Background
The present-day advancements in the field of technology present a major breakthrough or opportunity for the healthcare system at large. This is purposely due to the myriad of information management, analysis and sharing products that come with health information technology (HIT). This means that accurate health information can be quickly and safely transacted between the patient and the healthcare provider as well as between the healthcare providers. One of the areas that the contemporary advancements in technology could be feasibly harnessed is through the provision of post-discharge patient care. The post-discharge phase of care presents a unique care situation since the healthcare provider lacks direct physical interaction with the patient and hence posing the challenge of offering close monitoring. In the absence of proper post-discharge care, patients are pretty vulnerable to medication non-adherence, non-adherence to the post-discharge advice or patient teaching as well as the potential of exacerbation. Of course, the outcomes of these include; a high probability of mortality, deterioration of health, re-hospitalization and increased ED visits. This majorly applies to chronic conditions such as hypertension, diabetes, heart disease and obesity among others that require use of control and management interventions on a long-term basis. For instance, according to the Centers for Disease Control and Prevention (2013), up to 49% of Americans living with hypertension do not comply or adhere to their long-term therapy (Centers for Disease Control and Prevention, 2013). Furthermore, 25% to 50% of persons living with, or at the risk of developing cardiovascular disease, discontinue statins in just one year after treatment initiation (Centers for Disease Control and Prevention, 2013). Medication non-adherence as well as failure to comply with post-discharge instruction is associated with approximately $100-$289 billion annually in terms of cost (Centers for Disease Control and Prevention, 2013). Moreover, non-adherence is viably associated with an estimated 50% of all treatment failures and over 125,000 deaths annually across the United States (Centers for Disease Control and Prevention, 2013).
Believably, it is core to the nursing profession to improve the overall concept of care in order to improve quality and safety and the problem of non-adherence/non-compliance to medication and post-discharge instruction squarely falls into their domain, in terms of coming up with evidence-based and technological-based interventions to help in averting this snowballing problem. This is essentially through relying on the present-day technological innovations, notably in health information technology (HIT) to bridge the gap and lapses in care provision that are occasioned by the physical distance between the patient and the care provider in the post-discharge phase of care. As Bartel, Chan & Kim (2014), assert, majority of post-discharge patient mortalities within the first 30 days post discharge are associated with sub-optimal compliance to medication and physician’s advice. Nonetheless, Bartel, Chan & Kim (2014), suggest that an effective post-discharge monitoring can go a long way in reducing post-discharge mortalities.
Introduction to the proposed technology
Tele-nursing is one of the recently developed technologies that could help in addressing the issue of compliance as well as adherence and subsequently enhance patient outcomes especially among remote patients during post-discharge. Essentially, tele-nursing refers to the utilization of tele-health technologies to remotely provide nursing care to patients (Souza-Junior et al., 2016). As such, tele-nursing involves the utilization of various technologies such as videoconferencing, e-mails and tele-monitoring equipment in the delivering nursing care to remote patients. Nurses usually engage in tele-nursing practice in order to monitor the progress of patients especially during their post-discharge phase, plan and come up with the suitable interventions based on the patient’s progress, intervene and subsequently evaluate the patients’ outcomes whereby this promotes care continuity. In addition, tele-nursing helps in addressing the physical barrier between healthcare professionals and patients since the technology helps nurses to remotely monitor their patients and educate them on various aspects pertaining to their care. For instance, the technology helps care professionals to remotely assess the patient’s progress and make medication adjustments based on their progress.
In regard to adherence and compliance, tele-nursing is among the most effective approach that fosters communication between nurses and their patients during their post-discharge phase and efficient monitoring whereby this promotes patient adherence to treatment plans as well as medications. For example, tele-nursing assists in monitoring and detecting for any side effects associated with the prescribed medications whereby this helps in making appropriate medication adjustments thereby enhancing the safety of patients. According to Asante (2013), tele-nursing help in fostering adherence to treatment plans as well as medications among diabetic since the technology assists healthcare professionals in educating patients on the appropriate dosages and timing whereby this helps in maintain an optimal blood sugar level and prevents exacerbation of the disease. In addition, the technology assists nurses to educate their patients on the relevant dietary changes as well as self-monitoring pertaining to their blood glucose whereby this promotes effective management of the disease. Moreover, the technology enables nurses to educate patients in regard to their progression of the disease continuously and maintain consistent data information pertaining to their medications as well as vital signs whereby this helps in developing the relevant interventions and preventing hospital readmissions. Similarly, a study by Peh et al. (2016), established that the utilization of tele-nursing in the provision of nursing care helped in increasing patient’s adherence to medications among patients with COPD (Chronic Obstructive Pulmonary Disease) whereby this enhanced their overall safety and outcomes and minimized cases of hospital readmissions.
