Practicum Project: Assessing The Problem Essay

Practicum Project: Assessing The Problem Essay

 

Leadership, Collaboration, Communication, Change Management, and Policy Considerations

Individualizing nursing care at the individual, family, and population levels takes into account certain factors for successful coordination and transition. Leadership, collaboration, communication, change management, and policy are key considerations in promoting quality and safe care at these levels. The care for the patient should not end in the clinical area but should continue in the community. Therefore, understanding community factors that will impact patient care can require nursing leadership, collaboration, communication, change management, and policy knowledge and skills. In this practicum project, I selected a patient whom I met in the clinical area, and his family consented to participate in my project. The purpose of this problem is to describe this patient’s health problem, substantiate this problem using evidence-based sources, describe policies relevant to the health problem, and propose leadership strategies that can improve the health problem.

The Patient’s Health Problem

My selected patient, Annie (not her actual name), is a 12-year-old black female diagnosed with gastroesophageal reflux disease (GERD) at age 6 and asthma at 8. During our first encounter in the clinical area, Annie was admitted through the emergency department with acute exacerbation of asthma. She had a wheeze, acute and persistent cough, and difficulty breathing. After stabilization in the ED, she was transferred to the inpatient unit for further medical care. Annie is the only child in her family. Her mother, 27, is alive and well. Her father, 30, is obese. Since her diagnosis with asthma, Annie has been using her Ventolin inhaler when needed. During this admission, her symptoms were not controllable by her usual dose of Ventolin thus, they sought help in the emergency department. Annie was also diagnosed with childhood obesity. She had a body mass index (BMI) of 30.1 (147 cm and 65 kg). Her GERD symptoms are still present but are milder and occasional.

Supporting Evidence for the Health Problems

Annie’s diagnoses during that hospitalizations were childhood obesity, acute asthma exacerbation, and GERD. These are common health problems faced only by children in the united states but also adults. At the top of her diagnoses list was asthma. Pediatric asthma is a common disease among American children, especially blacks and American Asians. According to Azmeh et al. (2020), pediatric asthma affects about 14% of the world’s children population. The risk of hospitalization or even mortality from asthma among children is higher among African American children than non-Hispanic white children. Disparities in education, health access, and socioeconomic status play critical roles in these variations in risks (Azmeh et al., 2020). From my training, these pieces of evidence are relatable and valid. Most asthma patients I have interacted with are from urban and low socioeconomic regions. The concept of urban comes into play here because of the evidence that has been associated with the hygiene hypothesis and the ‘farm effect.’ This hypothesis posits that a lack of earlier exposures to these triggers contributes to symptomatic disease later because the immune system is not already primed for these triggers.

Asthma co-occurs with other medical comorbidities even in childhood. The recent argument about the inflammatory triad explains the occurrence of asthma, GERD, and obesity. Recent data shows that the prevalence of asthma, GERD, and obesity has risen among children (Katwa & Kabra, 2018). Esophageal dysmotility and abnormalities in neuronal function explain the co-occurrence of asthma and GERD (Paoletti et al., 2021). Other comorbid conditions that present with asthma are mental health problems such as insomnia and obstructive sleep apnea. These pieces of evidence are essential because patient-centered management and holistic care that form part of the current nursing care paradigm require the incorporation of patient-specific factors into their care and providing care in all dimensions of health, respectively.

Nursing care for asthma must consider the presence of comorbidities. According to Ronco et al. (2022), one of the contributors to the poor implementation of evidence-based care for severe pediatric asthma is the presence of comorbidities. Most patients present with mild to moderate disease, but the severe disease can present even in the background of good treatment adherence. The subgroup of patients with commodities such as Annie’s health problem is poor responders to treatment because an underlying disease or condition could be exacerbating the systems. Therefore, evidence-based care must not overlook the role of diseases such as GERD and obesity.

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Obesity has been documented as a risk factor for asthma. Gupta et al. (2018) described that the association between obesity and asthma suggests severe disease that could complicate poor control of symptoms. This is important in nursing even though the causal relationship has not been ascertained through scientific literature. Addressing obesity can reduce risks by minimizing the causes of inflammation in the triangle of inflammation (Gupta et al., 2018). According to Fletcher et al. (2020), a single intervention for asthma management can have little effect on patient outcomes. Policy and model-driven interventions that incorporate holistic and multiple interventions can have meaningful positive patient outcomes.

