Assessment 4 Remote Collaboration and Evidence-Based Care Essay

Assessment 4 Remote Collaboration and Evidence-Based Care Essay

 

 

Remote Collaboration and Evidence-Based Care video script

Hello, and Welcome to my video presentation on Remote Collaboration and Evidence-Based Care. This is part of the NURS-FPX4030 course at my university, Capella University. In this video, I want to review a Villa Health case scenario involving collaboration and evidence-based practice. Thereafter, I will propose an evidence-based plan to improve patient safety and outcomes in the scenario. I will also discuss how I used evidence-based practice to formulate this plan using Stetler’s model. I will reflect on the relevance and usefulness of the evidence and finally explain the benefits of interdisciplinary collaboration and strategies to mitigate the challenges of this collaboration. I hope you enjoy my video presentation.

In the Villa Health scenario, Dr. Copeland and Nurse Anderson discuss the treatment of a two-year-old patient named Caitlynn, who has been admitted to the pediatric unit with pneumonia. It is mentioned that this is Caitlynn’s second admission for pneumonia in the last six months and that she had a meconium ileus at birth. They discuss Caitlynn’s symptoms, including decreased breath sounds, rhonchi in the upper lobes, shallow respirations, and a fever. They also mention that Caitlynn has decreased subcutaneous tissue in her extremities, which could be a sign of the malabsorption of nutrients. They discuss the possibility that Caitlynn may have cystic fibrosis. They plan to start her on an IV with piperacillin and recommend a high-protein, extra-calorie diet along with fat-soluble vitamins. They also discuss the challenges that Caitlynn’s parents may face in providing her treatment at home and plan to consult with social services and possibly arrange for telemedicine appointments to help coordinate care and prevent unnecessary trips to the hospital.

My proposed evidence-based plan to improve patient safety and outcomes in the scenario will involve a five-step process. The nurse, as the care coordinator, will add a social worker as a new team member, use mobile phone telecommunication technology to communicate synchronously with Catelyn’s parents and healthcare professionals, organize interdisciplinarily debriefs every two weeks, utilize community resources, and educate the mother on infection prevention statues at home. This evidence-based plan is an interdisciplinary approach where a team with a nurse, physician, pediatrician, physical therapist, social worker, and the patient’s mother would be working together in a coordinated fashion to ensure the patient’s safety and quality of life for the child.

According to a research article by Kapnadak et al. in 2020, the cystic fibrosis foundation, also known as CFF guidelines, advocated for communication between healthcare providers regarding routine advanced care planning, goals, and decision-making. This care plan aims at meeting this recommendation by bringing together a team of care professionals and the patient family through modern technology, specifically mobile phone technology. The CFF also recommended pulmonary rehabilitation programs and thus called for the mobilization of community resources to improve patient health. Rehabilitation programs and community-based laboratories are useful resources that Catelyn would need to promote early screening and prevention of complications. A review by Chen et al. in 2021 emphasized family awareness and involvement and as a result, my plan included patient education and engagement to ensure the best quality and safety outcomes.

In this evidence-based plan, I used Stetler’s model to gather bets and current clinical information. This model is a six-step framework including evidence preparation, validation, comparative evaluation, decision-making, application, and evaluation. I used this model to prepare top-level evidence sources, including the most recent guidelines, and review studies to understand best practices. According to an article by Fineout-Overholt (2019) on the appraisal of evidence, these sources met the criteria for credible and quality evidence sources. To ensure that these interventions were valid, I evaluated the credibility of the sources by assessing the sources’ authoritativeness, currency, accuracy, and purpose. I then incorporated these practices into an interdisciplinary team setting, with each member playing specific contributory roles. Using this model, my plan is at the decision-making stage, awaiting implementation and evaluation. To ensure that the nurse achieves quality and safety using this plan, the interdisciplinary team will regularly assess readmissions, infections, patient growth parameters such as weight and height, and the mother’s satisfaction with the care. These parameters are essential pointers to the safety and quality of the care offered by this team.

Of the sources of evidence that I used in gathering the plan, the article by Kapnadak et al. in 2020 was the most relevant. This source provided various evidence items that covered various aspects of care for cystic fibrosis in an interdisciplinary way.  The role of community care and clinical care is emphasized by the authors. Moreover, this article reviewed the best current guidelines from reputable. This source of evidence was relevant because it addressed the safety and quality of current interventions for multidisciplinary care strategies as well as medical recommendations for cystic fibrosis patients. This source also addressed the care for patients across the human lifespan. Because of current advancements in cystic fibrosis treatments, patient growth and become adults while living with the disease. Therefore, care should take into account different needs at different stages. The role of the mental health of caregivers and the patient was also expressed in this resource. Therefore, I can say that this article was relevant because it addressed safe, holistic, and multidisciplinary care across the human lifespan.

