NURS FPX 6021 Assessment 2 Change Strategy and Implementation

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Name

Capella University

NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1

Prof. Name

Date

Change Strategy and Implementation

Type II Diabetes Mellitus is a chronic condition marked by insulin resistance and a relative lack of insulin, leading to high blood sugar levels. This disorder is mainly caused by lifestyle factors and genetics. It affects about 34.2 million people, or 10.5% of the U.S. population, with over 463 million adults worldwide living with diabetes, a number expected to reach 700 million by 2045 (Vidal et al., 2022). Acute Renal Failure, also known as acute kidney injury, is a sudden drop in kidney function, causing waste buildup in the blood and electrolyte imbalances.

It can be triggered by severe infections, dehydration, or diabetes complications. It affects an estimated 13.3 million people globally each year, with higher mortality rates in low- and middle-income countries (Tassew et al., 2021). The assessment aims to comprehensively analyze Type II Diabetes Mellitus and Acute Renal Failure, focusing on their prevalence, risk factors, pathophysiology, and impact on public health. The primary objective of this assessment is to evaluate the burden of Type II Diabetes Mellitus and Acute Renal Failure on individual and population health. 

Data Table of Clinical Outcomes 

The following data table reflects the current and desired states of key clinical outcomes for accompanying symptoms of diabetes, along with relevant interventions and outcomes. The table is focused on three primary clinical outcomes: excess fluid volume, ineffective health maintenance, and fatigue. The data in this table contains no personal identifiers that would breach HIPAA regulations. The focus is on clinical outcomes and interventions rather than specific patient identifiers.

Data Table 

The desired states are based on best practices, guidelines, and authoritative sources such as the American Diabetes Association, National Kidney Foundation, and other peer-reviewed studies. The data and outcomes are tailored to acute care and community settings, focusing on managing diabetes and renal failure in these environments. They are appropriate for the change strategy proposed, which involves comprehensive, interprofessional, and patient-centered care plans.

Areas of Ambiguity and Uncertainty

Detailed information on the patient’s comorbid conditions, medication adherence history, and dietary habits would further refine interventions. The availability and accessibility of community resources to support the care plan are not detailed, which could affect the feasibility of some recommendations. Understanding the patient’s psychological state and readiness for lifestyle changes would enhance the effectiveness of the care plan (Salas & Arias, 2023). Further data in these areas would improve the clarity and personalization of the treatment plan for the patient.

Proposed Change Strategies

Several change strategies are proposed for acute care and community settings to achieve desired clinical outcomes in managing diabetes and related conditions. The first strategy involves enhanced patient education and support through comprehensive programs covering disease management, dietary practices, medication adherence, and lifestyle changes (Tam et al., 2020). Personalized care plans and self-monitoring tools will empower patients to manage their conditions effectively.

Interprofessional collaboration involves dietitians, endocrinologists, social workers, nephrologists, and home health nurses to provide cohesive and comprehensive care. Regular interprofessional team meetings and shared electronic health records (EHRs) will facilitate communication and coordination (Robertson et al., 2022). Effective utilization of community resources is critical. Identifying and leveraging local resources, such as support groups and wellness programs, will provide additional patient support. A care coordinator will assist patients in navigating and accessing these resources.

Monitoring and follow-up are essential. Regular follow-up appointments, remote monitoring tools, and telehealth services will track patient progress, provide timely interventions, and offer continuous support, especially for those in community settings (Coffey et al., 2022). Incorporating psychosocial support into the care plan is vital. Psychosocial assessments, counseling services, and support groups will address mental health concerns and enhance the overall effectiveness of the care plan.

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

To ensure the success of these strategies, interventions must be tailored to each patient’s unique conditions, medication adherence history, and dietary habits. Motivational counseling is essential for assessing the availability and accessibility of community resources and evaluating patients’ readiness for lifestyle changes. Potential challenges include resistance to lifestyle changes and limited access to community resources. Addressing these challenges involves motivational interviewing, continuous support, advocating for resource allocation, and establishing stronger community partnerships. Coordination among diverse healthcare professionals will be facilitated through EHRs and regular interprofessional meetings.

