A Nursing vignette, presented as a part of National Nurses Week.
Deborah Greenwood, PhD, RN, BC-ADM, CDE, FAADE
Program Coordinator and Diabetes Clinical Nurse Specialist, Sutter Health Integrated Diabetes Education Network
2015 President, American Association of Diabetes Educators
Nurses implement informatics principles in many different ways when caring for patients. Chronic diseases, including diabetes, require self-management 24 hours a day, 7 days a week. Informatics can support self-management through technology enabled models of care, including remote patient monitoring. A case study published in the American Journal of Nursing ("Better Type 2 Diabetes self-management using Paired Testing and Remote Monitoring") shares how remote monitoring can facilitate patient engagement in self-management through patient education, ongoing support and care coordination.
Through the use of the electronic health record (EHR) secure messaging feature, virtual visits were conducted between people with diabetes and nurses who were certified diabetes educators. The remote monitoring technology implemented a complete feedback loop that enabled productive interactions, a key requirement of the chronic care model. During these productive interactions, actionable patient generated blood glucose data were evaluated against evidence based guidelines, and identified as within goal range or not. These data were synthesized and analyzed by software designed for the intervention, and identified changes in blood glucose from before meal to after meal that were within target. These data were then displayed in both table and graphic representation, back to the patient, to facilitate the development of glucose pattern analysis skills.
During the intervention patients had the opportunity to engage with the nurse via the secure message feature to ask questions about lifestyle change that may impact blood glucose values. After four weeks of automated data exchange the patient met with the nurse via telephone to synthesize the past month of data and to engage in care coordination. A key piece of care coordination was to evaluate the patient's medication and to identify the potential need for medication change. Diabetes is a progressive disease that often requires intensification of medication over time; however, many patients are not aware of this fact and often felt that more medication was a personal failure. The frequent discussion, virtual messaging and remote care increased the ability for patients to engage with nurses to increase their knowledge about diabetes management and begin to feel empowered in their ability to make decisions and self-manage their disease. At the end of this intervention, a majority of the patients changed medication and improved their overall glucose management.
Informatics principles are essential as we envision new models of care for chronic disease such as diabetes. Through the use of remote monitoring, technology allows for (1) the generation of actionable data that can be (2) turned into essential information that (3) increases the knowledge of both patients and providers and ultimately (4) leads to a wisdom that is crucial for improved outcomes.