Evidence-based Health Evaluation and Application of the PHII

Evidence-based Health Evaluation and Application of the PHII

The primary focus of population health is to improve the general well-being and health of the public or a large portion of a specific group in a population, for example, women or infant health. Therefore, PHIIs (population health improvement initiatives) are defined as the shared healthcare and promotion efforts that are defined by the population’s socio-economic, behavioral, genetic, environmental, and healthcare factors (Institute of Medicine et al., 2012). Today, a majority of PHIIs are designed to protect and improve the welfare and health of the overall population by proposing EBP-based initiatives that encourage healthy behaviors. Specifically, a majority of PHIIs target to create awareness by educating the public on how to live healthier lifestyles, for example, by choosing healthier diets. PHIIs are community-based programs that also target to support healthy living by preventing the spread of infectious diseases, as well as outbreaks.

In that regard, the role of healthcare workers is often to examine the evidence presented by patients (by looking at their disease, medication, and family histories, examining the clinical symptoms, and checking laboratory test results) and then use it to identify the most appropriate care plan that is specific to the individual patient needs. Healthcare providers often apply findings from PHIIs, particularly patient’s care programs to determine care models that best fit their patients. This case study aims to apply PHII evidence presented by Alicia Balewa (head of Safe Headspace) to propose the most suitable EBP-based plan of care for Mr. Nowak, a patient who is ailing from a TBI (traumatic brain injury) after a fall and has been complaining of losing his balance since undergoing cholesterol testing.

In that regard, the primary purpose of this assessment is first to identify the expected outcomes of the PHII (those that were met and those that were not) and propose a strategy for fostering these outcomes; then propose a personalized care plan for Mr. Nowak that puts into consideration the insights from the PHII and justify the selection; finally suggest a framework for examining the outcomes of the selected personalized approach.

The projected outcomes of the PHII that were, and were not, met

Safe Headspace is a relatively new not-for-profit organization that is built on the principle of better experiences and outcomes for patients suffering from traumatic brain injury or TBI. Outcomes of the interview conducted with Alicia Balewa, the head of Safe Headspace, reveal that the solution to TBI was multifaceted, meaning that different approaches worked for certain individuals better. For example, exercise recorded the best and most effective outcome. Alicia and her team convinced nearly 50 percent of their participants (about 400 people, largely men aged 45 and 80) to follow exercise recommendations made by the CDC, especially moderate aerobic workouts. After four weeks, nearly everyone recorded an improvement in muscle, memory, and mood control. Even though about 25 percent of the participants dropped out after week four, the remaining 75 percent that continued with the program for three months recorded a 75 percent improvement in short-to-medium-term memory, a 15 percent increase in muscle control, and a 22 percent boost in mood.

Besides exercise, the team also achieved the expected outcomes for therapy – an approach that came second to work out. Safe Headspace assigned a team of trained psychotherapists to assess TBI patients – most of whom had not undergone any counseling exercise after their trauma. Subsequently, 9 percent of the patients were placed on anti-psychotics and 40 percent on anti-depressants. Participants that began following their medication schedule strictly maintained positive and regular contact with their therapists. After six months, these individuals recorded memory improvement (6 percent) and mood improvement (26 percent).

Meditation was the third intervention that the Safe Headspace team tried to examine. Even though just a few participants were willing to try it, the outcomes were unprecedented. The researchers prescribed a ten-to-fifteen-minute daily home meditation treatment and a 60-minute weekly group session to all 23 people who showed interest in the program. Although two patients dropped out after three weeks due to disinterest, the remaining 21 recorded improvements in muscle control (32 percent) and mood 70 percent).

Although exercise, medication, and meditation produced positive results, some interventions like memory exercises (such as crossword puzzles and Sudoku) that targeted the elderly population did not yield any meaningful outcomes. Furthermore, it became apparent that a few individuals opted for strength training as opposed to the aerobic training the team provided. These participants only recorded a 4 percent improvement in muscle control.

