Week 7: Course Project – Recommendations

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(Week 7: Course Project – Recommendations)

Technology, Society, and Culture

February 18, 2022

Week 7: Course Project – Recommendations

 Week 7: Course Project – Recommendations

Introduction

Remote patient monitoring (RPM) entails using digital technologies to monitor and obtain medical and other health data of patients in their remote locations or homes and transmit the information electronically to healthcare providers for evaluation needed to develop recommendations and instructions. RPM has seen an increase in adoption, parallel to telehealth, since the beginning of the Covid-19 virus because of the increased need to avoid physical contact in in-patient visits (Mantena & Keshavjee, 2021). RPM is used for patients’ close monitoring and is often deployed as an element of a tiered approach to increase bed availability in healthcare facilities by discharging patients early and monitoring them remotely. Technologies used include wearable devices, symptom surveys, and other digital devices that gather and send information to the practitioner. Remote patient monitoring facilitates monitoring specific patient health aspects from their home, increasing healthcare access and utilization. One primary impact of RPM is increasing convenience by reducing physical contact and unnecessary patient visits (Mantena & Keshavjee, 2021). Generally, the technology is applied for remote monitoring of patient vitals and overall health adopting digital and smart devices, helping with timely disease identification to prevent progression and enhancing care quality and patient safety. Although the primary purpose of RPM is increasing access to healthcare and health service utilization, it is out of reach of some patient populations, including low-income earners and ethnic minorities that experience high poverty rates and live in marginalized areas with limited internet connectivity. Increasing reach is an ethical consideration that would allow all patient populations to enjoy the benefits brought along by RPM. (Week 7: Course Project – Recommendations)

Thesis

Telehealth services, including remote patient monitoring, have been increasingly utilized recently, particularly during and after the COVID-19 pandemic. Telehealth technologies like RPM have become indispensable, helping increase healthcare access and service utilization. However, several ethical issues associated with the practice need addressing to ensure the technology achieves optimal outcomes and fulfils its purpose. RPM poses ethical issues regarding patient autonomy, privacy and confidentiality, equity of access, data security, and erosion of professional-patient relationships. These ethical issues still require standard and particular application rules to ensure equitable access, respect for patient autonomy and privacy and confidentiality, data protection, professional liability, quality of care, and promotion of professional-patient relationships. (Week 7: Course Project – Recommendations)

Ethical Dilemmas

Currently, remote patient monitoring, like other telehealth technologies, could only be adopted as complementary or supplementary care delivery approaches to traditional care delivery because of the ethical issues surrounding the practice. Ethical evaluation of RPM is imperative to promoting its full adoption in healthcare and ensuring a future where RPM becomes integral to everyday healthcare services. RPM poses ethical dilemmas regarding informed consent and autonomy, patient privacy, confidentiality, data security, equitable access, and professional-patient relationship. RPM is increasingly practiced in contemporary healthcare scenarios, and addressing these ethical issues is necessary (Solimini et al., 2021). According to the theory of Principlism, healthcare providers should respect a patient’s autonomy and promote beneficence, non-maleficence, and justice. However, the ethical problems posed by RMP conflict with the theory of Principlism, posing ethical dilemmas for healthcare providers.

Most patients, especially those with chronic conditions, are given guidelines regarding using remote patient monitoring and what devices would aid with disease monitoring and communication with providers. However, patients are not provided information regarding the risks and benefits of remote patient monitoring systems and devices or requested informed consent to engage in remote therapy, which conflicts with the principle of autonomy (Solimini et al., 2021). With RPM, it is difficult for patients, especially older adults, to retain control of who has access to their personal information and health records. RPM increases the risk of patient data being shared or linked without their knowledge, jeopardizing their autonomy, privacy, confidentiality and data security. Noticeably, RPM can make patients more autonomous by getting more involved in their care, but it can also jeopardize autonomy if the information is withdrawn from them regarding the risks and benefits of RPM or who has access to their health data and for what purposes (Solimini et al., 2021). Also, like other digital technologies, RPM increases the risk of data loss through cybersecurity. Without adequate privacy and cybersecurity controls within RPM systems, patient data and communications with care providers can land in unauthorized hands that can harm the patient, conflicting with the principle of beneficence and non-maleficence.

Considerably, RPM’s core purpose is increasing access to healthcare services. Traditional healthcare delivery has presented issues with healthcare access because particular patient populations, including marginalized and rural communities, low-income earners, ethnic and racial minorities, and immigrants, report low healthcare service utilization. Still, RPM poses ethical issues with equitable access to the services as it requires the use of digital devices and reliable internet access, which low-income earners, marginalized and rural communities, and ethnic and racial minorities have limited access to, conflicting with the principle of justice and fairness (Solimini et al., 2021). RPM can only fulfil its purpose and ensure healthcare service access to all if problems with reliable internet connectivity and the cost of using RPM are addressed. Moreover, RPM presents an ethical dilemma regarding the provider-patient relationship because of the loss or reduced face-to-face therapeutic relationships. Face-to-face clinical encounter has a therapeutic value and has been the longstanding premise of the provider-patient relationship (Mehta, 2018). The loss of the physical presence of a provider might eradicate the therapeutic value of provider-patient relationships, and RPM can be limited only to patients with a preexisting relationship with the provider. (Week 7: Course Project – Recommendations)

Recommendations

Promoting patient autonomy is critical to enhancing patient trust in healthcare services and increasing service utilization. Strategies to enhance patient autonomy in RPM systems include clarifying risks, benefits, and expectations of using RPM, enhancing clinical competence in RPM practice, establishing participative decision-making, and improving decision-making competence, including gaining informed consent from patients or caregivers regarding using RPM. The concern over RPM’s threat to patient privacy, confidentiality, and data security is legitimate because patients might not certainly know who they are communicating with or sharing their personal details and health information with. A robust privacy and security plan for any RPM system is required to gain patient confidence, and it should be communicated to the patient (Mehta, 2018). Healthcare organizations should adopt data encryption and other security tools like multiple-factor authentication to ensure patient data and communications do not proliferate (Jalali et al., 2021). Provider and patient training and education on properly using RPM systems and devices are fundamental to eliminating or reducing human errors that lead to security breaches. HIPAA compliance should be adopted for RPM systems in all healthcare scenarios to enhance competence in RPM practice. Furthermore, organizations should secure their wireless networks and messaging systems to reduce the risk of cyber theft (Jalali et al., 2021).

