NR 512 Week 5 Discussion, Knowledge Generation Through Nursing Informatics (Two Versions)

Week 5: Knowledge Generation Through Nursing Informatics In one of the reading assignments this week you reviewed advance nurse practitioner (APN) roles and the application of project management concepts, one of the major elements of NI, but new to most nurses. What type of application does this have for your practice? According to Sipes (2016, p. 16), the five steps of project management are similar to the five steps of the nursing process when caring for patients using evidence-based care. I like that they compared project management to planning a wedding. This helped to form the concept in my mind, a process with defined steps that must be completed by certain dates that all lead up to a conclusion. In that definition, each nursing class or the program leading up to graduation could be viewed as the same. As a primary care nurse practitioner, patients will require this type of mindset in order to manage their care. In a 2014 article, the authors describe chronic disease management and the importance of the primary nurse in this process (Van Dillen, & Hiddink, 2014). According to Van Dillen and Hiddink (2014), weight management and other chronic disease management requires a case management approach to their care. The practitioner must assess the patient’s situation and health behaviors making note of each patient’s needs. They must then plan interventions, teaching and treatment options. The practitioner must be skilled at communicating with and advocating for patients to meet their needs. By collaborating with outside resources, managing medications, and services, and educating patients, the nurse practitioner and practice nurse help to manage their patient’s chronic conditions. But what about those patients that either do not have primary care practitioners? Batchelor (2015) discusses a novel idea to address the problem of patients with no primary care physician. In this 2015 article, the author discusses the creation of a transitional care clinic that works with patients who have chronic diseases for thirty to sixty days after discharge from the hospital or emergency room, stabilizing their condition and then getting them connected with a primary care physician in the area. This seems like a perfect solution to the problem of ‘frequent flyers’ that do not have primary physicians and continue to frequent the emergency rooms with conditions that could easily be managed in the outpatient setting. Whatever we do as we enter the workforce, one thing is for sure, project management will be an integral part of our practice. Nichole References: Batchelor, C. (2015). Nurse practitioner-led transition care clinic - a new perspective on chronic disease management. Tar Heel Nurse, 77(6 Spec No), 18. Sipes, C. (2016). Project management for the advanced practice nurse, Springer. Van Dillen, S. E., & Hiddink, G. J. (2014). To what extent do primary care practice nurses act as case managers lifestyle counselling regarding weight management? A systematic review. BMC Family Practice, 15197. doi:10.1186/s   Reply: I agree that a practical and commonplace application of a concept can promote comprehension. By linking a familiar process to one that is perhaps more obscure can help us acquire that new knowledge. While we may not educate patients as to rigors of project management we can use this structure to organize an approach that has evidence to support its use for strategies for teaching. I appreciated that you recognized the need for patients and practitioners to mutually share expectation and needs so that the resulting plan of care will be more readily accepted. The time of transition of care has been identified as a critical area with a great potential for errors. What did the authors of the article reviewed note as the funding sources for this transitional care since monies are always a concern? Dr. Bev, Thank you for your response. The article that I reviewed did not list where the funding for the clinic came from. However, I did look into this particular clinic out of curiosity and it is a non-profit organization that does receive some government funding as well as private donations. The clinic bills the patient’s insurance if they do have insurance and also helps patients to apply for financial assistance as well as assisting patients to apply for other programs that they may qualify for. They have payment programs as well as financial assistance for low income families. The website stated that the assistance was 100% of charges for families with an income of two times the poverty level (FirstHealth of the Carolinas, Inc., n.d.). Unfortunately, patients with a decent income that do not have insurance, may still fall through the cracks if they were unable to or unwilling to pay the fees or arrange payment plans. One solution in some areas could be a free, student led medical clinic (Taylor, Hollett, Anderson, & Schwenk, 2016). These tend to be a good experience for the medical students to gain more patient interaction and for patients to receive free treatment, but they are only feasible near schools of medicine and for those patients who do not live in those areas, free clinics are few and far between. Sadly, there is no easy answer for all patients. References: FirstHealth of the Carolinas, Inc. (n.d.). Transition Care Clinics. Retrieved from FirstHealth of the Carolinas: Taylor, M. A., Hollett, Y. R., Anderson, J. P., & Schwenk, T. L. (2016). Educational value of a free medical clinic operated by medical students. Family Medicine, 48(2), 127-131.   Nichole, Great post this week! I agree with your assessment that there needs to be an upfront conversation between the practitioner and the patient regarding honest expectations of the care processes. And your report about the clinics being developed specifically to provide continuity of care and to provide case management and referrals to new primary care providers as well as specialty providers is something that I could support! As an ER nurse, this has always been the biggest annoyance. Not simply that they "don't care to follow up" but that there are very limited options for these patients. Mostly it seems that this is due to the "type of insurance" or being non-insured. In my way of thinking, hospitals that provide emergency and urgent care services would benefit from sponsoring clinics such as this. This service would cut the cost of hospital overhead, by cutting down on the "frequent flyers" that have no insurance or low insurance. These people have a tendency to not be able to pay the large bills anyway, so this sort of treatment clinic would potentially decrease their visit frequency for non-emergent chief complaints. Dawn