Remote Collaboration and Evidence-Based Care Essay

Remote Collaboration and Evidence-Based Care Essay

Hello, my name is Lisa Nelson. This recording will focus on remote collaboration and evidence-based care planning for the presented case in the Villa Health scenario. The scenario entails a pediatric female patient, 2year old Caitlynn Bergan, receiving care at Valley City Regional Hospital. The patient has a past medical history of meconium ileus, which she had at birth, along with recurrent pneumonia. She has already been hospitalized within the last six months. She is in the hospital, accompanied by her parents Doug and Janice Bergan. Upon assessment, the findings show that Caitlynn has decreased breath sounds at the right bases, scattered rhonchi in her upper lobes, and fever. After the respiratory therapist administered a nebulized treatment and physiotherapy, there were thick secretions noted. She is also suspected of having malabsorption of nutrients due to decreased subcutaneous tissue observed in her extremities. Caitlynn also has a positive sweat chloride test which confirms cystic fibrosis. Treatment for Caitlynn consists of intravenous piperacillin, pancreas enzymes, and chest physiotherapy. Her physician also recommends an extra-calorie, high-protein diet, and fat-soluble vitamins. When planning care for Caitlynn some nursing diagnoses to consider would be ineffective airway clearance related to excessive production of thick mucus as evidenced by abnormal breath sounds, ineffective cough, and altered respiratory rate and depth. Caitlynn will maintain clear, open airways as evidence by normal breath sounds, normal rate and depth of respirations, and ability to cough up secretions after nebulize aerosol treatments. According to the Cystic Fibrosis Foundation, this nursing diagnosis is relevant to Caitlynn’s care, in a consensus evaluation, daily airway clearance is recommended.  Imbalanced Nutrition: less than body requirements related to impaired digestive process and absorption of nutrients, as evidenced by weight of 20.7 lbs., and decreased subcutaneous tissue.  The patient will weigh within ten percent of ideal body weight. For successful implementation of this plan with the help of the care team, Caitlynn parents must record and describe food intake and a referral to a dietitian or nutritional support team may also be needed. A dietician or nutritional support team can individualize Caitlynn’s diet within prescribed restrictions. In support of these care plan decisions for Caitlynn, the consensus recommendation recommended in the CF Foundation Evidence-based Practice is that intensive treatment with behavioral intervention in conjunction with nutritional counseling is used to promote weight gain for children aged 1 to 12 years (Borowitz et al., 2009). Ratchford et al. (2018), also stated optimizing nutrition is critical, as higher growth parameters are associated with better pulmonary function and outcomes, but unfortunately, patients with this disease are prone to malnutrition, growth failure, and vitamin deficiencies.

Aside from the complexities arising from her latest diagnosis, Caitlynn and her parents reside in a rural area an hour away from the hospital and face several healthcare challenges with limited access to healthcare needs. According to Lahiri et al. (2016), national and international care guidelines recommend that preschoolers with cystic fibrosis get regular well-child care from a primary care physician. McHenry, where the patient lives, is a small town of less than a hundred without the advanced medical facilities available. The physician’s plan to address these challenges is telemedicine and coordinating care with Caitlynn’s pediatrician. Because of the severity of Caitlynn’s diagnosis, the interdisciplinary team may need to modify a plan to hold a biweekly teleconference meeting with her parents to ensure adherence to her treatment and evaluate and fix barriers as they arise. The benefits of telemedicine use within these specialties include decreased mortality, decreased hospital length of stay, higher adherence to recommended care, cost-effectiveness, and high patient and provider satisfaction (Lilly, 2011). During these teleconference meetings, the interdisciplinary team can educate Caitlynn’s parents on online support groups to help them cope with the new diagnosis.  The interdisciplinary team can also further collaborate on providing the family with a weekly survey such as the cystic fibrosis symptom progression survey that will be helpful with Caitlynn assessments. This survey will help the parents be more thorough and standardized when assessing Caitlynn. The survey will also help catch more variances quickly. According to Norrish et al. (2015), in the Oman Medical Journal, the use of this survey would provide an opportunity for patient engagement and relationship building, thereby enhancing patient education, and improving adherence to treatment.