The federal and local governments are responsible for extending reliable internet connectivity, even in remote areas, to increase RPM adoption and utilization. Also, financial aid for struggling populations would facilitate the acquisition of RPM devices. The government can increase grants to non-profit organizations, including American Medical Resource Foundation, MedShare, and Project CURE, helping patients acquire devices for disease management and remote monitoring of vital signs. Finally, RPM can enhance or jeopardize the provider-patient relationship depending on how it is adopted. RPM provides an opportunity to increase healthcare access for patients in geographical areas where reach is limited (Mehta, 2018). It is essential to ensure that RPM and traditional approaches complement each other rather than RPM replacing the traditional face-to-face approach. Providers should engage with patients to determine which visits require an in-person approach and which can be remote. (Week 7: Course Project – Recommendations)

Conclusion

Remote patient monitoring systems have existed for a long time, but their actual adoption increased during the COVID-19 pandemic, and they are now indispensable. Despite the opportunities it presents to enhance healthcare access and service utilization, it also poses ethical challenges and dilemmas that should be considered to ensure optimal RPM adoption. Ethical dilemmas RPM poses include the threat to patient autonomy, privacy, confidentiality, and data security, lack of equitable access, and eroding provider-patient relationships. Addressing these ethical dilemmas is vital for the future of RPM in a more networked and connected world and as people become more comfortable with electronic communication and virtual services. (Week 7: Course Project – Recommendations)

References

Jalali, M. S., Landman, A., & Gordon, W. J. (2021). Telemedicine, privacy, and information security in the age of COVID-19. Journal of the American Medical Informatics Association : JAMIA, 28(3), 671–672. https://doi.org/10.1093/jamia/ocaa310

Mantena, S., & Keshavjee, S. (2021). Strengthening healthcare delivery with remote patient monitoring in the time of COVID-19. BMJ health & care informatics, 28(1), e100302. https://doi.org/10.1136/bmjhci-2020-100302

Mehta, S. J. (2018). Telemedicine’s potential ethical pitfalls. AMA Journal of Ethics, 16(12), 1014-1017. https://journalofethics.ama-assn.org/article/telemedicines-potential-ethical-pitfalls/2014-12#:~:text=Ensuring%20that%20telemedicine%20is%20ethically,new%20technology%20must%20be%20effective.

Solimini, R., Busardò, F. P., Gibelli, F., Sirignano, A., & Ricci, G. (2021). Ethical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic. Medicina (Kaunas, Lithuania), 57(12), 1314. https://doi.org/10.3390/medicina57121314

 

 
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Discussion Board Rebuttal

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Discussion Board Rebuttal

Discussion Board Rebuttal

The author offers a compelling discussion on the project topic and the journal to publish the article. The clinical symptoms of emphysematous pyelonephritis, a rare necrotizing pyelonephritis, can range from minor abdominal pain to septic shock.1 It is a potentially fatal disorder that typically affects diabetic people, and in a limited number of cases, urinary tract obstruction could be responsible.1 Surgery is a mainstay treatment, but there are more contemporary approaches to address emphysematous pyelonephritis, including correction of any electrolyte and glucose problems and administration of antibiotics targeting Gram-negative bacteria, after resuscitation, before considering surgery, unless it is an emergency. Historically, surgery was the preferred and required form of treatment.1 Those who underwent surgery for the condition had to undergo long-term dialysis. The effect was frequently lethal if untreated.1 In this case, the predisposing factor may be a combination of blockage brought on by renal papillary cell carcinoma and poor tissue perfusion brought on by undetected diabetes, which resulted in gas generation and emphysematous pyelonephritis.

The article presented is a case report, hence appropriate to post in the Journal of the American Academy of Physician Assistants (JAAPA). The article topic is definitely an interesting topic for physician assistants because it is about a urologic condition. Also, no article addresses emphysematous pyelonephritis, and the best possible match was emphysematous cystitis. However, I disagree that the topic is too specialized for JAAPA just because no article addresses such a topic. JAAPA invites new research on topics that would interest Pas, and this article is the right one for the journal. The American Urologic Association (AUA) and the American Association of Surgical Physician Assistants (AASPA) journals are also suitable for publishing the topic because PAs are among the audience and can also be the first authors. The author seems limited with the Urologic Association (AUA) and the American Association of Surgical Physician Assistants (AASPA) journals regarding the ability to post case reports. I would say that ANNALS of Surgery, the International Journal of Surgery and Research and Practice, and the Surgery Journal are suitable for the topic because they have a wider audience and allow case reviews, and the author should look into them. (Discussion Board Rebuttal)

References

  1. Surur J. Acute bilateral emphysematous pyelonephritis. BMJ Case Rep. 2017;2017:bcr1020103425. Published 2017 Mar 8. doi:10.1136/bcr.10.2010.3425 https://pubmed.ncbi.nlm.nih.gov/22707665/

 

 
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Week 7: The Value of Peer Review

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Week 7: The Value of Peer Review

Week 7 The Value of Peer Review

Practice Question

For adults with a history of Schizophrenia (P) in the inpatient setting, does the implementation of technology with motivational interviewing (I), compared with current practice (C), impact medication nonadherence (O) in 8-10 weeks (T)? (Week 7: The Value of Peer Review)

The Value of the Peer Review Process of offering Feedback as a Future DNP-Prepared Nurse Leader

Peer review refers to team-based learning adopted to encourage reflection on individual behavior, offer professional skills development opportunities, and encourage people to contribute effectively to discussions or teamwork. Students have an amazing ability to offer meaningful and positive feedback, including helping their peers identify areas of improvement. But some students or peers might be shy or reluctant to correct their peers or indicate areas of improvement (Burgess et al., 2021). Peer review is an approach adopted to improve peer engagement, incorporate peer feedback in discussions, monitor outcomes and adequate knowledge, skills, and competency development and acquisition. It allows peers to be accountable, not only to their educators but also to their peers. It requires learners to work in teams, help each other synthesize information, and communicate with one another. Offering and getting feedback ensures effective learning experience among learners, developing reflective learners who can analyze their own and peers’ performance. Furthermore, it helps develop positive views and attitudes towards change and has a greater impact than feedback offered by faculty.

