NURS FPX6030 Assessment 2 PICO (T) and an Evidence-Based Approach
Assessment 2- PICO (T) and an Evidence-Based Approach
NURS-FPX6030: MSN Practicum & Capstone
Month Date, Year
PICO (T) and an Evidence-Based Approach
The purpose of this report is to provide an analysis of the healthcare problem in the organization that uses the most viable intervention-comparison-outcome-time (PICOT) approach. The PICOT is a framework which often applies to problems in the healthcare industries. Due to rising cases of hypertension in black Americans and other minorities in the United States, the purpose of capstone project is to base the learning from 20 confirmed practicum hours to find a solution for that problem by making and considering a PICOT question. Therefore, the capstone project provides the description of clinical hours spent and how it relates to this particular project. This is where the professional work of our registered nurses begins with brainstorming to explore the answer to this PICOT question. Using evidence-based practices, the goal is to improve the patient care outcomes and reduce hypertension. This is why the PICTO question formulation plays a critical role to help nurses create better strategies. The PICOT often deals with several components such as considering population/patient, intervention, comparison, outcome, and time (Aggarwal, 2021). The case study of our organization is analysed using the PICOT question.
Moreover, the element of ‘patient’ refers to the actual population of patients in the healthcare organization. The intervention refers to nurses who take actions to find the solutions; while the comparison element means comparing the interventions with other ones, and the outcomes help to provide the results needed. This strategy helps the organization to reduce overall costs of HTN treatment of minorities and enhance care quality. The PICOT question is: Can technology such as telemedicine can reduce hypertension costs of the organization due to increasing black patients and lead to an improvement of their condition to reduce depression and anxiety?
The Need for Improvement and Health Promotion and Quality
According to the PICOT question, the aim of this capstone project is to help nurses find the best interventions for HTN treatment in African American and minority patients in US. The credible sources from the scholarly literature have been analyzed using different databases and online journals. The aim is to search the required search terms and find the most important and credible source through analysis of peer-reviewed articles which match with our PICOT question (Blyler et al., 2020). This is done by the DNP and registered nurses to utilize the secondary resources online and explain the issue of hypertension in African American patients with the right treatment options. For instance, the most critical problem is the reimbursement based on performance-based outcomes (Megaship & Patel, 2022). Due to the surging population of hypertension patients, professionals utilize performance-based outcome measures as well as evidence-based practices. This ensures that the evidence-based practices are implemented in a way to improve the outcomes. Moreover, the second vital issue is the lack of education of our nursing staff due to which the black pateints are unsatisfied. The training of our professionals can help them to learn new skills and boost knowledge.
Using the evidence-based practices, the problem of hypertension can be solved. However, the sad fact is that our healthcare professionals are still not well-prepared to form PICOT questions related to hypertension issues of black patients. The lack research and development R&D skills to find the solution for depression. Our senior nurses suggested use of telemedicine to treat HTN black patients by using evidence-based practices. This report is based on the assumption that the evidence-based PICOT tools and questions play a major role in helping nursing and other practitioners to address a wide range of mental health problems (Beverly et al., 2022). For instance, using this framework, nurses can create background questions and better explore the current patients’ conditions to figure out the impact of medications or psychotherapy and how black patients are affected (Beverly et al., 2022). A question can be asked such as “What are the factors concerning HTN treatment of black Americans that are leading to their dissatisfaction? Using this question, it becomes easier for our nurses to search the relevant literature and compare different answers and evidence-based solutions to answer this question. This will help them to plan better treatments and interventions to make an early diagnosis of hypertension. The factors which may relate to increase and dissatisfaction of African American patients may range from their socioeconomic status, their skin color and race, their gender, and ethnicity etc (Wagner, 2020). therefore, using this technique, the challenges can be faced easily by nurses to provide black patients equitable and quality services for hypertension reduction (Beverly et al., 2022).
