see below

1/16/24, 3:27 PM Vila Health: Remote Collaboration and Evidence-Based Care Transcript

https://media.capella.edu/CourseMedia/nursfp4030element17273/transcript.asp 1/11

Vila Health ® Activity

Remote Collaboration and

Evidence-Based Care

Introduction

The Patient Presents

Collaboration Begins

Consulting With the Pediatrician

The Care Plan Continues

Respiratory Therapist Consult on Skype

Conclusion

Introduction

Evidence-based care can be a challenge in any medical situation, but particular challenges present themselves when care is being provided remotely. In order to provide quality care to patients who live in rural settings or have difficulty with transportation to a care site, health care professionals must sometimes collaborate with other professionals in

different ZIP codes or even time zones.

In this activity, you will observe how health care professionals

collaborate remotely and virtually to provide care for a patient

in Valley City, North Dakota.

The Patient Presents Dr. Erica Copeland and Virginia Anderson, a pediatric nurse,

discuss Caitlynn, who came into the ER last night and has now

been admitted to the pediatric unit.

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Dr. Copeland starts the conversation. Dr. Copeland: Nurse, can you give me an update on Caitlynn? I

know she’s two years old and she’s been admitted for

pneumonia. Does she have any history of breathing problems?

Virginia Anderson: Yes, this is her second admission for

pneumonia in the last six months. She had a meconium ileus at

birth.

Dr. Copeland: All right. Is she presenting with any other

symptoms?

Virginia Anderson: She has decreased breath sounds at the

right bases and rhonchi scattered in the upper lobes.

Respirations are 32 and shallow with a temp of 101.

Dr. Copeland: What have we done for her so far?

Virginia Anderson: The respiratory therapist administered

nebulized aerosol and chest physiotherapy. After the aerosol

she had thick secretions.

Dr. Copeland: I see her weight is 20.7 pounds, and there’s been

some decreased subcutaneous tissue observed in her

extremities?

Virginia Anderson: Correct. I noticed this too, so she might

have some malabsorption of nutrients.

Dr. Copeland: Have we done a sweat chloride test yet?

Virginia Anderson: Yes, and the results were 65

milliequivalents per liter. Also, the mother reports that when

she kisses her, she tastes salty.

Dr. Copeland: All right. Well, I think it’s fair to say we might be

dealing with cystic �brosis here. Let’s get her started on an IV

with piperacillin, and keep an eye on her temperature.

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Collaboration Begins Later, the diagnosis is con�rmed: Caitlynn has cystic �brosis.

Dr. Copeland, Virginia Anderson, and Rebecca Helgo, the

hospital’s respiratory therapist have a short consult, where

they realize that Caitlynn’s care will not be easy.

Dr. Copeland starts the conversation. Dr. Copeland: Let’s talk about Caitlynn Bergan. Her mother, uh,

[checks notes] Janice, has been informed of her diagnosis. I

didn’t realize this when she �rst came in, but she doesn’t live in

Valley City; she’s in McHenry.

Rebecca Helgo: That’s a tough drive during winter. They’re

over an hour away, aren’t they?

Dr. Copeland: That’s right. It was a toss-up between coming

here or going to Jamestown, but I guess the father — Doug —

thought Valley City was the better choice. Anyway, I’ve put her

on Pancrease enzymes and we’ll be recommending a high-

protein, extra-calorie diet along with the fat-soluble vitamins —

A, D, E, and K. I’ll update her pediatrician on her condition, and

order dornase alfa. Let’s see how she does with the breathing

treatments. How are those going?

Rebecca Helgo: Quite well, actually. She’s too young to get her

to do the huff breaths, but we’re keeping the secretions thin

and manageable with the aerosol treatments. I am concerned

about her day-to-day treatment, though. She’ll be back here

with pneumonia if the parents can’t stay on top of that. She’s

at risk for impaired gas exchange and respiratory distress,

which will cause her anxiety and more distress, and that’s not

going to help her stay well.

1/16/24, 3:27 PM Vila Health: Remote Collaboration and Evidence-Based Care Transcript

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Dr. Copeland: How well do you think the parents will be able to

handle the treatment?

Virginia Anderson: That might get tricky. I gather that the

mother and father are still married but separated. We’ll need to

make sure that at least one of them gets the education they

need. But they both work, and trips here aren’t the easiest

choice. We should get a social services consult to coordinate

services and identify some assistance for the family in

McHenry.

