Remote Collaboration and Evidence-Based Care

Hello, and welcome to this Remote Collaboration and Evidence-Based Care video. My name is Timeisha Williams, and I appreciate you being here with me today.

I will introduce a plan of care for a middle-aged man living in a rural community who has congestive heart failure and aims to improve his health. The aim is to help him improve his health by applying methods that work. I will also discuss the influence of the Iowa Model, highlighting the main studies on which we based our strategy and sharing the pros and cons of working remotely with a team of caregivers: Remote Collaboration and Evidence-Based Care.

Let’s begin with a brief overview of our patient’s situation.

The patient is an elderly man who has congestive heart failure and earlier suffered from hypertension. He looks tired, finds it hard to breathe, and his legs have become swollen. Since we couldn’t get in-person cardiology support, we made independent decisions about how to provide virtual support.

Here Is the Care Plan I Developed

I created a detailed plan for providing care to a 65-year-old male with congestive heart failure based on what is known in current medical guidelines and the experience of rural health teams.

From the start, I would help by prescribing lisinopril (an ACE inhibitor), carvedilol (a beta-blocker), and furosemide (a loop diuretic). Multiple authors, including Heidenreich (writing in 2022), point out that per the 2022 guidelines from the AHA/ACC/HFSA, these medications improve heart function, decrease symptoms, and help prevent patients from being hospitalized.

In addition, I will introduce telemonitoring that uses a digital scale, a pulse oximeter, and a blood pressure cuff. The patient would give daily updates on vital statistics to a nurse online for detection and alerting if their status changed. Multiple authors including Del Toro (writing in 2023) suggest that mobile telemonitoring applications can decrease how often CHF patients need to be readmitted and improve their survival.

In addition, I would explain how medication should be taken, what a low-sodium diet means, the importance of exercise, and the kinds of symptoms to watch for. According to Stahlman (writing in 2023), rural patients benefit from educational interventions and have demonstrated an ability to reduce self-care problems and the need for repeated hospital visits.

Even though the care plan is guided by evidence, more details would make it easier to care for each person individually. Learning the ejection fraction helps you tell if the patient has HFrEF (Heart Failure with Reduced Ejection Fraction) or HFpEF (Heart Failure with Preserved Ejection Fraction), a difference that might guide their medication treatment.

BNP levels, how the kidneys work, and electrolyte values help determine how much diuretic should be taken and when. Considering the patient’s comfort with technology, the availability of the internet, and helpful contacts will help decide if telemonitoring and educational resources are the right choice.

Let Me Show You How I Used the Iowa Model

I used the Iowa Model of Evidence-Based Practice to structure this care plan. According to authors Brunt & Morris (writing in 2023), this model provides a systematic process for identifying problems, reviewing evidence, and guiding practice changes.

The process began by identifying a problem-focused trigger—specifically, the patient’s worsening CHF symptoms compounded by his geographic isolation and lack of access to specialist care. Recognizing this as a priority concern with implications for patient safety and system-wide performance, I moved to the next step: forming an interdisciplinary team.

This included a cardiologist, primary care provider, pharmacist, and nurse educator. We reviewed and appraised current literature on CHF care in rural settings, examining the effectiveness of guideline-directed medical therapy, remote telemonitoring, and patient education interventions. These findings directly shaped my care plan, supporting the inclusion of ACE inhibitors, diuretics, telehealth devices, and structured caregiver teaching.

By the Iowa Model’s emphasis on evaluation and scalability, I would measure the care plan’s impact through patient-centered and clinical outcomes. These include 30- and 90-day hospital readmission rates, blood pressure stability, adherence to the medication regimen, and improvements in self-reported symptom control.

Additionally, I would use patient satisfaction surveys and nurse documentation to assess engagement with telemonitoring tools. This continuous feedback loop would inform whether the intervention is successful and if it should be expanded to other patients with similar barriers, ensuring both safety and sustainability of care.
Now, Let’s Reflect on the Evidence That Informed My Decisions

When developing this care plan, the most relevant and useful evidence came from current clinical practice guidelines and systematic reviews on heart failure management in rural settings. According to multiple authors, including Heidenreich (writing in 2022), the 2022 AHA/ACC/HFSA guidelines provided strong, graded recommendations for the pharmacologic management of heart failure, including ACE inhibitors, beta-blockers, and loop diuretics to reduce morbidity and mortality. This guideline is essential because it was created by primary cardiovascular organizations and backed by strong randomized controlled trials.

Equally important was a systematic review by Del Toro et al. (2023) obtained through the Cochrane Library, which synthesized multiple studies and demonstrated that mobile telemonitoring significantly reduces CHF-related hospitalizations and mortality, especially among patients with limited healthcare access. I found this evidence particularly relevant given the patient’s rural location and limited mobility. In addition, I used findings from Stahlman et al. (2023) found in PubMed to show how a structured educational program can boost self-care and reduce the chances of readmission.

These sources were chosen based on five key criteria: clinical applicability to CHF, currency within the last five years, methodological rigor, contextual fit for a rural population, and direct alignment with my care plan goals. Together, they formed the foundation for safe, targeted, patient-centered care.

Let’s Talk About Remote Collaboration—The Good and the Difficult

Interdisciplinary remote collaboration was vital in shaping and executing this evidence-based care plan. An important advantage was that cardiology, pharmacy, nursing, and nutrition experts could conference virtually and exchange opinions.

As a result, patients in rural areas received quick, organized clinic meetings focused on their medications, symptoms, and learning, since in-person services may be limited where they live. Virtual meetings and ongoing visits were also made possible by remote collaboration, helping sustain the continuity of care.

Despite these advantages, several challenges emerged. Problems with internet connection, delays in passing messages, and missing common ways to switch between health workers may slow teamwork. I suggest using SBAR as a communication framework in virtual meetings and making all electronic health record (EHR) data available to all who need it. These ways would increase openness and prevent errors in communication.

In the future, applying the SBAR model could help people from various disciplines have full and structured conversations. A registered nurse and a care coordinator ensure that the patient and everyone on the interdisciplinary team exchange information.

What Could We Improve Next Time?

Collaboration could be improved by introducing a common electronic health record for all care team members. Thus, essential tasks are continuous, and updates are shared in real-time from different places.

Patients who use helpful health apps can also follow their symptoms, remember their appointments, and interact with their nurses. These tools might help ensure that people who need care use the ER correctly and are involved in their health. In essence, combining technology, teamwork, and proof allows healthcare providers to close gaps in care.

References

Brunt, B. A., & Morris, M. M. (2023, March 4). Nursing Professional Development Evidence-Based Practice. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK589676/

Del Toro, M. R., Leaño, N. M. H., Barahona-Correa, J. E., Velandia, O. M. M., Ávila, D. G. F., & Peña, Á. a. G. (2023). Effectiveness of mobile telemonitoring applications in heart failure patients: Systematic review of literature and meta-analysis. Heart Failure Reviews 28, 431–452. https://doi.org/10.1007/s10741-022-10291-1

Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., Fang, J. C., Fedson, S. E., Fonarow, G. C., Hayek, S. S., Hernandez, A. F., Khazanie, P., Kittleson, M. M., Lee, C. S., Link, M. S., . . . Yancy, C. W. (2022). 2022 AHA/ACC/HFSA guideline for the management of heart failure: A report of the American college of cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation, 145(18). https://doi.org/10.1161/cir.0000000000001063

Stahlman, S., Huizar-Garcia, S., Lipscomb, J., Frei, C., & Oliver, A. (2023). Implementation of a heart failure educational intervention for patients with recent admissions for acute decompensated heart failure. Frontiers in Cardiovascular Medicine, 10. https://doi.org/10.3389/fcvm.2023.1133988

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Create a 5-10 minute video of yourself, as a presenter, in which you will propose an evidence-based plan to improve the outcomes the patient in the provided case study, and examine how remote collaboration provided benefits or challenges to designing and delivering the care.