As a future DNP-prepared nurse leader, peer review allows learners to develop multiple professional skills relevant to professional practice, including communication, organizational skills, problem-solving, teamwork, and individual and team accountability, which are critical to a successful career and fulfilment of expected roles and responsibilities. I have had the opportunity to offer peer review in topic discussion responses. In most courses, students are required to complete weekly discussions and respond to at least two classmates, critiquing, supporting, reflecting on, and offering more insights regarding their peers’ discussion posts. I have learned many concepts and expounded my understanding of course concepts from these peer responses, and I appreciate every opportunity I get to learn from others or offer positive and meaningful feedback to my peers. (Week 7: The Value of Peer Review)

References

Burgess, A., Roberts, C., Lane, A. S., Haq, I., Clark, T., Kalman, E., … & Bleasel, J. (2021). Peer review in team-based learning: influencing feedback literacy. BMC medical education, 21(1), 426. https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-021-02821-6

 

 
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M4 Discussion

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M4 Discussion

M4 Discussion

Measures That Have Been or Can Be Employed to Overcome Problems Related to Physician Maldistribution and Imbalance

Limited access to healthcare is associated with physician shortages in marginalized, rural, and remote areas where a lack of or insufficient general practitioners is typical. Ensuring balanced access to physicians is challenging for decision-makers because physicians’ access is influenced by healthcare demand, which is more in urban areas. However, there are strategies and measures adopted to address physician imbalance and maldistribution, including incentives to select family health as a specialty or provide services in remote and rural areas or generally underserved areas and recruiting foreign physicians using bilateral agreements (de Oliveira et al., 2017). There are federal programs in place to help address the issue to increase physician supply in remote areas, including the National Health Service Corps, making scholarship support conditional after committing to serve in these areas, and the Migrant and Community Health Center Programs, established to offer care in poor and under-served areas through federal grants and primary care training support and Area Health Education Centers (de Oliveira et al., 2017). Higher pay can also help remedy physician maldistribution. Increasing pay for primary care physicians working in underserved areas can be important in encouraging physicians to move their service provision to underserved areas. (M4 Discussion)

Initiatives To Recruit/Retain Physicians in Your Facility

The workforce crisis in primary care is an issue for healthcare managers allocated the duty of recruiting and retaining physicians, who are in high demand across the country experiencing shortages and maldistribution. Improving recruitment and retention is imperative, and it can be done through strategies like financial incentives, peer support, professional development and research support, retainer schemes, re-entry schemes, and hiring specialized recruiters or case managers (Verma et al., 2018). Also, according to Verma et al. (2018), I would adopt rural or underserved postgraduate training and primary care focused undergraduate placement to recruit and retain physicians in facilities located in rural and under-served areas. (M4 Discussion)

References

de Oliveira, A. P., Dussault, G., & Craveiro, I. (2017). Challenges and strategies to improve the availability and geographic accessibility of physicians in Portugal. Human resources for health, 15(1), 24. https://doi.org/10.1186/s12960-017-0194-3

Verma, P., Ford, J. A., Stuart, A., Howe, A., Everington, S., & Steel, N. (2018). A systematic review of strategies to recruit and retain primary care doctors. BMC health services research, 16, 126. https://doi.org/10.1186/s12913-016-1370-1

 
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M4 Assignment: Health Service Administrators’ Roles and Responsibilities

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(M4 Assignment: Health Service Administrators’ Roles and Responsibilities)

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M4 Assignment: Health Service Administrators’ Roles and Responsibilities

Healthcare organizations flourish and achieve their missions and visions thanks to effective and great leaders who develop the visions, own them, and motivate staff to work at their highest potential to achieve the vision. Healthcare leaders include nurse managers and health administrators who supervise teams and daily activities, including managing budgets and billing, ordering medical supplies and managing resources, and overseeing general staff in various healthcare facilities, including clinics. This paper addresses the roles and responsibilities of health service administrators and my ideal position in the healthcare system. (M4 Assignment: Health Service Administrators’ Roles and Responsibilities)

Roles and Responsibilities of Health Service Administrators

Health services administration is a leadership position that requires an individual to have a bachelor’s degree in healthcare administration or health service administration, a minimum of two years’ experience in health service administration, high-level competency in healthcare administration software, advanced experience in health records, billing, and medical insurance management, interpersonal and communication skills, and staff and budget management skills (Public Health Degrees, 2023). Health service administrators direct a healthcare organization’s operations, interacting, mostly with physicians, nurses, surgeons, and technicians, and occasionally with patients (Doyle, 2019). Health service administrators shape an organization’s policy to improve health service delivery and patient experience. Their work is primarily behind the scenes, making vital decisions for a healthcare institution, ensuring policy implementation and directing budget.

The roles of health service administrators are multiple, depending on the location and size of a healthcare institution. Common roles and responsibilities of health service administrators in healthcare institutions include developing work schedules for healthcare staff, managing the organization’s finances, managing the billing system and patient payments, facilitating interventions to improve an organization’s efficiency and quality, and ensuring the institution adheres to state and federal laws and regulations. Health service administrators are critical in clinical decision-making, impacting the success of healthcare organizations (Sorensen et al., 2019). Furthermore, health service administrators train staff members, facilitate communication between nurses and physicians, meet governing boards, and present investor meetings (Cronin et al., 2018). Additionally, monitoring medical equipment, including new purchases, maintenance, and repair, adopting cost-saving initiatives, and updating patient health records fall within a health service administrator’s jurisdiction.

