Assessing the Problem: Technology, Care Coordination, and Community Resources Considerations
The efficacy of the care coordination plan for the patient depends on the efficient use of resources and scientific technology. It plays a very important role in determining the quality of care and patients’ outcomes in terms of safety and effectiveness. This case study is based on the practicum hours spent with a patient, Mr. Mathew, aged 45 years, male with a history of diabetes for the past twenty years as a nursing student. Apart from being a genetic disorder, work stress played a part in development of diabetes. His condition and the medication regime were discussed in detail in this therapy. I provided him with the care plan which includes the involvement of a medical team. The use of technology was an important part of the care plan formulated (Fallon et al., 2022).
My main area of concern in this assessment will be to describe the level of care, care coordination, resource utilization and the role of technology in managing and monitoring diabetes with special reference to the case of Mr. Mathew.
Impact of Healthcare Technology on Patient with Diabetes
In the conversation with Mr. Mathew, I was able to describe and discuss the usage and efficacy of the medical devices that are used in diabetes control, namely glucose measuring apparatus or the digital glucometer and wearable devices to monitor the fluctuations in glucose level over 24 hours such as smart watches or fitness trackers etc. Additionally, the use of the
mobile apps such as Glucobyte and MySugarApp etc, The use of software like DiaBass and DexCom for the monitoring and recording of the data for future use was also considered. These apps and software support in providing the telehealth facility to the healthcare providers as well as the patients. They help in observing and recording the glucose level and also help in ensuring that the patient takes the right medication as prescribed depending on the disease.
These devices give Mr. Mathew basic facts about the disease and help him manage and regulate his disease. The glucometer will be useful to him to monitor the variations of the glucose level. The apps and software that are employed by the smart devices help in the provision of information and education to the patient on diabetes and management. They help the patients in guiding on how to execute the physicians’ medications, exercise regimen, dietary alteration or clinic visit depending on the assessment of the circumstances and signs (Magkos et al., 2020)
Some of the helpful websites for the patients with diabetes are: American Diabetes Association (ADA) – diabetes.org, Centers for Disease Control and Prevention (CDC) – Diabetes – cdc.gov/diabetes, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) – niddk.nih.gov, Diabetes Self-Management – diabetesselfmanagement.com and Diabetes Daily – diabetesdaily.com etc.
Evidence of Advantages and Disadvantages of the Use of Technology
The benefits and risks of using technology for the management of diabetes are presented below.
Following are some of the benefits concerning the application of the medical devices like glucometers (both digital and manual), mobile phone applications and software in the measurement of glucose level. These technologies do not only enable the healthcare professionals to track down the condition of the patient, but also in planning the care pattern in the future with the help of the data. The patient, by self-management, also feels confident and empowered and is more compliant with the therapeutic plan. The smart apps enable the patient to control and adjust the physical activities and eating habits so as to enhance their health status. In the same manner, the evidence based studies also support the effectiveness of the use of technology in diabetes. In the study by Sharma et al. (2022), the significance of the use of the electronic technology, such as glucose level tele monitoring as telehealth services was discussed. The findings of the research also led to the conclusion that the remote monitoring system can cause a permanent change in the ways of delivering healthcare. Another study done by Morulae et al. (2021) showed that the software and smart devices for self-management of diabetes among the patients was equally effective in reducing the glucose level of the patients. The same observation was made in the study by Fontecha et al. (2022)
According to the study, the telemedicine and mobile technology for the self-management of the diabetic patient was useful in monitoring the glucose level and also useful in the long term management of the glucose level in the patient.
However, it is also important to pay attention to the fact that these devices and the medical technologies also have some drawbacks although they are used in the healthcare system and by the patients. Many of them are associated with ambiguity or inaccuracy of the results due to non-validation or non-calibration. These disadvantages are discussed further in the light of
evidence based studies. Assessing the efficiency of the medical devices and technology for the early diagnosis and control of diabetes Vijayan et al. (2021) had some criticism on the credibility of the electronic devices on the accuracy of the collected data.
