Assignment Prompt & Instructions
APA format, in-text citation
Read the file with the suggestion and redo to improve the overall requirements
– ## ReviseNeeded.docx.pdf
**## ReviseNeeded.docx.pdf**
Student Name: Kelly Nhu Tran 1
Date: 10/19/2025
Problem of Interest
The healthcare sector is undergoing a profound change brought about by the need for
technological development and growing pressure to incorporate models of care delivery that
are both affordable and easily accessible. Telemedicine has taken center stage as a vital
intervention to solve the disparities in health care, especially in rural and underserved
populations, where shortages of healthcare providers, geographic isolation, and access to
specialty care pose significant challenges to the provision of quality health care practices
(Haleem et al., 2021). The community hospitals in the country, as the vital safety-net hospitals
to about 60 million Americans who live in rural areas, are under pressure to institute and
maintain telemedicine programs with high levels of operational, financial, and technological
limitations.
The data available in the industry indicates that although the use of telehealth
increased during the COVID-19 pandemic, rural hospitals are still grappling with the challenge
of implementation sustainability because of poor broadband connections, limited
reimbursement plans, lack of technology competency in the workforce, and the complexity of
regulatory compliance (Bouabida et al., 2022). These systemic issues continue to create
healthcare access inequities, which are leading to preventable emergency department visits,
delayed access to essential specialist care, and eventually poor patient outcomes in rural
areas that already face a disproportionate disease burden relative to urban areas.
Background
Healthcare Administration Problem
The rural adoption of telemedicine is much lower than the rate in urban healthcare
systems. This adoption gap points out the overall infrastructure gaps, such as a lack of
broadband internet access in about 25 per cent of rural Americans, a lack of capital base to
purchase the technology, and a lack of technical support facilities to support the sustainable
program implementation. The Medicare and Medicaid reimbursement models used in the past
offered low coverage of the telemedicine services, which posed a disincentive to poor
hospitals to invest heavily in their facilities without assured revenue flow rates (Jaffe et al.,
2020). Even though regulatory modifications in the COVID-19 phase opened up the
possibilities of telemedicine reimbursement, there is doubt about long-term policy adjustments,
which makes administrators reluctant to invest in the long term.
Matt Frederiksen-England
214530000000017046
Cite
Matt Frederiksen-England
214530000000017046
This should be a maximum of one paragraph. Be sure you are being clear and concise when you write.
Matt Frederiksen-England
214530000000017046
Citation needed.
2
Operational Problem
Healthcare sector is experiencing a paradigm shift due to the demand to develop
technological aspects and increased pressure to integrate models of care delivery that are
affordable and accessible. The stage of telemedicine as an important intervention has become
part of the solution to closing the gaps in health care, particularly in rural and underserved
communities, where access to specialty care, shortage of healthcare providers, and
geographic isolation are critical issues to the delivery of quality health care practices (Haleem
et al., 2021). The community hospitals within the nation that serve as the essential safety-net
hospitals to approximately 60 million Americans residing in rural communities are being
stressed to integrate and support telemedicine programs with high operational, monetary, and
technological constraints.
Information available in the industry shows that despite the fact that the number of
telehealth uses grew during the COVID-19 pandemic, rural hospitals continue to face the
problem of sustainability in implementation due to low broadband connections, insufficient
reimbursements plans, workforce lack of technology competency, and complexity in meeting
regulatory standards (Bouabida et al., 2022). These systemic problems persist in causing
inequity in healthcare access which is contributing to avoidable emergency department visits,
delay in accessing necessary specialist care and ultimately poor patient outcomes in rural
regions with already-disproportionate disease burden compared to urban areas.
Operational Problem Core Elements to be Corrected (Constructs)
Core Element Briefly Explain Connection to the Problem
Staffing
Methodology
Two factors directly cause underutilization of services, namely low
patient awareness and poor digital health literacy among older adults.
It is established by applying an extensive patient education plan,
simplify access to care, provide technology support initiatives, and
perform specific outreach to create awareness and alter the
preferences of individuals to use the appropriate type of virtual care.
Burnout and
Workload
Insufficient provider engagement caused by inefficient workflows,
heavy documentation, technical problems, and a lack of incentive
alignment are major obstacles to the program's success. It is fixed
through re-designing workflow, changing productivity metrics,
improving technical support, and leaders committing to making
telemedicine a core service delivery.
