250396 Discussion Board

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(250396 Discussion Board)

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Discussion Board

The project topic title is identifying mild traumatic brain injury (mTBI) post-concussive event. Currently, most mTBIs are unrecognized, underdiagnosed, and undertreated, which require further research.2 In this case, a literature search will aid in finding the best available evidence addressing the project topic, including the problem and recommended interventions or approaches to addressing the research problem. Regarding the search strategy, the project topic is already identified, and the remaining steps in the search strategy include developing search terms, search fields, phrases, wildcard and proximity operators, and search limits.

250396 Discussion Board

The search process will involve searching with keywords and exact phrases, adopting truncated and wildcard searches, and searching with subject headings and citations. The search strategy includes searching CINAHL, Embase, MEDLINE, PubMed, Cochrane Library, and Scopus databases for scientific evidence. These databases provide a wide variety of abstracts and full scholarly and peer-reviewed articles. Moreover, the search will include terms such as mild traumatic brain injury, concussion, mTBI symptoms and signs, post-concussive events, post-concussion symptoms, mTBI diagnosis, etiology, prevalence, and treatment.

I will adopt filters during the literature search to identify high-quality studies on the project topic, reducing the total number of records and increasing the likelihood of finding the appropriate records. Methodological search filters, including systematic reviews, randomized controlled trials, and diagnostic and observational studies, will help ease the search process. The search will also adopt MeSH terms for the various databases, including brain concussion or post-concussion syndrome, concuss*, and mild traumatic brain injury, mTBI or post#concuss*. The search process has identified multiple articles related to the project topic. However, Liu et al1, Polinder et al2, and Prince and Bruhns3 directly address the problem and perceived as the best available evidence so far. The search will continue to look for evidence for analysis and synthesis to find the best available evidence. (250396 Discussion Board)

References

  1. Liu Y, Lu L, Li F, Chen YC. Neuropathological Mechanisms of Mild Traumatic Brain Injury: A Perspective From Multimodal Magnetic Resonance Imaging. Front Neurosci. 2022;16:923662. Published 2022 June 17. doi:10.3389/fnins.2022.923662 https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2022.923662/full
  2. Polinder S, Cnossen MC, Real RGL, et al. A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury. Front Neurol. 2018;9:1113. Published 2018 December 19. doi:10.3389/fneur.2018.01113 https://pubmed.ncbi.nlm.nih.gov/30619066/
  3. Prince C, Bruhns ME. Evaluation and Treatment of Mild Traumatic Brain Injury: The Role of Neuropsychology. Brain Sci. 2017;7(8):105. Published 2017 August 17. doi:10.3390/brainsci7080105 https://pubmed.ncbi.nlm.nih.gov/28817065/
 
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250406 Classical Argument (Use This)

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Classical Argument

Introduction

Nurses’ commitment is addressing other people’s complex healthcare needs with competence and compassion. Nursing is perceived as a calling yet a very demanding and pressuring profession. Nurses experience mental, emotional, physical, and ethical challenges during nursing practice that impact their health and well-being. Depending on the setting and work environment, nurses risk infections, physical and verbal attacks, conflict, and other issues that elevate work-related stress, impacting their health and well-being. Poor nurses’ health and well-being also increase the potential of medical errors and other human errors that compromise patient care quality and safety. Additionally, nurses continue to cope with overwhelming workloads, inadequate resources and PPEs, stigma, and increasing health demands of various patient populations, especially the aging population, which adds to the stresses and demands at the workplace that jeopardize their health and well-being. Addressing nurses’ health and well-being is imperative to increasing job satisfaction and improving the quality and safety of patient care. Since work-related factors can negatively impact nurse health, nurse leaders should take steps to improve the working environment, encourage nurses to adopt self-care strategies, and provide education sessions to improve the well-being of their team members. (250406 Classical Argument (Use This))