Rebecca Helgo: I can do some education here, and then do a

Skype consult with one or both of them once she’s been

discharged and is back home.

Dr. Copeland: It sounded like both parents work long hours.

Are you going to be able to schedule times that work?

Rebecca Helgo: I may have to do some after-hours

appointments. We’ll have to sort that out.

Virginia Anderson: She’s had one bowel obstruction already,

so I think we need to help them monitor for DIOS too. Does the

pediatrician’s of�ce have a telemedicine relationship with us?

That might be helpful in preventing unnecessary trips here.

Dr. Copeland: Let’s �nd out a bit more and see what our

options are.

Consulting With the Pediatrician Later that day, Dr. Copeland and Virginia Anderson talk to Dr.

Benjamin, Caitlynn’s pediatrician, about how his of�ce can

coordinate with the hospital on Caitlynn’s care.

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Dr. Copeland greets Dr. Benjamin. Dr. Copeland: Hello, Dr. Benjamin. I’m sorry to be meeting

under such circumstances, but I hope we can work with you to

help the Bergans handle Caitlynn’s care. On the line with me is

Virginia Anderson, the nurse assigned to Caitlynn while she’s

here.

Dr. Benjamin: Hello to both of you. Yes, it’s unfortunate. This is

the �rst case I’ve seen among my own patients.

Dr. Copeland: Are you familiar with the CF protocol?

Dr. Benjamin: I am, but I’d love to get any more details that

relate to Caitlynn. She’s done with most of her immunizations,

but she’s still needs her HAV and in�uenza, of course. I’m also

not sure where to order some of the pancreatic enzymes and

medications you listed.

Virginia Anderson: We can help with all that. Do you have

telemedicine access to Valley City?

Dr. Benjamin: No, but we do have it with Cooperstown Medical

Center. We kind of have to in a town of less than 100 people.

Dr. Copeland: We may be able to use Skype on a more

informal basis for consults between us, but it might be good to

get connected with Valley City on your telemedicine equipment.

If the parents bring Caitlynn to you with symptoms, and you’re

not sure whether the hour-long trip is necessary, we can do a

telemedicine appointment and make sure.

Dr. Benjamin: All right. It sounds like we might see them often

initially, and I understand that bowel obstructions and

pneumonia are two possible complications. We can handle

some of those issues here, but assuming they have trouble

during working hours, I assume we can reach you by phone?

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Dr. Copeland: You or your staff can send me a text. If we need

to talk further we can set up a call, but if not, text is the

quickest way to get my attention, and the easiest way for me

to respond between things.

Virginia Anderson: And I’m available via text as well if you’re

having trouble reaching Dr. Copeland or if it’s a question I can

�eld.

The Care Plan Continues To address some of the questions that came up during the

consult, Virginia meets with Madeline Becker, the social worker

at the clinic in McHenry.

Virginia starts the conversation. Virginia Anderson: Hi, Madeline, this is Virginia Anderson at

Valley City Regional Hospital. I’m on the line with Marta

Simmons, our social worker here at the hospital.

Madeline Becker: Hi, both of you.

Marta Simmons: Madeline, we’re calling because Virginia is

working on a care plan for a child from McHenry, a Caitlynn

Bergan. She’s here after a bout of pneumonia and she’s been

diagnosed with cystic �brosis. We wanted to talk to you about

resources there for some of the issues the Bergans are going to

be dealing with.

Madeline Becker: Of course. I got the documentation you

emailed earlier. Fortunately, the Bergans are both employed

and have good insurance through Doug’s new job. But as you

may have heard, he was unemployed for some time, so money

is tighter than it might seem.

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Virginia Anderson: We’ve talked to Janice and she isn’t sure

what her insurance covers as related to the breathing and

other treatments Caitlynn is likely to need.

Madeline Becker: I can do some initial work on that. I’ll need a

release from Janice to get detailed information, but I should be

able to get general coverage information. What other

resources might they need? McHenry is pretty small, as I’m sure

you’re aware.

Marta Simmons: The main issue is going to be the stress of

caring for a child with a chronic illness. Even a group that helps

members deal with grief would be helpful. Children with CF live

much longer than they used to, but it’s still a dif�cult condition.

Madeline Becker: There isn’t a group like that here, but there is

one in Sheyenne. I mean, it’s more for parents in grief already,

parents who have lost a child, but it’s a sizable group, relatively

speaking. I’m sure there will be some parents who understand

what it’s like to have a child with a dif�cult condition.