Interdisciplinary collaboration to plan care faces various challenges, which include but are not limited to ineffective communication, role overlap, resource limitations, and scheduling difficulties. Nevertheless, interdisciplinary collaboration to plan patient care ensures that various professionals meet most if not all patient care needs, and multiple specialized efforts are gathered towards addressing patient care; thus, patient-centered care and team care becomes more efficient, and most importantly, the patient gets satisfied with the care they receive.  To address various challenges, the interdisciplinary approach of advanced planning, regular and timely communication, and clear role communication can ensure that team members work interdependently to achieve team goals. These interventions will improve teamwork spirit and culture.

According to a publication by Rajendran (2022), teamwork makes dream work and effective interdisciplinary communication is one of the ways to achieve these dreams. Future collaboration will require advanced critical planning to leverage all required resources, both material and human. Using a model-based interdisciplinary collaboration and change management will promote systematic evaluation and improvement in teamwork. In Nurse Anderson’s case, timely planning would have made it easier to bring various team members, such as social workers, on board and reduce the time duration between which Catelyn would receive community care.

In conclusion, interdisciplinary collaboration is a complicated care delivery strategy that requires planning, communication, and evaluation to promote patient safety and care coordination quality. I have attached my references for this video presentation below. Thank you for watching my video. Goodbye.

References

Chen, Q., Shen, Y., & Zheng, J. (2021). A review of cystic fibrosis: Basic and clinical aspects. Animal Models and Experimental Medicine, 4(3), 220–232. https://doi.org/10.1002/ame2.12180

Fineout-Overholt, E. (2019). A guide to critical appraisal of evidence. Nursing Critical Care, 14(3), 24–30. https://doi.org/10.1097/01.ccn.0000554830.12833.2f

Kapnadak, S. G., Dimango, E., Hadjiliadis, D., Hempstead, S. E., Tallarico, E., Pilewski, J. M., Faro, A., Albright, J., Benden, C., Blair, S., Dellon, E. P., Gochenour, D., Michelson, P., Moshiree, B., Neuringer, I., Riedy, C., Schindler, T., Singer, L. G., Young, D., … Simon, R. H. (2020). Cystic Fibrosis Foundation consensus guidelines for the care of individuals with advanced cystic fibrosis lung disease. Journal of Cystic Fibrosis: Official Journal of the European Cystic Fibrosis Society, 19(3), 344–354. https://doi.org/10.1016/j.jcf.2020.02.015

Rajendran, L. (2022). “Teamwork makes the dream work”- interdisciplinary team dynamics within the operating room. Canadian Medical Education Journal, 13(1), 108. https://doi.org/10.36834/cmej.74102

Remote Collaboration and Evidence-Based Care

Evidence-based care can be a challenge in any medical situation, but particular challenges present themselves when care is being provided remotely. In order to provide quality care to patients who live in rural settings or have difficulty with transportation to a care site, health care professionals must sometimes collaborate with other professionals in different ZIP codes or even time zones.

In this activity, you will observe how health care professionals collaborate remotely and virtually to provide care for a patient in Valley City, North Dakota

 

Dr. Copeland and Nurse Anderson discuss Caitlynn, who came into the ER last night and has now been admitted to the pediatric unit.
Select the conversation below to listen in.

Dr. Copeland starts the conversation.

01:11

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Dr. Copeland: Nurse, can you give me an update on Caitlynn? I know she’s two years old and she’s been admitted for pneumonia. Does she have any history of breathing problems?

Virginia Anderson: Yes, this is her second admission for pneumonia in the last six months. She had a meconium ileus at birth.

Dr. Copeland: All right. Is she presenting with any other symptoms?

Virginia Anderson: She has decreased breath sounds at the right bases and rhonchi scattered in the upper lobes. Respirations are 32 and shallow with a temp of 101.

Dr. Copeland: What have we done for her so far?

Virginia Anderson: The respiratory therapist administered nebulized aerosol and chest physiotherapy. After the aerosol she had thick secretions.

Dr. Copeland: I see her weight is 20.7 pounds, and there’s been some decreased subcutaneous tissue observed in her extremities?

Virginia Anderson: Correct. I noticed this too, so she might have some malabsorption of nutrients.

Dr. Copeland: Have we done a sweat chloride test yet?

Virginia Anderson: Yes, and the results were 65 milliequivalents per liter. Also, the mother reports that when she kisses her, she tastes salty.

Dr. Copeland: All right. Well, I think it’s fair to say we might be dealing with cystic fibrosis here. Let’s get her started on an IV with piperacillin, and keep an eye on her temperature.

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Dr. Copeland starts the conversation.