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The proposed care plan aims to provide an evidence-based care framework that adequately caters to the patient’s needs for improved safety and patient outcome. From personal experience reviewing cases such as Caitlynn’s, the Ottawa model can help develop a care plan tailored to Caitlynn’s needs considering her conditional and situational background.

Christenbery (2018), describes the Ottawa Model as an interactive design that displays research as a 3-step system of interrelated stakeholder decisions and activities.

The first step entails assessing barriers and supports to the care process (Christenbery, 2018). In Caitlynn’s case, barriers include proximity to healthcare facilities and resources, insufficient access to cystic fibrosis knowledge and education, and the absence of readily available parent support systems. Herbert et al. (2021), who collected a total of 941 responses from 21 countries, note that medication access is a concern for people with cystic fibrosis, contributing to the high strain on management and treatment and having an impact on both mental and physical health of their loved ones. They conclude that it is necessary to develop focused quality improvement programs to aid in the reduction of treatment load. Since Caitlynn is newly diagnosed, the most practical way for her parents to understand the kind of treatment load ahead is for them to be in touch with the healthcare providers and more experienced parents in similar situations.

The pediatrician and social worker at the clinic in McHenry can only do so much for the Burgan family. Kirk & Milnes (2015), while studying online groups for people living with cystic fibrosis, concluded that online support groups tend to augment expert help in terms of self-management. They allow young people and parents to discuss their experiences, sentiments, and methods for living with long-term illnesses with their peers while also developing the knowledge to empower them in discussions with medical care providers. Martinez-Millana et al. (2019) explored mobile phone applications in the management and care of pediatric cystic fibrosis. They found that all the applications reviewed had features for tracking elements of disease and nutrition, including medications, diets, measurements, alerts, and instructional content. The Burgan family can significantly benefit from one such program with their access to internet services.

The next step in the Ottawa model is monitoring intervention and the extent of implementation (Christenbery,2018). This stage requires that Caitlynn’s physicians select relevant techniques to raise implementation awareness and give the necessary training and education to carry out the adoption. Janice has already received training on how to perform Caitlynn’s chest physiotherapy. However, she still requires other resources to educate her further on similar and different aspects such as nutrition. According to Button et al. (2016), Infants who have just been diagnosed with cystic fibrosis and their families must meet with the multidisciplinary group as soon as possible. It is essential to explain, display, and practice the function of physiotherapy in airway clearing procedures, exercise, and active play. Infants should be treated according to the standard guidelines for cystic fibrosis physiotherapy, including five modified postural drainage positions repeated once or twice a day as needed. Nutritional treatment and support are vital aspects of cystic fibrosis management. Turck et al. (2016) suggest that dietary treatment begins as soon as feasible after diagnosis, with frequent follow-up and patient/family education. The adjustment of energy consumption is vital to attain age-appropriate weight and height. In Caitlynn’s case, where pancreatic enzyme and fat-soluble vitamin therapy have started early, close monitoring is necessary. The key aims of multidisciplinary cystic fibrosis centers are to achieve standard development patterns in children and maintain an acceptable nutritional balance (Turck et al., 2016).

The final step in the Ottawa model is evaluating outcomes for the patient and her family (Christenbery, 2018). The benefits of adopting this evidence-based model include gaining a better understanding of the patient’s needs and obtaining maximum advantages of the remote collaboration process. Following this evidence-based practice should result in safe and positive outcomes for the patient since all the stages in this model can be reviewed and revisited in less than favorable outcomes.