Ideal State of Operations
The optimal option is a smooth incorporation of telemedicine services as a common element
of care delivery, high rates of utilization in the appropriate patient groups, strong provider
involvement and satisfaction, evidenced changes in the access metrics, and sustainable financial
performance enabling further investment. Telemedicine can serve as one of the evidence-based tools
in this ideal state to increase access to specialty care, decrease unnecessary emergency visits, improve
patient satisfaction because of the convenient delivery option, and enhance the hospital's
Matt Frederiksen-England
214530000000017046
This is an excellent source as your show there is a specific problem with sustainability. You need an additional 2 sources restating that as a problem.
Matt Frederiksen-England
214530000000017046
Although this is a good source to keep, I do not see a "problem" identified by your statement.
Matt Frederiksen-England
214530000000017046
Go through and add appropriate citations. If you are referencing the same source within a paragraph, see this resource. https://www.alverno.edu/media/alvernocollege/library/pdfs/multiple7.pdf
3
competitiveness and its value to the community.
Professional Practice Gap Statement…
Professional Practice Gap Statement
AdventHealth Hendersonville has inefficient use of telemedicine, although it has
substantial infrastructure investment, accompanied by only 15 percent of the entire population
with chronic diseases adopting the offered services, high non-emergency emergency visits,
and an average of 3-4 weeks to see a specialist in case of telehealth use. The optimal state of
the operation is a smooth integration of telemedicine as a standard requirement in the delivery
of care, high utilization among the right populations, high provider involvement, evidence-
based access improvements, and financially sustainable operations.
Summary of Evidence
The findings confirm that the issue of telemedicine integration costs is a major issue in
the industry that impacts the capacity of hospitals serving rural communities to deliver easy-to-
access, high-quality care to underserved populations. AdventHealth Hendersonville is a bright
example of how hospitals, whose technical infrastructure is sufficient, are facing significant
operational challenges related to the translation of technology investment into its meaningful
use and better results. The fundamental problem factors, which include patient
engagement/digital health literacy/ Problem and insufficient provider adoption/workflow
integration/ Problem, are interrelated and cause obstacles to achieving the potential benefits
of telemedicine. The gap in professional practices between the current suboptimal use and the
optimal seamless integration requires evidence-based approaches to cover both patient-facing
and provider-facing aspects.
Purpose of the Integrative Review
This integrative review aims to synthesize and critically evaluate the existing empirical
and grey literature to evidence-based interventions to enhance nurse staffing models and
burnout reduction in rural community hospitals. In this research, the efficiency of different
interventions, including acuity-based staffing tools, workload management systems, and
supportive practice environments, will be analyzed on such key outcomes as nurse burnout,
turnover intention, and patient safety indicators. The purpose of this review is to find relevant
solutions applicable in practice to solve the operational and workforce problems of HSOs,
such as AdventHealth Hendersonville, that are unique to the rural hospital setting. The results
will be aimed at equipping healthcare administrators with condensed evidence-based
information to make strategic decisions that can result in optimal operational and nurse
retention, and eventual change in the quality of healthcare services extended to rural people.
Integrative Review Question(s)
Which evidence-based practices are effective to increase the rates of telemedicine
utilization and sustainability of programs in rural hospitals with communities of predominantly
older adults with chronic disease management needs?
Theoretical and/or Conceptual Framework
Description
The Consolidated Framework for Implementation Research (CFIR) is the frame of
reasoning and acting on the issues of telemedicine integration into the rural community
hospital and its frameworks. CFIR provides a comprehensive, multi-tiered framework that
includes five key areas that affect how well something is implemented: the intervention's
characteristics, the outer setting, the inner setting, the characteristics of the people involved,
Matt Frederiksen-England
214530000000017046
Cite.
Matt Frederiksen-England
214530000000017046
Go through and remove the name/reference to any specific hospital organization.
Matt Frederiksen-England
214530000000017046
Between the ideal state and the practice gap you need quantitative data to show the problem (with citations). You need to draw a comparison between the two. For example, currently, many hospitals have 10% of surgeries result in a surgical site infection (Brown, 2025), but many are able to achieve 5% (CMS, 2024).
Matt Frederiksen-England
214530000000017046
Include a citation to the creator of CFIR
Matt Frederiksen-England
214530000000017046
This seems to be focused on a different topic than telemedicine.