02:09

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Dr. Copeland: Let’s talk about Caitlynn Bergan. Her mother, uh, [checks notes] Janice, has been informed of her diagnosis. I didn’t realize this when she first came in, but she doesn’t live in Valley City; she’s in McHenry.

Rebecca Helgo: That’s a tough drive during winter. They’re over an hour away, aren’t they?

Dr. Copeland: That’s right. It was a toss-up between coming here or going to Jamestown, but I guess the father — Doug — thought Valley City was the better choice. Anyway, I’ve put her on Pancrease enzymes and we’ll be recommending a high-protein, extra-calorie diet along with the fat-soluble vitamins — A, D, E, and K. I’ll update her pediatrician on her condition, and order dornase alfa. Let’s see how she does with the breathing treatments. How are those going?

Rebecca Helgo: Quite well, actually. She’s too young to get her to do the huff breaths, but we’re keeping the secretions thin and manageable with the aerosol treatments. I am concerned about her day-to-day treatment, though. She’ll be back here with pneumonia if the parents can’t stay on top of that. She’s at risk for impaired gas exchange and respiratory distress, which will cause her anxiety and more distress, and that’s not going to help her stay well.

Dr. Copeland: How well do you think the parents will be able to handle the treatment?

Virginia Anderson: That might get tricky. I gather that the mother and father are still married but separated. We’ll need to make sure that at least one of them gets the education they need. But they both work, and trips here aren’t the easiest choice. We should get a social services consult to coordinate services and identify some assistance for the family in McHenry.

Rebecca Helgo: I can do some education here, and then do a Skype consult with one or both of them once she’s been discharged and is back home.

Dr. Copeland: It sounded like both parents work long hours. Are you going to be able to schedule times that work?

Rebecca Helgo: I may have to do some after-hours appointments. We’ll have to sort that out.

Virginia Anderson: She’s had one bowel obstruction already, so I think we need to help them monitor for DIOS too. Does the pediatrician’s office have a telemedicine relationship with us? That might be helpful in preventing unnecessary trips here.

Dr. Copeland: Let’s find out a bit more and see what our options are.

 

Dr. Copeland greets Dr. Benjamin.

01:46

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Dr. Copeland: Hello, Dr. Benjamin. I’m sorry to be meeting under such circumstances, but I hope we can work with you to help the Bergans handle Caitlynn’s care. On the line with me is Virginia Anderson, the nurse assigned to Caitlynn while she’s here.

Dr. Benjamin: Hello to both of you. Yes, it’s unfortunate. This is the first case I’ve seen among my own patients.

Dr. Copeland: Are you familiar with the CF protocol?

Dr. Benjamin: I am, but I’d love to get any more details that relate to Caitlynn. She’s done with most of her immunizations, but she’s still needs her HAV and influenza, of course. I’m also not sure where to order some of the pancreatic enzymes and medications you listed.

Virginia Anderson: We can help with all that. Do you have telemedicine access to Valley City?

Dr. Benjamin: No, but we do have it with Cooperstown Medical Center. We kind of have to in a town of less than 100 people.

Dr. Copeland: We may be able to use Skype on a more informal basis for consults between us, but it might be good to get connected with Valley City on your telemedicine equipment. If the parents bring Caitlynn to you with symptoms, and you’re not sure whether the hour-long trip is necessary, we can do a telemedicine appointment and make sure.

Dr. Benjamin: All right. It sounds like we might see them often initially, and I understand that bowel obstructions and pneumonia are two possible complications. We can handle some of those issues here, but assuming they have trouble during working hours, I assume we can reach you by phone?

Dr. Copeland: You or your staff can send me a text. If we need to talk further we can set up a call, but if not, text is the quickest way to get my attention, and the easiest way for me to respond between things.

Virginia Anderson: And I’m available via text as well if you’re having trouble reaching Dr. Copeland or if it’s a question I can field.

 

 

Virginia starts the conversation.

01:59

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Virginia Anderson: Hi, Madeline, this is Virginia Anderson at Valley City Regional Hospital. I’m on the line with Marta Simmons, our social worker here at the hospital.

Madeline Becker: Hi, both of you.

Marta Simmons: Madeline, we’re calling because Virginia is working on a care plan for a child from McHenry, a Caitlynn Bergan. She’s here after a bout of pneumonia and she’s been diagnosed with cystic fibrosis. We wanted to talk to you about resources there for some of the issues the Bergans are going to be dealing with.

Madeline Becker: Of course. I got the documentation you emailed earlier. Fortunately, the Bergans are both employed and have good insurance through Doug’s new job. But as you may have heard, he was unemployed for some time, so money is tighter than it might seem.

Virginia Anderson: We’ve talked to Janice and she isn’t sure what her insurance covers as related to the breathing and other treatments Caitlynn is likely to need.

