Patient, Family, or Population Health Problem Solution
Hypertension is a chronic health condition characterized by escalated blood pressure levels in the arteries above normal. The increased blood pressure ultimately leads to increased complications of stroke, heart disease, renal failure, and vision loss (Mayo Clinic, 2022). The Food and Drug Administration (FDA) called hypertension a “silent killer” because it typically shows no symptoms, and the victims are unaware of it until it causes complications (FDA, 2021). As evaluated by the Centers for Disease Control and Prevention (CDC), around 47% of the adult population in the US is prone to hypertension, making it a significant public health concern (CDC, 2020). In this assessment, I will propose a suitable intervention plan for my patient David based on the evaluations that I made through the two-hour practicum with him.
Role of Leadership and Change Management in Hypertension Management
Nurses play a critical role in caregiving for patients as they provide direct care, such as administering medications, monitoring vital signs, and acting as leaders of the overall caregiving process (Cummings et al., 2020). One strategy for nurses to effectively perform as leaders, according to Ferreira et al. (2020), is Transformational Leadership. Transformational nurse leaders can promote a patient-centered approach to hypertension management by encouraging their teams to focus on each patient’s needs (Ferreira et al., 2020). Amor et al. (2019) argued that inspirational communication is a technique used by transformational nurse leaders to inspire and motivate their team members. To inspire David through such communication, I will use stories, metaphors, and other techniques to communicate the importance of hypertension management and its impact on his life (Amor et al., 2019). Transformational nurse leaders can also empower patients to manage their hypertension by providing education and support. For this, I will encourage David to make lifestyle modifications, including quitting smoking, modifying lifestyle habits, and increasing physical activity (Kaminsky et al., 2021).
NURS FPX 4900 Assessment 4 Patient, Family, or Population Health Problem Solution
Regarding hypertension management, nurses are critical in leading and managing change for implementing new strategies and procedures (Leeuw et al., 2019). I will therefore apply the Lewin 3-step change model, a widely used framework for change management, to effectively manage change in hypertension management as follows (Okubo, 2022).
- Unfreeze: I will analyze the current practices in hypertension management and identify gaps or areas for improvement (Todkar et al., 2020). It will use evidence-based practices to establish the need for change and engage key stakeholders to support the change process.
- Change: I will work collaboratively with other healthcare professionals to identify evidence-based practices for hypertension management and implement them. This phase will also provide education and training to David and his family on medication adherence, lifestyle modifications, and self-monitoring techniques (Todkar et al., 2020).
- Refreeze: In this stage, the new practices and processes are reinforced and integrated into the organizational culture. I will hence evaluate patient outcomes and identify any issues that may arise during the implementation process making necessary adjustments for sustainable practices (Li et al., 2020).
Intervention Need and Plan Proposition
In the two-hour practicum session, David complained about his poorly controlled blood pressure and lack of timely medication administration by the nurse. I found that David’s blood pressure remains high after the prescribed treatment, and he is at risk of developing complications of renal failure. It is, therefore, crucial to develop an intervention plan that addresses his specific needs promoting effective hypertension management. Based on my analysis from the practicum, using a remote monitoring system is the best-suited technology-led intervention for David. The system will allow remote monitoring of David’s blood pressure levels and medication adherence (Kitt et al., 2019). I suggest using wearable devices such as blood pressure cuffs and smartwatches for monitoring through the intervention. These devices can capture and transmit data to a central database accessible to the healthcare team that I will work with (Kario, 2020).
The monitoring system will also involve a mobile app that aims to provide David with medication reminders, lifestyle modification tips, and access to educational resources (Persell et al., 2020). The app will incorporate an electronic prescribing service (EPS) protocol that ensures accurate dosing and reduce the risk of medication errors. As the nurse gave David an ACE inhibitor overdose, an EPS system will assist me by flagging wrong dosages and reviewing them to ensure the appropriate dosage (Omboni et al., 2020). As per my expectations, the plan will be effective as it improves medication adherence, enables early detection of changes in blood pressure, and allows for timely adjustments to treatment. I will also be able to ensure favorable health outcomes for David by obtaining his feedback timely through the system (Kario, 2020).
Communication and Collaboration Strategies
Establishing a clear communication channel with the caregiving team is necessary to implement a remote monitoring system as proposed. According to Hirshberg et al. (2019), one technique to achieve this is to use a secure messaging platform that allows patients to communicate with their nurses and healthcare providers easily. The technique will help David receive timely and accurate information about his health status and treatment plan (Hirshberg et al., 2019). Another way is to use a shared care plan that includes all relevant staff and patient facilitators (Erturkmen et al., 2019). This can help ensure that everyone is on the same page and that there is a shared understanding of the patient’s health status and treatment plan. As Bullington et al. (2019) suggested, I will use open-ended questions and paraphrasing statements to clarify misunderstandings and ensure effective communication with David and my team. For further trust and rapport-building with colleagues and David, I will adapt to active listening and understanding their perspective (Bullington et al., (2019).
NURS FPX 4900 Assessment 4 Patient, Family, or Population Health Problem Solution
Moreover, I will prioritize patient-centered care in implementing the remote monitoring system (Millenson et al., 2019). One technique to achieve this is to involve David in the development of the system and solicit feedback on an ongoing basis. Through this, I will ensure that the system meets their needs and preferences of David and maximizes his engagement and adherence to the monitoring program (Kadhim et al., 2020). I will also use standardized protocols for patient monitoring and management by adhering to evidence-based guidelines for hypertension management (Pette et al., 2020). Additionally, Poncette et al. (2019) argue that nurses and patients should receive appropriate training and support to use the remote monitoring system effectively. I suggested the development of online modules that the caregiving team and David can complete at their own pace can ensure that everyone is comfortable using the system (Poncette et al., 2019).