Strategy proposal for improving the outcomes of the PHII

As suggested by Alicia, one of the obstacles that hampered the efficacy of their interventions stemmed from the fact that not all participants were comfortable with the therapies or treatment options presented to them by the research team – even though they all expressed the desire to get professional help. For instance, the elderly population disliked the memory exercises, such as crossword puzzles and Sudoku. Also, some participants expressed their desire for strength training as opposed to the aerobic exercises that Safe Headspace prescribed. This was a huge problem because it affected their commitment and effort to the interventions prescribed. As a result, the team recorded no significant outcomes in some of these approaches.

Therefore, one strategy proposal for improving the outcomes of the PHII is to design an approach that accommodates the desires, needs, and wishes, as well as the tastes and preferences, of all participants. Several studies have documented the benefits of considering patient preferences when making treatment decisions. A study by Ambigapathy, Chia, & Ng (2016) established that shared decision-making, with patients taking an active role in making decisions that touch on their care, is an important step to improved quality and efficacy of healthcare interventions. In the research above, patients were given self-administered questionnaires, which included demographic data and specific questions about their actual and preferred role after and before the consultation. 51.1 percent of the patients preferred shared-decision making.

Therefore, for this particular PHII, incorporating patient preferences and needs could help improve acceptance rates, commitment, and, subsequently, the healthcare outcomes of the TBI interventions. Rather than sticking to the three intervention recommendations, including aerobic exercises, medication (anti-depressants and anti-psychotics), and meditation, Safe Headspace could have expanded its options to include treatment options preferred by the patients.

An Approach To Personalized Patient Care That Incorporates Lessons Learned From The PHII Outcomes

Orem’s self-care care model is the best framework that can be used to personalize care for Mr. Nowak – who suffered a moderate traumatic brain injury and has no indications of posttraumatic stress disorder. Dorothea Orem proposed Orem’s model and recommends that nurses (or healthcare providers) must diagnose the self-care deficits in patients, after which they must identify the role that patients and nurses ought to play to meet these demands. Orem’s model is classified into three major sections: assessment, diagnosis, implementation, and evaluation. The assessment step is intended to help care providers gather data for problem identification or determining the patient’s self-care needs that must be addressed. The second step is the root-cause analysis, which involves diagnosing the patient is issues and then proposing an effective care plan based on unique patient needs. The last step involves implementing and evaluating the outcomes of the interventions (Khademian, Ara, & Gholamzadeh, 2020).

Orem’s self-care model, in several ways, connects with the HPII outcomes and can fundamentally help to improve the efficacy of the TBI interventions that could be tailored to meet the care needs of Mr. Nowak. One limitation that affected the achievement of optimum results in the HPII is the lack of patient consideration in the design of the treatment models. The preferences of patients were not incorporated in the design of the treatment plan. For example, some elderly patients were uncomfortable with the use of some memory exercise regimens, such as crossword puzzles.

Orem’s model will, therefore, ensure that the needs of Mr. Nowak are assessed, the symptoms of TBI are properly diagnosed, an appropriate care plan is established, the proposed plan is implemented piecemeal, and the outcomes evaluated. The sentiments, desires, and preferences of Mr. Nowak will also be factored into the tailored care approach. This will reduce any chances of rejection, dissatisfaction, and disdain with the proposed interventions upon implementation.

Justification of the approach to personalized care for the patient

Even though there is no concrete evidence to demonstrate the specific application of Orem’s model to TBI patients, several studies have shown the benefits of the technique to trauma patients in general. For example, a quasi-experimental study by Khatiban, Shirani, & Oshvandi (2018) to evaluate the use of Orem’s framework to improve practices, attitudes, self-care knowledge, and respiratory conditions chest-tube trauma patients revealed that the experimental group (those assigned to Orem’s model) recorded improved outcomes compared to participants assigned to the control group (routine care). For three days, the experimental group recorded significant improvements in self-care and attitudes. The outcomes of this study involving trauma patients with chest complications can also be extrapolated to TBI patients because trauma is the central symptom in both cases. The explanation for improved outcomes when using Orem’s model to treat trauma patients is that the technique factors in the self-care needs of patients, as well as their therapy wishes and preferences.

Framework proposal for evaluating the outcomes of the approach

Evaluating the outcomes of Orem’s model is very critical in ensuring that the desired patient outcomes are achieved; that Mr. Nowak’s TBI symptoms are alleviated or stopped. The first outcome that can be used to measure the success of the model is patient experience and satisfaction. The tool can be considered meaningful if Mr. Nowak is comfortable with it and ready to undertake it from start to end. The other outcomes that can be used to evaluate the results of Orem’s model are efficacy, efficiency, and effectiveness.