The efficiency and effectiveness of the care system can be evaluated by regularly assessing patient outcomes, such as fluid volume status, blood glucose levels, fatigue levels, and nutritional status. Patient satisfaction surveys and interviews and monitoring healthcare utilization rates will help gauge the impact of interventions. Continuous improvement will be driven using data from these evaluations to refine and enhance care strategies (Sugandh et al., 2023). Implementing these change strategies aims to achieve desired clinical outcomes for patients with diabetes and related conditions, ultimately improving their overall health and quality of life through comprehensive, interprofessional, patient-centered care.

Justification of the Proposed Change Strategies

The proposed change strategies are relevant and appropriate for achieving desired clinical outcomes in diabetes management. Enhanced patient education and support empower patients by improving their knowledge and self-management skills, as supported by guidelines from the American Diabetes Association, which emphasizes comprehensive patient education for effective diabetes management (ADA, 2023). Interprofessional collaboration ensures cohesive care, leveraging the expertise of various healthcare professionals, as recommended by the National Institute for Health and Care Excellence (NICE) guidelines that highlight the importance of coordinated care in chronic disease management (Ju, 2022). Utilizing community resources provides additional support, aligning with best practices that recognize the role of community-based interventions in improving health outcomes. Regular monitoring and follow-up enable timely adjustments to care plans. Incorporating psychosocial support addresses mental health barriers to adherence, as outlined in research emphasizing the impact of psychological well-being on chronic disease management. These strategies address the multifaceted needs of patients, ultimately improving their health and quality of life.

Quality Improvement

The proposed change strategies are designed to improve safety and equitable care in diabetes management. Enhanced patient education improves safety by empowering patients with the knowledge to manage their condition, reducing the risk of complications. Interprofessional collaboration ensures comprehensive care, leveraging diverse expertise for more accurate diagnoses and safer, more effective treatments (Bhattad & Pacifico, 2022). Utilizing community resources and establishing care coordination promotes equitable access to care, addressing social determinants of health. Regular monitoring ensures early detection and intervention, enhancing patient safety. Psychosocial support addresses mental health barriers, promoting adherence and equitable care (Upadhaya et al., 2020). These strategies are supported by guidelines from the American Diabetes Association, the National Institute for Health and Care Excellence (NICE), and evidence from peer-reviewed studies, ensuring they are evidence-based and effective. Additionally, these strategies align with the Quadruple Aim by improving patient outcomes, enhancing patient experiences, reducing healthcare costs, and supporting healthcare provider well-being through coordinated and comprehensive care.

Utilizing  Interprofessional Considerations Ensuring Successful Implementation

Interprofessional collaboration is crucial for the successful implementation of change strategies in diabetes management. Strategies such as enhanced patient education, support, regular monitoring, and follow-up best leverage interprofessional considerations (Nurchis et al., 2022). These strategies ensure successful implementation by involving a team of dietitians, endocrinologists, social workers, nephrologists, and home health nurses, facilitating cohesive and comprehensive care. Regular interprofessional team meetings and shared electronic health records (EHRs) will enhance communication and coordination among healthcare providers. This collaboration not only ensures accurate and effective treatment plans but also supports the well-being of healthcare professionals by fostering a team-based approach, reducing individual workload, and enhancing job satisfaction. The strategies are supported by guidelines from the American Diabetes Association and the National Institute for Health and Care Excellence (NICE) (Forsyth et al., 2021). These guidelines promote patient safety and equitable care by addressing all patient needs comprehensively and collaboratively.

Conclusion

Diabetes-related renal disease significantly impacts global public health. The proposed change strategies focus on enhancing patient education, promoting interprofessional collaboration, utilizing community resources, and incorporating psychosocial support to improve clinical outcomes and quality of life for patients. By aligning with evidence-based practices and guidelines, these strategies aim to address the complex needs of patients with chronic conditions, ultimately mitigating complications and improving overall healthcare delivery.