On the other hand, tele-nursing is associated with an increased productivity among the nurses since the method enables nurses to provide care to an increased number of patients since this minimizes the nurse travel time particularly to the remote areas and enhance satisfaction of nurses thereby minimizing nurse turnover. Furthermore, the technology promotes patient compliance with the discharge plan especially in regard to lifestyle changes and treatment regimens since the technology fosters surveillance and assessment of patients (Boroumand & Moeini, 2016). More importantly, the technology promotes accessibility to healthcare services especially among remote patients as well as low-income patients since the approach is associated with reduced costs. For instance, the use of videoconferencing helps patients to effectively communicate to care professionals on their progress and obtain immediate responses from the care professionals. Overall, tele-nursing is an effective approach that helps in enhancing patient adherence to medications and compliance to treatment plan after their hospital discharge whereby this minimizes cases of hospital readmissions, reduces health expenditure and enhances their overall outcomes.
Quality impacts of the technology
This technology (tele-nursing) is quite promising in terms of achieving the desired care outcomes. The care process is made up of different care stages and the post-discharge phase of care presents a vital stage in this process. This means that the overall quality of care is the total sum of the outcomes achieved in all the care stages-not excluding the post-discharge phase. As afore-mentioned, the physical barrier created when the patient is discharged is a potential pitfall for exacerbation, mortality, re-hospitalization and ED visits. Nonetheless, tele-nursing provides a myriad of products that can be relied on to fine-tune these clinical variables towards the intended levels of quality. For instance, through tele-nursing the apparent physical barrier is bridged and from a remote locality, it becomes pretty easy to continue with a close patient monitoring as well as promoting information exchange between the patient and the nurse. One of the areas that can potentially benefit from tele-nursing is health promotion and hence adherence. Staying in contact with the patient during the post-discharge phase through telecommunication helps in inculcating a sense of self-agency and self-efficacy among patients, hence spurring an intrinsic motivation to adhere to medications and discharge instruction. On the other hand, to some extent, non-compliance is occasioned by various developments such as allergic reactions to medications, adverse drugs effects or even challenges that may emanate from the patient’s immediate social and economic situation. Nevertheless, the beauty of tele-nursing is that it provides a window for identifying or getting aware of any of these developments before hand, and hence gaining a vantage point in terms of addressing them. In a nut-shell, this technology is associated with a number of potential benefits that include; reduction in post-discharge mortalities, morbidities, deteriorations, re-hospitalization and ED visits. In the overall, this improves the larger quality of care rendered and provides the building blocks for achieving a high level of patient satisfaction.
Apart from being a quality improvement undertaking, use of tele-nursing comes in handy width regard to safety promotion. Being a healthcare provider comes with the obligation of ensuring patient safety throughout the course of care provision including the post-discharge phase. Through the incorporation of tele-nursing, various patient safety hazards can be proactively addressed. For instance, through tele-monitoring, it is arguably easy to identify exacerbations in patient’s vital signs such as blood pressure and blood sugar-something that may place the healthcare provider and the patient at a vantage point in terms of pursuing proactive measures. On the other hand, through continuous exchange of information with the patient, undesirable events that may arise from situations such as adverse drug effects or reactions can be addressed quite on time, hence arresting their progress to severe levels.
Stakeholders
The success of incorporating this technology into the organization is tethered to various stakeholders whose contribution has immense effects to the technology. These include; the technical support team, nurse informaticist, nurse managers, physicians, pharmacists, hospital management and the patients. An inter-disciplinary approach is quite essential in the implementation of tele-nursing since every member, by the virtue of expertise in their individual disciplines may bear great resource to this proposal in terms of ideological contribution and moral support. For any new technology to accept in an organizational setting it has to win the support and commitment of every organizational member and this explains why an inter-disciplinary approach is necessary in order to win an organization-wide support for the technology.
Each of the above-mentioned stakeholders plays a unique role in the successful and effective use of tele-nursing. For instance, the technical support team that would comprise of IT experts is crucial for the purposes of maintenance and updates to the tele-nursing platforms. On the other hand, the nurse informaticist would play a crucial role in promoting the management and handling of information exchanged and collected through the platform. Evaluation of the project outcomes is vital towards understanding the overall effectiveness and success of the project. In this regard, it would be the role of the nurse informaticist to assist in data collection for the various variables and subsequently, their analysis into meaningful information that can be used for further improvements. The proposed technology majorly touches on the nursing fraternity and this warrants the inclusion of nurse managers. Nurse Managers bear a sound understanding of nursing practice and this would bring worthy information towards designing the architecture of this technology in a manner that promises optimal utilization by the nurses. Additionally, nurse managers are involved in developing nursing policies and guidelines within an organization and their inclusion would be necessary so as to anchor the technology on sound nursing practice policy. Healthcare provision is a team approach and in as much as tele-nursing hugely invests on the nursing force, physicians and pharmacists are equally important for the purposes of consultations and collaborations towards promoting post-discharge care. It is up to the management to decide the feasibility of tele-nursing and subsequently provide financial support to help in the implementation of this technology. In this connection, the inclusion of the hospital management as a stakeholder is necessary in order to win its support and solicit for financial assistance. Last but not least, patients form an integral component of this technology. It is through their cooperation and utilization of tele-nursing that its benefits can be realized. Furthermore, when it comes to the evaluation of tele-nursing- patients form an imperative source of feedback and information.