My ideal position in the healthcare system is the healthcare administrator role because I believe this role is more valuable as the healthcare system shifts from the traditional fee-for-service model to the contemporary value-based model. Patient experience and satisfaction are central to healthcare service provision, and skilled leaders are required in nonclinical positions in every facility (Western Governors University, 2020). Becoming a healthcare administrator is where I see myself in the next 5 to 10 years, coordinating care, managing resource utilization, and facilitating interventions to improve patient experience and health outcomes. I desire to lead, and I perceive myself as a change agent and collaborative, which are fundamental attributes towards becoming a healthcare administrator. This role allows me to work in various healthcare settings, including hospitals, nursing homes, health plans, large practice groups, and health systems, increasing the flexibility of my career. Currently, I am working to gain on-the-job experience and later education requirements for healthcare administrators to enhance my career readiness when an opportunity presents itself. (M4 Assignment: Health Service Administrators’ Roles and Responsibilities)

Conclusion

Most nurses desire to move up the career ladder to become clinical nurse managers, directors of nursing, chief nursing officers, and healthcare administrators. Healthcare administrators interact more with healthcare providers and minimally with patients, directing organizations’ operations, developing and implementing policies, managing and training healthcare staff, and managing billing systems, health records, and budgets. I aim to be a healthcare administrator in the next 5 to 10 years, and currently, I am working on my career readiness. I believe the value of healthcare administrators is growing as the healthcare system moves from a fee-for-service model to value-based models, and patient-centered care becomes more influential in healthcare delivery. (M4 Assignment: Health Service Administrators’ Roles and Responsibilities)

References

Cronin, C. E., Schuller, K. A., & Bolon, D. S. (2018). Hospital administration as a profession. Professions and Professionalism, 8(2), e2112-e2112.

Doyle, L. (2019, June 5). Healthcare administrators: roles, responsibilities, and career outlook. Northeastern University. https://www.northeastern.edu/bachelors-completion/news/how-to-become-a-healthcare-administrator/

Public Health Degrees. (2023). How to become a healthcare administrator. https://www.publichealthdegrees.org/careers/healthcare-administrator/

Sorensen, J., Johansson, H., Jerdén, L., Dalton, J., Sheikh, H., Jenkins, P., May, J., & Weinehall, L. (2019). Health-Care Administrator Perspectives on Prevention Guidelines and Healthy Lifestyle Counseling in a Primary Care Setting in New York State. Health services research and managerial epidemiology, 6, 2333392819862122. https://doi.org/10.1177/2333392819862122

Western Governors University. (2020, January 14). The top 4 nursing leadership roles. https://www.wgu.edu/blog/top-4-nursing-leadership-roles2001.html/

 
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M5-Week 5 Discussion – Capitation

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M5-Week 5 Discussion - Capitation

(M5-Week 5 Discussion – Capitation)

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M5-Week 5 Discussion-Capitation

Capitation

Capitation is a payment method for healthcare services where entities, including physicians or physician groups, get risk adjustment amounts of money for every individual assigned to them per period per time, regardless of the service volume the individual needed (Tummalapalli et al., 2022). Capitation is viewed as an alternative payment approach to the fee-for-service (FFS), which remains the primary reimbursement mechanism for outpatient visits. (M5-Week 5 Discussion – Capitation)

The Impact of a Capitated Managed Care Contract on a Small, General Medicine Physician Group

Capitation is a contemporary reimbursement approach for healthcare providers that aligns with the current trend of paying for value rather than volume because capitation contracts are based on performance. Capitation ensures that providers get better incentives for preventive care, cost control, and efficiency. It is expected to balance out high-frequency users with plan members using little or no healthcare over time (Tummalapalli et al., 2022). Capitation is common in managed care organizations to ensure cost effectiveness by controlling healthcare utilization by ensuring the physician is at financial risk for services offered to patients (Alguire, 2022). Understandably, a physician would get better incentives for services well-provided, quality services, and cost-effectiveness and risk losing reimbursements or costs exceeding those reimbursed for poor quality services or cost-ineffectiveness. Rates of resource utilization in physician care are used to ensure patients do not get suboptimal care through healthcare services underutilization (Alguire, 2022). Typically, the general medicine physician group is always at a financial risk after signing the capitated contract if they do not control the overall cost of healthcare service utilization, including referrals. (M5-Week 5 Discussion – Capitation)

Why the Contract is Desirable

This contract can be desirable for the physician group because of better incentives, and the money is paid in advance to the physician group for the healthcare services delivered. Therefore, the physician group would enjoy greater financial certainty (Alguire, 2022). The group can offer a range of services and ensure cost-effectiveness while providing the best treatment. This contract ensures that the physician group has better incentives to promote preventative care. (M5-Week 5 Discussion – Capitation)

References

Alguire, P. C. (2022). Understanding capitation. American College of Physicians. https://www.acponline.org/about-acp/about-internal-medicine/career-paths/residency-career-counseling/resident-career-counseling-guidance-and-tips/understanding-capitation

Tummalapalli, S. L., Estrella, M. M., Jannat-Khah, D. P., Keyhani, S., & Ibrahim, S. (2022). Capitated versus fee-for-service reimbursement and quality of care for chronic disease: a US cross-sectional analysis. BMC health services research, 22(1), 19. https://doi.org/10.1186/s12913-021-07313-3

 