Background

Nurse health and well-being, or lack thereof, significantly impacts nurses, patients, healthcare institutions, and society because nurses struggle to care for others if they cannot care for themselves. Nurse health and well-being are associated with the well-being of patients and are accounted as physical and mental health, job satisfaction, and job engagement. It affects patients and their views on the care quality received and the healthcare system regarding turnover rates and hiring and training costs. Over one million nurses are expected to retire by 2030, which would add to the shortage of nurses in the healthcare system (Flaubert et al., 2021). Retaining nurses and supporting new entries is fundamental to the healthcare workforce’s development, growth, and sustainability. Lack of or poor nurse health and well-being is associated with high turnover rates, increasing the cost of hiring and training new nurses. The National Health Care Retention and RN Staffing Report provide that the healthcare system spends an average of $44,000 on replacing an RN. For hospitals, the turnover cost is about $3.6-6.1 million annually (Flaubert et al., 2021). With these effects on patients and the healthcare system, promoting and facilitating nurse health and well-being is critical to ensure a healthy workforce, patient health and safety, a functioning healthcare system, and the financial health of healthcare institutions. (250406 Classical Argument (Use This))

250406 Classical Argument (Use This)

Work-Related Factors Impact Nurse Health and Well-being

Nurse health and well-being is multifaceted and includes physical health, occupational safety and health, and mental and behavioral health. Work-related factors are attributed to poor or a lack of nurses’ health and well-being, including nurse burnout which is prevalent and has significant effects on patients, healthcare teams, and health organizations. Rates of burnout among nurses in the United States are between 35 and 45 percent (Flaubert et al., 2021). Burnout is associated with emotional exhaustion, a low sense of individual accomplishment, and depersonalization, leading to poor patient outcomes, increased healthcare costs, clinician illness, suicidal thoughts and actions, and high turnover rates. Nurse burnout is attributed to heavy workloads, working overtime, staff shortages, skill-job mismatch, inadequate training, and heavy documentation.

Poor nurse health and well-being lead to compassion fatigue, a nurse’s diminished capacity to offer care at the highest level, attributed to extended exposure to ill people and patients’ traumatic experiences. Factors such as prolonged stress, inadequate support, heavy workloads, many hours per shift, and conflict lead to compassion fatigue, which indicates a lack of nurse well-being (Babapour et al., 2022). Individual factors leading to compassion fatigue include previous exposure to trauma, lack of awareness regarding compassion fatigue, lack of self-care, and diminished ability to set professional boundaries. Furthermore, poor nurse health and well-being, as indicated by compassion fatigue, increase suicidal thoughts and actions. According to Flaubert et al. (2021), nurses reported higher suicide rates than the general population, and little has been done to address the high suicide rates among nurses.

Poor nurse health and well-being include increased use of substances and alcohol to cope with work-related or occupational stress. Nurses report similar rates of substance use disorders as the general population, with about 10 percent reporting SUD (Flaubert et al., 2021). Nurses are also exposed to health problems related to SUD, including trauma and abuse history, substance use at an early age, genetic predisposition, and comorbid mental health disorders, but the risk of use increases due to easy access to controlled substances. High SUD rates among nurses are also linked to workplace stress and lack of education and adequate support (Flaubert et al., 2021). Nurses reporting poor health and well-being report poor physical health, including high overweight and obesity rates related to poor nutrition, lack of adequate sleep, and sedentary lifestyles or limited physical activities. Additionally, the healthcare environment presents ethical challenges that impact nurses’ moral well-being. Moral distress impacts nurse integrity, making responding to moral or ethical uncertainty, ethical dilemmas, and other moral concerns difficult. Moral suffering is a component of poor nurse health and well-being (Flaubert et al., 2021). Moreover, the constant interaction between nurses and patients, families, communities, administrators, and colleagues is necessary, but it can also cause stress that considerably impacts nurse well-being. Negative social interactions, including conflicts, discrimination, bullying, incivility, and racism, are to blame for nurses’ social health and well-being. (250406 Classical Argument (Use This))

