Remote Collaboration and Evidence-Based Care

Demonstration of Proficiency

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

Create a 5-10 minute video of yourself, as a presenter, in which you will propose an evidence-based plan to improve the outcomes for a patient and examine how remote collaboration provided benefits or challenges to designing and delivering the care.

As technologies and the health care industry continue to evolve, remote care, diagnosis, and collaboration are becoming increasingly more regular methods by which nurses are expected to work. Learning the ways in which evidence-based models and care can help remote work produce better outcomes will become critical for success. Additionally, understanding how to leverage EBP principles in collaboration will be important in the success of institutions delivering quality, safe, and cost-effective care. It could also lead to better job satisfaction for those engaging in remote collaboration.

Demonstration of Proficiency

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

Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.

Reflect on which evidence was most relevant and useful when making decisions regarding the care plan.

Competency 3: Apply an evidence-based practice model to address a practice issue.

Explain the ways in which an EBP model was used to help develop the care plan.

Competency 4: Plan care based on the best available evidence.

Propose an evidence-based care plan to improve the safety and outcomes for a patient.

Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.

Identify benefits and strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team.

Communicate in a professional manner that is easily audible and uses proper grammar, including a reference list formatted in current APA style.

Propose an evidence-based care plan that you believe will improve the safety and outcomes of the patient in the Vila Health Remote Collaboration on Evidence-Based Care media scenario. ( Look at the end of the page for Villa Health Remote Collaboration)

Discuss the ways in which an EBP model and relevant evidence helped you to develop and make decision about the plan you proposed

Wrap up your video by identifying the benefits of the remote collaboration in the scenario, as well as discuss strategies you found in the literature or best practices that could help mitigate or overcome one or more of the collaboration challenges you observed in the scenario.

Sample paper

Hello. My name is Throughout this recording I will propose an evidence-based plan to improve the outcome for a patient. I will also examine how remote collaboration provides benefits and challenges in developing and delivering care. Although healthcare has gone through major advancements in the delivery of care, rural communities are still at a disadvantage when compared to urban areas. According to the National Rural Health Association, even though over 25% of the US population lives in rural areas, less than 10% of physicians practice in these areas (Ishfaq and Raja, 2015). Therefore, it is imperative that the healthcare system utilizes remote collaboration to provide evidence base care in rural communities. An evidence-based care plan utilizing remote collaboration will be developed to improve the patient outcome for Caitlyn who has been newly diagnosed with Cystic fibrosis. First, I would like to share some information with you about Caitlynn and her family. Caitlynn Bergan is a two-year-old girl who was admitted to Valley City Regional Hospital for pneumonia. During her hospitalization, she was newly diagnosed with Cystic Fibrosis. Caitlynn currently weight 20.7 pounds and exhibits signs of malabsorption. Caitlynn and her family live in a rural area called McHenry; it is over an hour away from the hospital. Caitlynns parents Doug and Janice are separated and they both work long hours. Caitlynns pediatrician Dr. Benjamin does not have much experience with treating cystic fibrosis. Dr. Benjamin will be collaborating with the doctor and nurse from Valley City Regional Hospital in attempt to treat Caitlynn in his office and minimize unnecessary trips to the hospital.

The hospital pediatrician, nurse, social worker, respiratory therapist and primary pediatrician collaborated to develop an evidence-based plan of care that would help Caitlynn and her family manage her cystic fibrosis within their rural town. Caitlynn was started on pancreatic enzymes and a high protein, high caloric diet with fat soluble vitamins. She was also started on aerosol treatments and chest physiotherapy. The social worker found a nearby support group that may help Caitlynn and her family cope with managing this chronic illness. I will now explain the ways in which an evidence-based practice model was used to help develop the care plan for Caitlynn. Telemedicine uses evidence-based practice and technology to delivery healthcare and improve patient outcomes in areas where doctors and patients are separated by distance. Telemedicine can be used to diagnose, treat and monitor patients (Ishfaq and Raja, 2015). Rural healthcare facilities utilize electronic medical records, and telecommunication to connect to regional hospitals. Caitlynns pediatrician Dr Benjamin can utilize telemedicine to connect to Valley City Regional Hospital. In doing so, Caitlynn can receive consultations with specialists and monitoring remotely. With telemedicine, Caitlynns family can also receive ongoing education regarding the management of cystic fibrosis. Having an interdisciplinary team available online and on the phone grants the Bergans the necessary support to manage caring for a child with a progressive chronic illness in a rural area in which these resources would not otherwise be available. The modalities for Caitlynn may include chest physiotherapy, breathing treatments, medication administration, and a nutrition plan. Cystic fibrosis is a hereditary disorder that causes mucus, sweat and digestive secretions to thicken which damages organs such as lungs, pancreas and intestines (Cystic Fibrosis, 2016). There is no cure for cystic fibrosis, but various interventions can be used manage this illness and minimize complications. Caitlynns plan of care includes pancreatic enzymes to aid in the absorption of nutrients. Chest physiotherapy and aerosol breathing treatments are included in Caitlynns plan of care in order to expel mucus and keep her airway open in order to improve lung function and decrease risk for developing pneumonia (Cystic Fibrosis, 2016). Caitlynns mother received education regarding chest physiotherapy and found it to be overwhelming initially. However, with the use of telemedicine, the respiratory therapist provided ongoing education and support. Now, I would like to reflect on which evidence was most relevant and useful when making decisions regarding the care plan. A study by Ishfaq and Raja published in 2015 stated that telemedicine has been shown to greatly improve access to healthcare services in rural areas. The utilization of telemedicine was most relevant and useful in Caitlynns care plan. Caitlynn, her family and her pediatrician are going to be utilizing telemedicine to consult with the team of Valley City Regional Hospital. In addition, it will be used to provide efficient, and convenient monitoring and education. By utilizing telemedicine for phone and video conferencing, Caitlynn will receive continuous monitoring, timely interventions and minimized complications. Lastly, I will identify benefits and strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team. Caitlynns parents faced a few challenges regarding remote collaboration with an interdisciplinary team. Their long work hours and inability to take time off for appointments due to financial obligations present as a challenge. Remote collaboration with the team that developed Caitlynns plan of care can help mitigate this challenge. The team can provide ongoing support and availability to Caitlynns parents after work. This minimizes the time her parents need to take off work while still ensuring Caitlynn receives continuity of care and necessary follow up. Another challenge is Dr. Benjamins inexperience with caring for patients with cystic fibrosis. The utilization of an electronic medical record and video conferencing with the team in Valley City Regional Hospital can help mitigate this challenge. Caitlynn and her parents would only have to travel to Dr. Benjamins office instead of the long distance to the hospital. Although the travel is decreased with the use of the electronic medical record and video conferencing; the team from Valley City Regional Hospital will still be able to be involved in Caitlynns plan of care. Access to healthcare is a human right. Remote collaboration helps make that possible. Telemedicine brings forth remote collaboration to rural areas to ensure patients in these areas receive evidence-based practice and improved outcomes. Evidence has shown that utilization of remote collaboration offers an efficient and flexible alternative to traditional services (Wang et al., 2019). As a nurse and patient advocate it is important to understand how remote collaboration can be used to provide evidence-based care to Caitlynn as well as other patients that otherwise may not have access.

VILLA Activity

Remote Collaboration and Evidence-Based Care

Evidence-based care can be a challenge in any medical situation, but particular challenges present themselves when care is being provided remotely. In order to provide quality care to patients who live in rural settings or have difficulty with transportation to a care site, health care professionals must sometimes collaborate with other professionals in different ZIP codes or even time zones

Dr. Copeland starts the conversation.

Dr. Copeland: Nurse, can you give me an update on Caitlynn? I know shes two years old and shes been admitted for pneumonia. Does she have any history of breathing problems?

Virginia Anderson: Yes, this is her second admission for pneumonia in the last six months. She had a meconium ileus at birth.

Dr. Copeland: All right. Is she presenting with any other symptoms?

Virginia Anderson: She has decreased breath sounds at the right bases and rhonchi scattered in the upper lobes. Respirations are 32 and shallow with a temp of 101.

Dr. Copeland: What have we done for her so far?

Virginia Anderson: The respiratory therapist administered nebulized aerosol and chest physiotherapy. After the aerosol she had thick secretions.

Dr. Copeland: I see her weight is 20.7 pounds, and theres been some decreased subcutaneous tissue observed in her extremities?

Virginia Anderson: Correct. I noticed this too, so she might have some malabsorption of nutrients.

Dr. Copeland: Have we done a sweat chloride test yet?