Insights into Current Technology Use and Barriers
The healthcare facilities and organizations utilize gadgets such as digital and manual glucose level apparatus for checking the glucose level of the diabetic patients either on the spot or continuously. These devices are quite beneficial as they allow the doctor or the healthcare provider to assess the condition of the patient even remotely. Mobile phone applications Glucobyte and MySugarApp or software like DiaBass and DexCom can be used to assess the state of the patient condition. However, if the medical team or the care providers are not in a position to manage such devise or software then the effectiveness of the device or system can be affected (Patil et al., 2022). At times, the financial position may also limit the type of devices that can be used or the upgrading or updating of the devices, if applications and software may have expired. Moreover, concerning the apps and software, it is important to have continuous internet connection which most of the time is not possible in the rural areas. Thus, there is a need to educate the patient on the use of technology that will help the patient to monitor himself.
Some of the patients, like Mr. Mathew, have partial medical insurance especially when it comes to medical devices and hospital visits; it can therefore be hard to afford good quality equipment. The good quality digital glucometers which is a very useful device for monitoring the patient’s condition costs between 400 to 500 USD depending on the brand used. There may also be instances whereby there are some technical issues with the devices that may force
repurchasing. Furthermore, the application that is installed in the mobile phones can also develop a monthly subscription fee of not less than 10-30 USD and this will also be an added cost. The patients’ technological literacy, especially for patients of old age like Mr. Mathew, is not ideal and may require the assistance of a health care provider to guide them through the application. This limits the efficacy of the used of medical devices and software (Birati et al., 2022).
Community Resources for Care Coordination
Diabetes is a chronic with a number of manifestations in the form of cardiovascular diseases, retinopathy, neuropathy and nephropathy etc. Hence, the management of this disease requires the doctors and other medical practitioners including the paramedical staff in order to address all the needs of the patients. Multidisciplinary care coordination team may include general practitioner, a diabetes specialist, endocrinologists, a registered nurse, a pharmacist, and a psychologist. They are involved in planning for the patient’s treatment, administration, dosage of the drugs, recommending exercises and offering counselling and encouragement to the patient.
Community Health Centers are ready to offer proper patient treatment, along with financial and psychological aid when needed, to manage all aspects of patient’s disease to improve life quality (Dan, 2020). Diabetes Centers as healthcare centers are also present for educating and providing medical support to the old age patients along with the knowledge about the changes in lifestyle and diet. Most of the pharmacies also offer free health promotion
activities inclusive of glucose level checks and medication therapy management to assist the community to manage the diabetes (Wanter, 2024).
The Local Health Departments also provide information such as educational materials and free screening for enhancing the community’s understanding of the disease and efforts towards the better control of diabetes in the population (Hill-Briggs et al., 2020). At times, the University and Hospital Outreach Programs conducted by the respective organizations assist in the conduct of educational workshops, awareness creation and free screening examinations for the management of diabetes (None Shofian Syarifuddin & None Wilson Samosir, 2022). Public Libraries can also help the community in better management of diabetes as they offer information materials and organize the workshops or seminars in order to raise awareness in the community.
In case of the patients who are immobile due to a health problem or living in a remote area with a lack of transport, option of mobile clinics is available. Transportation services for the healthcare facility are provided if one needs to be conveyed to the facility. Some of these places can also get the services of helicopter ambulance. Telehealth is also a preferred method of communication, if the patient is not experiencing a health crisis and urgent action is not required (de Kreutzenberg, 2022).
Counseling is significant especially for the patients suffering from chronic diseases. Patients can obtain the community resources such as the support groups and counseling sessions to feel mentally capable of combating the diseases. The support groups have been observed to be helpful in enhancing the Diabetic patients’ prognosis (Powers et al., 2020).
Some of the patients rely on their faith for coping with the illness as evidenced in the following passage. In such circumstances it is employed by the healthcare setting to provide the patient with emotional, psychological and religious support in the form of a chaplain etc.