Nurse Health and Well-being Impact Patient Outcomes

Nurse health and well-being do not affect nurses only but also patients and the overall healthcare delivery. Nurse health and well-being include burnout, compassion fatigue, and poor social, mental, behavioral, physical, and moral health, which are directly linked to patient care quality and safety. Improving nurse health and well-being directly translates to improved patient outcomes, indicating why it is critical to address factors influencing nurse health and well-being (The University of Rhode Island, 2021). Nurse well-being impacts patient experience and the patient’s perception of the care nurses provide. Burned out nurses or those experiencing compassion fatigue, for instance, struggle to provide patients emotional support and show empathy and respect. Moreover, overworked nurses report poor health and well-being, including physical health conditions like obesity and mental health issues like anxiety, depression, and PTSD.

Because nurses spend the most time with patients, poor health compromises patient care. According to The University of Rhode Island (2021), there is a direct relationship between nurse burnout and patient care quality. Aspects of nurse well-being, including burnout and compassion fatigue, trigger exhaustion and cynicism, leading to nurses distancing themselves from patient needs, compromising patient care quality and safety, and leaving patients dissatisfied with their care, leading to more complaints from individuals and their families (The University of Rhode Island, 2021). Patient safety is compromised by poor nurse health and well-being due to breaks out in communication and nursing and interprofessional teamwork, which increase the potential of medical errors that impact patient care. Conclusively, nursing health and well-being are directly associated with healthcare delivery and patient care quality and safety, increasing the need to enhance nurse health and well-being. (250406 Classical Argument (Use This))

Self-care Strategies, Provider Education, and Addressing Work-related Factors to Improve Nurse Health and Well-being

Addressing workplace factors affecting nurse health and well-being, adopting self-care strategies, and provider education are interventions that can help improve nurse health and well-being. Solving work-related stress, burnout, compassion fatigue, workplace conflict, job engagement, workload issues, and working overtime can help improve the work environment, which is associated with improved nurse health and well-being (Hofmeyer et al., 2020). Nurse leaders should establish healthy working environments to enhance job experience and satisfaction.

Self-care is an intentional effort to cater to one’s mental, physical, and spiritual well-being. To care for others, nurses should first care for themselves because compassion fatigue, workplace stress, and burnout are associated with poor health-promoting self-care. Self-care is considered a self-management tool for nurses to reduce the stress from working in the healthcare environment. Lack of self-care is linked with burnout, poor physical and mental health, depression, weight gain or extreme weight loss, unhealthy eating patterns, demoralization, back injury, and reduced job satisfaction (Williams et al., 2022). More attention is needed to enhance self-care in nurses because self-care helps minimize stress, replenish nurses’ compassion capacity and ability to care for others and improve the quality of care. Self-care serves as a stress management tool, helping nurses reduce work-related stress. Conclusively, adopting self-care practices like mindfulness, self-compassion, and emotional regulation can help nurses reduce stress and attend to their physical, mental, emotional, and spiritual needs (Hofmeyer et al., 2020).

Poor health-promoting self-care is associated with burnout and compassion fatigue, leading to poor patient outcomes and the risk of medical errors. Nursing care relies on empathy and compassion; the more burned out or stressed a nurse is, the more their capacity to offer kindness and compassion suffers (Monroe et al., 2021). Self-care replenishes nurses’ compassion capacity and ability to care for others. Nurses must practice self-compassion and understand their needs before helping others. Nurses should also learn to talk kindly to themselves because kind self-talk is linked to increased compassion capacity and pro-social behaviors like kindness, empathy, and altruism, helping them communicate better with colleagues, patients, and their families (Hofmeyer et al., 2020). In addition, acting with kindness and compassion helps reduce patient suffering and distress.