 
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Discussion Board Rebuttal 2

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Discussion Board Rebuttal

The author offers a compelling take and argument on Lars Sudman’s perception of leadership in Utopia. According to Sudman, even in Utopia, humans will be social and social beings form groups, and groups call for leadership. It indicates that leadership is integral even in the most perfect place. However, the approach to being a leader begins with leading oneself. Just like nurses cannot care for others adequately without caring for themselves first, leaders should self-lead before leading others. Regarding this article, the author provides valid points that I agree with and are right, according to Sudman. However, I consider effective leadership as beginning with a sense of purpose.1 The elements provided in the article are simply strategies to improve leadership quality and effectiveness. (Discussion Board Rebuttal 2)

Despite the need to self-lead, self-reflect, and self-regulate, great leaders have a sense of purpose, and that purpose is a greater tool for becoming an effective leader than any other approach.1 While self-leading, a leader needs a purpose because you cannot lead yourself without it. For instance, the example provided regarding the manager who failed to solve the provider-nurse conflict at the office focuses on the leader’s lack of self-regulation and, therefore, unable to see the fault in others. I will argue that, first, this manager lacked a sense of purpose and did not understand his role as a manager in the first place. Qualities like self-leadership, self-reflection, and self-regulation cannot be effective in unpredictable situations like provider-nurse conflict because leaders face new circumstances and scenarios daily, and they cannot wait until they self-reflect to address the issues accordingly. However, when one has an in-depth understanding of his role as a leader, then this purpose would guide appropriate response to unprecedented circumstances regardless of whether the leader has experienced a situation before or not.1  (Discussion Board Rebuttal 2)

References

  1. Craig N, Snook SA. From purpose to impact. Harvard Business review. 2018. https://hbr.org/2014/05/from-purpose-to-impact https://hbr.org/2014/05/from-purpose-to-impact
 
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Discussion Topic 1

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Adverse Selection and Favorable Selection

Adverse selection occurs when sellers possess information that consumers lack or consumers have information that sellers lack. This situation exploits asymmetric information, also information failure, which occurs when a transacting party has more material knowledge than the other party. In most circumstances, the seller is the more knowledgeable party (Hayes, 2022). In terms of insurance, high-risk patients tend to purchase insurance on higher premiums or life insurance in this selection. Favorable or advantageous selection adopts data that indicate service utilization tendency and predicts that high-death risk individuals would not pay for life insurance. It means that beneficiaries costing less than average after adjusting for particular demographics and clinical attributes disproportionately signed for Medicare Advantage, while those costing above average have disproportionately continued with traditional Medicare (Newhouse et al., 2016). The expectation is that a particular patient group will show lower than anticipated health service utilization. (Discussion Topic 1)

Implications

Generally, adverse selection tends to raise costs because consumers lack information help from insurers, creating an asymmetry in the insurance plans. In health insurance markets, adverse selection causes plan price distortions that cause inefficiencies in sorting customers across health plans. Medicare, the private individual market, the employer-sponsored market, consumer-directed health plans, and even the ACA should understand and take caution that adverse selection puts the insurer at an increased risk of losing money via the predicted claims (Cliff et al., 2022). These situations increase premiums that increase adverse selection further as healthier individuals opt from buying the increasingly unaffordable coverage. (Discussion Topic 1)

References

Cliff, B. Q., Miller, S., Kullgren, J. T., Ayanian, J. Z., & Hirth, R. A. (2022). Adverse selection in Medicaid: evidence from discontinuous program rules. American Journal of Health Economics, 8(1), 127-150. https://www.nber.org/system/files/working_papers/w28762/w28762.pdf

Hayes, A. (2022). Adverse selection: definition, how it works, and the lemons problem.

Newhouse, J. P., Price, M., Huang, J., McWilliams, J. M., & Hsu, J. (2016). Steps to reduce favorable risk selection in medicare advantage largely succeeded, boding well for health insurance exchanges. Health affairs (Project Hope), 31(12), 2618–2628. https://doi.org/10.1377/hlthaff.2012.0345

 
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Week 8: Course Project – Presentation

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February 22, 2023

Strongest Ethical Values

(Week 8: Course Project – Presentation)

Week 8: Course Project – Presentation

  • My strongest ethical values include respect of persons, beneficence, and justice.
  • Respect of persons has two distinct moral requirements:

1.Acknowledging autonomy.

2.Protecting individuals with diminished autonomy

  • Beneficence requires people to be treated with respect and secure their well-being.
  • It has two general rules, including:

1.Do not harm

2.Maximize potential benefits and reduce potential harm

  • Justice requires equal and fair share and treatment

Philosophers with the Greatest Influence

Week 8: Course Project – Presentation

  • I am intrigued by the works of Aristotle, Immanuel Kant, John Stuart Mill.
  • These philosophers emphasize humans as rational and autonomous beings.
  • Medical ethics are attributed to them (Cohen-Almagor, 2017).
  • Kant and JS Mill developed the concept of autonomy.
  • Kant’s influenced concepts of dignity, benevolence, and beneficence (Cohen-Almagor, 2017).
  • Mill’s Harm principle is now called nonmaleficence.
  • Aristotle contributed to the concepts of justice and responsibility.
  • (Week 8: Course Project – Presentation)

Respect for Patient Autonomy, Privacy, and Confidentiality and Data Security

  • RPM jeopardizes patient autonomy, privacy, confidentiality and data security.
  • Patients, especially older adults, experience challenges retaining control over access to their personal information and health records (Solimini et al., 2021).
  • RPM risks and benefits are often not shared with patients.
  • Data sharing using digital devices and network increases risk of cyber theft.
  • Older adults have limited knowledge of using digital devices, increasing the risk of data loss (Solimini et al., 2021).

(Week 8: Course Project – Presentation)

Equitable Access

Week 8: Course Project – Presentation

  • RPM is not equally accessible by all populations (Solimini et al., 2021).
  • RPM requires using digital devices and reliable internet.
  • These factors are limited in marginal, remote, and rural areas (Solimini et al., 2021).
  • Low income earners struggle to afford RPM equipment and reliable internet connectivity.
  • RPM access is limited to older adults due to technological illiteracy.
  • Ethnic and racial minorities report limited access to reliable internet connectivity.