Quality Improvement Method That Could Impact a Patient, Population
During the practicum hours, nurses and managers devised a range of solutions and planned strategies to positively impact the patient population and reduce the issue of increasing cases of African Americans’ hypertension. These challenges cannot be reduced by using the same traditional methods in the healthcare organization; which is why there is a dire need for adopting and implementing the telemedicine tools to offer better treatment to black Americans. The population our nurses are focusing of the black patients is between 22- 30 years. In the continuum of care, various stages are considered important including the screening and assessment of hypertension in black pateints increasing day by day. Hence, the foremost strategy is to offer a medication-based solution to HTN patients of colored races. In addition, the other good option is to provide behavioral therapies to black patients for enhancing their mental health and confidence in our staff (Ogunniyi, 2021). For example, the HTN condition of five pateints can be enhanced or improved within using the most important strategy called Cognitive Behavioral Therapy (CBT). Moreover, the use of Behavioral Activation Therapy (BAT) with CBT can also combine and work effectively to achieve better outcomes (Wagner, 2020).
Besides, telemedicine tools can also help our nursing professionals to improve the methods of treatment delivery for black HTN patients’ recovery. They can use the post and pre-COVID telemedicine technologies including the most popular videoconferencing. Using this tool, the dissatisfaction of black patients can significantly reduce when they do not have to come to the hospital for psychotherapy and can avail the treatment from caring nurses and psychotherapists at remote location. These tools can include counseling using the phone, Skype, and web-based apps to solve the problem of pateints. Moreover, telemedicine is also popular for helping nurses and patients benefit from tools such as PCs, desktops, and tablets with smart phones. These telecom-based solutions can help the nurses and doctors to enhance communication with remote patients and reduce their functional impairments to provide better solutions to hypertension. Therefore, telemedicine tools can help pateints to find the best medications for the black HTN patients as well as reducing the substance abuse. The start of telehealth was in the 20th century; however, it is ever more popular today for the improvement of nursing care.
Also, the nurses and managers also planned some synchronous treatment solutions which include real-time interactive nurse-to-client communication and remote collaboration. This does not mean that in the middle of remote communication, patients cannot collaborate with nurse’s face to face. The purpose of this strategy is to offer the affected pateints an ongoing care solution that can harness the power of telemedicine and telecom solutions with other technological devices and mechanisms/protocols (Omboni et al., 2022).
Moreover, the use of asynchronous solutions by nurses is another viable strategy. This allows them to share the healthcare data onetime and analyze it later to manage HTN symptoms more effectively. This helps nurses for example to manage symptoms such as depression and anxiety in black patients and monitor their mental health using software and client education. For example, our hospital can utilize this strategy by using web-based portals including emails, mobile applications and other telemedicine tools such as video calls. However, none of these solutions which are viable and cost effective come without challenges and limitations. The biggest weakness of telehealth is that there are ample funds required by the hospital to train the nurses and professionals to treat pateints remotely and use devices and troubleshoot them when necessary. Hence, despite immense benefit of telehealth tools, many evidence-based studies show that these quickly accessible options can become a problem sometimes when not managed efficiently. Moreover, some pateints may feel emotionally detached with their counselors during telehealth sessions.
Interventions that would help drive quality improvement
Many evidence-based researches such as Suresh and Megaship and Patel (2022) also advocate for the use of telemedicine solutions for devising best intervention for black pateints of mental health in America. It is indeed the most viable tool for treating mental health diseases in the US and the rest of the world which can drive improvements in care quality. Moreover, the intervention can help to meet the identified need of the target population of black and minority patients in the hospital suffering from HTN and other mental health diseases. Moreover, it is worth-mentioning that some limitations and drawbacks also exist regarding the use of this telemedicine solution. As the study of Wagner (2020) states that research has been limited and more information is needed to properly explore whether telemedicine will help medical professionals to adopt it as a sustainable and long-term solution.
Trough telemedicine, nurses and psychotherapists can use remote psychotherapy practices and can also help black patients who cannot travel. However, for HTN patients of minority races, some more uncertainties surround regarding using telemedicine tools the Prime Medical Center. This is because some scholars and medical professionals still fail to believe that the actual outcomes when compared the outcomes of remote therapy with in-person treatments will be viable. This means that solutions such as on-site CBT therapy can only be given to patients when they are physically present because it becomes difficult to touch them or emotionally ask them difficult questions over the phone. This means that online counseling vs face-to-face counseling should be compared.