Evaluation plan for the technology
Evaluation of the proposed technology is of utmost importance for the purposes of mapping the success of the project and determining whether the intended objectives have been met. Additionally, evaluation helps in unearthing the weaknesses that may exist within the project, hence providing a basis for modifications and improvements.
Various types of data related to the primary variables affected by the project would be collected. These include patient satisfaction, post-discharge mortality and morbidity rates, rates of re-hospitalization as well as drug/discharge instruction adherence. A pre and post intervention approach of data collection would be used (six months pre and post-implementation) in order to compare differences between pre-implementation and post-implementation outcomes. This being the case, data would be collected both qualitatively and quantitatively. Patient satisfaction is subjective in nature and as such, qualitative approaches of data collection would be used. In this regard, regular telephone interviews and internet questionnaire surveys would be administered to post-discharge patients in order to determine their general experience, opinions and perceptions about the new technology-something that would be subjected to analytical procedures to determine satisfaction levels. The qualitative component of data collection would seek to collect data related to self-reported quality of life, health confidence and self-efficacy levels. More importantly, the questionnaires and the interviews administered would be open-ended to allow for additional comments by the patients-something that can be further relied on for the purposes of improvement. For the quantitative variables (post-discharge mortality, morbidity, re-hospitalization and adherence rates) would be collected retrospectively from individual patient’s clinical records.
The whole process of project evaluation (including data collection and analysis) would be conducted by the nurse informaticist who would liaise with fellow healthcare professionals and the patients to collect and analyze the evaluation data. Data related to the project outcomes would be subsequently disseminated to all the stakeholders. Furthermore, the project outcomes would be disseminated to the larger healthcare sector, including public and private healthcare agencies for the purposes of making the evidence accessible and promoting its use on a larger scope.
Conclusion
In conclusion, tele-nursing stands out as a unique technology when it comes to addressing the physical barrier between the healthcare provider and the patient in the post-discharge phase of care. The physical barrier that occurs when a patient is discharged from the clinical settings can potentially lead to lapses in patient-monitoring and hence occasioning a huge possibility of medication and discharge instruction non-adherence. Non-adherence is associated with various undesired outcomes such as mortality, exacerbation, re-hospitalization and morbidities. The occurrence of these factors compromises the quality and safety of care rendered, hence leading to patient dissatisfaction and increased cost of care. Believably, the beauty of tele-nursing is that it provides a promising solution to this problem through promoting constant patient monitoring and exchange of vital clinical information that can be used for the purposes of self-efficacy and for prevention purposes. It is quite crucial to involve various stakeholders in the implementation of this project since its impacts are wide-spread and multi-pronged, affecting many healthcare parties-including patients. Evidence-based practice has evolved to become a vital concept when it comes to quality and safety improvement within the larger healthcare system and this makes it necessary to evaluate the project outcomes and share the findings with various health stakeholders within and outside the organization in a bid to ensure that the project and its findings find meaningful use within and outside the organization.
References
Asante, E. (2013). Interventions to promote treatment adherence in type 2 diabetes mellitus. British journal of community nursing, 18(6), 267-274.
Bartel, A. P., Chan, C. W., & Kim, S. H. H. (2014). Should Hospitals Keep Their Patients Longer? The Role of Inpatient Care in Reducing Post-Discharge Mortality (No. w20499). National Bureau of Economic Research.
Boroumand, S., &Moeini, M. (2016). The effect of a text message and telephone follow-up program on cardiac self-efficacy of patients with coronary artery disease: A randomized controlled trial. Iranian journal of nursing and midwifery research, 21(2), 171.
Centers for Disease Control and Prevention. (2013). Medication Adherence-[Primary care educators may use the following slides for their own teaching purposes]. Retrieved from http://www.cdc.gov/primarycare/materials/medication/docs/medication-adherence-01ccd.pdf
Peh, W. M., Tee, A., Ng, Y. K., & Chow, W. L. (2016). Evaluation of a chronic obstructive pulmonary disease (COPD) telehealthprogramme to reduce healthcare utilisation in a Singapore tertiary healthcare institute.Future Hospital Journal, 3(Suppl 2), s6-s6.
Souza-Junior, V. D., Mendes, I. A. C., Mazzo, A., & Godoy, S. (2016). Application of tele-nursing in nursing practice: an integrative literature review.Applied Nursing Research, 29, 254-260.