For example, for the recommended interventions (whether exercise, medication, meditation, or any other proposed approach), which are modeled based on Orem’s framework, to be considered successful and effective, they must be able to improve the overall psychological elements of TBI patients, such as short-to-medium term memory, muscle control, and mood. The tool should also be able to address other symptoms associated with TBI, such as blurry vision, dizziness, headaches, disorientation and confusion, and ringing in the ears (Galgano et al., 2017).

Conclusion

PHII is defined as a shared or group healthcare and promotion effort, including research, that is aimed at improving the health and welfare of the general population. PHII research is often informed by a population’s socio-economic, behavioral, genetic, environmental, and healthcare factors. Therefore, it is always the role of care providers to draw evidence from the outcomes of PHIIs and then apply what is relevant to their patients. This case study was aimed at extrapolating PHII evidence presented by Alicia Balewa (head of Safe Headspace) to Mr. Nowak’s case. Mr. Nowak is a patient who is ailing from a TBI (traumatic brain injury) after a fall and has been complaining of losing his balance since undergoing cholesterol testing. PHII Outcomes of an interview with Alicia Balewa, the head of Safe Headspace, revealed that the solution to TBI was multifaceted, meaning that different approaches worked for certain individuals better. The three main interventions that proved beneficial to patients with participants in the study (both with TBI and PSTD) include exercise, medication, and meditation.

For example, exercise recorded the best and most effective outcome. However, some of the caveats of the study included resistance to some of the interventions by participants; for example, older adults rejected some memory exercises, such as Sudoku. Therefore, designing an approach that considers the needs and preferences of patients is the only way to improve participation, acceptance, and patient experiences. Orem’s care model is the most appropriate framework that can help providers model a bespoke care plan for Mr. Nowak, a plan that factors his desires and preferences. Evaluating patient experiences, as well as the efficacy and efficiency of the intervention, can help determine whether or not Orem’s model was successful.

References

Ambigapathy, R., Chia, Y. C., & Ng, C. J. (2016). Patient involvement in decision-making: A cross-sectional study in a Malaysian primary care clinic. BMJ Open, 6(1), e010063. DOI: 10.1136/bmjopen-2015-010063

Galgano, M., et al. (2017). Traumatic brain injury: Current treatment strategies and future endeavors. Cell Transplantation, 26(7), 1118-1130. doi: 10.1177/0963689717714102

Institute of Medicine, et al. (2012). For the public’s health: Investing in a healthier future. National Academies Press.

Khademian, Z., Ara, F. K., &Gholamzadeh, S. (2020). The effect of self-care education based on Orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: A quasi-experimental study. International Journal of Community Based Nursing Midwifery, 8(2), 140-149.

Khatiban, M., Shirani, F., & Oshvandi, K. (2018). Orem’s self-care model with trauma patients: A quasi-experimental study. Nursing Science Quarterly, 31(3), 272-278. doi: 10.1177/0894318418774876

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Evidence-based Health Evaluation and Application of the PHII

Write a report on the application of population health improvement initiative outcomes to patient-centered care, based on information presented in an interactive multimedia scenario (**** SEE ATTACHED TRANSCRIPT FOR SCENARIO***)

Preparation

In this assessment, you will base your Patient-Centered Care Report on the scenario presented in the Evidence-Based Health Evaluation and Application media piece. Some of the writing you completed and exported from the media piece should serve as pre-writing for this assessment and inform the final draft of your report. Even though the media piece presented only one type of care setting, you can extrapolate individualized care decisions, based on population health improvement initiative outcomes, to other settings.
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Requirements

Writing, Supporting Evidence, and APA Style

• – Write clearly and logically, using correct grammar and mechanics.
• – Integrate relevant evidence from 3–5 current scholarly or professional sources to support your evaluation, recommendations, and plans.
• – Apply correct APA formatting to all in-text citations and references.
• – Attach a reference list to your report.
  

  Evidence-based Health Evaluation and Application of the PHII

Report Content:

Address the following points in a 4–6 page report: