Complete Medical Theories Disc (WALDEN)

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Complete Medical Theories Disc (WALDEN)

Nursing homework help

Question Description

I’m studying for my Health & Medical class and need an explanation.

 

Describe one biomedical theory or model frequently used in health care and provide your rational for how it relates to improved patient outcomes.

Describe one biomedical theory or model that is utilized in your specific practice area. Provide at least two examples related to its application

think sometimes the lack of pressure of a face-to-face meeting can put patients at ease and actually allow a conversation to develop. Sometimes we do use video visits so we can still get a visual component. I do think there are visits that need to be conducted in person, there are for sure complaints that require an assessment. At the same time, does a stable diabetic need to come in physically to the clinic to be evaluated every 3 months? Could they maybe switch to a 6 month in clinic schedule and do a 3 month follow-up on the phone with lab orders they go and complete on their own schedule? Would that really decrease the quality of care they receive? Pain medication is a great example of an in-clinic visit. These patients have very specific schedules and pain contracts with providers. We do not routinely prescribe controlled substances for pain since we are a SUD clinic and treat opioid abuse with medication and therapy. This is not a common issue I run into as I do not have my CS 2 license. I luckily can tell patients I cannot legally prescribe that for you and it pretty much ends the conversation about opioids. Thanks for the questions!