Evaluation of Evidence

The above evidence evaluates the biological and social aspects of Annie’s health problem. The information on epidemiology was current and was used to put Annie’s health problem in the population health perspective. The sources used are credible. To support their credibility, a systematic literature search used ensured that current, relevant, and authoritative sources. The authors’ information showed that the contributors of information in these sources were authoritative. Moreover, they were sourced from two key renowned journals PubMed and science direct. The selected articles used to substantiate Annie’s health problem were younger than five years and thus were current and provided reliable and valid information.

Reasons for Choosing this Health Problem

I chose this patient’s case because of two key reasons. Annie’s health problem was peculiar due to comorbidities and other socioeconomic issues that could potentially have played a part in her health. Annie assented to participate in my practicum project and her mother consented to this process. Our interaction sparked a bond that I believed would be critical to the success of my learning and practice. The presence of other comorbidities would provide an opportunity to offer and exercise my care coordination, nursing leadership, communication, and health policies in nursing care for this patient in a ‘non-usual’ setup. These comorbidities increase the risk of premature mortality or reduce the quality of life of this patient, thus the need for intervention.

Impact of State Board of Nursing Standards and other Health Policies

The practice of nursing is governed legally by health policies that can come from organization-level policies, state boards of nursing standards, or national policies. The care for patients with asthma included both medical and nursing care. Organizational policies such as standards of practice and organizational protocols are essential to a nurse as they determine the process of care delivery for quality and safe patient care. More important to a nurse are state board of nursing standards and regulations. State boards of nursing regulate the scope of practice for a nurse and licensure for the nurse. The scope of practice varies for graduate, advanced practice, and doctorate-level nurses (Church et al., 2022). According to Lockhart (2020), the state boards determine certain care provisions for every cadre of nurses. At the national level, policies such as the Affordable Care Act and The Nurse Practice Act guide nursing care for patients, including asthma patients. Affordable care access concerns financial access, medication management, and information use for patients. This policy is relevant to nursing care for Annie’s health problem because the management of chronic health problems requires care coordination that will have to abide by ACA policy programs and requirements.

More specific policies and programs such as the national asthma public policy agenda (NAPPA), the CDC’s National Asthma Control Program, School-Based and Asthma Management Program Act guide nursing care at the hospital and community levels by controlling funding, prevention strategies, coordination, and access to services. These policies affect nursing and the scope of practice by determining the roles and input of nurses and nursing. The National Department of Health and Human Services through the Healthy People Objectives set goals for the treatment of asthma. These goals, especially healthy people 2030 goals on respiratory disease, provide nurses and other healthcare professionals with targets and aims for their care for asthmatic patients. Meeting these goals at the patient and family levels contributes to national health prevention of asthma and other related diseases. A nurse, as the care coordinator, thus understands whom to communicate to and collaborate with and what kind of information is relevant to communicate with these stakeholders as determined by the provisions of these policies.

Leadership Strategies to Improve this Patient’s Health Problem Outcomes

The management of Annie’s health problem will aim at improving her quality of life and safety, and prevent mortality (Kiper, 2018). Successfully managing severe asthma and the other co-occurring conditions that Annie presented with, a nurse will ensure that they manage the resources using both human and material. Therefore, nursing leadership skills will be required. Key leadership strategies will include coordinating Annie’s care to ensure that she gets multidisciplinary and multidimensional care, enabling and promoting self-management at home, ensuring effective teamwork in the interdisciplinary approach, enhancing model- and evidence-driven asthma management through planning and utilization of EBP, and promoting culturally sensitive care. Determinants of Annie’s health problem are more sociocultural and socioeconomic than physical or psychological. Ensuring patient-centered, timely, and safe care through cultural sensitivity and holistic care could be achieved through these strategies.

As part of nursing leadership, care coordination will be integral in meeting the outcomes of these strategies. To successfully coordinate Annie’s care, they will have to deliberately and effectively collect and communicate useful and pertinent information about Annie’s health that will ensure that appropriate human and material resources both clinical and community – are utilized to optimize results. Collaboration with other healthcare professionals, such as physicians and physical therapists, will ensure that Annie receives multidimensional and multidisciplinary care to promote the holistic approach. A review study by Fletcher et al. (2020) found that community resources and community-based care providers play an integral part in asthma management. These resources need to be coordinated to ensure safety and quality and prevent interruptions and lack of direction.

