State Health Department Proposal

State Health Department Proposal

FREE Example of a State Health Department Proposal for NUR 405

Slide 1 for the State Health Department Proposal


  • Description of our community
  • Lack of certain healthcare services
  • A need to put all the pieces together

Our community is a small, rapidly growing city which is surrounded by residential housing and recreation with a total population of about 64,000 individuals. Our city currently supplies our community members with many essential pieces of a successful and healthy community which has lead to our growing population. With this growing population new challenges are created that must be met to continue to serve the residents of our community. With the aging population growing disproportionately to the rest of the population, a few holes have appeared in the massive puzzle of a complete and healthy community. Primarily the pieces that need to expand and be reshaped are those that care for our elderly population. Our city currently supplies many services that give support to this population through assisted living, extended care facilities, and outpatient primary care offices. The issue identified is that this population needs more. This population is at increased risk for many health discrepancies and have limited access to these facilities. We also find that with this growing population these facilities are running out of resources. In order to put this puzzle together, to make it a complete healthcare system for all of our residents, we need to switch gears and focus on the preventative care of this growing population by aiming for care in their home setting.

Slide 2 for the State Health Department Proposal

Health Issue: Vulnerable Population for the State Health Department Proposal

The Elderly in our Community as a Growing Population The United States has experienced a gradual demographic transition from patterns of high fertility and high mortality rates to low fertility and delayed mortality. The transition begins with declining infant and childhood mortality. Lower childhood mortality contributes to a longer life expectancy and a younger population. Declines in fertility rates and improvements in adult health led to an older population. The median age of the America’s population is increasing (CDC, 2003). The population of adults over age 65 is growing at three times the rate of the population of family members available to care for them.

The Office of Elder Affairs in the U.S. projects a 37% increase of elderly population (65+) between 2000 and 2020. The Centers for Disease Control and Prevention, estimate the proportion of the population aged >65 years is projected to increase from 12.4% in 2000 to 19.6% in 2030 (CDC, 2003). In terms of actual figures, the number of persons aged >65 years is expected to increase from approximately 35 million in 2000 to an estimated 71 million in 2030. Another staggering figure is that the number of persons aged >80 years is expected to increase from 9.3 million in 2000 to 19.5 million in 2030 (CDC, 2003). These demographic changes increase the demand of paid caregivers.

Slide 3 for the State Health Department Proposal

Health Issue:Current Problems for the State Health Department Proposal

  • Available Resources
  • Lack of services for this age group
  • No current home healthcare services
  • Extended care facilities are beginning to be filled

Another concern is the projected growth in the elderly support ratio. If the number of working taxpayers relative to the number of older persons declines, inadequate public resources will be available. Another problem with the ratio of >65 aged persons to <65 aged persons is that fewer adults will be available to provide informal care to older family members. The anticipated increase in the number of older persons will have dramatic consequences for public health, the healthcare financing and delivery systems, and informal care giving. This issue is of great concern for our community as there are no services for home health that are supplied at this time. It is more important now than ever before to implement such a program that will increase the health of our community. It is also important to note that the limited availability of extended care services in this community is growing thin with the aging population growing and alternative must be created (Dansky, 2008).

In order to meet the demands of an aging population, new and innovative measures need to be developed and used. Emphasis should also be placed on the functioning and quality of life for seniors. Some of the needs of seniors can be met by using telehealth. Telehealth is a clinical information system that transmits data over ordinary telephone lines. Telehealth is used by individuals in their homes to communicate electronically with health care providers (Dansky, 2008).

Slide 4 for the State Health Department Proposal

Health Issue:Current Problems for the State Health Department Proposal

  • Increasing Healthcare Costs
  • Costs 5 times greater in the elderly
  • Nursing home expenditures doubled in cost
  • Public programs do not cover the costs

The increased number of seniors will lead to increased health care costs. The healthcare costs per capita for persons aged >65 years in the United States is three to five times greater than the cost for persons <65 years (CDC, 2003). The rapid growth in the number of seniors and the Baby Boomers starting to reach their 60s, coupled with the continued advances in medical technology, is expected to create upward pressure on healthcare and long-term care spending. The demands associated with long-term care might pose the greatest challenge for personal, family, and public resources. Nursing home and home healthcare expenditures doubled during the years from 1990 to 2001, reaching approximately 132 billion dollars. Public programs, including Medicaid and Medicare paid 57% of the cost, whereas patients or their families paid 25% (CDC, 2003).

Slide 5 for the State Health Department Proposal

Health Issue: Current Problems for the State Health Department Proposal

  • Polypharmacy
  • Increased risk for unintentional overdose or misuse
  • Increased risk for hospitalization
  • Increased risk for mismanaged chronic conditions

Polypharmacy is a growing concern in the United States population and worldwide. This concern doubles when talking about the elderly population as about 50% of the elderly population are prescribed more than five medications (Chakraborty, Rambhade, Patil, U. K., & Sharma, 2010). “Due the fact that people are living longer, the elderly population, which often suffers from multiple chronic diseases requiring multiple medications, continues to increase. These patients are much more likely to experience Polypharmacy and its negative consequences, especially adverse drug reactions (ADRs)” (Chakraborty, Rambhade, et al., 2010, p. 119). Because of this increased risk for adverse drug reactions, the admission rate to acute care facilities also increases with associated symptoms. Symptoms associated with polypharmacy closely resemble symptoms of other diseases and illnesses which increase the likelihood of inpatient admission and also the prescription of new medications that may add to the risk of polypharmacy. Common symptoms related to polypharmacy include fatigue, loss of appetite, tremors, and dizziness. When a patient displays these symptoms, it may be thought to be associated with currently diagnosed chronic health conditions such as diabetes, congestive heart failure, or hypertension, which may lead to the changing or adding of medications. This frequent changing of medications can lead to a mismanaged chronic condition and poor outcomes for the elderly individual.

Slide 6 for the State Health Department Proposal

Health Issue: Current Problems for the State Health Department Proposal

  • Many elderly people suffer from multiple health issues.
  • Fixed incomes may limit the availability of obtaining needed health care services and prescriptions
  • Home health services provide continuity of care for the elderly population

The elderly population may suffer from multiple chronic health diseases at the same time. For example, an elderly patient may have diabetes, congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease and hyperlipidemia all at the same time. The costs of the prescription drugs may limit the ability to pay for adequate medications to maintain and control these diseases. Home health services provide continuity of care for the elderly population and some agencies offer telehealth services to aid patients in controlling their chronic diseases and prevent hospitalizations.

Slide 7 for the State Health Department Proposal

Health Issue:A Possible Solution for the State Health Department Proposal

  • A local Telenursing Agency

A possible solution to all these problems mentioned and the one that is being proposed is the creation of a Telenursing Agency in our community. Phoenix Telenursing Services can help to provide preventative and palliative care to these high risk problems. Phoenix Telenursing Services can put all the pieces to this puzzle together.

Slide 8 for the State Health Department Proposal

Telenursing for the State Health Department Proposal

  • Defining Telenursing
  • Providing autonomy
  • Using technology
  • Benefits
  • Cost savings

Telenursing care is an umbrella term for nursing interventions at a distance. Telenursing is a technique, not a technology. Visits from a home health nurse have some drawbacks. The first problem is with transportation time. Second, the visit does not provide monitoring of the patient's response to, and compliance with, medications or treatments. Telenursing will save travel time and costs. Nursing care will be more readily available for seniors and improve compliance with care. Telenursing can also limit unscheduled visits to doctors (Arnaert, 2001).

Telenursing allows elderly people to maintain their autonomy by strengthening their emotional, relational, and social abilities. Many needs and expectations related to autonomy are unfulfilled:

  • 1. The need for physiological and physical safety may not be met because of the physical dependency older people often experience
  • 2. Behavioral and emotional security is threatened by mental deterioration
  • 3. The need to feel a sense of belonging is often countered by the social isolation of the elderly, as is their need for friendship, affection, and love (Arnaert, 2001).

Proper management of these needs improves the autonomy of the elderly and may reduce their requirements for acute care. By monitoring physiological functioning and intervening when appropriate, telehealth promotes independent living and reduces adverse health events (Arnaert, 2001).

The skeptics of this type of service might question whether the elderly can use this type of technology. Many seniors are not technophobes, although they will often express feelings of being "left behind" by technology. Barriers do exist, such as lack of skills, unintelligible manuals, and limited educational backgrounds. Nonetheless, all elderly people are familiar with the telephone and the television, which are information and communication technologies. Moreover, many elderly people already use personal computers and the Internet to obtain information and for email (Dansky, 2008).

Many benefits exist with telenursing. Video-telephony refers to any form of face-to-face video communication. Video-telephony guarantees a more natural style of communication. A more personalized, trusting relationship develops between client and staff. This in turn permits a degree of intimacy, for example when discussing needs, expectations, and feelings (Arnaert, 2001).

Studies have shown that elderly people are neither uninterested in technology, nor incompetent in its use. Video-telephony has been well accepted, largely because of the visual contact it provides. All videotelephony projects have shown that social isolation is not increased by use of the technique (Arnaert, 2001).

The personalized attention associated with telenursing care appears to have created strong feelings of proximity, integration, security, and safety. The prevention of isolation and reduced loneliness led to improvements in personal health and well being. Many seniors that have used telenursing services experience an improvement in the quality of their social lives, increased levels of activity, improved memory, positive self-perception, and maintenance of a network of friends (Arnaert, 2001).

Society demands that health care costs be controlled whereas quality and access to care are maintained. Seniors are disproportionately heavy consumers of social services and health care services. Money and time can be saved if telehealth services are used. The average video-telephony intervention was about 60% shorter than an onsite visit. The average onsite visit lasts about 45 minutes, while the video-telephony visit last an average of 18 minutes (Arnaert, 2001).

Nursing care delivered via telenursing services can supplement and strengthen traditional care for the elderly. Telenursing and video-telephony care expands the traditional boundaries of health care delivery for the elderly at home. Although technology by itself is no cure for the problems of an aging population, when applied judiciously it can bolster the position of vulnerable aging citizens (Arnaert, 2001).

Slide 9 for the State Health Department Proposal

Telehealth Services for the State Health Department Proposal

  • Systems should be unobtrusive
  • Can reduce anxiety for elderly patients and family members.
  • Increases in number of patients using these services will increase over the next 20 years

Elderly patients will be an important part of the telehealth market Ideally, any telehealth system should be easy to use and unobtrusive in the patients home. Having a system in place in the home can provide a measure of security and reduce anxiety for the patient and family members. According to the Telehealth Monitor (2009) “over the next two decades an increasing number of people will reach the age of which they need the type of support that can be provided using a telecare service” (p. 2). More elderly patients have access to computers and this will enable marketers to market their telehealth products to this generation.

Slide 10 for the State Health Department Proposal

Telehealth Services for the State Health Department Proposal

  • Improved patient outcomes are expected
  • Allows nurses to be in tune to patients current needs
  • Elderly patients benefit when this is used in conjunction with conventional treatment

According to the National Care Planning Council (2011) “a greater thrust toward demonstrating improved patient outcomes and accountability of monies spent has become the order of the day” (p.3). Patient outcomes are improved by these services because it allows the nurses and physicians earlier access to the patient in the event the patient becomes symptomatic. Conventional treatments such as physicians visits, routine check ups, prescription medications, and regular testing such as mammography can be augmented with the advent of telehealth services. Elderly patients can be educated to recognize the signs and symptoms of their diseases and when to call the physician. Having telehealth services in place can give the patient an added support to manage their disease processes.

Slide 11 for the State Health Department Proposal

Professional Nursing Leadership Skills Required for the State Health Department Proposal

  • Leadership defined
  • Management defined

The leadership for Phoenix Telenursing Services will not consist of management alone. This organization will recruit nurses that are not only concerned with having the appropriate clinical knowledge and skills, but also the necessary leadership and management skills that will be required to form an effective partnership within the vulnerable population of elderly in the community. Leadership ensues each time an individual makes an attempt to influence another person’s beliefs, opinions, or even behaviors (Hershey & Blanchard, 1988). Phoenix Telenursing Services knows that leadership is a combination of intrinsic personality traits, learned leadership skills, and characteristics of the situation. The function of a leader is to guide people and groups to accomplish common goals. For example, an effective nurse leader is able to inspire others on the healthcare team to make patient education and important aspect of all care activities.

It is important to note that leaders may not have formal authority granted by the Phoenix Telenursing Services organization, but are still able to influence others. “A job title does not make a person a leader. Only a person’s behavior determines if he or she occupies a leadership position” (Marquis & Huston, 2006, p. 47). Leadership ability may be related to qualities, such as unique personality characteristics, exceptional clinical expertise, or relationships with others in the organization. These are key leadership and management concepts that will guide Phoenix Telenursing Services professional nurses in meeting the organization’s and community’s expectations.

Phoenix Telenursing Services management pertains to the actions associated with coordinating people, time, and supplies to accomplish desirable results and necessitates problem-solving and decision-making functions. The managers within this organization will maintain charge of the day-to-day functions to obtain identified objectives and goals. The managers will plan and organize what is to be done, who is to do it, and how it is to be done.

Also leadership and management are intertwined and it is difficult to discuss one without the other, these concepts are different. Leadership is the capability to direct or inspire and influence people, while management is a synchronization of sources (time, people, supplies) to create and achieve outcomes. People in general are guided, as opposed to activities and things are managed. Leaders are able to motivate and inspire others, whereas managers have the assigned responsibility for accomplishing the goals of the organization. A good manager should also be a good leader, and in this organization, the managers and the nurses under them will all be required to be effective leaders from the ground up. Phoenix Telenursing Services mangers meet the minimum requirements of having both leadership and managerial characteristics that will be necessary for the success of the organization within the community (Marquis & Huston, 2006).

Slide 12 for the State Health Department Proposal

Leadership & Management Skills for the State Health Department Proposal

  • Technical Skills
  • Human Skills
  • Conceptual Skills

Phoenix Telenursing Services requires three skill sets for organizational leadership and management. Hersey and Blanchard (1988) identify three major areas required for effective leadership: technical skills, human skills, and conceptual skills. Technical skills includes clinical expertise and of nursing knowledge. When an individual has human skills, it means having the ability and judgment to work with people in an effective leadership role. When an individual has conceptual skills, it means having the ability to understand the complexities of the overall organization and to recognize how and where one’s own area of management fits into the overall organization.

At the staff nurse level of management, a considerable amount of technical skill and clinical expertise is needed because the nurse generally is involved in direct supervision of patient care and may be required to help train and mentor nurses and other healthcare providers. As one advances from lower levels to higher levels in the organization, more conceptual skills are needed. The common denominator at any level of management is the ability to work with people and provide effective leadership (Hersey & Blanchard, 1988).

Slide 13 for the State Health Department Proposal

Required Management Style for the State Health Department Proposal

  • Situational Management Style
  • Participative Management Style
  • Philosophy

Phoenix Telenursing Services nurses assume various roles as they function in leadership and management positions. The first step in this organization toward being an effective nurse leader and manager is to clearly understand the job description, roles and responsibilities, and policies and procedures related to the position employed in or assigned. The following are the primary roles and styles that management of Phoenix Telenursing Services will assume.

Three prevalent management behavior styles were identified by Lewin (1951) and White and Lippit (1960): authoritarian, democratic, and laissez faire. At one extreme, the autocratic manager makes all decisions with no staff input and uses the authority of the position to accomplish goals. At the opposite extreme is the laissez-faire manager, who provides little direction or guidance and will forgo decision making. Democratic management is also often referred to as participative management because of its basic premise of encouraging staff members to participate in decision making.

Depending on the situation, the nurse manager may need to use different types of management styles. This is how the concept of situational leadership was born within Phoenix Telenursing Services. Situational leadership requires consideration of staff members’ needs and experiences, the manager’s abilities, and the goals and tasks to be accomplished. The health care system of the twenty-first century requires the use of a democratic or participative management style that will involve the staff in goal setting, problem solving, and decision making. Phoenix Telenursing Services knows that health care settings are driven to become increasingly cost-effective while continuing to improve quality, customer satisfaction, and positive patient outcomes. This organization understands that staff directly involved in the challenges presented by patient care most often can suggest the most workable, practical solutions. Phoenix Telenursing Services philosophy is conceptualizing that problem solving and goal attainment are more likely to be successful when staff are involved in decisions affecting their daily work (Marquis & Huston, 2006).

Slide 14 for the State Health Department Proposal

Method to Measure and Demonstrate the Outcomes for the State Health

  • Department Proposal
  • Current Statistics
  • Acute Care
  • Extended Care
  • Survey

The success of the organization will be evident throughout the community. To demonstrate the success of the organization, it is planned to continuously monitor certain statistics gathered by the organization as well as data from the local community hospital. The local area hospital currently gathers statistics on admissions to the hospital related to demographics, admission rates, readmission rates, and admissions related to medication error or adverse effects. The organization plans to use this information that has been gathered over the past year to represent a baseline status of the health of the community. To add to this baseline information, a planned Healthcare Access Survey will be sent to a random selection of the current residents within the community. This survey will evaluate the satisfaction of the residents to healthcare services in the area and their accessibility, including monitoring of chronic illness, access to healthcare related advice, ease of follow-up care, and other associated information.

Slide 15 for the State Health Department Proposal

Method to Measure and Demonstrate the Outcomes for the State Health

  • Department Proposal
  • Admission rates
  • Acute Care
  • Extended Care
  • Readmission rates
  • Acute Care
  • Polypharmacy

After the implementation of the Phoenix Telenursing Services program, the plan is to continue to monitor these hospital statistics to observe for any trends that may be related to the interventions of the program. It is expected that a trend of increased admissions of the elderly (age 60 and above) to acute care will continue to increase as this population increases, but the hope is to see that the number of admissions to extended care facilities will begin to slow in expansion as the addition of Phoenix Telenursing Services will decrease the burden at home and allow more individuals to stay in the home. The acute care readmission rates is expected to decrease as well. Readmitted clients to the hospital, is usually due to the development of a new problem, or due to deterioration in health status related to the primary or to a secondary medical diagnosis. Significant respiratory, cardiovascular or GI symptoms are generally present at hospital readmission. Typically, readmitted clients are 75 years or older. Chronic illness appears to be the best indicator for hospital readmission. The crucial time period for hospital readmission during home care is the first 2-3 weeks following hospital discharge. Because this will be one of the target time frames for the organization’s intervention, it is believed Phoenix will positively affect these outcomes. This decrease in readmissions will be related to the better understanding by the clients of their discharge instructions including: follow-up with primary care providers, medication routines, and diet management related to medications and health conditions such as diabetes.

Polypharmacy is a growing concern nationwide and we believe this program’s resources will aide the community in lowering complications related to this problem. Polypharmacy in the elderly frequently leads to medication errors including overdoses and ineffective medication routines. By supplying followup telenursing to those that are thought to be at increased risk for these complications, a better understanding of proper use and increased understanding by family members should lead to a decreased number of admissions related to medication errors.

The results from all of these outcome data will be compared throughout the time the program is practicing, and a one year overall comparison will also be made to the baseline data that was collected prior the launch of the organization. This one year mark will allow us to determine if there is a true statistical significance found before and after the interventions were initiated. This will also allow the organization to see any areas of concern in the program that may need improvement or redirection.

Slide 16 for the State Health Department Proposal


  • Community Benefits
  • Growth
  • The Future

As the Board can see, by awarding the $500,000 to Phoenix Telenursing Services, the surrounding community is expected to experience profound benefits for the elderly and aging population. By combining information technology with clinical skills, Phoenix Telenursing Services can provide a significant advantage to the success of professional nurses helping the elderly within the community because they will be demonstrating their ability to provide cost-effective outcomes measurement to the elderly. These creative implications will help create balance within the community for health care spending, especially noting cost-effectiveness. Growth within the community is expected after the integration of these new, innovative services. With the advancement of this program, the elderly will not be left behind in any community. Phoenix Telenursing Services will be there to help expand health services and resources within communities across the nation.

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