References

ADA. (2023). Navigating nutrition | ADA. Diabetes.org. https://diabetes.org/food-nutrition 

Bhattad, P. B., & Pacifico, L. (2022). Empowering patients: Promoting patient education and health literacy. Cureus, 14(7). https://doi.org/10.7759/cureus.27336 

Coffey, J. D., Christopherson, L. A., Williams, R. D., Gathje, S. R., Bell, S. J., Pahl, D. F., Manka, L., Blegen, R. N., Maniaci, M. J., Ommen, S. R., & Haddad, T. C. (2022). Development and implementation of a nurse-based remote patient monitoring program for ambulatory disease management. Frontiers in Digital Health, 4(2). https://doi.org/10.3389/fdgth.2022.1052408 

Forsyth, J. R., Chase, H., Roberts, N. W., Armitage, L. C., & Farmer, A. J. (2021). Application of the National Institute for Health and Care Excellence Evidence Standards Framework for digital health technologies in assessing mobile-delivered technologies for the self-management of type 2 diabetes mellitus: A scoping review. JMIR Diabetes, 6(1), e23687. https://doi.org/10.2196/23687 

Ju, H.-H. (2022). Improving care coordination of patients with chronic diseases. The Journal for Nurse Practitioners, 18(8). https://doi.org/10.1016/j.nurpra.2022.06.011 

NKF. (2023, September 12). Social determinants of health and chronic kidney disease. National Kidney Foundation. https://www.kidney.org/atoz/content/social-determinants-health-and-chronic-kidney-disease 

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Nurchis, M. C., Sessa, G., Pascucci, D., Sassano, M., Lombi, L., & Damiani, G. (2022). Interprofessional collaboration and diabetes management in primary care: A systematic review and meta-analysis of patient-reported outcomes. Journal of Personalized Medicine, 12(4). https://doi.org/10.3390/jpm12040643 

Robertson, S. T., Rosbergen, I. C. M., Jones, A. B., Grimley, R. S., & Brauer, S. G. (2022). The effect of the electronic health record on interprofessional practice: A systematic review. Applied Clinical Informatics, 13(03), 541–559. https://doi.org/10.1055/s-0042-1748855 

Salas, S. E., & Arias, M. G. (2023). Behavior modification for lifestyle improvement. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK592418/ 

Sugandh, F. N. U., Chandio, M., Raveena, F. N. U., Kumar, L., Karishma, F. N. U., Khuwaja, S., Memon, U. A., Bai, K., Kashif, M., Varrassi, G., Khatri, M., Kumar, S., Sugandh, F., Chandio, M., Raveena, F. N. U., Kumar, L., Karishma, F. N. U., Khuwaja, S., Memon, U. A., & Bai, K. (2023). Advances in the management of diabetes mellitus: A focus on personalized medicine. Cureus, 15(8), 1–13. https://doi.org/10.7759/cureus.43697 

Tam, H. L., Wong, E. M. L., & Cheung, K. (2020). Effectiveness of educational interventions on adherence to lifestyle modifications among hypertensive patients: An integrative review. International Journal of Environmental Research and Public Health, 17(7). https://doi.org/10.3390/ijerph17072513 

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Tassew, W. C., Birhan, N., & Zewdu, Y. (2021). Incidence and predictors of acute kidney injury among newly diagnosed type 2 diabetes patients at chronic follow-up clinic of the University of Gondar comprehensive specialized hospital: A retrospective follow-up study. Research and Reports in Urology, Volume 13, 613–622. https://doi.org/10.2147/rru.s306467 

Upadhaya, N., Regmi, U., Gurung, D., Luitel, N. P., Petersen, I., Jordans, M. J. D., & Komproe, I. H. (2020). Mental health and psychosocial support services in primary health care in Nepal: Perceived facilitating factors, barriers, and strategies for improvement. BioMed Central Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-2476-x 

Vidal, T. M., Williams, C. A., Ramoutar, U. D., & Haffizulla, F. (2022). Type 2 diabetes mellitus in Latinx populations in the United States: A culturally relevant literature review. Cureus, 14(3). https://doi.org/10.7759/cureus.23173