Empowering education on strategies to improve nurse health and well-being is needed in the working environment. There is a lack of awareness regarding factors affecting nurse health and well-being, including burnout, stress, and compassion fatigue, which limits efforts to address these issues (Chaghari et al., 2017). For instance, nurses may not be aware if they are burnout, stressed, or lack compassion fatigue due to a lack of understanding. Provider education would help nurses understand their characteristics, how to identify these feelings, and how to approach them, including strategies to address burnout, compassion fatigue, and stress to improve their overall wellbeing. (250406 Classical Argument (Use This))

Opposition and Refutation

An opposing argument is that nursing is a calling and nurses should put the needs and interests of patients first before theirs. Nurses should seek to enhance patient experience and promote quality and safety of care in all encounters. This argument is true because the focus is always to promote patient-centered and holistic care. However, this argument would be unrealistic if nurses forget to care for themselves before caring for others. The Code of Ethics recognizes self-care as a nurse’s responsibility because when nurses are not caring for themselves, they cannot care for their patients (Purdue University Global, 2021). In addition, the American Nurses Association Code of Ethics posits that nurses should extend to themselves the moral respect they extend to others, and nurses owe themselves the same duty they owe to other individuals (Purdue University Global, 2021). Based on these provisions, nurses should care for themselves first before caring for others and promote their health and well-being before that of patients because poor nurse health and well-being are associated with poor patient outcomes. (250406 Classical Argument (Use This))

Conclusion

Nursing is a demanding profession, and the work environment is pressuring and stressful, impacting nurse health and well-being. Work-related factors, including occupational stress, burnout, compassion fatigue, workplace conflict, heavy workloads, and working overtime, contribute to unhealthy nurse behavior, including poor-health promoting self-care behavior. Promoting a healthy work environment is the foundation of ensuring a healthy workforce. Self-care strategies and providing education are interventions that help improve nurse health and well-being. Nurses should always care for themselves before caring for others. (250406 Classical Argument (Use This))

References

Babapour, A. R., Gahassab-Mozaffari, N., & Fathnezhad-Kazemi, A. (2022). Nurses’ job stress and its impact on quality of life and caring behaviors: A cross-sectional study. BMC nursing, 21(1), 1-10.

Chaghari, M., Saffari, M., Ebadi, A., & Ameryoun, A. (2017). Empowering Education: A New Model for In-service Training of Nursing Staff. Journal of advances in medical education & professionalism, 5(1), 26–32.

Flaubert, J. L., Le Menestrel, S., Williams, D. R., & Wakefield, M. K. (2021). The future of nursing 2020-2030: Charting a path to achieve health equity.

Hofmeyer, A., Taylor, R., & Kennedy, K. (2020). Knowledge for nurses to better care for themselves so they can better care for others during the Covid-19 pandemic and beyond. Nurse education today, 94, 104503. https://doi.org/10.1016/j.nedt.2020.104503

Monroe, C., Loresto, F., Horton-Deutsch, S., Kleiner, C., Eron, K., Varney, R., & Grimm, S. (2021). The value of intentional self-care practices: The effects of mindfulness on improving job satisfaction, teamwork, and workplace environments. Archives of psychiatric nursing, 35(2), 189–194. https://doi.org/10.1016/j.apnu.2020.10.003

Purdue University Global. (2021, April 28). The importance of self-care for nurses and how to put a plan in place. https://www.purdueglobal.edu/nursing/self-care-for-nurses/

The University of Rhode Island. (2021, July 19). The Importance of Nurse Well-Being. https://online.uri.edu/articles/importance-of-nurse-well-being.aspx

Williams, S. G., Fruh, S., Barinas, J. L., & Graves, R. J. (2022). Self-Care in Nurses. Journal of radiology nursing, 41(1), 22–27. https://doi.org/10.1016/j.jradnu.2021.11.001

 
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250406 Reverse Outline

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(250406 Reverse Outline)

Article Title: Nurse health and well-being

Author’s name: (Student Name)

Year of publication: 2023

250406 Reverse Outline

Introduction:

  • THESIS Statement: Since work-related factors can negatively impact nurse health, nurse leaders should take steps to improve the working environment, encourage nurses to adopt self-care strategies, and provide education sessions to improve the well-being of their team members. (250406 Reverse Outline)

Background:

Body Topic 1 – Work-related factors impact nurse health and well-being

Paragraph 1: Work-related factors – Nurse burnout

  • Work-related factors are attributed to poor or a lack of nurses’ health and well-being, including nurse burnout which is prevalent and has significant effects on patients, healthcare teams, and health organizations.
  • Burnout is associated with emotional exhaustion, a low sense of individual accomplishment, and depersonalization, leading to poor patient outcomes, increased healthcare costs, clinician illness, suicidal thoughts and actions, and high turnover rates.
  • Nurse burnout is attributed to heavy workloads, working overtime, staff shortages, skill-job mismatch, inadequate training, and heavy documentation.

Paragraph 2: Compassion fatigue

  • Compassion fatigue is a nurse’s diminished capacity to offer care at the highest level, attributed to extended exposure to ill people and patients’ traumatic experiences.
  • Factors such as prolonged stress, inadequate support, heavy workloads, many hours per shift, and conflict lead to compassion fatigue, which indicates a lack of nurse well-being

Paragraph 3: Work-related stress/occupational stress/physical health, moral distress/ social well-being

  • Nurses report similar rates of substance use disorders as the general population
  • Nurses reporting poor health and well-being report poor physical health, including high overweight and obesity rates related to poor nutrition, lack of adequate sleep, and sedentary lifestyles or limited physical activities.
  • Moral suffering is a component of poor nurse health and well-being
  • Negative social interactions, including conflicts, discrimination, bullying, incivility, and racism, are to blame for nurses’ social health and well-being.

Body Topic 2 – Nurse health and well-being impact patient outcomes

Paragraph 1: Patient experience and patient perception of care

  • Nurse well-being impacts patient experience and the patient’s perception of the care nurses provide
  • Improving nurse health and well-being directly translates to improved patient outcomes

Paragraph 2: Patient outcomes

  • There is a direct relationship between nurse burnout and patient care quality
  • Patient safety is compromised by poor nurse health and well-being due to breaks out in communication and nursing and interprofessional teamwork, which increase the potential of medical errors that impact patient care.

Body Topic 3 – Self-care strategies, provider education, and addressing work-related factors to improve nurse health and well-being

Paragraph 1: Addressing work-related factors to improve nurse health and well-being

  • Addressing work-related stress, burnout, compassion fatigue, workplace conflict, job engagement, workload issues, and working overtime can help improve the work environment, which is associated with improved nurse health and well-being.

Paragraph 2: Self-care strategies

  • Nurses should first care for themselves because compassion fatigue, workplace stress, and burnout are associated with poor health-promoting self-care.
  • Self-care serves as a stress management tool, helping nurses reduce work-related stress.

Paragraph 3: Self-care strategies

  • Self-care replenishes nurses’ compassion capacity and ability to care for others.

Paragraph 4: Empowering education

  • Provider education would help nurses understand burnout, stressed, or lack compassion fatigue

Opposition: Nurses should put the interest and needs of patients first.

Refutation: Nurses should take care of themselves and promote their health and well-being before caring for others or promoting patients’ health and well-being. (250406 Reverse Outline)

Conclusion:

Reflection:

The reverse outline helped with proof-reading my work and allowed me to check paragraph organization. From this outline, I see the paper presents the information in a logical manner and the information is focused and aligned with the thesis statement. (250406 Reverse Outline)

References

https://www.ncbi.nlm.nih.gov/books/NBK573902/

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

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 (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)

Table of Contents

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:

  1. To evaluate the role of technology on medication adherence among inpatient schizophrenia patients.
  2. To assess the impact of motivational interviews on medication adherence among inpatient schizophrenia patients.
  3. 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:

  1. I identified medication non-adherence among schizophrenia patients as warranting EBP adoption.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. The project team and I will implement motivational interviewing into a pilot program that includes follow-up schizophrenia patients only.
  8. 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)

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

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

 

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

 
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M4 Assignment: Health Service Administrators’ Roles and Responsibilities

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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/

 
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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)

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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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