Introduction
Incorrect decision-making among medical partners negatively affects the health of patients. It has been researched that decision-making is considered a vital element of nursing practice (Arsenault Knudsen et al., 2021). The decision-making process in the shared method also helps medical workers and patients choose the treatment option most suitable for patients’ preferences (de Mik et al., 2018). Nurses make important decisions all the time, and those decisions impact patients’ health (Nibbelink & Brewer, 2018). A case from personal nursing practice shows that the most effective way to implement changes in the decision-making process is to use telemedicine to improve the monitoring of patients not only with diabetes but also with other chronic diseases.
Background to the Decision on Practice Modification
In one case, before implementing changes in nursing practice, a nursing team relied primarily on patient assessment skills during self-monitoring of blood glucose levels. This case concerns the therapeutic isolation of patients with diabetes (Type 2 diabetes). Traditional medicine practice involves recommending SBMG to patients with diabetes and considering their skill and judgment to treat the disease. However, in this department, it was found that the hospital practically did not follow this recommendation. This trend has affected patients’ health; that is, some patients have experienced the adverse effects of low blood glucose levels. A similar practice was described by Alqarni et al. (2019), which indicated that 21 to 42 percent of patients suffered from adverse effects of poor glycemic control, exposing them to greater health risks. Overall, changes in this specific case have been needed to increase the quality of service.
The Decision to Change Practice
In order to improve the quality, it was decided to implement the Telehealth technique for monitoring patients with diabetes. The nursing team collaborated with the doctors, who formulated a suitable way to better monitor the patients. Telehealth was most effective in monitoring HbA1c levels for patients with Type 2 diabetes. This method involved telephone interventions, and the nursing team settled on a simple approach to initiate change. Healthcare providers used telephone interventions such as calls and text messages to learn and document whether patients self-monitored blood glucose at the appropriate times. Medical staff often contacted patients who did not share their blood sugar readings. Telephone interventions are readily available to patients and nurses, regardless of the workplace, given that many diabetes patients in hospitals are working class.
Steps
In the decision-making process, five main steps were implemented. The first was exploratory research: surveying hospital patients about using their blood sugar self-monitoring data by healthcare professionals. The second was a summary of the evidence showing the poor use of SBMG and the adverse health effects it caused for patients. The third step was transforming the evidence into guidelines that included recommendations for nurse facilitation for SBMG. The fourth step was practice integration, which involved the adoption of telemedicine in supporting and guiding patients in the diabetes care unit. The final step was process and outcome evaluation (positive improvement in patient management). This five-step process became the foundation for the team of nurses working with the hospital’s physician to establish a telemedicine support system for diabetes patients.
Evidence
The nursing department used evidence to change the decision-making process. The main one was the survey, which consisted of a sample of 100 patients with diabetes who were in this department was used. The evidence showed that the planned change in practice included approximately half of the diabetes patients in the hospital. These people did not follow the requirements of the SBMG hospital guidelines, and healthcare professionals did not adequately monitor the process. The nursing team also considered evidence from previous studies, including Pappas et al. (2018). Researchers have shown that telehealth is effective in helping patients control blood sugar, a key health indicator for diabetics. A similar opinion is contained in Alqarni et al. (2019), who noted that patients had poor adherence to SBMG recommendations, requiring nurse intervention to improve health and well-being. Thus, the evidence of the ineffectiveness of this system proved that patients needed to receive proper control from medical professionals.
The Effectiveness of Change
The change in the care of patients with diabetes was quite effective. Thus, the transition from traditional passive care and support for treating patients with methods available at that time to the use of telemedicine tools proved effective (Mann et al., 2020). Effectiveness is evidenced by 97 percent compliance with SBMG instructions was observed. Whenever patients received a monitoring call from a nurse, they admitted they had forgotten to monitor their blood glucose. However, after the call or message, they performed this action and sent their indicators to the medical worker. The implementation of telemedicine improved adherence even when nurses did not call their patients. The positive dynamic was because many patients remembered and sent their levels before the end of the observation period. Evidence of a positive trend from the use of change in nursing is consistent with previous research by Lee, Greenfield, and Pappas (2018). Therefore, telemedicine and related facilities were effective in monitoring the condition of diabetic patients.
Conclusion
Overall, to effectively implement changes in the decision-making process, it is necessary to use a team approach that includes the cooperation of all nurses on one change. The personal method shows that the use of telemedicine effectively affects the monitoring and control of patients with diabetes. The main tasks of this change are to ensure the provision of medical care to the patient and to promote the improvement of the quality of care and optimization of the processes of organization and management of health care.
References
Alqarni, A. M., Alrahbeni, T., Al Qarni, A., & Al Qarni, H. M. (2019. Adherence to diabetes medication among diabetic patients in the Bisha governorate of Saudi Arabia – a cross-sectional survey. Patient Preference and Adherence, 13, 63–71. Web.
Arsenault Knudsen, É. N., King, B. J., & Steege, L. M. (2021). The realities of practice change: Nurses’ perceptions. Journal of Clinical Nursing, 30(9-10). Web.
de Mik, S. M. L., Stubenrouch, F. E., Balm, R., & Ubbink, D. T. (2018). Systematic review of shared decision-making in surgery. British Journal of Surgery, 105(13), 1721-1730. Web.
Lee, P. A., Greenfield, G., & Pappas, Y. (2018). The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: a systematic review and meta-analysis of systematic reviews of randomised controlled trials. BMC Health Services Research, 18(1). Web.
Mann, D. M., Chen, J., Chunara, R., Testa, P. A., & Nov, O. (2020). COVID-19 transforms health care through telemedicine: Evidence from the field. Journal of the American Medical Informatics Association, 27(7), 1132–1135. Web.
Nibbelink, C. W., & Brewer, B. B. (2018). Decision-making in nursing practice: An integrative literature review. Journal of Clinical Nursing, 27(5-6), 917–928. Web.