NURS FPX 4900 Leadership, Collaboration, Communication, Change Management, and Policy Considerations Essay

NURS FPX 4900 Leadership, Collaboration, Communication, Change Management, and Policy Considerations Essay

 

Part 1: Assessing the Problem

Health problems exist at individual, family, group, and population levels. Before providing nursing care solutions to these problems, necessary assessment needs to be done as part of the nursing process. The level at which the problem exists determines the approach to care. At the family level, the sociocultural determinants impact their health. The health policies, either local, state, or national, determine the management of these conditions at the personal and family level. The purpose of this paper is to describe a patient problem, substantiate the problem using evidence-based practice, and propose leadership strategies to improve patient outcomes.

Defining the Patient Problem

JK is a 27-year-old male – a friend of mine who moved into the US seven years ago. He lives in the same neighborhood as mine and we’ve known each other for the past three years. JK is from the black community and does a clerical job in a law firm in the city. About eighteen months ago he was diagnosed with type II diabetes mellitus. He is worried that he would also be diagnosed with hypertension because one of his paternal uncles was hypertensive but passed on from heart failure because he would not adhere to his treatment. JK is married with one child – a 2-year-old girl. He is married to an African American lady with whom he shares ethnicity and country of origin. His maternal aunt who lives back in his native country is diabetic but not hypertensive. Otherwise, his family, past medical, and past surgical history are unremarkable and he reports that he is physically healthy. He is concerned about his body mass index (BMI) which is borderline overweight. He is aware that his current condition, diabetes mellitus condition will be lifelong but is controllable on medication and lifestyle modification. His current concerns are major issues because they may impact his behavioral change and health preventative strategies to prevent disease progression.

Evidence-based Approach to the Patient Problem   

Diabetes mellitus type II is one of the chronic medical illnesses that require a multidisciplinary approach to manage and prevent. Carpenter et al. (2019) acknowledged the role of nursing interventions in promoting self-malmanagement among diabetes patients. The nursing interventions aim at improving physiologic, biologic, biochemical, and psychological outcomes. In their integrated review research, Carpenter et al. (2019) recommended offering self-management to patients with type 2 diabetes. According to Sapra et al. (2021), the risk of anxiety is one of the nursing concerns among patients with diabetes mellitus. Altered health maintenance is another nursing concern that would also result from diabetes mellites.

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By 2015, the International Diabetes Federation estimated one in every eleven adults aged between 20 and 80 years globally had diabetes mellitus. This prevalence in the US is increasing with age and sometimes with biochemically diagnosable diabetes mellitus are not aware of their diagnosis (Centers for Disease Control and Prevention, 2020). With childhood and adolescent obesity, these prevalence data have been worsening in the United States. This calls for the input of nurses to exercise their health prevention and promotion to manage the disease at individual and population levels. Martos-Cabrera et al. (2021) advocated for nursing intense health education for patients with diabetes mellitus type 2. In their quasi-experimental study, the patients who received nursing intense health education had significant improvements in physiological and biochemical outcomes that were inferred from mean HbA1c levels. using Nola Pender’s health promotion theoretical model, the preventative intervention should aim to manipulate personal characteristics, behavioral experiences, and the individual’s interaction with the surrounding (Gorbani et al., 2020; Habibzadeh et al., 2021). Management patient’s problem would require more than one intervention at the individual level.

The evidence sources used above are reliable sources from peer-reviewed and scholarly journals. Among these sources, one was a book chapter that is regularly reviewed and updated. Another source was a statistical report by the centers for disease control and prevention (CDC). The results and conclusions from these sources are consistently complementing and supporting each other findings. The sources had a well-reported methodology and systematic documentation. These criteria made my sources reliable.  The levels of evidence in the hierarchy were also higher in these sources (Melnyk & Fineout-Overholt, 2018). Unreliable sources have authors who have no proven expertise and knowledge in the respective fields. These sources have no systematic organization and may represent mere opinions of authors. Therefore, sometimes the unreliable are not peer-reviewed. Most websites are also unreliable save for government, educational, and corporate or organizational websites.

