Nursing Paper Help Archives - Page 33 of 144

A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance

(A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance)

A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance

Abstract

Background: The project aims to evaluate the impact of technology with motivational interviewing on medication adherence among inpatient schizophrenia patients.

Problem: The project addresses medication adherence among schizophrenia patients.

Methods: The project adopts a pre-test and post-test analysis approach. Fifty consecutive schizophrenia patients following up with treatment will participate in the study.

Intervention: This DNP project pursues a nurse-led intervention to improve medication adherence and symptom management.

Results:

Conclusions:

Keywords: Medication non-adherence, Schizophrenia, motivational interviewing, success factors influencing motivational interviewing positive effects, motivational interviewing impact on medication adherence, motivational interviewing strategies.

Dedication (NR 709)

Acknowledgment (NR 709)

Abstract 2

Dedication (NR 709) 3

Acknowledgment (NR 709) 4

Introduction. 7

Problem.. 7

Project Aim and Supporting Objectives (NR 702) 9

Practice Question (NR 702) 9

Research Synthesis and Evidence-Based Intervention. 10

Evidence-Based Intervention. 10

Evidence Synthesis. 11

Main Themes in the Research 11

Contrasting Elements in the Research 12

Research Support for the Evidence-Based Interventions. 13

Evidence-Based Intervention Implementation. 13

Explanation of the Evidence-Based Intervention. 13

Steps in the Intervention Implementation. 14

Participant Engagement during Intervention Implementation. 14

Methodology. 16

Organizational Setting. 16

Population. 16

Translational Science Model and Project Management Plan. 17

Project Management Plan. 19

Formative Evaluation Plan. 19

Plans for Sustainability. 20

Anticipated Outcomes. 21

Expected Change after Implementing Motivational Interviewing. 21

References. 22

Appendices, Tables, and Figures. 25

Appendix A.. 25

Johns Hopkins Nursing Evidence-Based Practice. 25

Table 1: Implementation Plan. 31

Table 2: Formative Evaluation Plan. 32

A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance

Introduction

Schizophrenia is a mental disorder that impairs thought processes, patterns, perceptions, emotional responses, and social interactions (NIMH, n.d.). Schizophrenia is persistent and can be severe and disabling when symptoms are not adequately managed (NIMH, n.d.). This DNP project pursues a nurse-led intervention to improve medication adherence and symptom management. Mucci et al. (2020) recommend a person-centered approach to healthcare that encompasses building therapeutic relationships between providers and patients and collaboration between providers when working with schizophrenia patients to achieve compliance. Specifically, the project aims to evaluate the impact of technology with motivational interviewing on medication adherence among inpatient schizophrenia patients. This DNP Project Manuscript provides the introduction, background, problem, project aim, supporting objectives, practice question, literature synthesis, and methodology. (A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance)

Problem

Numerous studies have shown a varying prevalence of Schizophrenia globally and in the US. The global prevalence of Schizophrenia among non-institutionalized persons ranges between 0.33% and 0.75%, while in the United States, Schizophrenia is 0.25% to 0.64% (NIMH, n.d.). Non-adherence to medication among Schizophrenia patients is well documented in the United States (US) and globally. Desai and Nayak (2019) suggest most schizophrenia patients are non-compliant with medication, a national and global problem that affects 70% of patients.

Non-adherence increases the use of outpatient and hospital-related resources, while comorbidities and demographic factors exacerbate the problem. Additionally, it affects health outcomes among schizophrenia patients, increasing the risk of premature death compared to the general population, making it a significant health problem at the practicum site. The average life lost in the US due to Schizophrenia is about 28.5 years (NIMH, n.d.). Most comorbid conditions associated with Schizophrenia, including liver disease, heart disease, and diabetes, increase the risk of premature and go unrecognized. Over 50% of schizophrenia patients have additional behavioral and mental health problems. According to NIMH (n.d.), an estimated 4.9% of individuals diagnosed with Schizophrenia commit suicide, significantly higher than the general population, estimated at 14.2 per 100,000 people or 0.0142%.

The financial costs associated with managing Schizophrenia increase exponentially with co-occurring mental, physical, and behavioral health conditions. The direct costs include those related to the hospital stay and medication due to worsening symptoms and general health conditions. In contrast, the indirect costs include costs due to social service needs, lost productivity, involvement of criminal justice, and issues beyond healthcare. The total cost of managing Schizophrenia and co-occurring health problems averages $2,004 to 94,229 per person per year (Kotzeva et al., 2022). Per Kotzeva et al. (2022), indirect costs make up 50-60% of the total cost, making it the primary cost driver, averaging $1,852 to $62,431 per person per year.