Erin Christine Shankel, DNP, RN, FNP-BC and Linda G. Wofford, DNP, RN, CPNP Abstract: Symptom Management Theory, developed by faculty at the University of California, San Francisco, is a middle-range nursing theory which explains the interaction between symptom experience, symptom management strategies, and outcomes. Successful integration of the model into the emerging field of telemonitoring has the potential to improve outcomes and lower costs associated with the management of chronic diseases. Modifications to the model related to communication, feedback, and adherence may make it more suitable for this application. Key Words: chronic disease, nursing theory, symptom management theory, symptom assessment, telemedicine Symptom Management Theory as a Clinical Practice Model for Symptom Telemonitoring in Chronic Disease A s chronic disease and life expectancy continue to increase simultaneously, management of chronic conditions will become increasingly burdensome in terms of both manpower and financial costs. Now more than ever, creative strategies for the management of chronic diseases are needed. The field of telemedicine is growing rapidly, and clinical practice models must evolve to guide and support development of chronic disease management initiatives. The aim of this article is to discuss the potential of Symptom Management Theory (SMT) (Humphreys et al., 2014) to improve outcomes and lower costs associated with the management of chronic diseases. The financial burden of chronic disease is staggering. Currently, the percentage of U.S. dollars spent on chronic conditions is about 75% among the general population (Harris & Wallace, 2012) and is closer to 95% among those over age 65 (Centers for Disease Control and Prevention, 2013) Among older adults, the percentage who report having one or more chronic diseases rose more than 5% between 1998 and 2008, and that trend will likely continue (Dall et al., 2013). Furthermore, by 2050 the number of Americans over 65 is expected to more than double to 89 million, compared to 40.5 million in 2010 (Dall et al., 2013). This growing population of older and sicker patients is projected to lead to a 25% increase in health care Burden of Chronic Disease expenditures by 2030 (Centers for Disease Control The prevalence of chronic diseases such as osteoar- and Prevention, 2013). thritis, asthma, chronic obstructive pulmonary disease The U.S. is ill-equipped to handle the financial [COPD], heart disease, hypertension, depression, and burden of increasing medical costs, but the healthcare diabetes is on the rise. Approximately half of all Ameri- field also lacks the manpower (Dall et al., 2013). Lowcans have been diagnosed with at least one chronic er-cost methods of preventing and managing chronic disease, and one in four has multiple chronic diseases conditions can be found in lower-acuity settings, such (Ward, Schiller, & Goodman, 2014). The reason for as primary care. However, fewer and fewer physicians this rapid increase is multifactorial. On one hand, poor are choosing to go into primary care, and even increaslifestyle choices abound. On the other hand, advances ing numbers of other clinicians (such as nurse practiin medicine are contributing to greater life expectantioners [NPs] and physician assistants [PAs]) cannot cies, giving genetic predispositions for disease more make up the gap. In the U.S. only 35% of physicians time to come to fruition. are primary care providers (PCPs), compared to 50% in other industrialized countries (Bodenheimer, et al., The Journal of Theory Construction & Testing – 31 – Volume 20, Number 1 2009). Of note, most of these countries with higher percentages of PCPs have better outcomes, lower costs, and better access to care than what is seen in the U.S. Bodenheimer et al. (2009) suggest that there are three ways that increased demand for low cost, lowacuity management of chronic diseases can be met: specialty care, primary care, or multidisciplinary teams. Their extensive research examined differences in the way chronic diseases are managed in specialty and primary care settings. In the first scenario, specialists are uniquely equipped to manage individual conditions, but they are more likely than generalists to order expensive diagnostic tests unnecessarily (Bellinger et al., 2010). There are also well-documented disparities in access to specialty care, especially among those living in rural areas and/or with low incomes (Bellinger et al., 2010). If number of PCPs continue to dwindle, many patients may be forced to seek routine care in specialty settings, thereby promoting a steeper increase in medical expenditures and health disparities. Reliance on specialists alone would reduce coordination of care and emphasis on health promotion typically found in primary care (Bellinger et al., 2010). The second scenario, in which primary care fills the gap, is more ideal but, as previously mentioned, current workforce trends do not suggest this will be feasible. The third scenario would use a multidisciplinary team – made up of physicians, NPs, PAs, registered nurses, pharmacists, and community health workers – to address the needs of patients with chronic conditions. According to Friedman et al. (2014), this option has potential to ease disease burden, improve outcomes, and reduce costs, but successful implementation will require significant changes to the current health care system. For instance, one of the most weighty barriers to implementation of team-based care is reforming deeply held beliefs about traditional physician role and identity. Changes required to convert the traditional healthcare system to a team-based system are meritorious, but they will take time. A fourth option may exist. Telemonitoring, a field in which technology is used to provide remote health care, could allow specialists, primary care providers, and multidisciplinary teams to more efficiently manage symptoms of chronic disease. Because collaborative management of chronic diseases places much of the onus on patients to perform adequate self-care between visits (Estes, 2008), remote communication with providers is sometimes necessary. For example, a patient who has asthma might see his NP every six months for routine evaluation, but within that interval he will likely experience recurring and remitting respiratory symptoms related to many factors, including oral health (Estes, 2010). Telemonitoring can provide a method by which patients’ self-care strategies are guided by interactive communication with providers, allowing patients like this one to receive immediate input about appropriate management options. The Journal of Theory Construction & Testing Telemedicine and Telemonitoring of Chronic Diseases Telemonitoring is a subset of telemedicine. Telemedicine is defined as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status” (American Telemedicine Association, n.d.). The field is relatively new and much has yet to be discovered, but emerging research shows great potential. A 2015 review of literature (American Telemedicine Association, 2015) shows that high quality, cost-effective care can be delivered through telemedicine while also achieving high rates of patient satisfaction. While telemedicine is a term that can broadly be used to describe any sort of direct patient care (including diagnosis, treatment, or consultation) that occurs via technology for patients