Problem Statement (PICOT) Topic: Telehealth support for Gestational Diabetes patients

Assessment 2 Instructions: Problem Statement (PICOT)

Develop a 7 page problem statement that presents information related to the problem-intervention-comparison-outcome-time (PICOT) approach to nursing research.

 

Topic: Telehealth support for Gestational Diabetes patients

Target population: Pregnant women in outpatient clinic in San Diego, CALIFORNIA, USA

 

Introduction

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.

For the first section of your final capstone project you will develop a proposal for an intervention plan to fulfill a need within a specific population. This assessment is meant to capture your initial thoughts about the need and impacting factors to help focus your in-depth analysis later on in the course.

First you will brainstorm and crystallize some of your ideas for this assessment, specifically ideas around needs, a target population, and some initial support from the literature and other sources of evidence. The problem statement is an important part of your capstone project as it will help illustrate the importance of your project, as well as help to clarify your project’s scope.

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Preparations

Read Guiding Questions: Problem Statement (PICOT) [DOC]. This document is designed to give you questions to consider and additional guidance to help you successfully complete this assessment.

As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment.

As you reflect on your work in the field, what population do you feel has the greatest need? Why? Is the need across the population, or within a specific setting?

What interventions already exist for the selected population? Are they effective? Why or why not?

How will site support from your practicum and your preceptor support your goals and objectives?

 

Instructions

Note: The assessments in this course are sequenced in such a way as to help you build specific skills that you will use throughout your program. Complete the assessments in the order in which they are presented.

Your problem statement will focus on presenting information related to the problem-intervention-comparison-outcome-time (PICOT) approach to nursing research. You will also present a brief literature review that supports the need you identified in your problem statement and the appropriateness of your broad intervention approach. Provide enough detail so that the faculty member assessing your problem statement will be able to provide substantive feedback that you will be able to incorporate into the other project components in this course, as well as into the final draft of your project.

At minimum, be sure to address the bullet points below, as they correspond to the grading criteria. You may also want to read the scoring guide and the Guiding Questions: Problem Statement (PICOT) document (linked above) to better understand how each criterion will be assessed.

Reminder: these instructions are an outline. Your heading for this this section should be titled Problem Statement and not Part 1: Problem Statement.

Your Problem Statement (PICOT) should be structured as follows:

 

PART 1: PROBLEM STATEMENT (2–3 PAGES)

Need Statement (1 paragraph).

• Analyze a health promotion, quality improvement, prevention, education or management need.

Population and Setting (1–2 paragraphs).

• Describe a target population and setting in which an identified need will be addressed.

Intervention Overview (1–2 paragraphs).

• Explain an overview of one or more interventions that would help address an identified need within a target population and setting.

Comparison of Approaches (1–2 paragraphs).

• Analyze potential interprofessional alternatives to an initial intervention with regard to their possibilities to meet the needs of the project, population, and setting.

Initial Outcome Draft (1 paragraph).

• Define an outcome that identifies the purpose and intended accomplishments of an intervention for a health promotion, quality improvement, prevention, education, or management need.

Time Estimate (1 paragraph).

• Propose a rough time frame for the development and implementation of an intervention to address and identified need.

 

PART 2: LITERATURE REVIEW (10–15 RESOURCES, 3–6 PAGES)

Analyze current evidence to validate an identified need and its appropriateness within the target population and setting.

Evaluate and synthesize resource from diverse sources illustrating existing health policy that could impact the approach taken to address an identified need.

ADDRESS GENERALLY THROUGHOUT

Communicate problem statement and literature review in way that helps the audience understand the importance and validity of a proposed project.

Practicum Hours Submission

Additional Requirements

• Length of submission: 7 double-spaced pages.
• Number of resources: 10–15 resources. (Your final project summation will require 12–18 unique sources across all sections.)
• Written communication: Written communication is free of errors that detract from the overall message.
• APA formatting: Resources and citations are formatted according to current APA style. Header formatting follows current APA levels.
• Font and font size: Times New Roman, 12 point.

 

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

 

Competency 1: Lead organizational change to improve the experience of care, population health, and professional work life while decreasing cost of care.

Explain an overview of one or more interventions that would help drive quality improvement related to an identified need within a target population and setting.

Competency 2: Evaluate the best available evidence for use in clinical and organizational decision making.

Analyze a health promotion, quality improvement, prevention, education, or management need.