Non-adherence to medication among schizophrenia patients is a significant problem at the practicum site, associated with an increased risk of premature death compared to the general population, hospital stays, frequent readmissions, and increased healthcare burden for the family and the system. Family and patient education help address non-adherence, but no evidence indicates desired success because it continues to be a problem among this patient population. In addition, there is no documentation of other interventions to address the non-adherence at the practicum site. This project is an opportunity to adopt motivational interviewing and technology, evidence-based interventions with indicated benefits, and high success rates in addressing non-adherence. (A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance)

Project Aim and Supporting Objectives (NR 702)

The DNP project aims to determine the impact of motivational interviewing and technology on medication adherence among inpatient schizophrenia patients. The project objectives are as follows:

To evaluate the role of technology on medication adherence among inpatient schizophrenia patients.
To assess the impact of motivational interviews on medication adherence among inpatient schizophrenia patients.
To compare the impact of technology and motivational interviewing on medication adherence and the current interventions for enhancing medication adherence at the practicum site

Practice Question (NR 702)

The following practice question will serve as the basis of the DNP project: 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 non-adherence (O) in 8-10 weeks (T)?

Research Synthesis and Evidence-Based Intervention

Evidence-Based Intervention

Motivational Interviewing (MI) is an evidence-based intervention to encourage behavioral change. MI is a collaborative, goal-oriented communication approach that focuses on the language of change to help people bolster personal or intrinsic motivation for and commitment to a particular objective by considering the individual’s need for change in an accepting and compassionate atmosphere. MI guides communication, balancing good listening and offering information and advice to empower individuals to change by eliciting their meaning, need, and capacity for change. Its foundation is a respectful and curious approach to interacting with people to promote a natural change process while honoring the patient’s autonomy. MI is primarily used for patients unwilling or ambivalent to change, combining different evidence-based interventions from cognitive and social psychology. It assumes that individuals with problematic attitudes and behaviors have varying readiness for change levels. Not recognizing the ambivalence would lead to patients rendering well-intentioned medical advice threatening their autonomy and freedom of choice, increasing their will to exercise their freedom to make choices, and increasing non-adherence. The DNP project adopts MI as an evidence-based intervention to increase personal motivation for and committed attitudes and behaviors to help schizophrenia patients find their meaning and need for change in an accepting and empathetic atmosphere, aiming to improve medication adherence. The Motivation Interviewing Network of Trainers (MINT) endorses this intervention to encourage behavioral change. (A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance)

Evidence Synthesis

This evidence-based synthesis of research supports the intervention, motivational interviewing, and its impact on medication adherence. Ten articles fit the inclusion criteria, which required articles to be five years old or less, evidence-based, peer-reviewed, and demonstrate the efficacy of the chosen intervention, i.e., technology with motivational interviewing (MI) in improving medication adherence. Both qualitative and quantitative studies supporting the intervention were selected for this paper. The ten articles selected for review include Dobber et al. (2018), Dobber et al. (2020), Harmacnci and Budak (2022), Zomahoun et al. (2017), Pupus et al. (2022), Palacio et al. (2019), Hogan et al. (2020), Aubeeluck et al. (2021), Khadoura et al. (2021), and Abughosh et al. (2019).

Of the selected articles, six were level I, one was level II, and three were level III. The types of evidence included in level I evidence are clustered randomized controlled trials, experimental studies, and systematic reviews of RCT with or without meta-analysis. Types of evidence in level II evidence is a prospective study. Finally, level III evidence includes a qualitative multiple case study, mixed method study, and secondary data analysis. All studies were high quality, with consistent, generalizable findings, a sufficient sample size for the respective designs and study purpose, adequate control, definitive conclusions, and pervasive recommendations based on the results. (A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance)

Main Themes in the Research

The primary themes include success factors influencing MI positive effects, association between MI techniques and medication adherence, and MI impact on medication adherence. Regarding success factors influencing MI positive effects, Dobber et al. (2018) and Dobber et al. (2020) established that trusting relationships between patients and therapists, the therapist’s ability to adopt or tailor MI strategy to a patient’s issues, and incorporating the patient’s values, needs, and perceptions of long-term medication adherence can increase MI-intervention success for medication adherence in schizophrenia patients and that a trusting relationship and empathy could help trigger mechanisms of change and enhance medication adherence. On the association between MI techniques and medication adherence, various MI techniques, including telephonic MI, fidelity-based feedback, face-to-face MI, MI-consistent (MICO) method, and MI-techniques-based psychoeducation are associated with improved medication adherence (Palacio et al., 2019; Abughosh et al., 2019; Hogan et al., 2020; Harmanci & Budak, 2022). Regarding MI impact on medication adherence, Papus et al. (2022), Zomahoun (2018), Aubeeluck et al. (2021), and Khadoura et al. (2021) established a positive association between MI and medication adherence and associated factors self-efficacy and patients’ intrinsic motivation. (A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance)

Contrasting Elements in the Research

Regarding MI-based telephone intervention, Palacio et al. (2019) found varying effects across various categorical measures, implying that telephonic MI impacted different groups or measures differently. However, Abughosh et al. (2019) findings across all patient groups were consistent, indicating better results for those who received two or more calls. Themes vary across the studies. Dobber et al. (2018) and Dobber et al. (2020) address the success factors influencing MI’s positive effects. Palacio et al. (2019), Abughosh et al. (2019), Hogan et al. (2020), and Harmanci and Budak (2022) address specific MI techniques adopted to address medication adherence, including telephonic MI, fidelity-based feedback, face-to-face MI, MI-consistent (MICO) method, and MI-techniques-based psychoeducation. Papus et al. (2022), Zomahoun (2018), Aubeeluck et al. (2021), and Khadoura et al. (2021) address MI in general and its effectiveness in improving medication adherence. (A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance)