Virginia Anderson: All right, that helps. Now, we’re going to

provide as much education as we can before Janice takes

Caitlynn home, but what kind of resources are there in

McHenry? If she doesn’t have home Internet access, does the

library offer it? Is there a library?

Madeline Becker: No, the closest library is in Cooperstown.

Marta Simmons: Well, we’ll talk to the Bergans’ pediatrician

and see if they might be able to help if they need materials and

can’t get them easily at home. This is progressive and lifelong,

and they’re going to need some support as they learn to deal

with it.

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Respiratory Therapist Consult on Skype

A few days after Janice and Caitlynn go back to McHenry,

Janice calls to talk to someone about whether she’s doing

Caitlynn’s chest physiotherapy correctly. Virginia and Rebecca,

the respiratory therapist, call her back on Skype to answer her

questions.

Virginia Anderson starts the conversation. Virginia Anderson: Hi, Janice, thanks for contacting us! We’re

getting back to you about Caitlynn. With me on the line is

Rebecca Helgo, the respiratory therapist who helped you out

when you were here.

Rebecca Helgo: Hi, Janice.

Janice: [sounding stressed] Hi.

Virginia Anderson: Janice, how is it going with Caitlynn?

Janice: Well, that’s why I called, actually. Not so good. I mean,

not bad, but I guess I’m not remembering everything you told

me when we practiced the physiotherapy, the chest

physiotherapy.

Virginia Anderson: That’s okay, Janice. I know this feels

overwhelming. Caitlynn’s condition is an extensive one, and

we’re here to help you manage it. We’ll continue to be here as

you’re �guring this out, okay?

Rebecca Helgo: That’s right, Janice. I know you’ll get the hang

of it, but in the meantime there’s a lot to learn. So you had

some questions about the chest physiotherapy? What’s going

on?

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Janice: Okay, if you can see on the camera, Caitlynn has these

red marks on her ribs here. Is that a symptom of something?

Rebecca Helgo: Can you get the camera just a bit closer?

Janice: How’s that?

Rebecca Helgo: Okay, very good. Yes, those look like marks

from the percussion. Are those over her last two ribs?

Janice: I think so.

Rebecca Helgo: That’s one thing you’ll have to remember: You

don’t want to do the percussion on her last two ribs on either

side, her backbone, or her breastbone. And when you do it

anywhere else, you don’t want to leave red marks. So if you see

those, that’s a hint that you’re doing the percussion just a bit

too hard.

Virginia Anderson: Don’t worry, you haven’t hurt her that I can

see. Plus, you’re obviously really staying on top of things and

you’re following the recommended treatment procedures for

Caitlynn, and I really want to praise you for that. So, is she

acting like that area is hurting her? Or can you tell?

Janice: No, it doesn’t seem like it’s hurting her at all.

Rebecca Helgo: She should be �ne, then.

Virginia Anderson: And remember, Janice, if you continue to

have trouble with this, we’ve got other options. There’s a vest

that vibrates the child if percussion isn’t getting the job done.

And you won’t have to do exactly this forever. As she gets older

and can learn how to do huff coughs, you’ll be doing less work

and she’ll be doing more.

Janice: Okay. Thank you, that makes me feel better. I couldn’t

get hold of my pediatrician and I was just getting worried.

Rebecca Helgo: Good, that’s what we’re here for.

Virginia Anderson: Janice, should we review the signs and

symptoms of respiratory distress? We’re happy to go over

anything you need to feel more con�dent about monitoring

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Caitlynn.

Janice: I think I remember those. I feel like I check for them

every hour.

Rebecca Helgo: [chuckles] That’s understandable. Well,

remember to check with Dr. Benjamin or me or Virginia if you

need to.

Conclusion As you saw in this activity, coordinating care can be a

challenge when the patient lives far from her provider or when

multiple providers are distant from each other. Many

technologies may be necessary in order to provide quality

evidence-based care to patients when care teams and patients

are not in the same location. Nurses and other health care

professionals must �nd creative solutions when problems arise,

so that care planning for remote patients is just as

comprehensive and outcome-based as that for patients nearby

or on site.

Re�ection Questions As you work on your assignment, consider these questions:

How was remote collaboration used to improve the quality and safety of the care being provided in the scenario?

This question has not been answered yet.

In what ways was evidence-based practice being effectively applied to help the patient in the scenario? Were there opportunities for improvement? If so, what were they?

This question has not been answered yet.

1/16/24, 3:27 PM Vila Health: Remote Collaboration and Evidence-Based Care Transcript

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