(Week 8: Course Project – Presentation)

Professional-Patient Relationships

Week 8: Course Project – Presentation

  • RPM reduces in-person or face-to-face patient visits.
  • Face-to-face patient encounters have more therapeutic value (Mehta, 2018).
  • Face-to-face encounters have been the longstanding promise of provider-patient interactions.
  • The reduced or loss of this physical encounter diminishes the therapeutic value, negatively impacting provider-patient relationships.
  • Currently, RPM is limited to patients with preexisting relationships with a provider.

(Week 8: Course Project – Presentation)

Recommendations to Address First Ethical Concern

  • Enhance patient autonomy by:

1.Sharing RPM risk and benefits with patients

2.Enhancing clinical competence in RPM practice

3.Establishing participative decision-making

4.Improving decision-making competence (Mehta, 2018)

  • Develop robust patient privacy and data security plan and protocol, including HIPAA rules.
  • Adopt data encryption and multi-factor authentication (Jalali et al., 2021).
  • Train and educate providers and patients on proper use of RPM systems.
  • Securing wireless networks and messaging systems (Jalali et al., 2021).

(Week 8: Course Project – Presentation)

Recommendations to Address Second Ethical Concern

  • Local and federal governments to extend reliable internet connectivity to rural and remote areas.
  • Offer financial aid to struggling populations to help acquire RPM equipment.
  • Increase grants to non-profit organizations helping vulnerable people acquire RPM equipment.
  • Organizations include American Medical Resource Foundation, MedShare, and Project CURE.
  • Increase insurance coverage of RPM services.

(Week 8: Course Project – Presentation)

Recommendations to enhance Provider-Patient Relationships

  • Ensure RPM and traditional approaches complement rather than compete.
  • Engage patients to determine which visits are better in-person or remote.
  • Minimize distance between providers and patients (Mehta, 2018).
  • Promote multi-channel communication, including text and instant messages and e-mail.
  • Engage in more information sharing and positive feedback.
  • Promote inclusive decision-making and patient engagement in care coordination.

(Week 8: Course Project – Presentation)

Conclusion

  • RPM presents multiple opportunities to improve healthcare delivery (Mantena & Keshavjee, 2021). .
  • However, it poses ethical dilemmas that need addressing.
  • The future of RPM and widespread adoption relies on effective addressing of:

1.RPM threat to patient autonomy, privacy, confidentiality, and data security.

2.RPM’s lack of equitable access.

3.RPM’s erosion of therapeutic provider-patient relationships

  • It will ensure that patients are more comfortable with electronic communication and virtual services.

(Week 8: Course Project – Presentation)

References

  • Cohen-Almagor, R. (2017). On the philosophical foundations of medical ethics: Aristotle, Kant, JS Mill and Rawls. Ethics, Medicine and Public Health, 3(4), 436-444. https://www.sciencedirect.com/science/article/abs/pii/S2352552517301706
  • Jalali, M. S., Landman, A., & Gordon, W. J. (2021). Telemedicine, privacy, and information security in the age of COVID-19. Journal of the American Medical Informatics Association : JAMIA, 28(3), 671–672. https://doi.org/10.1093/jamia/ocaa310
  • Mantena, S., & Keshavjee, S. (2021). Strengthening healthcare delivery with remote patient monitoring in the time of COVID-19. BMJ health & care informatics, 28(1), e100302. https://doi.org/10.1136/bmjhci-2020-100302
  • Mehta, S. J. (2018). Telemedicine’s potential ethical pitfalls. AMA Journal of Ethics, 16(12), 1014-1017.
  • Solimini, R., Busardò, F. P., Gibelli, F., Sirignano, A., & Ricci, G. (2021). Ethical and Legal Challenges of Telemedicine in the Era of the COVID-19 Pandemic. Medicina (Kaunas, Lithuania), 57(12), 1314. https://doi.org/10.3390/medicina57121314
 
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Nursing Paper Example on Hepatitis E [SOLVED]

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Nursing Paper Example on Hepatitis E [SOLVED]

Hepatitis E, an infectious liver ailment caused by the Hepatitis E virus (HEV), presents a formidable challenge to global health, with its prevalence notably pronounced in developing regions. This paper embarks on a journey to unravel the intricate facets of Hepatitis E, delving into its causative factors, clinical manifestations, underlying mechanisms, diagnostic criteria, treatment modalities, and patient education strategies. As a disease primarily transmitted through the fecal-oral route, often via contaminated water or food sources, Hepatitis E underscores the critical importance of sanitation and hygiene practices in disease prevention. Furthermore, its ability to induce flu-like symptoms, jaundice, and liver dysfunction underscores the need for heightened awareness and vigilance in clinical settings. By comprehensively exploring Hepatitis E from multiple perspectives, this paper seeks to equip healthcare professionals and stakeholders with the knowledge and insights necessary for effective disease management and control, ultimately striving towards a future free from the burden of Hepatitis E. (Nursing Paper Example on Hepatitis E [SOLVED])

Nursing Paper Example on Hepatitis E [SOLVED]

Causes

Hepatitis E virus (HEV) is the primary causative agent behind Hepatitis E, a viral liver disease known for its global prevalence, particularly in regions with inadequate sanitation infrastructure. The transmission of HEV predominantly occurs through the fecal-oral route, often facilitated by the consumption of contaminated water or food. In areas with poor sanitation, such as rural communities and refugee camps, the risk of Hepatitis E outbreaks escalates, highlighting the intimate connection between hygiene practices and disease transmission. Moreover, zoonotic transmission represents another significant avenue for HEV dissemination, with genotypes 3 and 4 exhibiting the ability to infect various animal reservoirs, including pigs, wild boars, deer, and rabbits. Human infection can occur through direct contact with infected animals or through the consumption of undercooked meat products, emphasizing the importance of food safety measures in disease prevention.

