Mid Range Theory Application For Health Promotion Model

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

Sharing information about the patient’s health status helps to create continuity of care between the medical staff and family members involved in the patients care. As stated in the textbook Leddy & Pepper 's Conceptual Bases of Professional Nursing (2014), “Patient-centered care was created in efforts to improve quality and safety in nursing and healthcare emphasizing the importance of patient-centered care, during which nurses use a holistic care approach considering each patient’s personal preferences, values, family situations, religious and cultural traditions, and specific life- style”

(Mann, 2014, p.2) These strategies include: broadening access to primary care services; focus on individuals who frequently utilize the emergency department (super-utilizers); and targeting the needs of individuals with behavioral health problems. (Mann, 2014, pp 2-4) Many resources and processes have been implemented in order to help decrease inappropriate emergency department visits. This paper is going to demonstrate some resources and processes that are in place to help individuals obtain health care at the appropriate health care setting.

The patient centered medical homes (“PCMH”) approach “focuses on keeping people well, managing chronic conditions like diabetes or asthma, and proactively meeting the needs of patients.” According to the Arkansas Department of Health, chronic diseases like cancer heart disease or diabetes affect approximately over fifty percent of adult Arkansans. Yet chronic diseases are often preventable. The high rate of chronic diseases can partly be attributed health insurance coverage—“when people don’t have health insurance they tend to avoid seeing doctors. People

The role of nurse practitioner is valuable when discussing collaborative care. There are so many levels of care, so many health entities, and so many insurer criteria involved that it is instrumental to have a role that can work towards help bring all aspects together. In addition to diagnosing, treating, and managing care, the role of the nurse practitioner is to manage simple and episodic acute health issues along with chronic disease (Sangster-Gormley, Martin-Misener, & Burge, 2013). It is important to note that although this is a function of this role, nurse practitioners also practice from a holistic point of view which allows them to help manage patient conditions or wellness in a more complete fashion. This includes helping patients have access to care beyond primary and secondary care settings. This encourages nurse practitioners to work alongside other health care and allied health professions, and families to create an individualized plan for every patient (van

As health care continues to evolve, these changes may facilitate or hinder the availability of health care resources for lower income populations. According to the American Association of Nurse Practitioners (2017), “By providing high-quality care and counseling, NPs can lower the cost of health care for patients” .Moreover, practicing at the primary care level, and focusing on prevention, counseling, and screening will help decrease the prevalence of inpatient hospitalizations due to people not understanding their health. As an FNP in primary health care setting, I will have the ability to see my patients for wellness visits, and reinforce the routine knowledge needed for them to make ideal life style choices, that will maintain their good health. The overall goal, which I want to obtain in this vital role is to change the mind set of individuals to disease

In some areas of population health, technology in enhanced patient information is utilized to perform risk stratification to identify the high risk patients. These patient’s often have uncontrolled BP, diabetes with an HgbA1c over 9, COPD, etc. Once identified as high risk or potential high risk, these patients receive additional care or patient outreach to help manage their condition. Some organizations employee RN Health Coaches and Care Coordination teams to help these patients and identify gaps in care. The primary care physician assumes care of the patient along with striving for the patient to become active in their overall health thereby keeping them out of the hospital (Sanford, 2013). One enhanced area of population management is the PCMH model. PCMH practices increase patient’s engagement in shared decision making while providing compensation for care coordination, care management and medical consultation outside of traditional face-to-face visits (Berryman, Palmer, Kohl &Parham, 2013). A patient centered approach pushes for changes not only in the delivery of medicine but in traditional encounters. In addition, PCMH encourages increased access to the patient’s primary care physicians and improved patient satisfaction scores. PCMH and population health encourages providers to increase after hours care to decrease emergency department visits and/or hospitalizations. Thereby reducing cost and improving the patient’s