at a distance, telemonitoring is understood more narrowly as using telecommunication technologies to remotely monitor data about patient status (Pare, Jaana, & Sicotte, 2007). Both objective and subjective data can be telemonitored. Objective data, like blood glucose readings, vital signs, and weight, are easily measured by patients from home and transmitted via phone, SMS messages, Smartphone applications, or computer. Similarly, subjective symptoms can be tracked and transmitted from patients to health care providers. Because symptoms are the most common reason patients seek healthcare (Lee & Miaskowski, n.d.), an acceptable alternative method of managing symptoms might eliminate the need for some of these costly visits. Telemonitoring could potentially provide guided self-management of symptoms, thereby reducing unnecessary resource utilization. The full implications of symptom telemonitoring are not yet known, but so far it appears that “remote patient monitoring that tracks vital signs of patients with chronic diseases is offering more-frequent contact between the patient and the primary care provider, providing earlier detection of potential problems, and allowing real-time alerts, resulting in a proactive, affordable option for bestpractice health care” (Schwartz & Britton, 2011, p. 216). Telemonitoring has the potential to offer patients a more active and immediate role in managing their health. When a patient experiences symptoms—for example, wheezing—telemonitoring permits him to share those symptoms with his provider in real time. The role of the provider is to suggest symptom management strategies (e.g., a nebulizer treatment), and the role of the patient is to then implement the recommended strategies as he sees fit. Continued telemonitoring can help providers evaluate ongoing symptom status outcomes, such as reductions in coughing or wheezing. These steps – communication of a symptom experience, recommendation of symptom management strategies, and evaluation of outcomes – make up the three conceptual domains of SMT. This pro- – 32 – Volume 20, Number 1 cess of experiencing and reporting symptoms, seeking management, and evaluating outcomes is familiar, as it frequently happens in traditional face-to-face patient encounters. Telemonitoring, however, changes the timing and context of these steps, and may alter the way SMT is understood. Overview of SMT Most published telemonitoring interventions do not use any documented behavioral change theories, clinical guidelines, or assessment tools to inform their design (Al-Durra, Torio, & Cafazzo, 2015). Many articles that do include theoretical frameworks use theories such as the Transtheoretical Model, which focus on patient motivation and behavior (Battaglia, Benson, Cook, & Prochazka, 2013; Finkelstein & Cha, 2009; Tabak, et al., 2012). While these articles are helpful in understanding the diffusion and adoption of telemonitoring systems, there is a paucity of clinical practice models and theoretical frameworks addressing adherence and communication with telemonitoring. SMT (Dodd et al., 2001; Humphreys et al., 2008; Humphreys et al., 2014) may be useful in filling this gap. SMT (Dodd et al., 2001; Humphreys et al., 2008; Humphreys et al., 2014) was originally introduced by the nursing faculty at University of California, San Fransisco (UCSF) in 1994, was updated in 2001, and again in 2008. (See Figure 1.) The model development was a collaborative effort, incorporating the expertise of faculty with diverse experience in managing symptoms of chronic diseases such as heart disease, diabetes, cancer, COPD, and chronic pain. It is a deductive, middle range theory describing three simultaneously interactive factors within the domain of nursing care (Humphreys et al., 2008). These three main factors are symptom experience, symptom management strategies, and symptom status outcomes (See Figure 1). Each of these domains is connected to the others with bidirectional arrows, symbolizing the mutual interaction of each factor with both of the other factors. Additionally, a broken bidirectional arrow between symptom management strategies and outcomes labeled “adherence” exists to show the risk of nonadherence that occurs at this stage. The model has been described extensively elsewhere (Humphreys et al., 2014), but this article will briefly summarize the essential points. The commonly acknowledged starting point of the model is the symptom experience component. Here the patient perceives, evaluates, and responds to symptoms. Examples could include wheezing, as used in a previous example, or a multitude of other symptoms, such as anxiety, headache, joint pain, or insomnia. Figure 1. Symptom Management Model. Reprinted from “Advancing the Science of Symptom Management,” by M. Dodd, S. Janson, N. Facione, J. Faucett, E. S. Froelicher, J. Humphreys, K. Lee, C. Miaskowski, K. Puntillo, S. Rankin, and D. Taylor, 2001, Journal of Advanced Nursing, 33(5), 668-676. Copyright 2001 by Blackwell Science Ltd. Reprinted with permission. The Journal of Theory Construction & Testing – 33 – Volume 20, Number 1 Figure 2. Newcomb’s Spiral Symptom Management Model. Environment Person Health Symptom experience communication Symptom management adherence Outcomes feedback Reprinted from “Using Symptom Management Theory to Explain How Nurse Practitioners Care for Children with Asthma,” by P. Newcomb, 2010. Journal of Theory Construction & Testing, 14(2), 40-44. While patients’ perceptions are extremely valuable, the meanings patients assign to their symptoms occasionally lead to ill-timed or inappropriate symptom management strategies. For instance, a person who is wheezing may not perceive his symptoms as severe enough to seek treatment until the wheezing is so acute that it becomes necessary to go to the emergency room. Janson and Becker (1998) described this phenomenon in an article showing that, among patients with asthma, two of the most common reasons that patients delay seeking care during an acute exacerbation are the concepts of “minimization” and “uncertainty”. Minimization refers to under-recognition of an asthma episode’s severity, while uncertainty refers to a patient’s ambiguity about how to interpret a symptom’s meaning or what to do about it. Because patients suffering from chronic condition often deal with recurring and remitting symptoms for long stretches of time between health care visits, patients are left to interpret their symptoms through the lens of their own lay knowledge and past experience. Not surprisingly, this interpretation affects how and when they progress to the next phase of the model, symptom management strategies. During the second stage of symptom management strategies, an intervention may be performed. According to Humphreys et al. (2014), the goal of The Journal of Theory Construction & Testing Symptom experience symptom management is to “avert, delay, or minimize the symptom experience” (p. 144). However, because patients may delay seeking advice and treatment due to issues like minimization or uncertainty, the invasiveness, risk, cost, and potential success of the symptom management strategy varies accordingly. Using the example of asthma, if a patient delays seeking treatment for early signs of an exacerbation, what could have been managed conservatively through increased inhaled corticosteroid doses often progresses to a need for oral corticosteroids, emergency