The research also reveals that telemedicine psychotherapy has also benefitted thousands of patients during the COVID-19 era and this is a viable strategy for nurses at Prime Medical Center as well. This is because the magnitude of this remote treatment effect is comparable at times when the counseling is given using the traditional ways to black Hen patients. This makes patients a victim of professional and personal biases of nurses and doctors (Wagner et al., 2020). Another study by Ye and Anstey (2022) also compares the diversity and racial issues in healthcare organizations in the US and compare them with the outcomes of treating HTN. These patients were randomly assigned to the telehealth interventions including mobile phone calls from trained counselors. At six separate occasions, the counselors interacted with black HTN patients during four months. They discovered the volume of HTN relapse after recovery; they utilized the power of IT and used interactive software to perform computerized CBT. The study states that the statistically significant improvement in HTN patients was observed as more than 26% of black patients improved. Therefore, compared to face-to-face consultations, telemedicine has proven to be more viable and sustainable and effective solution.
Potential interprofessional alternatives to an initial intervention
The project analysis also shows that more problems exist in telemedicine implementation such as this technology is still are in its infant stages and far from being perfect (Suresh et al., 2022). Firstly, the Teledyne expenses for the organization are higher than conventional services offered to patients of HTN. Moreover, this technology also has a tendency to be misused by nurses and staff members. The telehealth integration with other tools such as the Electronic Medical Records (EMR) is also technically not convenient for all patients and staff members; some black patients are illiterate suffering from HTN and they need good education or training. On the other side of the story, professionals in our organization also believe that telehealth solution is significantly cost-effective in terms of reducing costs. The American Journal of Emergency Medicine also states that telemedicine solutions have been convenient and inexpensive during COVID-19 because American organizations saved $20 to $120 per visit of patients due to technology (Omboni et al., 2020). Hence, the same goal of Prime Medical Center is the reduce costs and improve quality can be achieved using these particular solutions.
According to the study of Ogunniyi (2021), the author states that telemedicine solutions are quite sophisticated but hard to measure in terms of effectiveness. This is because the technology is always changing and evolving for good. The smooth transition of technology with proper nursing education can make it cost effective in American hospitals and clinics (Blyler et al., 2020). The administrators must also follow the regulations set by the Health Insurance Portability and Accountability Act HIPAA of 1996 and follow its security protocols to reduce and control costs and avoid any HTN readmissions that they are seeking to achieve. This shows that telemedicine can help the organization to significantly and positively reduce the gap patients and professionals to treat HTN in black people effectively; the technology is there to save lives and costs for in-patients and remote counselling. However, experts also believe that it may be hard to replace in-patient or face to face visit with telehealth solutions completely. This shows that telemedicine is not yet the most viable or the perfect 100% solution compared to traditional HTN treatment methods for black people in our organization.
There have been significant advancements in psychotherapy and medicines over the past few years. In the PMC center, the trend of face-to-face patient communication is more prevailing compared to Internet-based solutions. This is mainly due to the lack of education and nurses’ knowledge of telemedicine tools; this is the reason many black Americans are still not sure they must prefer to use the web-based psychotherapy solutions or the traditional ones. The need to achieve vital social benefits of face-to-face interactions as well that are impossible with technology. Therefore, this can only happen when all the parties and professionals are well educated and the organization is able to better handle the financial costs and facets of using telemedicine widely.
Health Policy Outcomes to Identify the Purpose and Intended Accomplishments
We also explored during the practicum hours that the proposed intervention of telemedicine interventions for black people’s treatment can significantly influence the positive outcomes. Many factors were found to be affecting the effectiveness of the technology such as managerial support, social issues of nurses, and managerial effectiveness of the organization (Blyler et al., 2021). For instance, some African American patients of HTN also said that they feel lonely without in-person counselling and they find it difficult to adopt the internet-based therapy solutions. The nurses also found that young HTN patients found technology as interesting and it helped them to feel more joyful and less lonely. This can also impact the social support of these patients in terms of reducing HTN symptoms. This means that the overall results or the outcomes of this endeavor have been observed in the practicum hours as a potential for telemedicine to change the condition of these pateints.