Insights into Current Use and Potential Barriers
There are a number of factors which act as barrier in the optimal outcomes of the care coordination plan for the management of diabetes. One challenge is the management of healthcare team, comprised of general practitioners, diabetes specialists, endocrinologists, nurses, pharmacists, and psychologists. Conflicts are common and can be encountered in the team due to difference in the medical opinion of the experts. This may have a negative impact on the health care services offered by the interdisciplinary team, reducing the quality of services (Catapan et al., 2021).
The other issue on the healthcare system is the difference in number of patients and healthcare providers available. This puts compromise on the patient care due to imbalance in the ratio. The other challenge that the healthcare system has to deal with is the inability to hire a large medical staff since the process is due to financial restraints (Elbarbary et al., 2020).
The financial constraints, communication and collaboration breakdown among the care team members, healthcare system documentation related complications and challenges, and the patient’s knowledge and understanding level are also some of the potential barriers (Dorey et al., 2023). Another concern that the patient may experience is the bias by health care professionals based on their race, gender, status, socioeconomic status or immigration status. This is one of the
important factor in the reduction of the effectiveness of care plan which affects the ability of service providers to deliver health care services to the population (Lee et al., 2020).
State Board Nursing Policies and Governmental Policies
The care plan or the interventions given are based on the State Board Nursing Practice and the state policies. American Nurses Association (ANA) is the main source of the nursing practice standards. It gives directions on prevention, detection and management of diabetes. It also complies with the ethical principles of health care and they include the principle of beneficence, non-maleficence, autonomy and justice. These are the most important standards concerning the nursing care and increasing the patient safety (American Nurses Association, 2019).
The Health Information Technology (Health IT) Standards is meant for the exchange of information between the several healthcare organizations in the care coordination plan for the betterment of public health. The electronic data in the form of statistics helps in making a decision to initiate change or developing an interventional plan (Miandoab et al., 2023).
Likewise, Mobile Health (mHealth) Policies encourage the utilization of the latest use of technology by the patients. This can be in form of devices, for example a glucometer (single point or continuous), software, and mobile applications. These are useful tools to give a glimpse on the disease status. They are also very helpful for the patients who reside in the rural areas or cannot visit the health care facility due to some health or operational issues (Ali Sherazi et al., 2022).
Electronic Health Record (EHR) Incentive Programs is a policy that seeks to promote an electronic record of information about the patient and his or her health. They are useful in the
Role of Policies in Addressing Patient Safety, Care Cost Efficacy
The effective use of the healthcare policies can play a significant role in optimizing the patient safety, patient care and the cost.
Addressing Patient Safety and Care
The proper implementation of these policies helps in the process of harmonization and rationalization of the medical care procedures. It helps in the organization of the healthcare facility to provide the improved patient care to the patients. With these practices it is possible to avoid medication errors and ensure that the healthcare system provides right and error free care to the patient to improve the results. The effectiveness of therapeutic care is provided through the use of medical devices, mobile apps, and software in which patients’ health outcomes in terms of patient safety are improved (Domingo-Lopez et al., 2022). Counseling therapies and support groups are also useful in reducing the impact of the disease on the mental wellbeing of the patients. They also assist in enhancing their health which is affected through the chronic impacts of the disease. The implementation of these policies in efficient manner has a positive impact in the improvement of the patient’s safety. Adherence to the care plan may help in controlling the diabetes and the associated effects and also improve the results for patients such as Mr. Mathew
Care Cost Efficacy
The policies also assist in reducing the cost of care not only for the patients but also to the healthcare systems. The point and continuous monitoring of the glucose level through the glucometers and utilizing various mobile applications and software etc., coupled with the healthcare team virtually along with the ground support is beneficial in enhancing the health and safety of the patients of diabetes. The following steps can help in preventing the occurrence of diabetic episodes, hence decreasing the number of medical emergencies and subsequent hospitalization and procedures (Siegel et al., 2020). It is economical to the patient, and to the entire health system as well. The programs including telehealth or mobile health also reduce the hospitalizations. This also results in an effectiveness of care cost. The patient awareness and education can also lead to the patient’s autonomy in managing the disease and its symptoms, which is important for controlling the health cost utilization. Therefore, it is cost effective on the care of patients such as Mr. Mathew who has partial health insurance for drugs, equipment, and hospital charges.