One of the suggestions is for licensed practical nurses and registered nurses to incorporate health care education and counseling, using evidenced based clinical guidelines, to patients with chronic conditions through continued care offered via home visits and telephone follow-up calls (Institute of Medicine, 2010). It is also recommended to utilize APRNs as primary care providers in both outpatient and inpatient settings as this decreases the provider to patio ratio thus potentially enhancing the quality of care, and it allows the APRNs to practice to their fullest abilities (Institute of Medicine, 2010). APRNs participating as primary care providers widen the opportunity for health promotion, disease prevention, and limiting disabilities via early diagnosis and treatment. Transformation to a health care system driven by primary care practice as suggested by the IOM report will create a more qualified, accessible, and value driven health care system (Tri-Council for Nursing, 2010).

In addition to benefitting the patient, the patient-centered approach also benefits the heath care provider. Andrews (2009) and Charmel and Frampton (2008) stated that an increase in the attention to quality care will increase patient satisfaction and thus increase the chance the patient will return to the facility for future care (as sighted by Dabney and Tzang 2013). The nurse can also use the Four Gap Model created by Parasuraman (et al., 1985) to analyze and improve their patient oriented care as suggested by Dabney and Tzang (2013). If a patient’s expectations is met or exceeded by their perception of service, then word of mouth with another prospective patient may potentially narrow the gap between nurse prospective of care and delivery of standards before interaction with said patient exists (Dabney and Tzang 2013).

I am a Nurse Manager in the hemodialysis unit. The unit has eleven stations with a patient population of 40. The age range of veterans that receive care in this unit is 40 – 92. Most of the hemodialysis patients have difficulty managing their chronic illness and usually receive treatment three times a week for five hours of each visit. Most of them have

The presence of nurse practitioners (NP) in health care has been necessary for more than five decades. The American Association of Nurse Practitioners (AANP) indicates that there are over 205,000 NPs in the United States being utilized by Americans for their health care needs (AANP, 2015). NPs are a vital part of the modern health care system and are accepted by both health care consumers and other health care providers (Fairman, 2015). A study performed by Hart and Mirabella (2015), of emergency department patients determined that patients were satisfied with treatment by a NP in the past and were willing to receive treatment from the NP during their current visit. A study conducted in emergency departments in Canada indicated that NPs demonstrate attentiveness, comprehensive care, and role clarity (Thrasher 2008). These positive characteristics are critical components of patient satisfaction. Additionally, NPs have been utilized more especially with more American developing insurance coverage through health care reform. According to the Department of Health and Human Services (2013), those seeking services in primary care is expected to continually rise through 2020. This increased demand is largely due to the growth of an aging population and from the Affordable Care Act increase in insurance benefits. The Affordable Care Act, along with the shortage of primary care physicians, has expanded the role of the nurse

From my experience volunteering in the emergency department at my county’s largest healthcare provider, Union Hospital, I recognize the medical issues,

Avoidable emergency department (ED) encounters places a significant burden on the health care system. Seniors 65 years or older have the highest rate of hospital encounters of any other age group (Bulut, Yazici, Demircan, Keles & Demir, 2015). The Center for Medicare and Medicaid (CMS) have placed stiff penalties on hospitals that are not able to reduce repeat encounters (“Coordinating better care & lowering costs”, 2017). These penalties result in the loss of guaranteed funding if the hospitals are not able to reduce readmission rates. Therefore, hospitals are seeking solutions to solving this challenge (“Coordinating better care & lowering costs”, 2017). Care transition teams are in place to help mitigate repeat encounters,

NARAP studies on the emergency department as a platform to facilitate primary health care screenings follow this model. During their weekly shifts, RAs approach as many non-emergent patients and their visitors as possible to ask a detailed history on the prevention or screening issue under study. Working within Research Associate program at HUMC, I will be able to gain access to the epic database which provides the university center with electronic health information. I

The results supported the constructs of attitude, subjective norms and perceived control for the nurses’ promotion of PA to patients. Their beliefs about benefits, risks, and barriers (including their knowledge about PA interventions) of PA promotion significantly impacted the content of patient education activities (p. 241).