4
and the implementation process. This framework is especially useful for looking at how
telemedicine is adopted because it takes into account that successful implementation
depends not only on how well the intervention works or how technically advanced it is, but
also on how different factors, such as the organization, the people involved, the
implementation strategies, and the outside environment, interact with each other. .
Theoretical Alignment Table
Practice-based Problem Constructs Theoretical Framework Elements
Patient Engagement and Digital Health
Literacy Deficits
Outer Setting (Patient Needs &
Resources): CFIR acknowledges the role
of needs, preferences, and resource
limitation knowledge among external
stakeholders, patients with low digital
health literacy and technology access
barriers in implementing success.
Patient Engagement and Digital Health
Literacy Deficits
Intervention Characteristics (Complexity
and Adaptability): CFIR insists that
interventions should be flexible so that
they can accommodate a wide range of
user needs and make them seem less
complex so that they could be adopted by
a wider range of populations with different
levels of technological competence.
Provider Adoption and the Workflow
Integration Barriers
The CFIR inner setting domain has an
examination of such issues as organizational
culture, leadership interaction, availability of
resources, and staff capacity. All these may
result in provider resistance, in-efficiency in
workflow, and bad incentive structure.
Provider Adoption and Workflow Integration
Barriers
Individual characteristics (knowledge, beliefs,
and self-efficacy): CFIR does not ignore the role
of such beliefs of interventions provided by the
provider as his/her sense of effectiveness,
his/her confidence in the use of new
technologies, and his/her sense of the relative
advantage in implementation..
5
References
Bouabida, K., Lebouché, B., & Pomey, M.-P. (2022). Telehealth and COVID-19 Pandemic: An
Overview of the Telehealth Use, Advantages, Challenges, and Opportunities during
COVID-19 Pandemic. Healthcare, 10(11), 2293.
https://doi.org/10.3390/healthcare10112293
Haleem, A., Javaid, M., Singh, R., & Suman, R. (2021). Telemedicine for healthcare:
Capabilities, features, barriers, and Applications. Sensors International, 2(2), 100–117.
Jaffe, D. H., Lee, L., Huynh, S., & Haskell, T. P. (2020). Health Inequalities in the Use of
Telehealth in the United States in the Lens of COVID-19. Population Health
Management, 23(5), 368–377. https://doi.org/10.1089/pop.2020.0186
Olawade, A. C. D., Olawade, D. B., Ojo, I. O., Famujimi, M. E., Olawumi, T. T., & Esan, D. T.
(2024). Nursing in the Digital Age: Harnessing telemedicine for enhanced patient care.
Informatics and Health, 1(2), 100–110. https://doi.org/10.1016/j.infoh.2024.07.003
Matt Frederiksen-England
214530000000017046
Only capitalize the first letter of the title (and subtitle, if applicable) and any proper nouns.
Matt Frederiksen-England
214530000000017046
Only capitalize the first letter of the title (and subtitle, if applicable) and any proper nouns.
Appendix A: DHA Practice-Based Problem Literature Review Matrix
Appendix A: DHA Practice-Based Problem Literature Review Matrix Operational
Problem Source #1
Author/Date: Jaffe, D. H., Lee, L., Huynh, S., & Haskell, T. P. (2020).
Theoretical Framework Implicitly based on models of healthcare access and utilization,
focusing upon demographic and geographic hindrances.
Research question/hypotheses: What patient demographics (age, region, urban/ rural,
mental health status) are predictors regarding the use of telehealth in relation to face-to-
face care?
Methodology: A retrospective cohort study based on combined claims and survey data.
Multivariate logistic regression was the primary method of analyzing the data.
Findings and discussion: Discovered that some demographic variables were less predictive
of the use of telehealth: adults (45 and older) (OR 0.684) and rural populations (urban vs.
rural) (OR 1.543). This quantifies this issue of the problem of inequality of access in
operation.
In summary: The rapid shift to telehealth due to COVID-19 has exacerbated already
existing disparities in access, leaving an operation-level problem in which some groups of
patients continue to be underserved by new virtual care models.
Future studies need to examine the factors behind these differences, such as digital literacy,
trust in technology as well as platform design.
Practical implications: The organizations should be eager to recognize vulnerable groups
and develop support systems (e.g., technical assistance, low-tech options) to facilitate the
digital divide and provide equitable service delivery.
Yes, empirical research
Appendix A: DHA Practice-Based Problem Literature Review Matrix Operational
Problem Source #2.