Impact of State Policies on Nursing Practices
The policies also affect the nursing scope of practices. ANA supports the implementation of health information technology in the nursing practice which has increased the responsibility of a nurse in capturing and processing the patient data with an aim of improving the quality of care. The integration of EHR in the health care system has affected the ways the nurses document the information and history of their patients improving the co-ordination of health care services
(Zarora et al., 2022). Mobile Health (mHealth) technologies have enabled the nurses to do patient monitoring remotely thus extending the role of the nurse in chronic disease treatment and patient education. Through the National Diabetes Prevention Program (NDPP) nurses have been more involved in preventive care and management of chronic diseases, and have embraced technology in tracking the patient’s progress along with educating them (Lim et al., 2019). All together, these policies and technologies have enhanced the nursing practice authority, which requires new skills in health IT and patient-centered care from the nursing staff. Through promoting value based care and the integration of Health Information Technology (Health IT), CMS has been a key component in development of the nursing scope of practice. Some of the CMS programs include payment reforms.
Implications for Ethical Professional Practice
In relation to the nursing practice, the policies of the state and federal government have a great impact on the ethical issues. These are employed to ensure that the healthcare staff adheres to the four cardinal principles of health care which include beneficence (the patient’s maximum benefit), non-maleficence (no harm is intended to the patient), autonomy (patient’s permission in treatment processes) and justice (equal distribution of health care without discrimination (Hübner et al., 2022). This means that the details of the patients and the health related information is stored in the computers and electronic media.
Personal data of the organizations can be infringed; therefore, the patient data should be protected. It is essential to protect patient privacy, especially while handling issues concerning the patient personal and health information. Data acquisition and archiving is another function
that is undertaken by health technology. The nursing staff should ensure that the health data and information of patients are not accessible to other people. Certain measures should be put in place to secure the data, and it should be made physically and virtually impossible for an unauthorized person to gain access to the data or disclose the data.
In addition, the aspects like ethical issues in relation to the allocation of a limited health resource in a competitive health care setting also come under ethical practice of the nurses. The nursing staff has to allocate the available resources in a fair manner protecting the rights of the vulnerable and marginalized population in the communities (Marsh et al., 2021). The patient care should be provided equally to all the patients, based on the need of the patient irrespective of his color, gender and his economic status. It is essential in the protection of the patient’s identity and his or her information especially during the treatment as in the case of Mr. Mathew.
Practicum Hours
When I was doing my practicum as a nursing student, I spent 2 hours with a diabetic male patient by the name Mr. Mathew aged 45 years. He has been diabetic for more than two decades now. The discussion was directed towards evaluating the quality of care and the safety in handling diabetes for the patient. Cost effectiveness of the medications that the patient was taking along with the devices, apps and the software that was also done. The care coordination plan for diabetes was considered with reference to the community resources and advanced technology for management of the condition. The medical care coordination team of health care professionals was also consulted for their advice and medical attention. The practicum hours were quite helpful in respect of assessing the status of the patient and formulating a treatment plan for the status of the patient.
Conclusion
In conclusion, the assessment takes an overview of how the technology affects the care quality and safety. Care coordination plan was formulated to improve the patient’s care experience while considering the cost factor. The community resources that can be harnessed in order to improve the patients with diabetes were also analyzed. Impact of the healthcare practices regarding the nursing care plans and ethical concerns were also studied. Therefore, it is suggested that an extensive care plan for Mr. Mathew should be formulated with the participation of the medical and nursing departments with assistance from the communities for improvement in diabetes and the following care plan will be more effective.
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