State Board Nursing Guidelines for the Proposed Intervention
There are multiple policies observed in the US that are significant in providing legal and ethical guidance in using remote monitoring systems.
- The Act for Health Insurance Portability and Accountability (HIPAA) is another set of federal regulations concerning protected health information (PHI). I will mandatorily follow HIPAA regulations when using remote monitoring systems to protect the PHI of patients as it demonstrates the measures to avoid data breaches while delivering remote care services (Peregrin, 2019).
- The Telehealth Nursing Practice Guidelines proposed by the American Telemedicine Association (ATA) guide the use of telehealth technologies, including remote monitoring, for nursing practice. They cover patient assessment, informed consent, and documentation (Rodin, 2020).
- Digital Health Implementation Playbook by the American Medical Association (AMA) guides on implementing digital health technologies such as remote monitoring systems into healthcare practices. It covers selecting technology vendors, ensuring data privacy and security, and developing workflows (AMA, 2021).
- The Report by the Institute of Medicine’s Future of Nursing suggests changes to professional nursing practices to improve healthcare delivery in the US. One of the recommendations is to utilize technology such as telehealth and remote monitoring systems to enhance patient care (Institute of Medicine, 2021).
These policies and guidelines are significant because they provide me with a framework for safely, effectively, and ethically using remote monitoring systems. By complying with these standards, I will ensure that David receives high-quality care, unlike the previous experience reported in the practicum session (Ortega et al., 2020).
Quality, Safety, and Cost Considerations of Proposed Intervention
Implementing remote monitoring systems for David’s hypertension management can improve care quality and patient safety and reduce costs. According to Mohammed et al. (2019), remote monitoring systems can improve care quality by allowing nurses to access real-time patient data enabling more timely and accurate decision-making. This will enable me to personalize the treatment plan for David to increase effectiveness and improve outcomes. Additionally, the remote monitoring system can facilitate me in conducting sessions of education and self-management for David, empowering him to actively participate in the care process and improve his overall health literacy (Mohammed et al., 2019).
The proposed remote monitoring system can ensure patient safety by minimizing the risk of medication errors and adverse drug events (ADEs) due to improper dosage or medication non-adherence (Banks et al., 2020). I will promptly intervene and prevent potential complications by regularly updating the healthcare team about David’s blood pressure levels. Finally, implementing remote monitoring systems can lead to cost savings for both David and the healthcare system. By enabling earlier intervention and more effective management of hypertension, remote monitoring systems can reduce the need for expensive hospital admissions and emergency department visits (Snoswell et al., 2020). Additionally, promoting self-management and preventing complications using wearable devices can reduce healthcare costs in the long term (Vijayan et al., 2021). According to research published by Forbes, wearable devices can lower healthcare expenses by up to 16% of the total expenditure (Pando, 2019). In another study, wearable devices saved $361 per individual cost and $8566 of the expenses for the full services offered by hospitals (Snoswell, 2020).
Technology Factors, Care Coordination, and Community Resources
Technology
Telehealth technology allows nurses to communicate with patients remotely using remote monitoring and other virtual tools (Haleem et al., 2021).
- Wearable Devices: Wearable devices are increasingly popular in healthcare as a tool for remote monitoring. I will use these devices to remotely assess David’s blood pressure, heart rate, and physical activity levels. These devices will allow real-time monitoring and feedback to David, reminding him to take his medications or make lifestyle changes as needed (Kario, 2020).
- Mobile Application: The mobile app will enable patients to access their medical data through patient portals, including blood pressure readings, medication schedules, and lifestyle modification goals (Chandler et al., 2019). David can also receive reminders for lifestyle changes and communicate with me through the app.
- Electronic Prescription Service (EPS): I can electronically send David’s antihypertensive medication prescription to the pharmacy through this protocol. This will reduce the need for paper prescriptions and minimize the risk of errors associated with handwritten prescriptions (Annisa et al., 2023).
Care Coordination and Community Resources
For the proposed intervention of a remote monitoring system, care coordination is necessary to ensure my effective collaborative efforts to provide the best possible care for David. This includes coordinating the monitoring of David’s blood pressure levels, medication management, lifestyle modifications, and follow-up appointments. By working collaboratively and sharing information, I can ensure that David’s care is comprehensive, coordinated, and patient-centered, ultimately leading to better health outcomes (Simpson et al., 2022). In the case of wearable devices, care coordination can involve regular communication with the healthcare team to review patient data, adjust medication regimens, and provide education and support (Tackling & Borhade, 2019).
In the case of the proposed intervention for David, I can obtain support and resources to complement the remote monitoring system and care coordination by utilizing community resources. Considering the condition of David, I suggest the following community resources seek collaboration.
- American Heart Association: Provides resources and education on hypertension management and lifestyle modifications (Barone Gibbs et al., 2021);
- National Kidney Foundation: Offers resources and support for individuals with hypertension and kidney disease (Sperati et al., 2019);
- Local Health Clinics and Hospitals: Offer measures for screening, treatment, and education programs about conditions like Hypertension (Flor et al., 2020);
- Community-Based Organizations: Help provide resources and support for hypertension management, such as healthy food initiatives and stress reduction programs (Hannan et al., 2022).
I will use these resources to reinforce the education and support for David through the remote monitoring system. This usage will likely improve David’s self-management and adherence to the intervention.
Conclusion
The proposed remote monitoring system plan can improve patient outcomes while significantly reducing healthcare costs. The intervention requires effective collaboration between nurses, patients, and community resources. Nursing policies and guidelines provide a framework for the safe and effective use of technology in healthcare. Care coordination and the utilization of community resources are essential components of the intervention to ensure patient engagement and long-term success.
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