Research Support for the Evidence-Based Interventions

MI was selected because of its adaptability to many settings (Pupus et al., 2022). Moreover, MI has significantly impacted medication adherence (Dobber et al., 2018; Dobber et al., 2020; Harmacnci and Budak, 2022; Zomahoun et al., 2017; Pupus et al., 2022; Palacio et al., 2019; Hogan et al., 2020; Aubeeluck et al., 2021; Khadoura et al., 2021; Abughosh et al., 2019). MI is also associated with various mental health outcomes that promote medication adherence, such as hope and mental well-being (Harmacnci & Budak, 2022). These aspects of MI suggest that the intervention is evidence-based and can help mitigate medication non-adherence among schizophrenia patients in an inpatient facility. (A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance)

Evidence-Based Intervention Implementation

Explanation of the Evidence-Based Intervention

Across the research studies, MI is an evidence-based, collaborative tool for improving medication adherence. The studies acknowledge MI focuses on patient ambivalence and lack of the individual’s motivation and commitment to change. Patients are aware of the positive effects of medication, such as preventing psychotic relapse and readmission but are burdened by the side effects and the need to take medication as prescribed. The therapist is at the center of implementing MI in healthcare organizations and is deliberately influencing patients’ motivation for change by adopting strategies such as change talk elicitation, sustain talk, developing trusting relationships with patients, adopting empathetic attitudes, and communicating partnerships with patients. The therapist can intervene through the four overlapping processes of MI. The processes include engaging or relation building, focusing or identifying a patient’s change, evoking or eliciting change talk and client’s need for change, and planning or helping the patient create a comprehensive change plan. The therapists are integral across studies in implementing MI techniques such as telephonic MI, calling and communicating with the patients, fidelity-based feedback, face-to-face MI, MI-consistent (MICO) method, and MI-techniques-based psychoeducation. Generally, the studies consider the therapist imperative in implementing MI and the patient and patient perspectives as the drivers of MI.

Steps in the Intervention Implementation

Across the research studies, MI and MI techniques have been adopted using the four processes of MI: engaging, focusing, evoking, and planning. The first process, engaging, allows the therapist to develop a good trusting and working relationship with the client to understand the problem, using reflective listening to understand the client and the ambivalent attitude. The second process is focusing, which involves identifying a clear objective and goal, including identifying target behavior, exploring ambivalence and barriers, and establishing discrepancy. The project’ intervention target behavior is medication adherence. In the evoking process, the therapist tries to evoke the client’s internal motivation and needs for change and reinforce the overall motivation for change. This process involves the change talk that stimulates desire and motivation for change and mobilizes commitment, and sustain talk, which ensures the target behavior is sustained over time.

Participant Engagement during Intervention Implementation

Motivational interviewing is more patient-centered, promoting the patient’s autonomy while eliciting motivation, the need for change, and commitment to change. The practitioner will engage patient perspectives through the implementation and the MI processes to ensure continuous patient engagement. Practitioners involved will continuously ask questions, reinforce responses using affirmations, and adopt a lot of reflective listening to ensure the patients feel heard and engaged, encouraging their involvement through the intervention implementation. A good and trusting relationship will precede every activity to establish good engagement before beginning the change conversation. The therapists will use the guiding style to engage participants, clarify strengths, motivation, and need for change, and foster autonomy in decision-making to ensure full involvement throughout the implementation. (A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance)

Methodology

This section describes the organizational setting, project population, translation science model and project management, plans for sustainability, and anticipated outcomes.

Organizational Setting

The healthcare setting is a general mental health facility located in Los Angelos, California, for treating various mental health disorders. The organization adopts mental health teams based in communities, that offer daily support and treatment while helping schizophrenia patients gain independence. The teams include nurses, therapists, psychiatrists, psychologists, and social workers.

The study focuses on patients with Schizophrenia as the primary diagnosis. Schizophrenia is associated with significant thinking or cognitive, behavioral, and emotional problems. Individuals between 16 and 25 are the most vulnerable, although new schizophrenia cases increase in their teenage years. Most patients present with hallucinations, delusions, and confused or disturbed thoughts that impact behavior and social and occupational functioning. About 150-230 schizophrenia patients are seen monthly at the facility or in their respective homes by the mental health teams based in the communities. On average, a hospitalized schizophrenia patient can stay in the hospital between 11 days to 23 days, depending on the condition and symptoms severity. An experienced psychiatrist coordinates a team consisting of a combination of psychopharmacologists, therapists, social workers, nurses, vocational counselors, and case managers contributes to patient health management and outcome.

Population

The first 50 consecutive schizophrenia patients that fit the inclusion criteria will be involved in the study. The project population includes schizophrenia patients experiencing thinking or cognitive, behavioral, and emotional problems, both men and women reporting at the facility or requesting home visits from the mental health team based in the communities. The inclusion criteria is: patients diagnosed with Schizophrenia according to the International Statistical Classification of Diseases-10 criteria, between 18 and 65 years, and receiving treatment for the last six months, follow-up patients, patients with multiple schizophrenia episodes, and patients with recent psychotic relapse after non-adherence to therapy will be considered. The research invites existing users of health services at the facility to participate in the study. Participants will provide informed consent before collecting data as an inclusion requirement. In addition, the study will recruit any follow-up schizophrenia patient attending psychiatric evaluation in the inpatient or outpatient departments after consent. The exclusion criteria include acutely psychotic patients during the interview and patients with cognitive deficits impacting the interview or data collection. The researchers will first communicate participation requests and study details via text messages, which are suitable even for older patients.