State Board Nursing Practice Standards

All states and the district of Columbia in the united states have state boards of nursing that regulate the nursing practice and licensure. The management of my patient in the private or public nursing practice settings would all have to abide by the relevant board of nursing regulations. Management of diabetes mellitus requires combination strategies for best outcomes. Both nonpharmacological and pharmacological strategies can be used concurrently. Nurses are educated and trained to care for patients, diagnosis, and treat their illnesses. Unfortunately, not all state boards of nursing allow nurses both registered nurses (RNs) and advanced practice registered nurses (APRNs), to practice to the full extent of their practice and training (Brom et al., 2018). For example, my state is a restricted practice authority. This means that nurses can diagnose illnesses but would require physician supervision to prescribe medication or medical devices to the patients. The state boards of nursing regulate the nurse’s scope of practice in their states. Nursing training allows for nurses to complete the nursing process including assessment of patients, their management, and evaluation. My patient’s problem would require additional nonpharmacological nursing interventions such as patient education and self-monitoring at home besides their medication therapies (Chatterjee et al., 2018). In independent practice as a nurse in my state, I would not be legally eligible to prescribe the medication and this would limit my scope of practice. Therefore, I would need to collaborate with physicians to manage this patient fully. My nursing leadership skill would come in handy to achieve the best outcomes for my patient’s problem

Proposed Leadership Strategies to Improve Outcomes

Nursing leadership has various elements including but not limited to teamwork, awareness of the delivery system, interdisciplinary collaboration (Stevenson University, 2018), ethical care, patient advocacy, and patient safety (Brunt & Bogdan, 2021). Nursing leadership strategies for the management of this patient will include care coordination, care collaboration, and care communication. These strategies will aim at improving the management of patient care, enhancing patient-centered care, and improving patient experience. My patient, JK had anxiety related to the diagnosis and possible familial occurrence of his illness and related outcomes of his management. To enhance care coordination, I will connect Mr. JK to community resources and online support groups for diabetics to improve their management outcomes. I will also connect him to a dietician to educate him about nutrition modifications (Martos-Cabrera et al., 2021). Collaborating with his physician to prescribe his medications and evaluate the outcomes regularly to improve glucose control in this patient would ensure improved long-term care outcomes. I would offer counseling to alleviate anxiety improve patient-centered care that would be culturally sensitive because his family history was remarkable. Communicating his care with relevant stakeholders is another leadership strategy that would ensure seamless care continuity. Therefore, nursing leadership has a huge role in improving the care outcome for this patient.

Conclusion

Mr. JK who is well known to me has been diagnosed with diabetes mellitus and will require a multidisciplinary approach. Medical and nonpharmacological interventions will be appropriate for the best outcomes of his management. The patient has a remarkable family history of chronic illness and has well-known risk factors for his disease. This finding had made him anxious and sought professional advice. Reliable evidence-based literature used to evaluate his disease condition supports the need for nursing interventions and the appropriateness of his diagnosis. Patient health education and self-management are needed alongside medical management as backed by Nola Pender’s health promotion theoretical model. However, my state board of nursing regulations is yet to allow nurses to independently prescribe medications and devices. Therefore, collaborative, coordinative, communication leadership skills will be appropriate to promote seamless management for this patient that will involve multidisciplinary care.

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References

Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners, 30(3), 120–130. https://doi.org/10.1097/JXX.0000000000000023

Brunt, B. A., & Bogdan, B. A. (2021). Nursing Professional Development leadership. In StatPearls [Internet]. StatPearls Publishing.