Analyze current evidence to validate an identified need and its appropriateness within the target population and setting.

Competency 3: Apply quality improvement methods to impact patient, population, and systems outcomes.

Describe a quality improvement method that could impact a patient, population, or systems outcome.

Competency 4: Design patient- and population-centered care to improve health outcomes.

Propose a rough time frame for the development and implementation of an intervention to address an identified need.

Competency 5: Integrate interprofessional care to improve safety and quality and to decrease cost of care.

Analyze potential interprofessional alternatives to an initial intervention with regard to their possibilities to meet the needs of the project, population, and setting.

Competency 6: Evaluate the ability of existing and emerging information, communication, and health care technologies to improve safety and quality and to decrease cost.

Evaluate and synthesize resources from diverse sources illustrating existing health policy, health care technologies, or other communications that could impact the approach taken to address an identified need.

Competency 7: Defend health policy that improves the experience of care, population health, and professional work life while decreasing cost of care.

Define an outcome that identifies the purpose and intended accomplishments of an intervention for a health promotion, quality improvement, prevention, education, or management need.

 

Note: You will also be assessed on additional criteria unaligned to a course competency:

Communicate problem statement and literature review in a way that helps the audience to understand the importance and validity of a proposed project.

 

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Problem Statement: Telehealth Support for Gestational Diabetes patients

Gestational diabetes occurs among pregnant women and specifically implies having high levels of blood sugar. This happens because the body fails to produce a sufficient amount of insulin; a hormone that controls the amount of blood sugar. Often, gestational diabetes occurs during the second and third trimesters but disappears shortly after birth. Giannakou et al. (2019) have identified a list of risks of gestational diabetes and the need for appropriate and timely intervention. Some of these risks are a higher than normal growth of the fetus, excessive amniotic fluid and premature birth among others.

 

Population

The population that is targeted by the current research study are pregnant women in an outpatient clinic in San Diego, California. The target populations are selected from the outpatient clinic because they are easy to access and discuss their situation, possible interventions and objective of the study.

 

Intervention

The proposed intervention is telehealth. This is in recognition that while there is a sufficient supply of health care clinics in the San Diego area, not all patients are able to attend to the periodic clinic visits in part due to their condition and the distance between their residences and hospital. In addition to this, the use of telehealth is intended to supplement physical visits because digital tools allow for examinations to take place virtually. The fact that the target population make day visits to clinics for checkups and treatment implies that the caregivers are unable to afford sufficient observation. This means that they could miss out on identifying changes in vitals such as blood sugar. Intervention through telehealth enables caregivers to have more time to observe pregnant women and guide them on ways to assess their blood sugar levels.

 

Comparison

Commonly used approaches by most healthcare organizations are issuing test kits to at-risk pregnant mothers and having them conduct their tests back at home. In addition to this, they are then required to monitor their diet to ensure that the possibility of an increase in blood sugar is suppressed. While this approach has been helpful, it however preempts the one-on-one observation a caregiver takes on their patients virtually through telehealth. The fact that patients are expected to follow the guidelines as issued during their last visit. It is highly likely that with telehealth day to day follow-ups are made possible and with it better patient outcomes. Vora et al. (2020) have stated that high blood sugar levels are reduced and managed with a proper diet and physical exercises. Caregivers are challenged with making these verifications when they are done away from the health care settings like with outpatients visiting clinics periodically. A benefit that telehealth would be able to create is a daily check and monitoring of the individual patients without having them visit the clinic.

 

Outcome

The use of telehealth on gestational diabetes patients yields improved patient outcomes at a lesser cost. The patients are able to access valuable and high-quality care in the comfort of their homes saving a lot of time and financial resources. Zork (2022) has discussed the issues of convenience for both patients and caregivers and addressed the plight of people with mobility challenges. Telehealth increases the reach of the provider to pregnant mothers who are limited in their movement to and from one place to the other perhaps due to distance from the hospital or other physical challenges. With the objective being to alleviate the safety of patients by giving them the best quality care, the fact that the use of telehealth helps achieve this goal and many others further justifies its importance and adoption in helping address gestation diabetes patients.

 

Time

Owing to the fact that gestational diabetes has become a common ailment in the San Diego area and California at large, the proposed timeframe for the telehealth intervention is 10 months. The rationale for this timeframe is to allow sufficient time for providers to purchase and install the necessary equipment and technology to support the intervention. In addition to this, within this set timeframe the staff members who will be in frequent use of these technologies internally and remotely will be trained on how to install, use them and share the appropriate knowledge with their patients.