Translational Science Model and Project Management Plan

The Iowa model of evidence-based practice will help implement motivational interviewing to enhance medication adherence among schizophrenia patients. It supports evidence-based practice implementation, research utilization, and knowledge transformation processes (Duff et al., 2020). Per the Iowa model, the DNP practice project development and implementation include the following steps:

I identified medication non-adherence among schizophrenia patients as warranting EBP adoption.
Medication non-adherence is a priority for the organization as it is linked with increased treatment failure, hospitalization, readmission, and mortality rates. Addressing this problem would improve hospital and patient health outcomes.
I developed a team of a combination of psychopharmacologists, therapists, social workers, nurses, vocational counselors, and case managers to develop, examine, and implement motivational interviewing to address medication non-adherence among schizophrenia patients.
I developed a 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 non-adherence (O) in 8-10 weeks (T)?” to guide literature search and the DNP project. I searched for peer-reviewed articles from various databases, including PubMed, MEDLINE, and CINAHL, addressing the impact of motivational interviewing on medication adherence.
I reviewed the articles based on their abstract, research purpose, methodology, research findings, evidence level, and quality and presented the results of 10 articles on the evidence synthesis summary tool/table. Based on the evidence, motivational interviewing is scientifically supported, sound, and clinically significant.
Ten articles were identified as providing the best evidence to help answer the research question. Based on the assessment, the evidence is sufficient to guide and inform the implementation of motivational interviewing at the healthcare facility.
The project team and I will implement motivational interviewing into a pilot program that includes follow-up schizophrenia patients only.
The team and I will evaluate the implementation results to determine the impact of motivational interviewing on medication adherence among schizophrenia patients. Clinically significant results will warrant the implementation of motivational interviewing organization-wide.

Project Management Plan

The DNP project implementation will take 12 weeks to complete. Week 1 will involve identifying participants and collecting pre-implementation data. In week 2, steps 1, 2, and 3 will be completed, including problem identification, priority determination, and team development. In week 3, steps 4, 5, and 5, involving evidence gathering and analysis, research articles critiquing and synthesis, and evidence assessment for adequacy will be completed. The implementation of motivational interviewing will begin in week 4 and through weeks 5, 6, 7, 8, 9, 10, and 11. Finally, in week 12, post-summative data after intervention implementation will be collected and outcomes evaluated, which is step 8 of the project implementation plan, to determine the effectiveness of motivational interviewing in addressing medication adherence among schizophrenia patients and whether it is suitable to implement in the rest of the organization and patient populations. See Appendix B for implementation plan table.

Formative Evaluation Plan

The formative evaluation will include individual evaluation conducted before, during, and after intervention implementation aiming to improve project development and implementation design and performance and ensure activities are completed effectively and efficiently. This formative evaluation will help understand why and how the project works and other factors at work during project development and implementation and increase the likelihood of successful results or outcomes through continuous improvements informed by evaluation results at different project implementation steps. See Appendix C for formative evaluation plan table.

Plans for Sustainability

The sustainability objective is to ensure motivational interviewing’s organization-wide adoption and patients continues to enjoy its benefits in improving medication adherence over time. The project manager will have a checklist against which they will ensure that the intervention maintains alignment with the organization mission and vision statements and continues to achieve the project goals and objectives. The checklist will include critical success factors, including medication adherence measures that will help assess the continued effectiveness of the intervention. The sustainability plan adopts continuous quality and performance improvement that will require consistent data collection after project implementation. The project team will gather data on MI from patient records and the organization’s medical data regarding treatment failure, hospitalization, readmission, and mortality rates over time and patients’ self-reported surveys and interviews on changes in medication adherence behavior over time to measure the continual effectiveness of the intervention. The project team will continually conduct project auditing and feedback collection from providers, patients, family members, caregivers, and opinion leaders on the performance of MI post-implementation. The project team assigned with sustainability responsibilities will analyze the data and feedback to inform continuous quality improvement initiatives to ensure project sustainability. Additionally, ongoing provider and patient education will help ensure MI continues to improve medication adherence into the future. (A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance)

Anticipated Outcomes

Expected Change after Implementing Motivational Interviewing

Implementing motivational interviewing is expected to improve medication adherence behavior, which is indicated by measures including treatment failure, readmission, hospitalization, and mortality rates. The desired changes based on these measures include decreased treatment failure rate, reduced readmission rate, decreased hospitalization rates, and decreased mortality rate associated with Schizophrenia. Per Aubeeluck et al. (2021), MI interventions significantly improved medication adherence in 5 RCTs and systolic blood pressure in 1 RCT. Khadoura et al. (2021) found that MI significantly improved medication adherence, self-efficacy, and intrinsic motivation for patients in the intervention group. According to Papus et al. (2022), MI improved medication adherence in 23 RCTs and risky behaviors and disease symptoms in 19 RCTs. Additionally, Zomahoun (2018) established that MI interventions might help improve medication adherence for chronic conditions in adults. The evidence indicates a positive relationship between motivational interviewing and medication adherence, although measures used vary for the different studies. (A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance)