Carpenter, R., DiChiacchio, T., & Barker, K. (2019). Interventions for self-management of type 2 diabetes: An integrative review. International Journal of Nursing Sciences, 6(1), 70–91. https://doi.org/10.1016/j.ijnss.2018.12.002

Centers for Disease Control and Prevention. (2020). National Diabetes Statistics Report 2020. Cdc.Gov. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

Chatterjee, S., Davies, M. J., Heller, S., Speight, J., Snoek, F. J., & Khunti, K. (2018). Diabetes structured self-management education programs: a narrative review and current innovations. The Lancet. Diabetes & Endocrinology, 6(2), 130–142. https://doi.org/10.1016/S2213-8587(17)30239-5

Gorbani, F., Mahmoodi, H., Sarbakhsh, P., & Shaghaghi, A. (2020). Predictive performance of Pender’s health promotion model for hypertension control in Iranian patients. Vascular Health and Risk Management, 16, 299–305. https://doi.org/10.2147/VHRM.S258458

Habibzadeh, H., Shariati, A., Mohammadi, F., & Babayi, S. (2021). The effect of educational intervention based on Pender’s health promotion model on quality of life and health promotion in patients with heart failure: an experimental study. BMC Cardiovascular Disorders, 21(1), 478. https://doi.org/10.1186/s12872-021-02294-x

Martos-Cabrera, M. B., Gómez-Urquiza, J. L., Cañadas-González, G., Romero-Bejar, J. L., Suleiman-Martos, N., Cañadas-De la Fuente, G. A., & Albendín-García, L. (2021). Nursing-intense health education intervention for persons with type 2 diabetes: A quasi-experimental study. Healthcare (Basel, Switzerland), 9(7). https://doi.org/10.3390/healthcare9070832

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Lippincott Williams and Wilkins.

Sapra, A., Bhandari, P., & (Hughes), A. W. (2021). Diabetes Mellitus (Nursing). In StatPearls [Internet]. StatPearls Publishing.

Stevenson University. (2018, February 6). Elements of nurse leadership. Stevenson.Edu. https://www.stevenson.edu/online/about-us/news/nurse-leadership

In a 5-7 page written assessment, define the patient, family, or population health problem that will be the focus of your capstone project. Assess the problem from a leadership, collaboration, communication, change management, and policy perspective. Plan to spend approximately 2 direct practicum hours meeting with a patient, family, or group of your choice to explore the problem and, if desired, consulting with subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form.

Introduction
Nurses in all professional roles work to effect positive patient outcomes and improve organizational processes. Professional nurses are leaders in problem identification, planning, and strategy implementation—skills that directly affect patient care or organizational effectiveness.

Too often, change agents jump to a conclusion that an intervention will promote the envisioned improvement. Instead, the ideal approach is to determine which interventions are appropriate, based on an assessment and review of credible evidence. Interventions could be patient-facing or involve a change in policy and process. In this assessment, you’ll identify and make the case for your practicum focus area, then explore it in depth from a leadership, collaboration, communication, change management, and policy perspective.

This assessment lays the foundation for the work that will carry you through your capstone experience and guide the practicum hours needed to complete the work in this course. In addition, it will enable you to do the following:

Develop a problem statement for a patient, family, or population that’s relevant to your practice.
Begin building a body of evidence that will inform your approach to your practicum.
Focus on the influence of leadership, collaboration, communication, change management, and policy on the problem.
Preparation
In this assessment, you’ll assess the patient, family, or population health problem that will be the focus of your capstone project. Plan to spend approximately 2 hours working with a patient, family, or group of your choice to explore the problem from a leadership, collaboration, communication, change management, and policy perspective. During this time, you may also choose to consult with subject matter and industry experts about the problem (for example, directors of quality or patient safety, nurse managers/directors, physicians, and epidemiologists).

To prepare for the assessment, complete the following:

Identify the patient, family, or group you want to work with during your practicum The patient you select can be a friend or a family member. You’ll work with this patient, family, or group throughout your capstone project, focusing on a specific health care problem.
Begin surveying the scholarly and professional literature to establish your evidence and research base, inform your assessment, and meet scholarly expectations for supporting evidence.
In addition, you may wish to complete the following:

Review the assessment instructions and scoring guide to ensure that you understand the work you’ll be asked to complete and how it will be assessed.
Review the Practicum Focus Sheet: Assessment 1 [PDF], which provides guidance for conducting this portion of your practicum.
Note: Remember that you can submit all, or a portion of, your draft assessment to Smarthinking Tutoring for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24-48 hours for receiving feedback.

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Instructions
Complete this assessment in two parts.