Madeline Becker: I can do some initial work on that. I’ll need a release from Janice to get detailed information, but I should be able to get general coverage information. What other resources might they need? McHenry is pretty small, as I’m sure you’re aware.

Marta Simmons: The main issue is going to be the stress of caring for a child with a chronic illness. Even a group that helps members deal with grief would be helpful. Children with CF live much longer than they used to, but it’s still a difficult condition.

Madeline Becker: There isn’t a group like that here, but there is one in Sheyenne. I mean, it’s more for parents in grief already, parents who have lost a child, but it’s a sizable group, relatively speaking. I’m sure there will be some parents who understand what it’s like to have a child with a difficult condition.

Virginia Anderson: All right, that helps. Now, we’re going to provide as much education as we can before Janice takes Caitlynn home, but what kind of resources are there in McHenry? If she doesn’t have home Internet access, does the library offer it? Is there a library?

Madeline Becker: No, the closest library is in Cooperstown.

Marta Simmons: Well, we’ll talk to the Bergans’ pediatrician and see if they might be able to help if they need materials and can’t get them easily at home. This is progressive and lifelong, and they’re going to need some support as they learn to deal with it.

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Virginia Anderson starts the conversation.

02:26

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Virginia Anderson: Hi, Janice, thanks for contacting us! We’re getting back to you about Caitlynn. With me on the line is Rebecca Helgo, the respiratory therapist who helped you out when you were here.

Rebecca Helgo: Hi, Janice.

Janice: [sounding stressed] Hi.

Virginia Anderson: Janice, how is it going with Caitlynn?

Janice: Well, that’s why I called, actually. Not so good. I mean, not bad, but I guess I’m not remembering everything you told me when we practiced the physiotherapy, the chest physiotherapy.

Virginia Anderson: That’s okay, Janice. I know this feels overwhelming. Caitlynn’s condition is an extensive one, and we’re here to help you manage it. We’ll continue to be here as you’re figuring this out, okay?

Rebecca Helgo: That’s right, Janice. I know you’ll get the hang of it, but in the meantime there’s a lot to learn. So you had some questions about the chest physiotherapy? What’s going on?

Janice: Okay, if you can see on the camera, Caitlynn has these red marks on her ribs here. Is that a symptom of something?

Rebecca Helgo: Can you get the camera just a bit closer?

Janice: How’s that?

Rebecca Helgo: Okay, very good. Yes, those look like marks from the percussion. Are those over her last two ribs?

Janice: I think so.

Rebecca Helgo: That’s one thing you’ll have to remember: You don’t want to do the percussion on her last two ribs on either side, her backbone, or her breastbone. And when you do it anywhere else, you don’t want to leave red marks. So if you see those, that’s a hint that you’re doing the percussion just a bit too hard.

Virginia Anderson: Don’t worry, you haven’t hurt her that I can see. Plus, you’re obviously really staying on top of things and you’re following the recommended treatment procedures for Caitlynn, and I really want to praise you for that. So, is she acting like that area is hurting her? Or can you tell?

Janice: No, it doesn’t seem like it’s hurting her at all.

Rebecca Helgo: She should be fine, then.

Virginia Anderson: And remember, Janice, if you continue to have trouble with this, we’ve got other options. There’s a vest that vibrates the child if percussion isn’t getting the job done. And you won’t have to do exactly this forever. As she gets older and can learn how to do huff coughs, you’ll be doing less work and she’ll be doing more.

Janice: Okay. Thank you, that makes me feel better. I couldn’t get hold of my pediatrician and I was just getting worried.

Rebecca Helgo: Good, that’s what we’re here for.

Virginia Anderson: Janice, should we review the signs and symptoms of respiratory distress? We’re happy to go over anything you need to feel more confident about monitoring Caitlynn.

Janice: I think I remember those. I feel like I check for them every hour.

Rebecca Helgo: [chuckles] That’s understandable. Well, remember to check with Dr. Benjamin or me or Virginia if you need to.

 

 

Conclusion

Congratulations! You have completed this activity.

As you saw in this activity, coordinating care can be a challenge when the patient lives far from her provider or when multiple providers are distant from each other. Many technologies may be necessary in order to provide quality evidence-based care to patients when care teams and patients are not in the same location. Nurses and other health care professionals must find creative solutions when problems arise, so that care planning for remote patients is just as comprehensive and outcome-based as that for patients nearby or on site.

As you work on your assignment, consider these questions:

 How was remote collaboration used to improve the quality and safety of the care being provided in the scenario?

(Maximum 2500 characters)

 In what ways was evidence-based practice being effectively applied to help the patient in the scenario? Were there opportunities for improvement? If so, what were they?

(Maximum 2500 characters)

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