References

Abughosh, S., Wang, X., Serna, O., Esse, T., Mann, A., Masilamani, S., Holstad, M. M., Essien, E. J., & Fleming, M. (2019). A Motivational Interviewing Intervention by Pharmacy Students to Improve Medication Adherence. Journal of managed care & specialty pharmacy, 23(5), 549–560. https://doi.org/10.18553/jmcp.2019.23.5.549

Aubeeluck, E., Al-Arkee, S., Finlay, K., & Jalal, Z. (2021). The impact of pharmacy care and motivational interviewing on improving medication adherence in patients with cardiovascular diseases: A systematic review of randomized controlled trials. International journal of clinical practice, 75(11), e14457. https://doi.org/10.1111/ijcp.14457

Cabarrus College of Health Sciences. (2023, February 3). Cabarrus College of Health Sciences Library: IOWA Model. https://cabarruscollege.libguides.com/c.php?g=465666&p=5283295

Desai, R., & Nayak, R. (2019). Effects of medication non-adherence and comorbidity on health resource utilization in Schizophrenia. Journal of Managed Care & Specialty Pharmacy, 25(1), 37-46. https://doi.org/10.18553/jmcp.2019.25.1.037

Dobber, J., Latour, C., de Haan, L., Scholte op Reimer, W., Peters, R., Barkhof, E., & van Meijel, B. (2018). Medication adherence in patients with Schizophrenia: a qualitative study of the patient process in motivational interviewing. BMC Psychiatry, 18(1), 1-10. https://doi.org/10.1186/s12888-018-1724-9

Dobber, J., Latour, C., van Meijel, B., Ter Riet, G., Barkhof, E., Peters, R., … & de Haan, L. (2020). Active ingredients and mechanisms of change in motivational interviewing for medication adherence. A mixed methods study of patient-therapist interaction in patients with Schizophrenia. Frontiers in psychiatry, 11, 78. https://doi.org/10.3389/fpsyt.2020.00078

Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidence-based practice environment: an interpretive description. Implementation science communications, 1, 85. https://doi.org/10.1186/s43058-020-00070-0

Harmanci, P., & Budak, F. K. (2022). The Effect of Psychoeducation Based on Motivational Interview Techniques on Medication Adherence, Hope, and Psychological Well-Being in Schizophrenia Patients. Clinical Nursing Research, 31(2), 202-216. https://doi.org/10.1177/10547738211046438

Hogan, A., Catley, D., Goggin, K., & Evangeli, M. (2020). Mechanisms of Motivational Interviewing for Antiretroviral Medication Adherence in People with HIV. AIDS and behavior, 24(10), 2956–2965. https://doi.org/10.1007/s10461-020-02846-w

Iowa Model Collaborative, Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy, A. M., Rakel, B., Steelman, V., Tripp-Reimer, T., Tucker, S., & Authored on behalf of the Iowa Model Collaborative (2017). Iowa Model of Evidence-Based Practice: Revisions and Validation. Worldviews on evidence-based nursing, 14(3), 175–182. https://doi.org/10.1111/wvn.12223

Khadoura, K. J., Shakibazadeh, E., Mansournia, M. A., Aljeesh, Y., & Fotouhi, A. (2021). Effectiveness of motivational interviewing on medication adherence among Palestinian hypertensive patients: a clustered randomized controlled trial. European journal of cardiovascular nursing, 20(5), 411–420. https://doi.org/10.1093/eurjcn/zvaa015

Kotzeva, A., Mittal, D., Desai, S., Judge, D., & Samanta, K. (2022). Socioeconomic burden of Schizophrenia: A targeted literature review of types of costs and associated drivers across ten countries. Journal of medical economics, (just-accepted), 1-18. https://doi.org/10.1080/13696998.2022.2157596

Mucci, A., Kawohl, W., Maria, C., & Wooller, A. (2020). Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making. Frontiers in psychiatry, 11, 761. https://doi.org/10.3389/fpsyt.2020.00761

National Institute of Mental health. (No date). Schizophrenia. Available at: https://www.nimh.nih.gov/health/statistics/schizophrenia (Accessed January 14, 2023)

Palacio, A., Garay, D., Langer, B., Taylor, J., Wood, B. A., & Tamariz, L. (2019). Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis. Journal of general internal medicine, 31(8), 929–940. https://doi.org/10.1007/s11606-016-3685-3

Papus, M., Dima, A. L., Viprey, M., Schott, A. M., Schneider, M. P., & Novais, T. (2022). Motivational interviewing to support medication adherence in adults with chronic conditions: a systematic review of randomized controlled trials. Patient Education and Counseling.