room visits, and hospitalizations. Authors of the model agree that more research is needed regarding how to deal with the issue of timeliness of patient-initiated strategies (Dodd et al., 2001). Dodd et al. (2001) assert that the type of intervention should be specific to the symptom and should be guided by current evidence within the field. This expectation is problematic in patients who have chronic diseases because they may be using symptom management strategies that are not evidence-based. Patients rely on information from their health care providers, and from family, friends, media, and the internet (Humphreys et al., 2014), especially when communication with providers does not occur between visits. There is increasing emphasis placed on shifting the responsibility for chronic disease symptom – 34 – Volume 20, Number 1 management to the individual patient (Humphreys et al., 2014), rightly affirming value of the patient’s own lived experience and self-knowledge. However, aligning the patient’s experience and self-awareness with the provider’s medical knowledge can only strengthen the accuracy of the patient’s interpretation of his symptom experience.This partnership between patient and provider can improve the efficacy of symptom management strategies. Multiple studies have shown that this type of collaboration, known as “informed self-monitoring” improves health outcomes (Janson & Becker, 1998; Janson et al. 2003, 2010, 2009). During stage three of the model, the symptom experience and symptom management strategies lead to symptom status outcomes, which can then go on to subsequently influence future symptom experience and, in turn, symptom management strategies. Outcomes can include quality of life, self-care, morbidity and comorbidy, mortality, functional status, emotional status, and direct and indirect costs (Dodd et al., 2001). For patients with chronic diseases, symptom experiences and evidence-based symptom management strategies may not immediately or obviously result in improved symptom status outcomes. For example, it may not be obvious to the hypertensive patient that daily adherence to prescribed medication is associated with gradual improvement in such blood pressure-related symptoms as headaches or blurred vision. Unless strategies are employed to assist patients to make these connections, positive symptom management strategies producing gradual clinical improvements may not be reinforced. Newcomb’s Modifications to the SMT Model Newcomb (2010) suggested an alteration to the SMT model in which communication and feedback were explicitly described as conceptual links between the model components symptom experience, symptom management strategies, and symptom status outcomes. (See Figure 2.) Communication, positioned between symptom experience and symptom management strategies in the model, emphasizes the bidirectional exchange of information between a patient’s experience of symptoms and his attempts at symptom management, which may involve the patient’s health care provider and/or family members. For example, Newcomb (2010) used this communication concept to explain the unique ways children and parents collaborate first to perceive and interpret asthma symptoms and then to respond. However, competing demands and limited access to care can negatively impact the patient’s likelihood of initiating communication with providers, and unfortunatly, in an outpatient setting, unscheduled communication relies upon the patient or parents taking initiative. The UCSF faculty who developed the model agree that “providers must establish and maintain good patient-provider communication if they are to understand their patient’s symptom perception, The Journal of Theory Construction & Testing accept symptom experience, and implement management strategies” (Humphreys et al., 2014, p. 155). Newcomb’s modified model makes the communication concept more explicit. The second concept Newcomb (2010) adds to the original SMT model is feedback. Feedback explains how patients evaluate the efficacy of their symptom management strategies in terms of their resulting health outcomes. Feedback refers to the patient’s receipt of information concerning whatever disease process is underlying the symptoms of interest, and this information can help the patient notice connections between the symptom experience and outcomes. For example, if a patient with uncontrolled asthma was prescribed a new daily controller medication and then returned to the clinic two weeks later stating, “I don’t think it makes much difference. I think I’m going to stop using it”, he could benefit from feedback. Appropriate feedback might include a comparison of a symptom survey completed during the current visit compared to one completed two weeks ago. If self-reported scores improved during the two-week interval, that information could inform the patient of gradual changes in his symptom experience that he may not have noticed on his own. Access to feedback can help patients make informed decisions about adherence, which can subsequently affect outcomes. When selfmanagement strategies result in improved symptom status outcomes, the successful strategies are likely to be repeated. As already discussed, some outcomes may not be immediately noticeable to patients with chronic diseases, which causes a breakdown in the SMT model at the point of feedback. Application of the SMT Model to Telemonitoring Telmonitoring technologies such as electronic logs, text messaging, and interactive SmartPhone apps can empower patients to track their symptoms, receive immediate feedback, and manage their chronic disease symptoms more effectively. Because of this cyclical process, the SMT model, which has been useful in a multitude of other clinical settings, shows promise within the field of telemonitoring. The model has gained particular acceptance in a few pockets of clinical practice such as oncology (Baggott, Cooper, Marina, Matthay, & Miaskowski, 2012; Cherwin, 2012; Steel et al., 2010) and cardiology (DeVon, Ryan, Rankin, & Cooper, 2010; Hwang, Ahn, & Jeong, 2012; Jurgens et al., 2009; McSweeney, Cleves, Zhao, Lefler, & Yang, 2010; Riegel et al., 2010). Health professionals within the disciplines of cancer and cardiac care may gradually become familiar with the theory through reading current literature relevant to their specialty. Likewise, those blazing trails in the field of telemonitoring must be exposed to SMT through reading about successful applications to their practice. – 35 – Volume 20, Number 1 Usefulness of SMT in the emerging field of telemonitoring has been explicitly addressed in only one article. In 2009, SMT was used as the framework for studying the effect of telehealth intervention on physical activity and functioning in patients who had recently undergone coronary artery bypass surgery (Barnason, Zimmerman, & Schulz). The intervention was a 6-week symptom management tool that was connected to the participants’ telephones. Participants responded to assessment questions, and received management strategies based on their reported symptoms. In this way, the patients’ symptom perceptions were immediately addressed by electronic symptom telemonitoring devices), with an expectation of improving outcomes related to activity and functioning. Comparing the telemonitoring group with the usual care group yeilded a significant main effect (F[1,209]= 4.66, p