Virginia Anderson: Yes, and the results were 65 milliequivalents per liter. Also, the mother reports that when she kisses her, she tastes salty.

Dr. Copeland: All right. Well, I think its fair to say we might be dealing with cystic fibrosis here. Lets get her started on an IV with piperacillin, and keep an eye on her temperature.

Dr. Copeland starts the conversation.

Dr. Copeland: Lets talk about Caitlynn Bergan. Her mother, uh, [checks notes] Janice, has been informed of her diagnosis. I didnt realize this when she first came in, but she doesnt live in Valley City; shes in McHenry.

Rebecca Helgo: Thats a tough drive during winter. Theyre over an hour away, arent they?

Dr. Copeland: Thats right. It was a toss-up between coming here or going to Jamestown, but I guess the father Doug thought Valley City was the better choice. Anyway, Ive put her on Pancrease enzymes and well be recommending a high-protein, extra-calorie diet along with the fat-soluble vitamins A, D, E, and K. Ill update her pediatrician on her condition, and order dornase alfa. Lets see how she does with the breathing treatments. How are those going?

Rebecca Helgo: Quite well, actually. Shes too young to get her to do the huff breaths, but were keeping the secretions thin and manageable with the aerosol treatments. I am concerned about her day-to-day treatment, though. Shell be back here with pneumonia if the parents cant stay on top of that. Shes at risk for impaired gas exchange and respiratory distress, which will cause her anxiety and more distress, and thats not going to help her stay well.

Dr. Copeland: How well do you think the parents will be able to handle the treatment?

Virginia Anderson: That might get tricky. I gather that the mother and father are still married but separated. Well need to make sure that at least one of them gets the education they need. But they both work, and trips here arent the easiest choice. We should get a social services consult to coordinate services and identify some assistance for the family in McHenry.

Rebecca Helgo: I can do some education here, and then do a Skype consult with one or both of them once shes been discharged and is back home.

Dr. Copeland: It sounded like both parents work long hours. Are you going to be able to schedule times that work?

Rebecca Helgo: I may have to do some after-hours appointments. Well have to sort that out.

Virginia Anderson: Shes had one bowel obstruction already, so I think we need to help them monitor for DIOS too. Does the pediatricians office have a telemedicine relationship with us? That might be helpful in preventing unnecessary trips here.

Dr. Copeland: Lets find out a bit more and see what our options are.

Dr. Copeland greets Dr. Benjamin.

Dr. Copeland: Hello, Dr. Benjamin. Im sorry to be meeting under such circumstances, but I hope we can work with you to help the Bergans handle Caitlynns care. On the line with me is Virginia Anderson, the nurse assigned to Caitlynn while shes here.

Dr. Benjamin: Hello to both of you. Yes, its unfortunate. This is the first case Ive seen among my own patients.

Dr. Copeland: Are you familiar with the CF protocol?

Dr. Benjamin: I am, but Id love to get any more details that relate to Caitlynn. Shes done with most of her immunizations, but shes still needs her HAV and influenza, of course. Im also not sure where to order some of the pancreatic enzymes and medications you listed.

Virginia Anderson: We can help with all that. Do you have telemedicine access to Valley City?

Dr. Benjamin: No, but we do have it with Cooperstown Medical Center. We kind of have to in a town of less than 100 people.

Dr. Copeland: We may be able to use Skype on a more informal basis for consults between us, but it might be good to get connected with Valley City on your telemedicine equipment. If the parents bring Caitlynn to you with symptoms, and youre not sure whether the hour-long trip is necessary, we can do a telemedicine appointment and make sure.

Dr. Benjamin: All right. It sounds like we might see them often initially, and I understand that bowel obstructions and pneumonia are two possible complications. We can handle some of those issues here, but assuming they have trouble during working hours, I assume we can reach you by phone?

Dr. Copeland: You or your staff can send me a text. If we need to talk further we can set up a call, but if not, text is the quickest way to get my attention, and the easiest way for me to respond between things.

Virginia Anderson: And Im available via text as well if youre having trouble reaching Dr. Copeland or if its a question I can field.

Virginia starts the conversation.

Virginia Anderson: Hi, Madeline, this is Virginia Anderson at Valley City Regional Hospital. Im on the line with Marta Simmons, our social worker here at the hospital.

Madeline Becker: Hi, both of you.