Zomahoun, H. T. V., Guénette, L., Grégoire, J. P., Lauzier, S., Lawani, A. M., Ferdynus, C., Huiart, L., & Moisan, J. (2018). Effectiveness of motivational interviewing interventions on medication adherence in adults with chronic diseases: a systematic review and meta-analysis. International journal of epidemiology, 46(2), 589–602. https://doi.org/10.1093/ije/dyw273

Appendices, Tables, and Figures

Appendix A

Johns Hopkins Nursing Evidence-Based Practice

Individual Evidence Summary Tool

Ó The Johns Hopkins Hospital/The Johns Hopkins University

Article #	Author & Date	Evidence Type	Sample, Sample Size & Setting	Study findings that help answer the EBP question	Limitations	Evidence Level & Quality
1.	Dobber, J., Latour, C., de Haan, L., Scholte op Reimer, W., Peters, R., Barkhof, E., & van Meijel, B. (2018).	A qualitative multiple case study	14 cases of schizophrenia patients were used in the study	Trusting relationships between patients and therapists, the therapist’s ability to use MI-strategy in the patient process, and considering patient values in long-term medication adherence can increase MI-intervention success for medication adherence in schizophrenia patients.	A small sample size can limit generalizability	Level III/Quality A
2.	Palacio, A., Garay, D., Langer, B., Taylor, J., Wood, B. A., & Tamariz, L. (2019)	Systematic Review and Meta-analysis	17 RCTs were included in the review	Telephonic MI and fidelity-based feedback were significantly linked to medication adherence.	Included a few studies focusing on non-minority populations. Most studies were on antiretroviral medications, limiting generalizability. The small sample size limited the power of analyses.	Level I/Quality A
3.	Dobber, J., Latour, C., van Meijel, B., Ter Riet, G., Barkhof, E., Peters, R., … & de Haan, L. (2020).	A Mixed Methods Study	14 cases of schizophrenia patients were included in the study.	A trusting relationship and empathy can help trigger mechanisms of change.	A small sample size limits generalizability. Limited visibility and measurability of most patient factors and change mechanisms.	Level III/Quality A
4.	Papus, M., Dima, A. L., Viprey, M., Schott, A. M., Schneider, M. P., & Novais, T. (2022).	A systematic review of randomized controlled trials	The study included 54 RCTs.	MI improved medication adherence in 23 RCTs and risky behaviors and disease symptoms in 19 RCTs.	The study focused on chronic conditions limiting generalizability for other disease conditions.	Level I/Quality A
5.	Zomahoun, H. T. V., Guénette, L., Grégoire, J. P., Lauzier, S., Lawani, A. M., Ferdynus, C., Huiart, L., & Moisan, J. (2018).	A systematic review and meta-analysis	The meta-analysis included 16 RCTs.	MI interventions might help improve medication adherence for chronic conditions in adults.	The sample size was small, limiting generalizability.	Level I/Quality A
6.	Hogan, A., Catley, D., Goggin, K., & Evangeli, M. (2020).	A secondary analysis of data	62 HIV adult patients were included in the study.	MI-consistent (MICO) method was positively associated with change and sustained talk.	The historic nature of the data and limited statistical control limits the study. In addition, one MI session was used, and there was no variable manipulation, limiting the establishment of causality.	Level III/Quality A
7.	Aubeeluck, E., Al-Arkee, S., Finlay, K., & Jalal, Z. (2021).	A systematic review of randomized controlled trials	8 RCTs were included in the study.	MI interventions significantly improved medication adherence in 5 RCTs and systolic blood pressure in 1 RCT.	Small sample size limited generalizability.	Level I/Quality A
8.	Khadoura, K. J., Shakibazadeh, E., Mansournia, M. A., Aljeesh, Y., & Fotouhi, A. (2021).	A clustered randomized controlled trial	355 hypertensive patients were included as participants.	MI significantly improved medication adherence, self-efficacy, and intrinsic motivation for patients in the intervention group.	The focus on one disease condition can limit generalizability.	Level I/Quality A
9.	Abughosh, S., Wang, X., Serna, O., Esse, T., Mann, A., Masilamani, S., Holstad, M. M., Essien, E. J., & Fleming, M. (2019)	A prospective study	11 students were included in implementing the intervention, and 743 patients were the subjects.	MI-based telephone intervention is promising in improving medication adherence. Patients who completed the initial call and at least 2 fall calls were more likely to be adherent.	The effects were for a short period, and more research is required for longer periods.	Level II/ Quality A
10.	Harmanci, P., & Budak, F. K. (2022)	A pretest-posttest control group design	150 schizophrenia patients participated in the study.	MI-techniques-based psychoeducation significantly enhanced medication adherence, hope, and psychological well-being for patients in the experimental group.	The effects were short-term, and clinicians should be careful when adopting the results.	Level I/Quality A

Appendix B

Table 1: Implementation Plan

Week	Activity
Week 1	Pre-implementation data collection.
Week 2	Step 1: Problem identification Step 2: Determining whether the problem is a priority to the organization Step 3: Team development
Week 3	Step 3: Evidence gathering and analysis Step 4: Research articles critique and synthesis Step 5: Evidence assessment for the adequacy
Week 4	Step 7: Intervention implementation
Week 5	Step 7: Intervention implementation
Week 6	Step 7: Intervention implementation
Week 7	Step 7: Intervention implementation
Week 8	Step 7: Intervention implementation
Week 9	Step 7: Intervention implementation
Week 10	Step 7: Intervention implementation
Week 11	Step 7: Intervention implementation
Week 12	Post-summative data collection Step 8: Outcome evaluation

