Summary
In the continuation of the COVID-19 pandemic, the US Congress began to consider the possibility of full authorization to conduct medical examinations using telemedicine. As the COVID-19 pandemic has shown, which sent millions of people worldwide to forced self-isolation, telemedicine systems with video communication have become an indispensable attribute of remote reception, management, and treatment of patients.
Their positive effect on the recovery of patients and providing them with the necessary assistance has been proven in practice (Kichloo et al., 2020). The COVID-19 Tele-Assessment General Educational Guidelines project aims to develop a handout that will guide and educate the nurses on performing the patient medical telehealth assessment. The purpose of the paper is to present a plan on how the project will be implemented. This plan will include the goal statement, project objectives, evidence-based literature review, methodology, resources, formative evaluation, summative evaluation, and the project timeline.
Goals Statement
The COVID-19 Tele-Assessment General Educational Guidelines project aims to develop educational guidelines for nurses who work with COVID-19 patients applying telehealth medicine practices. The focus area of the project is developing the handout guidelines, and the population is nurses in private and state health facilities across the US. Patient allocation and presentation of information for physicians can be tricky in reorganizing the work process and potential problems with capturing important details regarding well-being, health determinants, and general patients’ well-being. Therefore, there is a need to develop unified guidelines to advise the nurses in providing precise and comprehensive tele-assessment.
Project Objectives
The strategy to reach the widest audience will include several critical steps. Firstly, the handout materials will be developed; secondly, these materials will be sent to the CDC for approval and further dissemination among the healthcare facilities. Thirdly, the feedback and evaluation from the healthcare facilities will be received and the handout guidelines will be revised according to them. The first objective is creating in the 30 days COVID-19 Tele-Assessment General Educational Guidelines for the US nurses explaining the details of COVID-19 nursing tele-assessment. The second objective is analyzing in the 30 days the nurses’ feedback and evaluation and revise the COVID-19 Tele-Assessment General Educational Guidelines accordingly.
Literature Review
The creation of special guidelines for nursing assessments of COVID-19 patients through telemedicine practice is necessary, as telemedicine practice has become widespread but is not regulated. It is evidenced by the data on the high demand for telemedicine services. Cipriano & Murphy (2011) note that technology improves the quality of work with patients through awareness, reducing delays in care, and better workflow management. Moreover, the technologies can eliminate repetitive and mundane tasks and accomplish regulatory work (Cipriano & Murphy, 2011). Nursing informatics helps nurses accurately assess and monitor their patients’ progress.
Employees with knowledge in this area can help educate patients in installing equipment, thus carrying out telemedicine management. Therefore, developing uniform rules for working with patients can have long-lasting positive consequences, including positive social change (“Vision, mission, and goals,” 2021). Individuals can further benefit if they have more opportunities to manage their health data, and communities will benefit from the potential of evidence-based medicine and the increased ability to collect the patients’ health data. Data collection practices can also be spelled out in the guidelines.
Political changes at the federal and state levels are further evidence that telemedicine is rapidly gaining popularity. Congress is scrutinizing a proposal to remove Medicare restrictions on telehealth (“Expanding telehealth services during COVID-19 letter,” 2021). At the same time, the federal and state governments are already implementing the temporary lifting of restrictions, which allows analyzing the first results of the massive provision of diagnostic and counseling services on COVID-19 (Coughlin & Lerer, 2021). From the pandemic start to April 2020, the number of users of telemedicine services increased from 13 thousand to 17 million people per week (Coughlin & Lerer, 2021).
Healthcare providers are exploring opportunities to provide ongoing access to at-risk groups and rural communities, as 40% of rural communities did not have access to broadband in 2019 (Coughlin & Lerer, 2021). Service providers are also discussing the need to create a single database of patients’ health data for all US healthcare facilities to control the spread of outbreaks, record, and conduct research.
Notably, one of the potential drawbacks that should be addressed in the guidelines marketing campaign is the reluctance of patients to trust their health data. All US healthcare facilities are subject to the standards outlined in the Health Insurance Portability and Accountability Act of 1996 or HIPAA. The HIPAA Privacy Rule and HIPAA Security Rule provide national standards for protecting patients’ health data from unconsented disclosure to third parties (“Health Insurance Portability and Accountability Act of 1996,” 2021). Therefore, these standards should be considered when creating educational guidelines.
Havasy (2021) also notes the increased demand for telemedicine services, presenting the following data. About 33% of survey participants said that they are ready to receive medical services only online (Havasy, 2021). Half of the younger group stated that they would pay extra for this service (Havasy, 2021). At the same time, 65% said they would use whatever system is used in their healthcare facility, expressing confidence in the service providers (Havasy, 2021). Interestingly, there is evidence that the experience of telemedicine patients may be worse than with a traditional session (French et al., 2021). Still, many populations, such as immunocompromised people, long-term care patients, or nursing homes, are in dire need of this practice. The authors also say that virtual visits will be accompanied by remote monitoring and virtual triage of patients (French et al., 2021). This approach will completely overturn the usual organization of nursing work and prove the need to develop educational guidelines.