Author/Date: Olawade, A. C. D., Olawade, D. B., Ojo, I. O., Famujimi, M. E., Olawumi, T.
T., and Esan, D. T. (2024).
Theoretical Framework: A narrative review which integrates evidence but without a single
theoretical framework which unites the review; rather, it is concerned with practice and
issues of ethics.
Research question/hypotheses: How, why and what are the challenges, issues and
significance of telemedicine in the present day nursing practice, including ethical issues?
Methodology: An in-depth narrative review of primary research, systematic reviews, and
policy documents (2010-2023) identified in databases, including PubMed and CINAHL.
Findings and discussion: The analysis allowed identifying key themes: telemedicine
improves triage and monitoring and poses significant operational challenges. This consists
of alterations in work processes, necessity of training nurses and critical ethical and legal
concerns concerning patient privacy, data security, and informed consent within a digital
Appendix A: DHA Practice-Based Problem Literature Review Matrix
environment.
Conclusion: Telemedicine is a revolution in nursing, yet the integration introduces new
operational issues revolving around workplace workflow adjustments, ensuring clinician
competence, and creating high ethical and information security standards.
The next study must look into the development and the experimentation of particular
frameworks in training, workflow integration and ethical principles specially tailored
towards nursing telepractice.
To achieve this, healthcare organizations should invest in nurse training, modify how they
practice within the clinic and include telehealth in their practice process, and lobby
legislators to establish explicit legal and ethical principles of telemedicine use.
Empirical Research: No (It is a narrative review)
Appendix A: DHA Practice-Based Problem Literature Review Matrix Operational
Problem.
Source #3 Bouabida, K., Lebouche, B., and Pomey, M. (2022).
Theoretical Framework: An article which provides a summary of the various perspectives;
it does not adhere to a particular theoretical framework but discusses issues of systems and
user adoption.
Research question(s)/hypotheses: How do the advantages, challenges, and opportunities of
telehealth use in the COVID-19 pandemic look?
Methodology: The methodology was based on a reflexive overview and discourse with the
help of the analysis of the bibliographic sources in databases including PubMed and
Google Scholar. Not a systematic review.
Findings and discussion: The absence of human contact which decreases the quality of
care, concerns related to privacy and data security, and the insufficiency of access and
training on the patients and providers are identified as the key issues that contribute to the
reduced efficacy of telehealth. Also demonstrates varying access levels of the various
social and economic groups.
Conclusion: Telehealth is an excellent and affordable type of care access, but it suffers
numerous issues with care providers, data privacy, and equitable access that should be
resolved before it can achieve its full potential.
Future research implications: The present research raises further studies on the clinical,
organizational, socio-economic, and ethical implications of telehealth in the short and long
term.
Practical implications: Health systems must address concerns of patients and providers
with regard to their interactions with one another and the safety of their information. They
must also enhance training and set regulations to ensure that all people have access to
telehealth services.
Appendix A: DHA Practice-Based Problem Literature Review Matrix
No concrete studies (It's a summary of the viewpoint/article)
Appendix A: DHA Practice-Based Problem Literature Review Matrix.
Ideal State of Operations is a source.
Haleem, A., Javaid, M., Singh, R. P. and Suman, R. (2021).
Theoretical Framework: A descriptive review of telemedicine capabilities, without
reference to a specific theoretical framework.
Research question(s)/hypotheses: What are the abilities, applications, constraints, and uses
of telemedicine in healthcare?
Methodology: Descriptive literature overview and combination of telemedicine
applications and applications.
Analysis and findings: The present paper discusses the most appropriate telemedicine
system that must include all of the following features the chronic disease management,
remote patient monitoring, e-prescriptions, convenient scheduling, the protection of the
data, and the application of the latest technologies, such as AI and IoT. It emphasizes on a
patient-centered, efficient, and user-friendly workflow.
Conclusion: It can improve the situation of all persons by making hospital work more
effective, efficient, and making it easier to allow people to receive care through
Telemedicine. This is the most appropriate form of providing healthcare through
technology.
The further investigation of the topic should attempt to elaborate on the further evolution
and implementation of more advanced technologies (AI, IoT, VR) into telemedicine
platforms to expand their capabilities.
Healthcare organizations must endeavor to adopt holistic telemedicine solutions, in terms
of scheduling, EHR integration, remote monitoring, and secure communication so that they
achieve a desirable and very efficient state of operation.
Empirical Research: No (It is descriptive review)
**## ReviseNeeded.docx.pdf**
Student Name: Kelly Nhu Tran 1
Date: 10/19/2025
Problem of Interest
The healthcare sector is undergoing a profound change brought about by the need for
technological development and growing pressure to incorporate models of care delivery that
are both affordable and easily accessible. Telemedicine has taken center stage as a vital
intervention to solve the disparities in health care, especially in rural and underserved
populations, where shortages of healthcare providers, geographic isolation, and access to
specialty care pose significant challenges to the provision of quality health care practices
(Haleem et al., 2021). The community hospitals in the country, as the vital safety-net hospitals
to about 60 million Americans who live in rural areas, are under pressure to institute and
maintain telemedicine programs with high levels of operational, financial, and technological
limitations.
The data available in the industry indicates that although the use of telehealth
increased during the COVID-19 pandemic, rural hospitals are still grappling with the challenge
of implementation sustainability because of poor broadband connections, limited
reimbursement plans, lack of technology competency in the workforce, and the complexity of
regulatory compliance (Bouabida et al., 2022). These systemic issues continue to create
healthcare access inequities, which are leading to preventable emergency department visits,
delayed access to essential specialist care, and eventually poor patient outcomes in rural
areas that already face a disproportionate disease burden relative to urban areas.
Background
Healthcare Administration Problem
The rural adoption of telemedicine is much lower than the rate in urban healthcare
systems. This adoption gap points out the overall infrastructure gaps, such as a lack of
broadband internet access in about 25 per cent of rural Americans, a lack of capital base to
purchase the technology, and a lack of technical support facilities to support the sustainable
program implementation. The Medicare and Medicaid reimbursement models used in the past
offered low coverage of the telemedicine services, which posed a disincentive to poor
hospitals to invest heavily in their facilities without assured revenue flow rates (Jaffe et al.,
2020). Even though regulatory modifications in the COVID-19 phase opened up the
possibilities of telemedicine reimbursement, there is doubt about long-term policy adjustments,
which makes administrators reluctant to invest in the long term.
Matt Frederiksen-England
214530000000017046
Cite
Matt Frederiksen-England
214530000000017046
This should be a maximum of one paragraph. Be sure you are being clear and concise when you write.
Matt Frederiksen-England
214530000000017046
Citation needed.
2
Operational Problem
Healthcare sector is experiencing a paradigm shift due to the demand to develop
technological aspects and increased pressure to integrate models of care delivery that are
affordable and accessible. The stage of telemedicine as an important intervention has become
part of the solution to closing the gaps in health care, particularly in rural and underserved
communities, where access to specialty care, shortage of healthcare providers, and
geographic isolation are critical issues to the delivery of quality health care practices (Haleem
et al., 2021). The community hospitals within the nation that serve as the essential safety-net
hospitals to approximately 60 million Americans residing in rural communities are being
stressed to integrate and support telemedicine programs with high operational, monetary, and
technological constraints.
Information available in the industry shows that despite the fact that the number of
telehealth uses grew during the COVID-19 pandemic, rural hospitals continue to face the
problem of sustainability in implementation due to low broadband connections, insufficient
reimbursements plans, workforce lack of technology competency, and complexity in meeting
regulatory standards (Bouabida et al., 2022). These systemic problems persist in causing
inequity in healthcare access which is contributing to avoidable emergency department visits,
delay in accessing necessary specialist care and ultimately poor patient outcomes in rural
regions with already-disproportionate disease burden compared to urban areas.
Operational Problem Core Elements to be Corrected (Constructs)
Core Element Briefly Explain Connection to the Problem
Staffing
Methodology
Two factors directly cause underutilization of services, namely low
patient awareness and poor digital health literacy among older adults.
It is established by applying an extensive patient education plan,
simplify access to care, provide technology support initiatives, and
perform specific outreach to create awareness and alter the
preferences of individuals to use the appropriate type of virtual care.
Burnout and
Workload
Insufficient provider engagement caused by inefficient workflows,
heavy documentation, technical problems, and a lack of incentive
alignment are major obstacles to the program's success. It is fixed
through re-designing workflow, changing productivity metrics,
improving technical support, and leaders committing to making
telemedicine a core service delivery.
Ideal State of Operations
The optimal option is a smooth incorporation of telemedicine services as a common element
of care delivery, high rates of utilization in the appropriate patient groups, strong provider
involvement and satisfaction, evidenced changes in the access metrics, and sustainable financial
performance enabling further investment. Telemedicine can serve as one of the evidence-based tools
in this ideal state to increase access to specialty care, decrease unnecessary emergency visits, improve
patient satisfaction because of the convenient delivery option, and enhance the hospital's
Matt Frederiksen-England
214530000000017046
This is an excellent source as your show there is a specific problem with sustainability. You need an additional 2 sources restating that as a problem.
Matt Frederiksen-England
214530000000017046
Although this is a good source to keep, I do not see a "problem" identified by your statement.
Matt Frederiksen-England
214530000000017046
Go through and add appropriate citations. If you are referencing the same source within a paragraph, see this resource. https://www.alverno.edu/media/alvernocollege/library/pdfs/multiple7.pdf
3
competitiveness and its value to the community.
Professional Practice Gap Statement…
Professional Practice Gap Statement
AdventHealth Hendersonville has inefficient use of telemedicine, although it has
substantial infrastructure investment, accompanied by only 15 percent of the entire population
with chronic diseases adopting the offered services, high non-emergency emergency visits,
and an average of 3-4 weeks to see a specialist in case of telehealth use. The optimal state of
the operation is a smooth integration of telemedicine as a standard requirement in the delivery
of care, high utilization among the right populations, high provider involvement, evidence-
based access improvements, and financially sustainable operations.
Summary of Evidence
The findings confirm that the issue of telemedicine integration costs is a major issue in
the industry that impacts the capacity of hospitals serving rural communities to deliver easy-to-
access, high-quality care to underserved populations. AdventHealth Hendersonville is a bright
example of how hospitals, whose technical infrastructure is sufficient, are facing significant
operational challenges related to the translation of technology investment into its meaningful
use and better results. The fundamental problem factors, which include patient
engagement/digital health literacy/ Problem and insufficient provider adoption/workflow
integration/ Problem, are interrelated and cause obstacles to achieving the potential benefits
of telemedicine. The gap in professional practices between the current suboptimal use and the
optimal seamless integration requires evidence-based approaches to cover both patient-facing
and provider-facing aspects.
Purpose of the Integrative Review
This integrative review aims to synthesize and critically evaluate the existing empirical
and grey literature to evidence-based interventions to enhance nurse staffing models and
burnout reduction in rural community hospitals. In this research, the efficiency of different
interventions, including acuity-based staffing tools, workload management systems, and
supportive practice environments, will be analyzed on such key outcomes as nurse burnout,
turnover intention, and patient safety indicators. The purpose of this review is to find relevant
solutions applicable in practice to solve the operational and workforce problems of HSOs,
such as AdventHealth Hendersonville, that are unique to the rural hospital setting. The results
will be aimed at equipping healthcare administrators with condensed evidence-based
information to make strategic decisions that can result in optimal operational and nurse
retention, and eventual change in the quality of healthcare services extended to rural people.
Integrative Review Question(s)
Which evidence-based practices are effective to increase the rates of telemedicine
utilization and sustainability of programs in rural hospitals with communities of predominantly
older adults with chronic disease management needs?
Theoretical and/or Conceptual Framework
Description
The Consolidated Framework for Implementation Research (CFIR) is the frame of
reasoning and acting on the issues of telemedicine integration into the rural community
hospital and its frameworks. CFIR provides a comprehensive, multi-tiered framework that
includes five key areas that affect how well something is implemented: the intervention's
characteristics, the outer setting, the inner setting, the characteristics of the people involved,
Matt Frederiksen-England
214530000000017046
Cite.
Matt Frederiksen-England
214530000000017046
Go through and remove the name/reference to any specific hospital organization.
Matt Frederiksen-England
214530000000017046
Between the ideal state and the practice gap you need quantitative data to show the problem (with citations). You need to draw a comparison between the two. For example, currently, many hospitals have 10% of surgeries result in a surgical site infection (Brown, 2025), but many are able to achieve 5% (CMS, 2024).
Matt Frederiksen-England
214530000000017046
Include a citation to the creator of CFIR
Matt Frederiksen-England
214530000000017046
This seems to be focused on a different topic than telemedicine.
4
and the implementation process. This framework is especially useful for looking at how
telemedicine is adopted because it takes into account that successful implementation
depends not only on how well the intervention works or how technically advanced it is, but
also on how different factors, such as the organization, the people involved, the
implementation strategies, and the outside environment, interact with each other. .
