Name
Capella University
NURS-FPX 6030 MSN Practicum and Capstone
Prof. Name
Date
This assessment continues the discussion on the intervention designed for the Population, Intervention, Comparison, Outcome, and Time( PICOT) question developed and discussed in the previous two assessments. The PICOT question analyzes the strategic management of nurse-led care transition and how it impacts the efficiency of healthcare resource management compared to standard care provided for mothers in post-partum after giving birth to pre-term infants. This assessment delves into the intervention plan and the relevant theoretical, ethical, and legal perspectives.
The intervention designed to improve hospital resource management is nurse-led care transition programs. This intervention is based on various components and elements, each essential for effective implementation and achieving the desired outcome. The population’s health needs are thoroughly examined to tailor the care transition plans accordingly. Mothers who have given birth to pre-term babies require physical healthcare along with the challenges they encounter after pre-term birth. These can be varied from patient to patient, and a deeper analysis can help nurses develop transition care plans accordingly (Phillips et al., 2023).
Another significant intervention component is creating customized care plans that consider patients’ medical history, post-partum recovery, and psychosocial needs. Moreover, the nurses are expected to educate mothers about post-partum care and caring for pre-term infants, such as recognizing signs of complications, monitoring infants’ development, and self-care strategies. The nurses must foster interdisciplinary collaboration with relevant team members such as physicians, neonatologists, lactation consultants, and social workers to create a holistic care transition plan for mothers and their pre-term babies (Haemmerli et al., 2021).
These components will help nurses promote effective care strategies during care transition procedures, ultimately reducing hospital readmission rates and the need for emergency visits. This will improve the efficiency of healthcare resources and their effective allocation for other patients, fulfilling the identified need described in the previous assessment. The criteria that can be utilized to evaluate the success of this intervention plan are measuring the patient satisfaction scores through mothers’ surveys, analyzing reduction in hospital readmission rates, and better allocation of resources without complaints of resource scarcity in gynecology and neonatology wards (Seltzer et al., 2022).
The intervention plan’s components greatly depend on the cultural needs and the features of the population and setting. Considering the given population of mothers post-partum after giving birth to pre-term babies in hospitals, the cultural needs can vary due to diverse cultural backgrounds and their varied beliefs about health and illness. They all have different knowledge, perspectives, and beliefs in healthcare practices after childbirth and post-partum. Therefore, nurse-led care transition programs will require culturally competent care plans that consider the patients’ cultural considerations and their impact on care transitions (Hanssen et al., 2021). The educational materials must be in a language understandable by culturally diverse mothers who use cultural language. Moreover, the nurse practitioners will require additional training in providing care transition guidance and education in a culturally competent manner (Kamau et al., 2022).
The hospital will require culturally competent nursing staff to address these cultural needs and specific health policies to implement a patient-centered care culture. These cultural needs will require training, additional recruitment of qualified staff, and fostering collaboration among interprofessional teams to promote communication strategies to address cultural sensitivity among the target population (Srivastava, 2022). The analysis is based on the assumption that culturally diverse populations as patients are prone to dismiss the accomplishment of improving healthcare resource efficiency when their cultural beliefs do not align with healthcare practices (Argyriadis et al., 2022). Therefore, considering the cultural requirements of implementing intervention successfully is essential to manage healthcare resources efficiently.
Different theoretical nursing models apply to the intervention plan of nurse-led care transition programs for mothers after pre-term births. Roy’s Adaptation Model (RAM) is a nursing theory centralized on individuals adapting to internal and external stimuli to maintain balance and well-being (Kim & Kim, 2023). These stressors can prompt adaptive responses through coping mechanisms. This theory is relevant to the proposed intervention plan, as mothers who have given birth to pre-term babies experience emotional, physical, and psychosocial challenges that are addressed by nurse-led care transition programs and help them adapt to the current difficulties of the health challenges of post-partum and caring for pre-term infants (Tefera et al., 2022).