Methodology
The first objective of creating the COVID-19 Tele-Assessment General Educational Guidelines for the US nurses to explain the details of COVID-19 nursing telemedicine assessment will be accomplished in several steps. First, a team of professional nurses will be assembled to review existing research on the challenges that healthcare professionals typically face in providing telemedicine services. Next, team members will analyze how COVID-19 symptom tests can be adapted to telemedicine capabilities so that nurses can provide the most complete, detailed, and thoughtful assessments of patients’ health.
The second objective of analyzing the nurses’ feedback and revising the COVID-19 Tele-Assessment General Educational Guidelines will be accomplished similarly. The professional nurses’ team will study the feedback and evaluation, using the tables and other qualitative research tools to organize the information. Then, the guidelines will be revised according to the observations provided and considering the scientific data.
Resources
Various resources, including labor, material, and time costs, will be required to implement the presented plan. The most costly implementation will be in terms of time and labor resources since a full-fledged study of telemedicine in the United States during the pandemic can take about 2 weeks, given that each team member will undertake only a part of the general research. Material costs will be the use of computers and the Internet to send out the guidelines to the CDC and then printing 200 copies for distribution at the hospital to nurses.
It will likely be necessary to conduct a marketing campaign to draw attention to the issue, as well as preliminary questionnaires as part of preliminary qualitative research so that patients can express their suggestions, wishes, and concerns. Additional preliminary research will require labor, time, and material resources and will be carried out by members of the nursing team as part of the first preliminary stage of assessing ready-made guidelines, with the aim of initial addition and revision.
Formative Evaluation
The formative evaluation of the project will be carried out as part of a second interim study with third-party nursing professionals who will discuss how useful the guidelines have become in their work. An assessment will be made of how effectively the nurses could implement the new rules in their daily work. Nurses will be surveyed with closed-ended questions and will also participate in 15-minute blitz interviews, during which the developers of the guidelines will be able to assess various aspects of the application of the rules, including the impact on the reorganization and optimization of the nursing workflow, the quality of patient health assessment and ease of work with new rules.
During the formative evaluation, nurses will make first suggestions and leave feedback, which will be used for the final assessment of the plan implementation in the future. The formative evaluation will be carried out following the norms of such evaluation, and special attention will be paid to the quality of the nurses’ work with the new norms rather than their level of proficiency in new techniques of working with patients.
Summative Evaluation
A summative evaluation will be carried out as part of the final evaluation of the implementation of the project plan so that the nurses can again leave additional comments and share observations. The summative evaluation will be based on a scale of 5, where the surveyed nurses will be able to rate the quality of the guidelines, already revised, based on the analysis performed during the formative evaluation. Nurses will be asked to explain their grades with separate points for usability, content, patient benefits, workflow benefits, adequate technology use, and other aspects that will be disclosed in the guidelines. Detailed multi-faceted assessment will allow performing high-quality reflective analysis and introduce improvements in the future.
Timeline
The Timeline table (Appendix A) provides a graphic timeline for the work of the Practicum Project Plan. During the first two weeks of work on the plan implementation, nurses will collect and organize information, which will then be used to write the guidelines. Nurses will analyze research on telemedicine in the US and Europe over the past 5-10 years and will generalize trends, including areas that require improvement or special attention. During the third week, the guidelines will be drawn up and prepared for a formative evaluation, a plan for which will also be developed by the nursing team members. During week 4 a formative evaluation will be performed with nurses who agree to test and then use the guidelines in their daily work. The summative evaluation will be held during week 5, and during week 6 the guidelines will be revised accordingly.
References
Cipriano, P. F., & Murphy, J. (2011). The future of nursing and health IT: The quality elixir. Nursing Economics, 29(5), 286–289.
Coughlin, J., & Lerer, A. (2021). COVID-19 and the digital health policy impact. Web.
Expanding telehealth services during COVID-19 letter. (2021). HIMSS. Web.
Havasy, R. (2021). Consumer perspectives on telehealth and virtual healthcare survey highlights. Web.
Health Insurance Portability and Accountability Act of 1996. (2021). CDC. Web.
Jonathan French, J. (2021). Maintaining healthcare quality during COVID-19 and the future of care. Web.
Kichloo, A., Albosta, M., Dettloff, K., Wani, F., El-Amir, Z., Singh, J., Aljadah, M., Chakinala, R. C., Kanugula, A. K., Solanki, S., & Chugh, S. (2020). Telemedicine, the current COVID-19 pandemic and the future: A narrative review and perspectives moving forward in the USA. Family medicine and community health, 8(3). Web.
Vision, mission, and goals. (2021). Walden University. Web.
Appendix A
Table 1. Timeline.