Theoretical Alignment Table
Practice-based Problem Constructs Theoretical Framework Elements
Patient Engagement and Digital Health
Literacy Deficits
Outer Setting (Patient Needs &
Resources): CFIR acknowledges the role
of needs, preferences, and resource
limitation knowledge among external
stakeholders, patients with low digital
health literacy and technology access
barriers in implementing success.
Patient Engagement and Digital Health
Literacy Deficits
Intervention Characteristics (Complexity
and Adaptability): CFIR insists that
interventions should be flexible so that
they can accommodate a wide range of
user needs and make them seem less
complex so that they could be adopted by
a wider range of populations with different
levels of technological competence.
Provider Adoption and the Workflow
Integration Barriers
The CFIR inner setting domain has an
examination of such issues as organizational
culture, leadership interaction, availability of
resources, and staff capacity. All these may
result in provider resistance, in-efficiency in
workflow, and bad incentive structure.
Provider Adoption and Workflow Integration
Barriers
Individual characteristics (knowledge, beliefs,
and self-efficacy): CFIR does not ignore the role
of such beliefs of interventions provided by the
provider as his/her sense of effectiveness,
his/her confidence in the use of new
technologies, and his/her sense of the relative
advantage in implementation..
5
References
Bouabida, K., Lebouché, B., & Pomey, M.-P. (2022). Telehealth and COVID-19 Pandemic: An
Overview of the Telehealth Use, Advantages, Challenges, and Opportunities during
COVID-19 Pandemic. Healthcare, 10(11), 2293.
https://doi.org/10.3390/healthcare10112293
Haleem, A., Javaid, M., Singh, R., & Suman, R. (2021). Telemedicine for healthcare:
Capabilities, features, barriers, and Applications. Sensors International, 2(2), 100–117.
Jaffe, D. H., Lee, L., Huynh, S., & Haskell, T. P. (2020). Health Inequalities in the Use of
Telehealth in the United States in the Lens of COVID-19. Population Health
Management, 23(5), 368–377. https://doi.org/10.1089/pop.2020.0186
Olawade, A. C. D., Olawade, D. B., Ojo, I. O., Famujimi, M. E., Olawumi, T. T., & Esan, D. T.
(2024). Nursing in the Digital Age: Harnessing telemedicine for enhanced patient care.
Informatics and Health, 1(2), 100–110. https://doi.org/10.1016/j.infoh.2024.07.003
Matt Frederiksen-England
214530000000017046
Only capitalize the first letter of the title (and subtitle, if applicable) and any proper nouns.
Matt Frederiksen-England
214530000000017046
Only capitalize the first letter of the title (and subtitle, if applicable) and any proper nouns.
Appendix A: DHA Practice-Based Problem Literature Review Matrix
Appendix A: DHA Practice-Based Problem Literature Review Matrix Operational
Problem Source #1
Author/Date: Jaffe, D. H., Lee, L., Huynh, S., & Haskell, T. P. (2020).
Theoretical Framework Implicitly based on models of healthcare access and utilization,
focusing upon demographic and geographic hindrances.
Research question/hypotheses: What patient demographics (age, region, urban/ rural,
mental health status) are predictors regarding the use of telehealth in relation to face-to-
face care?
Methodology: A retrospective cohort study based on combined claims and survey data.
Multivariate logistic regression was the primary method of analyzing the data.
Findings and discussion: Discovered that some demographic variables were less predictive
of the use of telehealth: adults (45 and older) (OR 0.684) and rural populations (urban vs.
rural) (OR 1.543). This quantifies this issue of the problem of inequality of access in
operation.
In summary: The rapid shift to telehealth due to COVID-19 has exacerbated already
existing disparities in access, leaving an operation-level problem in which some groups of
patients continue to be underserved by new virtual care models.
Future studies need to examine the factors behind these differences, such as digital literacy,
trust in technology as well as platform design.
Practical implications: The organizations should be eager to recognize vulnerable groups
and develop support systems (e.g., technical assistance, low-tech options) to facilitate the
digital divide and provide equitable service delivery.
Yes, empirical research
Appendix A: DHA Practice-Based Problem Literature Review Matrix Operational
Problem Source #2.