Moreover, in the perspective of costs of our organization, the effectiveness of telemedicine solutions is also in the hands of our nurses and physicians and other managerial staff. Many young black patients loved online apps and the idea of treatment through mobile gadgets; it helped them to get ready support and avail consultation hours with professionals without hefty travel charges or hassle-free plans. Moreover, the evidence by the study of Beverly (2022) also shows that benefits of telehealth are immense in terms of improving mental wellbeing of patients through randomized trials of high quality (Blyler et al., 2021). This is because telemedicine can help people to utilize chat rooms where black people can easily access the information related to their diseases and treatment options. This means that in terms of costs reduction, the outcomes in PMC center are positive by reduce re-admissions which are helping the patients to also reduce their follow-up time. As a result, the LOS length of stay in the hospital is also reducing for HTN patients that are a desired objective for the organization.
The Time Frame for the Implementation
In the light of the above analysis of telemedicine solution to treat HTN in cooled people in American organization, the professionals have decided that the telemedicine solutions are the most effective for helping professionals at PMC which can help them enhance the effectiveness of remote therapy for hypertension. These solutions are hard to deliver at the initial stage and patients must receive these interventions at least 5 to 6 times per year to get the best outcomes and feel relieved from post-traumatic stress disorder or HTN relapse (Aggarwal et al., 2021). The implement and development plan for this solution has been decided to be not more than three months; this is ample time to meet the needs of black HTN patients.
Aggarwal, R., Chiu, N., Wachira, R. K., Moran, A. E., Raber, I., Shen, C., … & Kazi, D. S. (2021). Racial/ethnic disparities in hypertension prevalence, awareness, treatment, and control in the United States, 2013 to 2018. Hypertension, 78(6), 1719-1726.
Blyler, C. A., Ebinger, J., Rashid, M., Moy, N. P., Cheng, S., Albert, C. M., & Rader, F. (2021). Improving Efficiency of the Barbershop Model of Hypertension Care for Black Men with Virtual Visits. Journal of the American Heart Association, 10(13), e020796.
Blyler, C. A., Rashid, M., Moy, N. B., Kemp, K. A., & Rader, F. (2020). Telemedicine And the Barbershop Model of Hypertension Care for Black Men. Hypertension, 76(Suppl_1), A21-A21.
Eberly, L. A., Sanghavi, M., Julien, H. M., Burger, L., Chokshi, N., & Lewey, J. (2022). Evaluation of Online Patient Portal vs Text-Based Blood Pressure Monitoring Among Black Patients with Medicaid and Medicare Insurance Who Have Hypertension and Cardiovascular Disease. JAMA network open, 5(2), e2144255-e2144255.
Ogunniyi, M. O., Commodore-Mensah, Y., & Ferdinand, K. C. (2021). Race, ethnicity, hypertension, and heart disease: JACC focus seminar 1/9. Journal of the American College of Cardiology, 78(24), 2460-2470.
Omboni, S., McManus, R. J., Bosworth, H. B., Chappell, L. C., Green, B. B., Kario, K., … & Wakefield, B. J. (2020). Evidence and recommendations on the use of telemedicine for the management of arterial hypertension: an international expert position paper. Hypertension, 76(5), 1368-1383.
Suresh, S., Megaship, C., Patel, E., Nieman, K. M., & Rana, S. (2022). Racial Disparities in Diagnosis, Management, and Outcomes in Preeclampsia. Current Hypertension Reports, 1-7.
Wagner, T. D., Jones, M. C., Salgado, T. M., & Dixon, D. L. (2020). Pharmacist’s role in hypertension management: a review of key randomized controlled trials. Journal of Human Hypertension, 34(7), 487-494.
Ye, S., Anstey, D. E., Grauer, A., Meter, G., Moise, N., Schwartz, J., … & Abdalla, M. (2022). The Impact of Telemedicine Visits on the Controlling High Blood Pressure Quality Measure During the COVID-19 Pandemic: Retrospective Cohort Study. JMIR Formative Research, 6(3), e32403.