  Excellent Good Fair Poor
Main Posting 45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

 

Supported by at least three current, credible sources.

 

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

 

At least 75% of post has exceptional depth and breadth.

 

Supported by at least three credible sources.

 

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

 

One or two criteria are not addressed or are superficially addressed.

 

Is somewhat lacking reflection and critical analysis and synthesis.

 

Somewhat represents knowledge gained from the course readings for the module.

 

Post is cited with two credible sources.

 

Written somewhat concisely; may contain more than two spelling or grammatical errors.

 

Contains some APA formatting errors.

0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

 

Lacks depth or superficially addresses criteria.

 

Lacks reflection and critical analysis and synthesis.

 

Does not represent knowledge gained from the course readings for the module.

 

Contains only one or no credible sources.

 

Not written clearly or concisely.

 

Contains more than two spelling or grammatical errors.

 

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness 10 (10%) – 10 (10%)

Posts main post by day 3.

0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)

Does not post by day 3.

First Response 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

 

Responds fully to questions posed by faculty.

 

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

 

Demonstrates synthesis and understanding of learning objectives.

 

Communication is professional and respectful to colleagues.

 

Responses to faculty questions are fully answered, if posed.

 

Response is effectively written in standard, edited English.

15 (15%) – 16 (16%)

Response exhibits critical thinking and application to practice settings.

 

Communication is professional and respectful to colleagues.

 

Responses to faculty questions are answered, if posed.

 

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

 

Response is effectively written in standard, edited English.

13 (13%) – 14 (14%)

Response is on topic and may have some depth.

 

Responses posted in the discussion may lack effective professional communication.

 

Responses to faculty questions are somewhat answered, if posed.

 

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

 

Responses posted in the discussion lack effective professional communication.

 

Responses to faculty questions are missing.

 

No credible sources are cited.

Second Response 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

 

Responds fully to questions posed by faculty.

 

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

 

Demonstrates synthesis and understanding of learning objectives.

 

Communication is professional and respectful to colleagues.

 

Responses to faculty questions are fully answered, if posed.

 

Response is effectively written in standard, edited English.

14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

 

Communication is professional and respectful to colleagues.

 

Responses to faculty questions are answered, if posed.

 

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

 

Response is effectively written in standard, edited English.

12 (12%) – 13 (13%)

Response is on topic and may have some depth.

 

Responses posted in the discussion may lack effective professional communication.

 

Responses to faculty questions are somewhat answered, if posed.

 

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

 

Responses posted in the discussion lack effective professional communication.

 

Responses to faculty questions are missing.

 

No credible sources are cited.

Participation 5 (5%) – 5 (5%)

Meets requirements for participation by posting on three different days.

0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)

Does not meet requirements for participation by posting on 3 different days.

Total Points: 100