evidence-based collaborative care. However, coordination among healthcare professionals doesn’t play the part alone. It is essential to incorporate the use of community resources so that better community-based healthcare outcomes are achieved (Elliott et al., 2021). 

    NURS FPX 4900 Assessment 3 Assessing the Problem

    Several community organizations provide monetary, human, and materialistic resources for the management of chronic diseases like diabetes. According to the Centers for Disease Control and Prevention (CDC), community-based and religious organizations can have a positive impact on management of the diabetes type II. Various educational and motivational activities like physical rehab, mental exercises, diet and nutritional modifications, and management of medicines for diabetes can be provided by healthcare professionals using community spaces and resources.

    Community-based organizations offering the National Diabetes Prevention Program (NDPP) and lifestyle changes program have influenced many diabetic patients in modifying their living style and conditions eventually preventing the disease’s aggravation. Moreover, Diabetes self-management education and support (DSMES) assists in empowering patients to prepare goals in their lives and achieve them fruitfully for living with chronic diabetes (CDC, 2022). 

    Although care coordination and the use of community-based resources have various significant outcomes, there are potential barriers that hinder the application of these aspects. Geographical barriers are one of those essential challenges that need to be addressed for effective care coordination. Rural areas with non-developed transportation systems and with limited access to community health services can lead to hinder the process of appropriate coordination of care and community resources cannot be used in these areas (Evans et al., 2022).

    NURS FPX 4900 Assessment 3 Assessing the Problem

    A similar issue was observed in John’s case where he had to take a long-distance commute for his appointments and treatment to our hospital. It was then decided to provide him with telehealth services so that effective management and positive outcomes are achieved. Other barriers to care coordination in the community are a lack of patients’ trust, inadequate understanding of the care coordinator’s role, and patients not willing to take responsibility for self-managing their diseases (Williams et al., 2019). 

    Nursing Practices Standards and Governmental Policies 

    The introduction of healthcare technology, the use of community resources, and care coordination merely work on the standards of nursing practices and various policies by organizations and governments. The nursing practices standard provides guidelines for nursing to care for and manage patients with diabetes. The basic standards of nursing practice defined by the American Nurses Association are protection, promotion, and prevention of diseases and injuries. Moreover, the alleviation of existing diseases by appropriate diagnosis and treatment, advocacy for the patients and their families, and providing quality, effective, culturally-sensitive, ethically-sound, and patient-centered care (ANA, n.d.).

    Nursing is an information-based profession where evidence-based strategies and innovations are welcomed to improve nursing practices by providing accurate and effective care. Thus, the use of technology is based on these nursing standards to ensure that patients receive the best-practice care and achieves positive outcomes by balancing between nursing care and digitization (Garcia-Dia, 2020). Interprofessional collaboration and coordination of care are other important aspects of nursing practices. Coordination of care with other healthcare professionals in a community is one of the major responsibilities of nurses where patients are benefitted from the nursing care within their own spaces thus enabling them to make better health decisions in their lives and achieve improved outcomes (Karam et al., 2023).

    NURS FPX 4900 Assessment 3 Assessing the Problem

    Nursing practice is also based on a code of ethics and ethical principles such as beneficence, non-maleficence, justice, and autonomy. These ethical principles direct nursing actions which include implementation of technologies, coordination of care, and utilization of resources, and helps in solving ethical dilemmas in clinical as well as community practices.  On the other hand, governmental policies also support technology and telehealth needs, and care coordination in communities, especially for patients with chronic diseases like diabetes. The 21st Century Cures Act is developed to bring innovations and advancements in healthcare so that patients can receive faster and more efficient treatment. Moreover, this act entertains the Health Information Technology (HIT) policies which involve sharing of protected health information as part of care coordination (FDA, 2020).

    Another policy that focuses on sharing of protected health information is HIPAA guidelines. Health Insurance Portability and Accountability Act focus on the privacy, confidentiality, and security of patients’ information while sharing it with other healthcare professionals. This is one of the important aspects of care coordination (Edemekong et al., 2023). The Affordable Care Act (ACA) focuses on the provision of healthcare to reduce health disparities and improve accessibility (HealthCare.gov, n.d.). Prevention and wellness are essential components of ACA, which indicates that the strategies implemented for John using care coordination and community resources will ensure that John receives adequate prevention of diabetes complication and lifestyle modifications which will enable his wellness.

    These nursing practice standards and governmental policies are developed to enhance patient safety through the use of healthcare technologies. Moreover, it focuses on providing coordinated care so that quality healthcare is delivered according to patients’ preferences, minimization of adverse events, and sharing health information securely and confidentially. 

    Conclusion

    To conclude, diabetes is a chronic health condition that requires constant care, treatment, and management. To help patients like John, constant advancements in technologies and training related to those digital devices are essential for both patients and providers. Moreover, it is important to use community-based resources from various organizations so that patient receives personalized care and treatment modalities. Nursing practice standards and governmental policies play an important role to ensure that patients with diabetes and other chronic conditions obtain effective, evidence-based, and standardized care. 