 

Literature Review

While there has been an increase in the number of pregnant women experiencing gestational diabetes in recent years, the emergence of Covid-19 perhaps illuminated the degree of unpreparedness of the healthcare system in the country. Commenting on the challenges that women with gestational diabetes faced during the pandemic faced, Aziz et al. (2020) mentioned that the inability of a majority of them to access health care facilities increased their risks of gestational diabetes. Drawing from this, the researcher has suggested the need for the federal government to liaison with private and public health providers to embrace the use of technologies such as telehealth and telemedicine. The contemporary common approach and methods used are for pregnant mothers to make physical visits to hospitals where their vitals are checked and this reveals whether they are at risk of gestational diabetes (May et al., 2021). Since the collection of self-monitoring data in the case of gestational diabetes is not complicated, the intervention of using telemedicine and telehealth would come in handy for both caregivers and patients. What this would mean as noted by Uecker and Kinnaman (2021) is that the need for making frequent physical visits would be unnecessary. Proper training on how to gather the much-needed self-monitoring data using the toolkits provided by the healthcare providers and submitting the same virtually through digital forms such as mobile phones has had positive impacts. Döğer et al. (2019) have pointed out that clinicians follow up with the visiting patients to determine whether treatment is needed. The challenge that the physical visits present is that they are time-consuming, cumbersome and leave out a material proportion of pregnant women who otherwise need similar care. With the emergence and rise in popularity of telehealth and telemedicine, clinicians have found a much-needed intervention for gestational diabetes and other ailments pregnant and nursing mothers face.

Appuswamy and Desimone (2020) argue that it makes no logical sense for pregnant women to visit clinics just to have their glucose levels checked and end up spending a lot of time and financial resources to do so. Notably, a majority of them, they do this just as a precaution to safeguard their plight and that of the unborn child. However, the intervention of using digital technologies such as telehealth has enabled more women who are otherwise limited by the lack of mobility and resources to collect their own records and share them using simple applications on their smartphones. The benefit that this has on these women is that their risks of gestational diabetes and related negative outcomes are reduced. In addition to this, the healthcare provider is able to handle more patients at a time as they only advise those who need treatment based on the data collected to pay them a visit. A different view presented by Appuswamy and Desimone (2020) points to the importance of clinics holding large volumes of data. The researchers have discussed the issue of using telehealth from a holistic point of view where they argue that with larger volumes of data from patients, these providers are able to engage in more analysis on the prevalence of gestational diabetes and other illnesses and hence determine the various interventions required for the entire population.

While there are many benefits that are discussed by researchers on the use of telemedicine as an important intervention in healthcare, there are a few limitations that emerge and the key among them is the availability and access to technologies such as the internet and digital equipment needed to facilitate the intervention. In commenting on this, Natamba, Namara and Nyirenda (2019) have raised the question of whether healthcare providers factor in the possible limitation in accessing and using digital technologies. What is more, some patients may delay or misinterpret readings on the test kits availed to them or mistype while relaying the information to clinicians (Aziz et al., 2020). Challenges such as these are likely to have a slight negative impact on the use of telehealth in intervening in gestational diabetes in places like San Francisco and others. On their part, Natamba, Namara and Nyirenda (2019) have considered that while providers profit from the increase in digital data for patients which as mentioned enables the custodian to leverage the big data for research and analysis, there is one slight issue that needs to be factored in; that with the larger amount of data, more workload accrues for the healthcare organization. Needless to say, there need incremental resources and perhaps staff for managing and handling this accumulation of medical and personal data and this could stretch the existing resources for the provider.

The identified drawbacks of telehealth notwithstanding, Zork (2022) has argued that the benefits that are associated with the use of this intervention, in the context of the United States at least, far outweigh the costs. Patient outcomes are improved because of the convenience that the use of telehealth creates. The existing policy on increasing coverage of patients in the country benefits from the use of technology as the providers are able to attend to more patients from across wider regions. What’s more, the use of telehealth and its closely linked concept of telemedicine increase the efficiency of intervention over time. This means that as more people get accustomed to digital technology, their use and collection of their own medical data using specified medical kits, they increase the efficiency in personal and healthcare further adding to the success of intended interventions. A huge plus that Zork (2022) has talked about in her article on the revolution that technology is causing in health care is communication. Today, more than ever before, the communication between clinicians and patients has improved. In part, this has been boosted by the increase in the means of digital communication such as emailing, video calling, texting and the use of other digital-based applications such as social media and in-house medical applications. Suffice it to say, an increase in communication between these parties harnesses the understanding of the needs of the patients ultimately leading to better quality healthcare and patient outcomes.