The prevalence of Hepatitis E varies geographically, with genotypes 1 and 2 predominantly affecting developing countries in Asia, Africa, and Central America. These regions often grapple with inadequate sanitation facilities and limited access to clean drinking water, creating fertile ground for Hepatitis E transmission. Conversely, genotypes 3 and 4 are more commonly found in developed countries, where zoonotic transmission plays a significant role in sporadic cases and outbreaks. Climate-related factors, such as flooding and extreme weather events, can exacerbate the spread of Hepatitis E by contaminating water sources and disrupting sanitation infrastructure.

Additionally, certain demographic factors, including age and immunocompromised status, may increase an individual’s susceptibility to Hepatitis E infection. Pregnant women, in particular, face a heightened risk of severe complications from Hepatitis E, including fulminant hepatitis and adverse fetal outcomes. Overall, a multifaceted understanding of the diverse causes and transmission dynamics of Hepatitis E is essential for implementing targeted prevention strategies and mitigating its impact on global public health. (Nursing Paper Example on Hepatitis E [SOLVED])

Signs and Symptoms

Hepatitis E typically presents with a spectrum of symptoms ranging from mild flu-like manifestations to severe liver dysfunction, with the clinical course often influenced by factors such as the patient’s age, immune status, and underlying health conditions. The onset of Hepatitis E is characterized by nonspecific symptoms resembling those of a common viral infection, including fatigue, malaise, fever, and generalized weakness. These early symptoms may be easily overlooked or attributed to other causes, leading to delays in diagnosis and treatment initiation.

As the disease progresses, individuals infected with Hepatitis E may develop more specific symptoms indicative of liver involvement. Jaundice, marked by yellowing of the skin and sclerae, is a hallmark manifestation of liver dysfunction and is often accompanied by dark-colored urine and clay-colored stools. Abdominal discomfort, particularly in the right upper quadrant, may also be reported due to hepatomegaly or inflammation of the liver capsule.

In addition to these classical symptoms, Hepatitis E can manifest with a variety of extrahepatic manifestations, further complicating its clinical presentation. Neurological symptoms, such as confusion, altered mental status, and peripheral neuropathy, have been reported in severe cases of Hepatitis E, particularly among pregnant women and individuals with underlying liver disease. Furthermore, gastrointestinal symptoms, including nausea, vomiting, and anorexia, may contribute to the overall morbidity associated with Hepatitis E infection.

In pregnant women, Hepatitis E infection can precipitate acute liver failure, leading to adverse maternal and fetal outcomes, including preterm birth, stillbirth, and maternal mortality. Therefore, heightened vigilance is warranted when managing Hepatitis E in pregnant individuals, with prompt diagnosis and supportive care being essential for mitigating the risk of complications. Overall, a comprehensive understanding of the diverse signs and symptoms associated with Hepatitis E is crucial for timely recognition and management of this potentially debilitating condition. (Nursing Paper Example on Hepatitis E [SOLVED])

Etiology

The Hepatitis E virus (HEV), belonging to the family Hepeviridae, is the primary etiological agent responsible for Hepatitis E. HEV is a non-enveloped, single-stranded RNA virus with a genome comprised of three open reading frames (ORFs) encoding structural and non-structural proteins essential for viral replication and pathogenesis. The HEV genome exhibits considerable genetic diversity, leading to the classification of HEV into four distinct genotypes (genotypes 1–4), each with unique epidemiological characteristics.

Genotypes 1 and 2 predominantly affect humans and are associated with large-scale outbreaks of Hepatitis E in resource-limited regions, particularly in Asia, Africa, and Central America. These genotypes are primarily transmitted through the fecal-oral route, often due to contaminated water supplies or poor sanitation practices, highlighting the critical role of environmental factors in disease transmission.

In contrast, genotypes 3 and 4 have a broader host range and are capable of infecting both humans and various animal species, including pigs, wild boars, deer, and rabbits. Zoonotic transmission of HEV, particularly from infected swine to humans, represents a significant route of infection in developed countries, leading to sporadic cases and localized outbreaks of Hepatitis E. Consumption of undercooked meat products and direct contact with infected animals are implicated in zoonotic transmission, underscoring the importance of food safety measures and animal husbandry practices in preventing HEV transmission.

Furthermore, genetic variations within HEV genotypes contribute to differences in virulence, transmission efficiency, and clinical outcomes. Subtypes within each genotype may exhibit distinct geographical distributions and transmission dynamics, influencing the epidemiology of Hepatitis E on a global scale. Despite ongoing research efforts, the precise mechanisms underlying HEV pathogenesis and host adaptation remain incompletely understood, highlighting the need for continued exploration into the etiological factors driving Hepatitis E infection. (Nursing Paper Example on Hepatitis E [SOLVED])

Nursing Paper Example on Hepatitis E [SOLVED]

Pathophysiology

Hepatitis E virus (HEV) infection initiates a complex cascade of pathophysiological events within the liver, culminating in hepatocellular injury, inflammation, and dysfunction. Upon entering the host organism through the oral route, HEV gains access to hepatocytes, where it undergoes replication and assembly, facilitated by viral proteins encoded by the viral genome. The replication of HEV RNA leads to the production of viral particles, which are subsequently released into the bloodstream, perpetuating the infection and disseminating the virus to other organs and tissues.

The interaction between HEV and hepatocytes triggers a robust innate immune response, characterized by the production of pro-inflammatory cytokines and chemokines by infected cells and resident immune cells within the liver. This inflammatory milieu attracts circulating immune cells, including macrophages, natural killer cells, and T lymphocytes, to the site of infection, where they contribute to the clearance of infected hepatocytes and viral particles.

Concurrently, the host immune response attempts to contain viral replication through the production of neutralizing antibodies targeting viral antigens. However, in some cases, the immune response may inadvertently exacerbate liver injury, leading to a self-perpetuating cycle of inflammation and tissue damage.