Part 1
Define the patient, family, or population health problem that will be the focus of your capstone project. Assess the problem from a leadership, collaboration, communication, change management, and policy perspective and establish your evidence and research base to plan, implement, and share findings related to your project.

Part 2
Connect with the patient, family, or group you’ll work with during your practicum. During this portion of your practicum, plan to spend at least 2 hours meeting with the patient, family, or group and, if desired, consulting with subject matter and industry experts of your choice. The hours you spend meeting with them should take place outside of regular work hours. Use the Practicum Focus Sheet [PDF] provided for this assessment to guide your work and interpersonal interactions. Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form.

CORE ELMS
Complete the NURS-FPX4900 Volunteer Experience Form in CORE ELMS. Include a description of your relationship to the patient, family, or group in the Volunteer Experience comments field.

Requirements
The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.

Define a patient, family, or population health problem that’s relevant to your practice.
Summarize the problem you’ll explore.
Identify the patient, family, or group you intend to work with during your practicum.
Provide context, data, or information that substantiates the presence of the problem and its significance and relevance to the patient, family, or population.
Explain why this problem is relevant to your practice as a baccalaureate-prepared nurse.
Analyze evidence from peer-reviewed literature and professional sources that describes and guides nursing actions related to the patient, family, or population problem you’ve defined.
Note whether the authors provide supporting evidence from the literature that’s consistent with what you see in your nursing practice.
Explain how you would know if the data are unreliable.
Describe what the literature says about barriers to the implementation of evidence-based practice in addressing the problem you’ve defined.
Describe research that has tested the effectiveness of nursing standards and/or policies in improving patient, family, or population outcomes for this problem.
Describe current literature on the role of nurses in policy making to improve outcomes, prevent illness, and reduce hospital readmissions.
Describe what the literature says about a nursing theory or conceptual framework that might frame and guide your actions during your practicum.
Explain how state board nursing practice standards and/or organizational or governmental policies could affect the patient, family, or population problem you’ve defined.
Describe research that has tested the effectiveness of these standards and/or policies in improving patient, family, or population outcomes for this problem.
Describe current literature on the role of nurses in policy making to improve outcomes, prevent illness, and reduce hospital readmissions.
Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of this problem.
Propose leadership strategies to improve outcomes, patient-centered care, and the patient experience related to the patient, family, or population problem you’ve defined.
Discuss research on the effectiveness of leadership strategies.
Define the role that you anticipate leadership must play in addressing the problem.
Describe collaboration and communication strategies that you anticipate will be needed to address the problem.
Describe the change management strategies that you anticipate will be required to address the problem.
Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form.
Organize content so ideas flow logically with smooth transitions.
Apply APA style and formatting to scholarly writing.
Additional Requirements
Format: Format your paper using APA style. APA Style Paper Tutorial [DOCX] is provided to help you in writing and formatting your paper. Be sure to include:
A title page and reference page. An abstract is not required.
Appropriate section headings.
Length: Your paper should be approximately 5-7 pages in length, not including the reference page.
Supporting evidence: Cite at least five sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.
Proofreading: Proofread your paper, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on its substance.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

Competency 1: Lead people and processes to improve patient, systems, and population outcomes.
Define a patient, family, or population health problem that’s relevant to personal and professional practice.
Competency 2: Make clinical and operational decisions based upon the best available evidence.
Analyze evidence from peer-reviewed literature and professional sources that describes and guides nursing actions related to a defined patient, family, or population problem.
Competency 5: Analyze the impact of health policy on quality and cost of care.
Explain how state board nursing practice standards and/or organizational or governmental policies could affect a defined patient, family, or population problem.
Competency 7: Implement patient-centered care to improve quality of care and the patient experience.
Propose leadership strategies to improve outcomes, patient-centered care, and the patient experience related to a defined patient, family, or population problem and document the practicum hours spent with these individuals or group in the Core Elms Volunteer Experience Form.
Competency 8: Integrate professional standards and values into practice.
Organize content so ideas flow logically with smooth transitions.
Apply APA style and formatting to scholarly writing.
SCORING GUIDE
Use the scoring guide to understand how your assessment will be evaluated.