Appendix C

Table 2: Formative Evaluation Plan

Week	When	Why	How (Oversight)
Week 1	Pre-project implementation	· Understand the need for the project	· Leadership meetings
Week 2	Project development	· Clarify the need for the project	· Problem tree analysis · Priority Matrix · Stakeholder analysis
Week 3	Project development	· Clarify the need for the problem · Identify problem impact · Clarify intervention selected	· Literature review · Solution tree analysis
Week 4	Project implementation	· Develop project design before roll-out	· Focus group · Discussions
Week 5	Project implementation	· Improve project design as it is rolled out	· Semi-structured interview · ORID · Project diary
Week 6	Project implementation	· Ensure project implementation activities are delivered efficiently and effectively.	· Schedule tracking · Budget tracking · Observation · Dartboard · Questionnaire · Huddles
Week 7	Project implementation	· Ensure project implementation activities are delivered efficiently and effectively.	· Schedule tracking · Budget tracking · Observation · Dartboard · Questionnaire · Huddles
Week 8	Project implementation	· Ensure project implementation activities are delivered efficiently and effectively.	· Schedule tracking · Budget tracking · Observation · Dartboard · Questionnaire · Huddles
Week 9	Project implementation	· Ensure project implementation activities are delivered efficiently and effectively.	· Schedule tracking · Budget tracking · Observation · Dartboard · Questionnaire · Huddles
Week 10	Project implementation	· Ensure project implementation activities are delivered efficiently and effectively.	· Schedule tracking · Budget tracking · Observation · Dartboard · Questionnaire · Huddles and meetings
Week 11	Project implementation	· Ensure project implementation activities are delivered efficiently and effectively.	· Schedule tracking · Budget tracking · Observation · Dartboard · Questionnaire · Huddles and discussions
Week 12	Post-project implementation	· Ensure the project is completed successfully.	· Leadership meetings · Project team discussions · Schedule tracking · Budget tracking · Observation · Dartboard · Questionnaire

(A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance)

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

M5 -Assignment # 4- Adverse Selection vs. Favorable Selection

April 14, 2024/in Assignment Help, Assignment Help Nursing, BLOG, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays /by Aimee Grace

(M5 -Assignment # 4- Adverse Selection vs. Favorable Selection)

Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

M5 -Assignment # 4- Adverse Selection vs. Favorable Selection

Adverse selection occurs when vendors have information that customers do not or when customers possess information that sellers do not. This circumstance uses asymmetric information, also known as information failure, that happens when one side of a transaction knows more about the relevant subject matter than the other. Typically, the selling party has more knowledge (Hayes, 2022). High-risk patients frequently choose life insurance or insurance with higher premiums when buying insurance. Due to consumers’ lack of informational support from insurers and the resulting asymmetries in insurance plans, adverse selection typically increases costs. Adverse selection results in plan price distortions in the health insurance marketplaces, which makes it ineffective to sort clients among health plans. Medicare and other stakeholders should be aware of this and exercise caution because adverse selection increases the insurer’s risk of incurring losses from the anticipated claims (Cliff et al., 2022). These circumstances raise premiums, which worsen adverse selection when healthy people choose not to get the increasingly expensive insurance.

Favorable or advantageous selection utilizes information about service consumption patterns and assumes that those with high mortality risks will not acquire life insurance. In other words, beneficiaries whose costs were below average after accounting for specific demographics and clinical characteristics disproportionately opted for Medicare Advantage, while beneficiaries whose costs were above average disproportionately opted for traditional Medicare (Newhouse et al., 2016). It is anticipated that a specific patient population would use fewer medical services than was anticipated. Regarding favorable selection in HMO plans and Medicare programs, research indicates persistent evidence of strong favorable HMO selection. A favorable HMO selection happens if Medicare HMOs draw a disproportionate number of relatively healthy Medicare enrollees inside the payment “cells” designated by the risk adjustment variables within that payment formula (Goldberg et al., 2017). The evidence indicates that HMO enrollees had considerably lower pre-enrollment healthcare service utilization, reduced post-enrollment mortality rates, and increased self-reported health and functional status than those individuals who stayed in FFS.

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

Goldberg, E. M., Trivedi, A. N., Mor, V., Jung, H. Y., & Rahman, M. (2017). Favorable risk selection in Medicare Advantage: trends in mortality and plan exits among nursing home beneficiaries. Medical Care Research and Review, 74(6), 736-749. https://pubmed.ncbi.nlm.nih.gov/27516452/

Hayes, A. (2022). Adverse selection: definition, how it works, and the lemons problem. https://www.investopedia.com/terms/a/adverseselection.asp#:~:text=Adverse%20selection%20occurs%20when%20one,profitable%20or%20riskier%20market%20segments.

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

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

M4 Assignment: Health Service Administrators’ Roles and Responsibilities

April 14, 2024/in Assignment Help, Assignment Help Nursing, BLOG, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays /by Aimee Grace

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

Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

M4 Assignment: Health Service Administrators’ Roles and Responsibilities

Health Service Administrators’ Roles and Responsibilities

Introduction

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.