The progressive destruction of hepatocytes and disruption of liver architecture result in impaired hepatic function, manifested by biochemical abnormalities such as elevated serum transaminases (alanine aminotransferase and aspartate aminotransferase), bilirubin, and alkaline phosphatase levels. Additionally, the accumulation of inflammatory infiltrates and fibrotic tissue within the liver parenchyma may lead to the development of cirrhosis, particularly in chronic or immunocompromised individuals.

Overall, the pathophysiology of Hepatitis E underscores the intricate interplay between viral replication, host immune responses, and tissue damage, highlighting the need for a comprehensive understanding of the underlying mechanisms driving disease progression for the development of targeted therapeutic interventions and preventive strategies. (Nursing Paper Example on Hepatitis E [SOLVED])

DSM-5 Diagnosis

Diagnosing Hepatitis E entails a comprehensive evaluation of clinical symptoms, laboratory findings, and serological tests to confirm the presence of Hepatitis E virus (HEV) infection. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), does not include specific criteria for the diagnosis of Hepatitis E; however, clinical guidelines and recommendations provide a framework for establishing the diagnosis.

Patients presenting with symptoms suggestive of acute hepatitis, such as fatigue, malaise, jaundice, and abdominal pain, should undergo thorough medical history-taking and physical examination to assess for potential risk factors and exposures to HEV. A history of recent travel to endemic regions, consumption of contaminated water or food, or contact with infected individuals or animals should raise suspicion for Hepatitis E.

Laboratory investigations play a crucial role in confirming the diagnosis of Hepatitis E and assessing the severity of liver injury. Serum liver function tests, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin levels, are commonly elevated in Hepatitis E, reflecting hepatocellular damage and impaired liver function. Additionally, serological tests for HEV-specific antibodies, such as immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies, aid in confirming acute or past HEV infection.

Molecular assays, such as reverse transcription-polymerase chain reaction (RT-PCR), can detect HEV RNA in serum or stool samples, providing definitive evidence of active viral replication and aiding in the diagnosis of acute Hepatitis E.

Diagnostic criteria for Hepatitis E may vary depending on regional guidelines and laboratory testing availability. Clinicians should exercise clinical judgment and consider the broader context of the patient’s presentation when making a diagnosis of Hepatitis E, ensuring timely intervention and appropriate management of the disease. (Nursing Paper Example on Hepatitis E [SOLVED])

Treatment Regimens and Patient Education

The management of Hepatitis E primarily revolves around supportive care to alleviate symptoms, prevent complications, and promote liver regeneration. Although no specific antiviral therapy exists for Hepatitis E, several treatment strategies and patient education initiatives are essential for optimizing patient outcomes and reducing disease transmission.

Supportive Care: Patients with Hepatitis E benefit from adequate rest and nutrition to support liver function and promote recovery. Encouraging a balanced diet rich in fruits, vegetables, and lean proteins can help mitigate malnutrition and facilitate liver regeneration. Additionally, patients should abstain from alcohol and hepatotoxic medications to prevent further hepatocellular injury.

Symptom Management: Medications such as antipyretics and antiemetics may be prescribed to alleviate fever, nausea, and vomiting associated with Hepatitis E. However, caution must be exercised when administering medications, as certain drugs may exacerbate liver damage or interact with hepatic metabolism pathways.

Monitoring and Follow-up: Patients diagnosed with Hepatitis E should undergo regular monitoring of liver function tests to assess disease progression and monitor for potential complications such as acute liver failure. Close follow-up with healthcare providers ensures timely intervention and adjustment of treatment regimens as needed.

Preventive Measures: Patient education plays a crucial role in preventing Hepatitis E transmission and minimizing the risk of disease recurrence. Educating patients about the importance of practicing good hygiene, including handwashing with soap and water after using the restroom and before handling food, can help prevent fecal-oral transmission of the virus. Patients should also be advised to avoid consuming contaminated water or food, particularly in regions with poor sanitation infrastructure.

Vaccination: While no commercially available vaccine for Hepatitis E is widely available, ongoing research efforts are underway to develop effective vaccines against the virus. Patients should stay informed about advancements in vaccine development and discuss vaccination options with their healthcare providers, particularly if traveling to endemic regions or at increased risk of Hepatitis E infection.

Pregnancy Considerations: Pregnant women diagnosed with Hepatitis E require special attention and monitoring due to the increased risk of adverse maternal and fetal outcomes. Healthcare providers should closely monitor pregnant patients with Hepatitis E for signs of acute liver failure and provide supportive care as needed to optimize maternal and fetal health.

In summary, a comprehensive approach to the management of Hepatitis E encompasses supportive care, symptom management, preventive measures, and patient education initiatives aimed at reducing disease burden and promoting overall well-being. By empowering patients with knowledge and resources to prevent Hepatitis E transmission and manage the disease effectively, healthcare providers play a pivotal role in mitigating the impact of Hepatitis E on individual and public health. (Nursing Paper Example on Hepatitis E [SOLVED])

Conclusion

Hepatitis E represents a significant public health challenge worldwide, necessitating a multifaceted approach to its management and prevention. Through elucidating its causes, signs, symptoms, etiology, pathophysiology, DSM-5 diagnosis, treatment regimens, and patient education, this paper underscores the importance of comprehensive understanding and proactive intervention in combating Hepatitis E. While no specific antiviral therapy exists, supportive care, symptom management, and preventive measures play pivotal roles in alleviating symptoms, preventing complications, and reducing disease transmission. Patient education initiatives are crucial in empowering individuals to adopt hygienic practices and make informed decisions regarding vaccination and risk mitigation strategies. By integrating these strategies into clinical practice and public health policies, healthcare providers can effectively mitigate the impact of Hepatitis E, ultimately striving towards a future where the burden of this disease is minimized, and global health equity is realized. (Nursing Paper Example on Hepatitis E [SOLVED])

References

https://www.ncbi.nlm.nih.gov/books/NBK532278/

 
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