The one important lesson that covid-19 perhaps benefited the healthcare system is increasing awareness and illuminating the importance of virtual healthcare. With providers and patients alike forced by the pandemic to seek alternative ways of medical care that required minimal physical interaction, the ideas of telehealth were popularized at this time and people are recognizing the value provisions of the technology. That aside, since the pandemic is arguable diminished, telehealth and telemedicine are likely to stay longer and will probably be made industry standards over time. Drawing from this, Rutledge et al. (2021) claim that with telehealth, the sometimes infeasible and difficult in-patient visits are addressed. Telehealth ensures that patients that were receiving or require continued medical care and who are faced with unavoidable challenges still have an access to the care.

The details of the analyzed literature reveal two important issues. One is that the emergence and popularity of telehealth have many positive impacts and are likely to improve gestational diabetes patient outcomes over time. This is based on the fact that more patients will be reached, and also the convenience created. Two is that as providers and patients embrace this disruptive technology in healthcare, they will yield better results in the communication and care for patients. Importantly, the disruptive technology should be regarded more as an approach or alternative that supplements the existing physical and in-patient visits.

 

References

Appuswamy, A. V., & Desimone, M. E. (2020). Managing diabetes in hard to reach populations: a review of telehealth interventions. Current Diabetes Reports, 20(7), 1-10.

Aziz, A., Zork, N., Aubey, J. J., Baptiste, C. D., D’alton, M. E., Emeruwa, U. N., … & Friedman, A. M. (2020). Telehealth for high-risk pregnancies in the setting of the COVID-19 pandemic. American journal of perinatology, 37(08), 800-808. https://doi.org/10.1055/s-0040-171212

Döğer, E., Bozbulut, R., Acar, A. Ş. S., Ercan, Ş., Uğurlu, A. K., Akbaş, E. D., … & Cinaz, P. (2019). Effect of telehealth system on glycemic control in children and adolescents with type 1 diabetes. Journal of Clinical Research in Pediatric Endocrinology, 11(1), 70. https://doi.org/10.4274/jcrpe.galenos.2018.2018.0017

Giannakou, K., Evangelou, E., Yiallouros, P., Christophi, C. A., Middleton, N., Papatheodorou, E., & Papatheodorou, S. I. (2019). Risk factors for gestational diabetes: An umbrella review of meta-analyses of observational studies. PLoS One, 14(4), e0215372. https://doi.org/10.1371/journal.pone.0215372

May, S., Jonas, K., Fehler, G. V., Zahn, T., Heinze, M., & Muehlensiepen, F. (2021). Challenges in current nursing home care in rural Germany and how they can be reduced by telehealth-an exploratory qualitative pre-post study. BMC health services research, 21(1), 1-10.

Natamba, B. K., Namara, A. A., & Nyirenda, M. J. (2019). Burden, risk factors and maternal and offspring outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa (SSA): a systematic review and meta-analysis. BMC pregnancy and childbirth, 19(1), 1-11. https://doi.org/10.1186/s12884-019-2593-z

Rutledge, C. M., O’Rourke, J., Mason, A. M., Chike-Harris, K., Behnke, L., Melhado, L., … & Gustin, T. (2021). Telehealth competencies for nursing education and practice: the four P’s of telehealth. Nurse educator, 46(5), 300. https://doi.org/10.1097/NNE.0000000000000988

Uecker, M., & Kinnaman, J. (2021). A Comprehensive Analysis of the Importance and Implementation of Telehealth Behavioral Services in Rural Areas & Schools.

Vora, N. L., Hardisty, E., Coviello, E., & Stuebe, A. (2020). Telehealth to provide prenatal genetics services: Feasibility and importance revealed during global pandemic. Prenatal diagnosis, 40(8), 1040. https://doi.org/10.1002/pd.5716

Zork, N. M. (2022). Telehealth for the Management of Diabetes in Pregnancy. Current Diabetes Reports, 1-5. https://doi.org/10.1007/s11892-022-01476-x