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.

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.

References

Cronin, C. E., Schuller, K. A., & Bolon, D. S. (2018). Hospital administration as a profession. Professions and Professionalism, 8(2), e2112-e2112. https://journals.oslomet.no/index.php/pp/article/view/2112

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/

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Week 7: Course Project – Recommendations

April 14, 2024/in Assignment Help, Assignment Help Nursing, BLOG, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays /by Aimee Grace

(Week 7: Course Project – Recommendations)

Technology, Society, and Culture

February 18, 2022

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

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Discussion Board Rebuttal

April 13, 2024/in Assignment Help, Assignment Help Nursing, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays /by Aimee Grace

(Discussion Board Rebuttal)

Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

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

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/

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Week 7: The Value of Peer Review

April 13, 2024/in Assignment Help, Assignment Help Nursing, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays /by Aimee Grace

(Week 7: The Value of Peer Review)

Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

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

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

M4 Discussion

April 13, 2024/in Assignment Help, Assignment Help Nursing, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays /by Aimee Grace

(M4 Discussion)

Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

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

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

M4 Assignment: Health Service Administrators’ Roles and Responsibilities

April 13, 2024/in Assignment Help, Assignment Help Nursing, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays /by Aimee Grace

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

Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

M4 Assignment: Health Service Administrators’ Roles and Responsibilities

Roles and Responsibilities of Health Service Administrators

Conclusion

References

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

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

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

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

M5-Week 5 Discussion – Capitation

April 13, 2024/in Assignment Help, Assignment Help Nursing, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays /by Aimee Grace

M5-Week 5 Discussion - Capitation

(M5-Week 5 Discussion – Capitation)

Student’s Name:

Institution of Affiliation:

Course Code + Course Title

Instructor’s Name:

Assignment Due Date:

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

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Week 8: Course Project – Presentation

April 12, 2024/in Assignment Help, Assignment Help Nursing, Homework Help, Nursing Exam Help, Nursing Paper Help, Psychology assignment help, Solved Nursing Essays /by Aimee Grace

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

Abstract

Dedication (NR 709)

Acknowledgment (NR 709)

Table of Contents

A Nurse-Led Intervention in Schizophrenia Patients to Improve Medication Adherence Compliance

Introduction

Problem

Project Aim and Supporting Objectives (NR 702)

Practice Question (NR 702)

Research Synthesis and Evidence-Based Intervention

Evidence-Based Intervention

Evidence Synthesis

Main Themes in the Research

Contrasting Elements in the Research

Research Support for the Evidence-Based Interventions

Evidence-Based Intervention Implementation

Explanation of the Evidence-Based Intervention

Steps in the Intervention Implementation

Participant Engagement during Intervention Implementation

Methodology

Organizational Setting

Population

Translational Science Model and Project Management Plan

Project Management Plan

Formative Evaluation Plan

Plans for Sustainability

Anticipated Outcomes

Expected Change after Implementing Motivational Interviewing

References

Appendices, Tables, and Figures

Appendix A

Johns Hopkins Nursing Evidence-Based Practice

Individual Evidence Summary Tool

Appendix B

Table 1: Implementation Plan

Appendix C

Table 2: Formative Evaluation Plan

Do you need a similar assignment done for you from scratch? Order now! Use Discount Code "Newclient" for a 15% Discount!

M5 -Assignment # 4- Adverse Selection vs. Favorable Selection

References

Do you need a similar assignment done for you from scratch? Order now! Use Discount Code "Newclient" for a 15% Discount!

Health Service Administrators’ Roles and Responsibilities

Introduction

Roles and Responsibilities of Health Service Administrators

Conclusion

References

Do you need a similar assignment done for you from scratch? Order now! Use Discount Code "Newclient" for a 15% Discount!

Week 7: Course Project – Recommendations

Thesis

Ethical Dilemmas

Recommendations

Conclusion

References

Do you need a similar assignment done for you from scratch? Order now! Use Discount Code "Newclient" for a 15% Discount!

Discussion Board Rebuttal

References

Do you need a similar assignment done for you from scratch? Order now! Use Discount Code "Newclient" for a 15% Discount!

Week 7 The Value of Peer Review

Practice Question

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

References

Do you need a similar assignment done for you from scratch? Order now! Use Discount Code "Newclient" for a 15% Discount!

M4 Discussion

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

Initiatives To Recruit/Retain Physicians in Your Facility

References

Do you need a similar assignment done for you from scratch? Order now! Use Discount Code "Newclient" for a 15% Discount!

Roles and Responsibilities of Health Service Administrators

Conclusion

References

Do you need a similar assignment done for you from scratch? Order now! Use Discount Code "Newclient" for a 15% Discount!

M5-Week 5 Discussion-Capitation

Capitation

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

Why the Contract is Desirable

References

Do you need a similar assignment done for you from scratch? Order now! Use Discount Code "Newclient" for a 15% Discount!

February 22, 2023

Strongest Ethical Values

Philosophers with the Greatest Influence

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!

Do you need a similar assignment done for you from scratch? Order now!
Use Discount Code "Newclient" for a 15% Discount!