Change management is essential in nursing leadership. Changes in care personnel or treatment regimen are some of the instances where change management will be required during Annie’s management. Change communication and stakeholder engagement are two aspects of change management that will increase adaptation to these changes. Change communication will ensure preparedness and patient safety and stakeholder engagement will ensure that the patient and the care professionals in the multidisciplinary teams are kept abreast of the changes. This step will promote their participation and influence their understanding of the need for change toward a shared vision (Harrison et al., 2021). Model-based change management will promote systematic and seamless change during the care coordination for Annie’s health problem management. Stakeholder engagement and change communication will also promote patient-centered thinking, thus, patient-centered care.

Conclusion

Annie’s chief health problem is severe asthmatic exacerbation. However, she also has childhood obesity and chronic GERD. Literature synthesis showed that this combination is a common health problem in the US currently and forms part of the pathophysiological triangle of inflammation with synergistic risk on the patient health outcomes. Nursing management and leadership will be essential in the management of Annie’s health problem. However, organization-level policies, the state board of nursing standards and regulations, and national policies related to asthma management will determine how the nurse exercises this leadership as the care coordinator and leader. Proposed leadership strategies are multidimensional care, promotion of self-management, model-based change management, and cultural sensitivity. These strategies will enhance patient-centered, timely, and safe care.

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References

Azmeh, R., Greydanus, D. E., Agana, M. G., Dickson, C. A., Patel, D. R., Ischander, M. M., & Lloyd, R. D., Jr. (2020). Update in pediatric asthma: Selected issues. Disease-a-Month: DM, 66(4), 100886. https://doi.org/10.1016/j.disamonth.2019.100886

Church, C. D., Cosme, S. L., & White, M. L. (2022). Discovering your transition to practice. Nursing Made Incredibly Easy! 20(5), 39–42. https://doi.org/10.1097/01.nme.0000853788.27381.54

Fletcher, M. J., Tsiligianni, I., Kocks, J. W. H., Cave, A., Chunhua, C., Sousa, J. C. de, Román-Rodríguez, M., Thomas, M., Kardos, P., Stonham, C., Khoo, E. M., Leather, D., & van der Molen, T. (2020). Improving primary care management of asthma: do we know what really works? NPJ Primary Care Respiratory Medicine, 30(1), 29. https://doi.org/10.1038/s41533-020-0184-0

Gupta, S., Lodha, R., & Kabra, S. K. (2018). Asthma, GERD and obesity: Triangle of inflammation. Indian Journal of Pediatrics, 85(10), 887–892. https://doi.org/10.1007/s12098-017-2484-0

Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where do models for change management, improvement, and implementation meet? A systematic review of the applications of change management models in healthcare. Journal of Healthcare Leadership, 13, 85–108. https://doi.org/10.2147/JHL.S289176

Katwa, U., & Kabra, S. K. (2018). Advances in asthma – III. Indian Journal of Pediatrics, 85(10), 885–886. https://doi.org/10.1007/s12098-018-2784-z

Kiper, V. (2018). Translating leadership into safe nursing practice. Nursing Made Incredibly Easy! 16(3), 48–51. https://doi.org/10.1097/01.nme.0000531874.33036.2a

Lockhart, L. (2020). Nurse practice acts and the provision of safe, competent care. Nursing Made Incredibly Easy! 18(3), 56–56. https://doi.org/10.1097/01.nme.0000658204.89628.2a

Paoletti, G., Melone, G., Ferri, S., Puggioni, F., Baiardini, I., Racca, F., Canonica, G. W., Heffler, E., & Malipiero, G. (2021). Gastroesophageal reflux and asthma: when, how, and why. Current Opinion in Allergy and Clinical Immunology, 21(1), 52–58. https://doi.org/10.1097/ACI.0000000000000705

Ronco, L., Folino, A., Goia, M., Crida, B., Esposito, I., & Bignamini, E. (2022). Do not forget asthma comorbidities in pediatric severe asthma! Frontiers in Pediatrics, 10, 932366. https://doi.org/10.3389/fped.2022.932366

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 Capella Academic Portal 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: As you revise your writing, check out the resources listed on the Writing Center’s Writing Support page.

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 Capella Academic Portal Volunteer Experience Form.

Capella Academic Portal
Complete the NURS-FPX4900 Volunteer Experience Form in Capella Academic Portal. 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.

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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 Capella Academic Portal 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 Capella Academic Portal 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.