Introduction
As technologies and the healthcare industry continue to evolve, remote care, diagnosis, and collaboration are becoming increasingly more regular methods by which nurses are expected to work. Learning the ways in which evidence-based models and care can help remote work produce better outcomes will become critical for success. Additionally, understanding how to leverage EBP principles in collaboration will be important in the success of institutions delivering quality, safe, and cost-effective care. It could also lead to better job satisfaction for those engaging in remote collaboration.

Professional Context
Remote care and diagnosis is a continuing and increasingly important method for nurses to help deliver care to patients to promote safety and enhance health outcomes. Understanding best EBPs and building competence in delivering nursing care to remote patients is a key competency for all nurses. Additionally, in some scenarios, while you may be delivering care in person you may be collaborating with a physician or other team members who are remote.

Understanding the benefits and challenges of interdisciplinary collaboration is vital to developing effective communication strategies when coordinating care. So, being proficient at communicating and working with remote health care team members is also critical to delivering quality, evidence-based care.

Preparation
Before beginning this assessment, it would be helpful to review the following media activity to examine another example of remote collaboration:

• Vila Health: Remote Collaboration on Evidence-Based Care.

You may also wish to review Selecting a model for evidence-based practice changes. [PDF] and Evidence-Based Practice Models, which help explain the various evidence-based nursing models.

Remote Collaboration and Evidence-Based Care

Scenario

• Review the case study in the Assessment 04 Supplement: Remote Collaboration and Evidence-Based Care [PDF] ]resource. You will use this case study as the focus for this assessment.(ATTACHED)

Instructions

For this assessment, you are a presenter! You will create a 5–10-minute video using Kaltura or similar software. In the video:

• Propose an evidence-based care plan that you believe will improve the safety and outcomes of the patient in the case study presented in the Assessment 04 Supplement: Remote Collaboration and Evidence-Based Care [PDF] resource (ATTACHED). Add your thoughts on what more could be done for the patient and what more information may have been needed.
• Discuss the ways in which an EBP model and relevant evidence helped you to develop and make decisions about the plan you proposed
• Wrap up your video by identifying the benefits of the remote collaboration in the scenario, as well as discuss strategies you found in the literature or best practices that could help mitigate or overcome one or more of the collaboration challenges you observed in the scenario.
• Be sure you mention any articles, authors, and other relevant sources of evidence that helped inform your video. Discuss why these sources of evidence are credible and relevant. Important: You are required to submit an APA-formatted reference list of the sources you cited specifically in your video or used to inform your presentation. You are required to submit a narrative of all your video content to this assessment and to SafeAssign.

The following media is an example learner submission in which the speaker successfully addresses all competencies in the assessment.

• Exemplar Kaltura Reflection.
  • Please note that the scenario that the speaker discusses in the exemplar is different from the Vila Health scenario you should be addressing in your video. So, the type of communication expected is being model, but the details related to the scenario in your submission will be different.

Make sure that your video addresses the following grading criteria:

• Propose your own evidence-based care plan to improve the safety and outcomes for a patient in the provided case study.
• Explain the ways in which you used an EBP model to help develop your plan of care for the client.
• Reflect on which evidence you found in your search that was most relevant and useful when making decisions regarding your care plan.
• Identify benefits and strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team.
• Communicate in a professional manner that is easily audible and uses proper grammar, including a reference list formatted in current APA style.
• Refer to Using Kaltura as needed to record and upload your video.

Additional Requirements

• Length of video: 5-10 minutes.
• References: Cite at least three professional or scholarly sources of evidence to support the assertions you make in your video. Include additional properly cited references as necessary to support your statements.
• APA reference page: Submit a correctly formatted APA reference page that shows all the sources you used to create and deliver your video. Be sure to format the reference page according to current APA style. Submit a narrative of all of your video content.

Notes:

• Please phrase it in the first-person perspective
• NO AI USE AT ALL
• NO Falsifying of Resources/References/Citations