    References

    Agency for Healthcare Research and Quality. (2018). Care coordination. Retrieved April 26, 2023, from https://www.ahrq.gov/ncepcr/care/coordination.html 

    Alcántara-Aragón, V. (2019). Improving patient self-care using diabetes technologies. Therapeutic Advances in Endocrinology and Metabolism10, 204201881882421. https://doi.org/10.1177/2042018818824215 

    Aleppo, G., & Webb, K. (2018). Continuous glucose monitoring integration in clinical practice: A stepped guide to data review and interpretation. Journal of Diabetes Science and Technology13(4), 664–673. https://doi.org/10.1177/1932296818813581 

    American Nurses Association. (n.d.). Nursing scope of practice: American Nurses Association. Retrieved April 26, 2023, from https://www.nursingworld.org/practice-policy/scope-of-practice/ 

    Astier, A., Carlet, J., Hoppe-Tichy, T., Jacklin, A., Jeanes, A., McManus, S., Pletz, M. W., Seifert, H., & Fitzpatrick, R. (2020). What is the role of technology in improving patient safety? A French, German and UK Healthcare Professional Perspective. Journal of Patient Safety and Risk Management25(6), 219–224. https://doi.org/10.1177/2516043520975661 

    NURS FPX 4900 Assessment 3 Assessing the Problem Technology Care Coordination and Community Resources Considerations

    Centers for Disease Control and Prevention. (2022). Community-based organizations (CBOs). Retrieved April 26, 2023, from https://www.cdc.gov/diabetes/professional-info/community-organizations.html 

    Doupis, J., Festas, G., Tsilivigos, C., Efthymiou, V., & Kokkinos, A. (2020). Smartphone-based technology in diabetes management. Diabetes Therapy11(3), 607–619. https://doi.org/10.1007/s13300-020-00768-3 

    Edemekong, P. F., Annamaraju, P., & Haydel, M. J. (2023). Health insurance portability and accountability act. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK500019/

    Elliott, M. N., Adams, J. L., Klein, D. J., Haviland, A. M., Beckett, M. K., Hays, R. D., Gaillot, S., Edwards, C. A., Dembosky, J. W., & Schneider, E. C. (2021). Patient-reported care coordination is associated with better performance on clinical care measures. Journal of General Internal Medicine36(12), 3665–3671. https://doi.org/10.1007/s11606-021-07122-8 

    Evans, M. V., Andréambeloson, T., Randriamihaja, M., Ihantamalala, F., Cordier, L., Cowley, G., Finnegan, K., Hanitriniaina, F., Miller, A. C., Ralantomalala, L. M., Randriamahasoa, A., Razafinjato, B., Razanahanitriniaina, E., Rakotonanahary, R. J., Andriamiandra, I. J., Bonds, M. H., & Garchitorena, A. (2022). Geographic barriers to care persist at the community healthcare level: Evidence from rural Madagascar. PLOS Global Public Health2(12). https://doi.org/10.1371/journal.pgph.0001028 

    FDA. (2020). 21st Century cures act. U.S. Food and Drug Administration. Retrieved April 26, 2023, from https://www.fda.gov/regulatory-information/selected-amendments-fdc-act/21st-century-cures-act 

    NURS FPX 4900 Assessment 3 Assessing the Problem Technology Care Coordination and Community Resources Considerations

    Garcia-Dia, M. J. (2020). Balancing care with technology. Nursing Management51(4), 56–56. https://doi.org/10.1097/01.numa.0000657280.44223.10 

    HealthCare.gov. (n.d). Affordable care act (ACA) – glossary. Retrieved April 26, 2023, from https://www.healthcare.gov/glossary/affordable-care-act/ 

    Jiao, Y., Lin, R., Hua, X., Churilov, L., Gaca, M. J., James, S., Clarke, P. M., O’Neal, D., & Ekinci, E. I. (2022). A systematic review: Cost‐effectiveness of continuous glucose monitoring compared to self‐monitoring of blood glucose in type 1 diabetes. Endocrinology, Diabetes & Metabolism5(6). https://doi.org/10.1002/edm2.369 

    Karam, M., Chouinard, M.-C., Couturier, Y., Vedel, I., & Hudon, C. (2023). Nursing care coordination in primary healthcare for patients with complex needs: A comparative case study. International Journal of Integrated Care23(1), 5. https://doi.org/10.5334/ijic.6729 

    Miller, E. M. (2020). Using continuous glucose monitoring in clinical practice. Clinical Diabetes38(5), 429–438. https://doi.org/10.2337/cd20-0043 

    NURS FPX 4900 Assessment 3 Assessing the Problem Technology Care Coordination and Community Resources Considerations

    Northwood, M., Shah, A. Q., Abeygunawardena, C., Garnett, A., & Schumacher, C. (2022). Care coordination for older adults with diabetes: A scoping review. Canadian Journal of Diabetes46(7). https://doi.org/10.1016/j.jcjd.2022.09.053 

    Williams, M. D., Asiedu, G. B., Finnie, D., Neely, C., Egginton, J., Finney Rutten, L. J., & Jacobson, R. M. (2019). Sustainable care coordination: A qualitative study of primary care provider, administrator, and insurer perspectives. BMC Health Services Research19(1). https://doi.org/10.1186/s12913-019-3916-5