The strength of this theory is that RAM takes a holistic approach by considering multiple adaptive modes such as physiologic, role function, self-consent, and interdependence, which helps address various aspects of patients’ lives in the subject scenario. Moreover, it integrates the nursing processes such as assessing patients, diagnosing, planning, implementing, and evaluating. Therefore, it provides a systematic approach for nurses to guide their nurse-led care transition program effectively. The weaknesses of RAM are the complex nature of this model for novice nurses and the lack of clarity on residual stimuli, making them practically invalid (Kim & Kim, 2023).
Another theory, Peplau’s Interpersonal Relations Theory, focuses on nurse-patient relations. It is relevant to nurse-led care transition programs where nurses must communicate with mothers post-partum after pre-term birth and provide education, support, and guidelines in the care transition process. Through effective interpersonal relations between nurse and patient, the goal of managing healthcare resources is efficiently achieved as patients coordinate with nurses sufficiently (Salvador et al., 2022). The strengths of this theory are a strong emphasis on nurse-patient relations where significant health outcomes can be improved by creating a strong, positive, and healthy relationship. The weaknesses include the need for sufficient time to build deeper interpersonal connections and dependence on practical and therapeutic communication skills to foster connections (Salvador et al., 2022).
The strategies from other disciplines that can be adopted related to nurse-led care transition programs are social work support services such as connecting families with community resources and providing emotional support that can promote comprehensive care for mothers in post-partum with preterm babies. Other strategies include psychological strategies to promote positive behaviors and reinforcements to encourage desired behaviors and outcomes in maternal self-care and infant care (Mazza et al., 2021). These strategies significantly influence intervention plan components in enhancing care and adherence to the care plan.
The healthcare technologies relevant to the intervention plan of a nurse-led care transition program include mobile health applications. These apps can provide accessible resources, educational materials, and reminders to support mothers of pre-term babies in improving self-care and managing preterm infant care. This technology influences the design of nurse-led care program components as the education nurses provide can be practically applied with the help of these apps that promote consistency and adherence to care plans (Phagdol et al., 2021).
The subsequent section justifies the intervention plan using theoretical models, strategies, and technology. The RAM theoretical model suggests that the adaptive nature of humans to external stimuli can provide them with better coping mechanisms and help them adapt to the surrounding situations. This theory justifies the intervention plan, including educating mothers of pre-term infants to manage the health challenges effectively and adjust to the current healthcare scenarios with wisdom and correct knowledge (Kim & Kim, 2023). Similarly, the intervention’s component of interprofessional collaboration is justified by Peplau’s theory, which emphasizes the need for interpersonal connections and relations to enhance care coordination (Salvador et al., 2022).
The strategies of social support services and reinforcing psychological behaviors also justify the customized care plans based on health needs, such as mothers requiring social and community resources and psychological support. These strategies also justify the intervention’s component of thorough assessment to delve into specific patients’ needs and provide social and psychological support accordingly. The mobile health technologies justify the nurse-led care transition programs as the mothers can implement knowledge nurses share effectively through these apps, providing alarms, educational resources, and self-care support to mothers (Phagdol et al., 2021). The conflicting data from the earlier perspectives exist in literature where nurse-led care transition programs are not supported with strategies from other disciplines due to the need for extensive resources and time for collaboration (Dyess et al., 2023).
The relevant stakeholders of this intervention plan are nurses, mothers in post-partum with pre-term infants, social supporters, and psychologists. The needs of these stakeholders are vital to consider as they directly impact the nurse-led care transition programs. For instance, nurses must educate mothers, communicate with interprofessional team members, and manage the care transition process (Hays et al., 2022). The mothers must be adequately guided on post-partum and pre-term infant care with sufficient knowledge of the baby’s future follow-ups and managing challenges associated with pre-term infant care. The social supporters must coordinate with mothers, nurses, and community resources to deliver emotional and social support (Brazil et al., 2022). Psychologists are needed to provide mental health support to mothers. These needs must be adequately met to successfully implement the intervention plan components (Dyess et al., 2023).
The American Nurses Association is the governing body that guides nurses through healthcare policies. The health policies on care coordination necessary for care transition provide nurses with authentic guidelines for performing care transition plans for mothers having given pre-term births (ANA, 2023). The Health Insurance Portability and Accountability Act (HIPAA) regulations are vital to implement when mobile health apps are used. The HIPAA regulatory guidelines emphasize the importance of securing patients’ protected health information to prevent privacy breaches (Choi & Williams, 2022).