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References

Airway clearance techniques (ACTS). Cystic Fibrosis Foundation. (n.d.). Retrieved January 8, 2022, from https://www.cff.org/airway-clearance-techniques-acts#choose-what-s-best-for-you

Borowitz, D., Robinson, K. A., Rosenfeld, M., Davis, S. D., Sabadosa, K. A., Spear, S. L., Michel, S. H., Parad, R. B., White, T. B., Farrell, P. M., Marshall, B. C., & Accurso, F. J. (2009). Cystic Fibrosis Foundation evidence-based guidelines for management of infants with cystic fibrosis. The Journal of Pediatrics, 155(6). https://doi.org/10.1016/j.jpeds.2009.09.001

Button, B. M., Wilson, C., Dentice, R., Cox, N. S., Middleton, A., Tannenbaum, E., Bishop, J., Cobb, R., Burton, K., Wood, M., Moran, F., Black, R., Bowen, S., Day, R., Depiazzi, J., Doiron, K., Doumit, M., Dwyer, T., Elliot, A., … Holland, A. E. (2016). Physiotherapy for cystic fibrosis in Australia and New Zealand: A clinical practice guideline. Respirology, 21(4), 656–667. https://doi.org/10.1111/resp.12764

Christenbery, T. L. (2018). In Evidence-based practice in nursing: Foundations, skills, and roles (pp. 356–357). Springer Publishing Company.

Herbert, S., Rowbotham, N. J., Smith, S., Wilson, P., Elliott, Z. C., Leighton, P. A., Duff, A., & Smyth, A. R. (2021). Exploring the challenges of accessing medication for patients with cystic fibrosis. Thorax. https://doi.org/10.1136/thoraxjnl-2021-217140

Kirk, S., & Milnes, L. (2015). An exploration of how young people and parents use online support in the context of living with cystic fibrosis. Health Expectations, 19(2), 309–321. https://doi.org/10.1111/hex.12352

Lahiri, T., Hempstead, S. E., Brady, C., Cannon, C. L., Clark, K., Condren, M. E., Guill, M. F., Guillerman, R. P., Leone, C. G., Maguiness, K., Monchil, L., Powers, S. W., Rosenfeld, M., Schwarzenberg, S. J., Tompkins, C. L., Zemanick, E. T., & Davis, S. D. (2016). Clinical practice guidelines from the Cystic Fibrosis Foundation for preschoolers with cystic fibrosis. Pediatrics, 137(4). https://doi.org/10.1542/peds.2015-1784

Lilly, C. M. (2011). Hospital mortality, length of stay, and preventable complications among critically ill patients before and after Tele-ICU reengineering of Critical Care Processes. JAMA, 305(21), 2175. https://doi.org/10.1001/jama.2011.697

 

Martinez-Millana, A., Zettl, A., Floch, J., Calvo-Lerma, J., Sevillano, J. L., Ribes-Koninckx, C., & Traver, V. (2019). The potential of self-management mhealth for pediatric cystic fibrosis: Mixed-Methods study for healthcare and APP assessment. JMIR MHealth and UHealth, 7(4). https://doi.org/10.2196/13362

Norrish, C., Norrish, M., Fass, U., Al-Salmani, M., Lingam, G. S., Clark, F., & Kallesh, H. (2015). The cystic fibrosis symptom progression survey (CF-SPS) in Arabic: A tool for monitoring patients’ symptoms. Oman Medical Journal, 30(1), 16–25. https://doi.org/10.5001/omj.2015.04

 

Ratchford, T. L., Teckman, J. H., & Patel, D. R. (2018). Gastrointestinal pathophysiology and nutrition in cystic fibrosis. Expert Review of Gastroenterology & Hepatology, 12(9), 853–862. https://doi.org/10.1080/17474124.2018.1502663

 

Turck, D., Braegger, C. P., Colombo, C., Declercq, D., Morton, A., Pancheva, R., Robberecht, E., Stern, M., Strandvik, B., Wolfe, S., Schneider, S. M., & Wilschanski, M. (2016). Espen-Espghan-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clinical Nutrition, 35(3), 557–577. https://doi.org/10.1016/j.clnu.2016.03.004