Marta Simmons: Madeline, were calling because Virginia is working on a care plan for a child from McHenry, a Caitlynn Bergan. Shes here after a bout of pneumonia and shes been diagnosed with cystic fibrosis. We wanted to talk to you about resources there for some of the issues the Bergans are going to be dealing with.

Madeline Becker: Of course. I got the documentation you emailed earlier. Fortunately, the Bergans are both employed and have good insurance through Dougs new job. But as you may have heard, he was unemployed for some time, so money is tighter than it might seem.

Virginia Anderson: Weve talked to Janice and she isnt sure what her insurance covers as related to the breathing and other treatments Caitlynn is likely to need.

Madeline Becker: I can do some initial work on that. Ill need a release from Janice to get detailed information, but I should be able to get general coverage information. What other resources might they need? McHenry is pretty small, as Im sure youre aware.

Marta Simmons: The main issue is going to be the stress of caring for a child with a chronic illness. Even a group that helps members deal with grief would be helpful. Children with CF live much longer than they used to, but its still a difficult condition.

Madeline Becker: There isnt a group like that here, but there is one in Sheyenne. I mean, its more for parents in grief already, parents who have lost a child, but its a sizable group, relatively speaking. Im sure there will be some parents who understand what its like to have a child with a difficult condition.

Virginia Anderson: All right, that helps. Now, were going to provide as much education as we can before Janice takes Caitlynn home, but what kind of resources are there in McHenry? If she doesnt have home Internet access, does the library offer it? Is there a library?

Madeline Becker: No, the closest library is in Cooperstown.

Marta Simmons: Well, well talk to the Bergans pediatrician and see if they might be able to help if they need materials and cant get them easily at home. This is progressive and lifelong, and theyre going to need some support as they learn to deal with it.

Virginia Anderson starts the conversation.

Virginia Anderson: Hi, Janice, thanks for contacting us! Were getting back to you about Caitlynn. With me on the line is Rebecca Helgo, the respiratory therapist who helped you out when you were here.

Rebecca Helgo: Hi, Janice.

Janice: [sounding stressed] Hi.

Virginia Anderson: Janice, how is it going with Caitlynn?

Janice: Well, thats why I called, actually. Not so good. I mean, not bad, but I guess Im not remembering everything you told me when we practiced the physiotherapy, the chest physiotherapy.

Virginia Anderson: Thats okay, Janice. I know this feels overwhelming. Caitlynns condition is an extensive one, and were here to help you manage it. Well continue to be here as youre figuring this out, okay?

Rebecca Helgo: Thats right, Janice. I know youll get the hang of it, but in the meantime theres a lot to learn. So you had some questions about the chest physiotherapy? Whats going on?

Janice: Okay, if you can see on the camera, Caitlynn has these red marks on her ribs here. Is that a symptom of something?

Rebecca Helgo: Can you get the camera just a bit closer?

Janice: Hows that?

Rebecca Helgo: Okay, very good. Yes, those look like marks from the percussion. Are those over her last two ribs?

Janice: I think so.

Rebecca Helgo: Thats one thing youll have to remember: You dont want to do the percussion on her last two ribs on either side, her backbone, or her breastbone. And when you do it anywhere else, you dont want to leave red marks. So if you see those, thats a hint that youre doing the percussion just a bit too hard.

Virginia Anderson: Dont worry, you havent hurt her that I can see. Plus, youre obviously really staying on top of things and youre following the recommended treatment procedures for Caitlynn, and I really want to praise you for that. So, is she acting like that area is hurting her? Or can you tell?

Janice: No, it doesnt seem like its hurting her at all.

Rebecca Helgo: She should be fine, then.

Virginia Anderson: And remember, Janice, if you continue to have trouble with this, weve got other options. Theres a vest that vibrates the child if percussion isnt getting the job done. And you wont have to do exactly this forever. As she gets older and can learn how to do huff coughs, youll be doing less work and shell be doing more.

Janice: Okay. Thank you, that makes me feel better. I couldnt get hold of my pediatrician and I was just getting worried.

Rebecca Helgo: Good, thats what were here for.

Virginia Anderson: Janice, should we review the signs and symptoms of respiratory distress? Were happy to go over anything you need to feel more confident about monitoring Caitlynn.

Janice: I think I remember those. I feel like I check for them every hour.

Rebecca Helgo: [chuckles] Thats understandable. Well, remember to check with Dr. Benjamin or me or Virginia if you need to.