Author/Date: Olawade, A. C. D., Olawade, D. B., Ojo, I. O., Famujimi, M. E., Olawumi, T.
T., and Esan, D. T. (2024).
Theoretical Framework: A narrative review which integrates evidence but without a single
theoretical framework which unites the review; rather, it is concerned with practice and
issues of ethics.
Research question/hypotheses: How, why and what are the challenges, issues and
significance of telemedicine in the present day nursing practice, including ethical issues?
Methodology: An in-depth narrative review of primary research, systematic reviews, and
policy documents (2010-2023) identified in databases, including PubMed and CINAHL.
Findings and discussion: The analysis allowed identifying key themes: telemedicine
improves triage and monitoring and poses significant operational challenges. This consists
of alterations in work processes, necessity of training nurses and critical ethical and legal
concerns concerning patient privacy, data security, and informed consent within a digital
Appendix A: DHA Practice-Based Problem Literature Review Matrix
environment.
Conclusion: Telemedicine is a revolution in nursing, yet the integration introduces new
operational issues revolving around workplace workflow adjustments, ensuring clinician
competence, and creating high ethical and information security standards.
The next study must look into the development and the experimentation of particular
frameworks in training, workflow integration and ethical principles specially tailored
towards nursing telepractice.
To achieve this, healthcare organizations should invest in nurse training, modify how they
practice within the clinic and include telehealth in their practice process, and lobby
legislators to establish explicit legal and ethical principles of telemedicine use.
Empirical Research: No (It is a narrative review)
Appendix A: DHA Practice-Based Problem Literature Review Matrix Operational
Problem.
Source #3 Bouabida, K., Lebouche, B., and Pomey, M. (2022).
Theoretical Framework: An article which provides a summary of the various perspectives;
it does not adhere to a particular theoretical framework but discusses issues of systems and
user adoption.
Research question(s)/hypotheses: How do the advantages, challenges, and opportunities of
telehealth use in the COVID-19 pandemic look?
Methodology: The methodology was based on a reflexive overview and discourse with the
help of the analysis of the bibliographic sources in databases including PubMed and
Google Scholar. Not a systematic review.
Findings and discussion: The absence of human contact which decreases the quality of
care, concerns related to privacy and data security, and the insufficiency of access and
training on the patients and providers are identified as the key issues that contribute to the
reduced efficacy of telehealth. Also demonstrates varying access levels of the various
social and economic groups.
Conclusion: Telehealth is an excellent and affordable type of care access, but it suffers
numerous issues with care providers, data privacy, and equitable access that should be
resolved before it can achieve its full potential.
Future research implications: The present research raises further studies on the clinical,
organizational, socio-economic, and ethical implications of telehealth in the short and long
term.
Practical implications: Health systems must address concerns of patients and providers
with regard to their interactions with one another and the safety of their information. They
must also enhance training and set regulations to ensure that all people have access to
telehealth services.
Appendix A: DHA Practice-Based Problem Literature Review Matrix
No concrete studies (It's a summary of the viewpoint/article)
Appendix A: DHA Practice-Based Problem Literature Review Matrix.
Ideal State of Operations is a source.
Haleem, A., Javaid, M., Singh, R. P. and Suman, R. (2021).
Theoretical Framework: A descriptive review of telemedicine capabilities, without
reference to a specific theoretical framework.
Research question(s)/hypotheses: What are the abilities, applications, constraints, and uses
of telemedicine in healthcare?
Methodology: Descriptive literature overview and combination of telemedicine
applications and applications.
Analysis and findings: The present paper discusses the most appropriate telemedicine
system that must include all of the following features the chronic disease management,
remote patient monitoring, e-prescriptions, convenient scheduling, the protection of the
data, and the application of the latest technologies, such as AI and IoT. It emphasizes on a
patient-centered, efficient, and user-friendly workflow.
Conclusion: It can improve the situation of all persons by making hospital work more
effective, efficient, and making it easier to allow people to receive care through
Telemedicine. This is the most appropriate form of providing healthcare through
technology.
The further investigation of the topic should attempt to elaborate on the further evolution
and implementation of more advanced technologies (AI, IoT, VR) into telemedicine
platforms to expand their capabilities.
Healthcare organizations must endeavor to adopt holistic telemedicine solutions, in terms
of scheduling, EHR integration, remote monitoring, and secure communication so that they
achieve a desirable and very efficient state of operation.
Empirical Research: No (It is descriptive review)