Compliance with these policies and regulations promotes the effective implementation of intervention plans such as interprofessional collaboration, which requires the practice of care coordination policies where nurses are adequately communicating with multidisciplinary team members and creating care transition plans according to shared decisions of team members and the health needs of mothers and pre-term infants. The underlying assumptions of this analysis are grounded in theoretical perspectives that health policies by governing bodies and stakeholders’ collaboration can effectively direct the nurses to make the nurse-led care transition successful. Moreover, health policies are meant to guide nurses by paving the way for them to perform corrective steps in light of sound literature (ANA, 2023).
The ethical issues identified in this project are related to mothers’ autonomy in post-partum for creating care-transition plans according to their preferences and health needs. Moreover, privacy and security issues are raised during mobile health apps and interprofessional team collaboration. These ethical issues affect the intervention plan’s educational component and interprofessional collaboration element. Moreover, legal issues can arise when the nurses must practice the state nursing board policies and accreditation standards. Adherence to these legal standards and policies ensures nurses customize care transition plans accordingly (Iversen et al., 2021). These legal issues impact the nurse-led care transition plans. Failure to implement these health policies by the American Nursing Association can lead to incorrect and illegal healthcare practices and require organizational change to revise the guidelines and take stringent measures.
This assessment studied the intervention plan to discuss ethical, legal, and regulatory considerations. The nurse-led care program is based on interprofessional collaboration, educating postpartum mothers with preterm babies, and thorough health analysis. Moreover, theoretical models, strategies, and technologies, such as RAM and Peplau’s theory, are highlighted. Ethical, legal, and regulatory issues must be considered while designing the intervention.
ANA. (2023, December 21). Care coordination and the essential role of nurses | American Nurses Association (ANA). ANA. https://www.nursingworld.org/practice-policy/health-policy/care-coordinatio
Argyriadis, A., Patelarou, E., Paoullis, P., Patelarou, A., Dimitrakopoulos, I., Zisi, V., Northway, R., Gourni, M., Asimakopoulou, E., Katsarou, D., & Argyriadi, A. (2022). Self-Assessment of health professionals’ cultural competence: Knowledge, skills, and mental health concepts for optimal health care. International Journal of Environmental Research and Public Health, 19(18), 11282. https://doi.org/10.3390/ijerph191811282
Brazil, V., McLean, D., Lowe, B., Kordich, L., Cullen, D., De Araujo, V., Eldridge, T., & Purdy, E. (2022). A relational approach to improving interprofessional teamwork in post-partum haemorrhage (PPH). BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-08463-8
Choi, Y. B., & Williams, C. E. (2022). A HIPAA security and privacy compliance audit and risk assessment mitigation approach. Research Anthology on Securing Medical Systems and Records. https://www.igi-global.com/chapter/a-hipaa-security-and-privacy-compliance-audit-and-risk-assessment-mitigation-approach/309023
Dyess, N. F., Keels, E., Myers, P., French, H., Reber, K., LaTuga, M. S., Johnston, L. C., & Scala, M. (2023). Optimizing clinical care and training in the neonatal intensive care unit: The relationship between front line providers and physician trainees. Journal of Perinatology, 43(12), 1513–1519. https://doi.org/10.1038/s41372-023-01749-7
Haemmerli, N. S., Gunten, G. von, Khan, J., Stoffel, L., Humpl, T., & Cignacco, E. (2021). Interprofessional collaboration in a new model of transitional care for families with preterm infants – the health care professional’s perspective. Journal of Multidisciplinary Healthcare,14, 897–908. https://doi.org/10.2147/jmdh.s303988
Hanssen, I., Mkhonto, F. M., Øieren, H., Sengane, M. L., Sørensen, A. L., & Tran, P. T. M. (2021). Pre-decision regret before transition of dependents with severe dementia to long-term care. Nursing Ethics, 29(2), 344–355. https://doi.org/10.1177/09697330211015339
Hays, K., Denmark, M., Levine, A., de Regt, R. H., Andersen, H. F., & Weiss, K. (2022). Smooth transitions: Enhancing interprofessional collaboration when planned community births transfer to hospital care. Journal of Midwifery & Women’s Health, 67(6), 701–706. https://doi.org/10.1111/jmwh.13441
Iversen, A.-M., Stangerup, M., From-Hansen, M., Hansen, R., Sode, L. P., Kostadinov, K., Hansen, M. B., Calum, H., Ellermann-Eriksen, S., & Knudsen, J. D. (2021). Light-guided nudging and data-driven performance feedback improve hand hygiene compliance among nurses and doctors. American Journal of Infection Control, 49(6). https://doi.org/10.1016/j.ajic.2020.11.007
Kamau, S., Koskenranta, M., Kuivila, H., Oikarainen, A., Tomietto, M., Juntunen, J., Tuomikoski, A.-M., & Mikkonen, K. (2022). Integration strategies and models to support transition and adaptation of culturally and linguistically diverse nursing staff into healthcare environments: An umbrella review. International Journal of Nursing Studies, 136, 104377. https://doi.org/10.1016/j.ijnurstu.2022.104377
Kim, J., & Kim, H. (2023). A structural equation model on social re-adjustment of stroke patients: Based on Roy’s adaptation model. Journal of Korean Academy of Nursing, 53(4), 480–480. https://doi.org/10.4040/jkan.22140
Mazza, M., Caroppo, E., Marano, G., Chieffo, D., Moccia, L., Janiri, D., Rinaldi, L., Janiri, L., & Sani, G. (2021). Caring for mothers: A narrative review on interpersonal violence and peripartum mental health. International Journal of Environmental Research and Public Health, 18(10), 5281. https://doi.org/10.3390/ijerph18105281
Phagdol, T., Nayak, B. S., Lewis, L. E., Margaret, B., & George, A. (2021). Designing a mobile health intervention for preterm home care: Application of conceptual framework. Public Health Nursing, 39(1), 296–302. https://doi.org/10.1111/phn.13020
Phillips, S. E. K., Celi, A. C., Wehbe, A., Kaduthodil, J., & Zera, C. A. (2023). Mobilizing the fourth trimester to improve population health: Interventions for postpartum transitions of care. American Journal of Obstetrics and Gynecology, 229(1), 33–38. https://doi.org/10.1016/j.ajog.2022.12.309
Salvador, J. T., Al‐Madani, M. M., Al‐Hussien, A. M., Alqahtani, F. M., Alvarez, M. O. C., Hammad, S. S., Sudqi, A. I., Cabonce, S. G., Reyes, L. D. V., Sanchez, K. B., Rosario, A. B., Agman, D. D., & Al‐Mousa, A. A. (2022). Revisiting the roles of neonatal intensive care unit nurses towards vision 2030 of Saudi Arabia: A descriptive phenomenological study. Journal of Nursing Management, 30(7), 2906–2914. https://doi.org/10.1111/jonm.13637
Seltzer, E. K., Guntuku, S. C., Lanza, A. L., Tufts, C., Srinivas, S. K., Klinger, E. V., Asch, D. A., Fausti, N., Ungar, L. H., & Merchant, R. M. (2022). Patient experience and satisfaction in online reviews of obstetric care: Observational study. JMIR Formative Research, 6(3), e28379. https://doi.org/10.2196/28379
Srivastava, R. H. (2022). The health care professional’s guide to cultural competence – e-book. In Google Books. Elsevier Health Sciences. https://books.google.com/books?hl=en&lr=&id=FgxvEAAAQBAJ&oi=fnd&pg=PP1&dq=culturally+competent+care+and+communication+for+care+transition&ots=4iDgH3lV-_&sig=TlhCfBXP9WJWAv2kAvF2krqGr2M
Tefera, M., Assefa, N., Roba, K. T., Gedefa, L., Brewis, A., & Schuster, R. C. (2022). Women’s hospital birth experiences in Harar, eastern Ethiopia: A qualitative study using Roy’s adaptation model. BMJ Open, 12(7), e055250. https://doi.org/10.1136/bmjopen-2021-055250
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