Capella 4900 Assessment 1

Capella 4900 Assessment 1 Assessing the Problem Leadership Collaboration Communication Change Management and Policy Considerations

Name

Capella University

NURS-FPX 4900 Capstone project for Nursing

Prof. Name

Date

Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations

Hypertension (HTN), or high blood pressure, is a medical condition where the pressure of blood against artery walls is constantly higher than the normal range (Iqbal & Jamal, 2023). HTN can lead to several serious health issues like cardiovascular disease, stroke, and kidney problems. In my capstone project, I aim to focus on hypertension as a patient health problem. This part of the project covers the concepts of leadership, collaboration, communication, change management, and healthcare policies in addressing patient care problems and leading to improved outcomes. 

Defining Problem, Presence, and Relevance to Professional Practice

This capstone project focuses on Claudia Lara, my daughter, who is a 38-year-old female who has been diagnosed with hypertension for several years. Recently, Claudia had to rush to the hospital due to hypertensive urgency, where her blood pressure raised to 160/90mmHg and couldn’t be managed at home. During hospital examination, several contributing factors were recognized that led to this medical emergency. Claudia has poor medication adherence. She has recently lost her job, leading to financial constraints often preventing her from purchasing prescribed medications regularly. Additionally, her family expressed that she has poor dietary habits and leads a sedentary lifestyle due to no work. Hence, her blood pressure aggravates, leading to ineffective management of her health condition. 

Presence and Relevance of the Problem 

Approximately 30.7% of U.S adults are suffering from high blood pressure, out of which half of them have uncontrolled HTN due to several factors (He et al., 2023). Behavioral risks, such as poor lifestyle and medication non-compliance, are significant consequences of disease aggravation. According to the American Heart Association (AHA), the yearly national costs for hypertension amount to $47.3 billion in direct expenses and $3.9 billion in indirect costs (Park et al., 2020). These statistics substantiate the presence of ineffective management of HTN, acknowledging the need for comprehensive care. 

HTN and its associated factors are highly relevant to nursing practice due to the critical role nurses play in managing chronic diseases. It is pertinent to my practice because, as a nurse, I play a crucial role in identifying and addressing barriers to the effective management of chronic conditions. This project is vital for my understanding of these challenges to develop personalized patient care plans, provide education on affordable medication options, and offer strategies for healthier living (Gedam et al., 2022). Moreover, as a nurse, I can advocate for other patients by connecting them with community resources or support programs to improve health outcomes, emphasizing the holistic care approach central to the profession.

Evidence-Based Nursing Actions from Literature

Several peer-reviewed literature and nursing resources guide nurses’ actions in managing HTN, particularly in Claudia’s case. These actions include patient education and lifestyle modification, support for medication adherence, and referral to community resources. Gedam et al. (2022) emphasize the importance of nurse-led patient education related to disease management and lifestyle modification in improving patient knowledge and health outcomes in hypertensive clients. For Claudia, tailored advice on reducing sodium intake, incorporating physical activity into her daily routine, and stress reduction techniques can significantly improve her condition, leading to better blood pressure control and reduced risk of complications.

Another nursing action highlighted by the literature is the promotion of medication adherence through interventions like medication reminders, advice and education, and simplifying drug regimens (Dijkstra et al., 2021). For Claudia, nurses can set regular reminder systems, ensuring she takes her medications consistently. Moreover, for cost-effectiveness, nurses can identify affordable medication options, such as generic drugs or cost assistance programs. Finally, nurses can connect patients to community resources and support systems to alleviate some barriers to effective disease management (Novilla et al., 2023). In Claudia’s case, referrals to local food banks, employment services, and exercise programs can mitigate the impact of financial constraints and a sedentary lifestyle. 

Credibility of Resources 

The CRAAP test, encompassing Currency, Relevance, Authority, Accuracy, and Purpose, evaluates source quality and reliability. It ensures information timeliness (Currency), relevance to the topic (Relevance), credibility of authors and journals (Authority), truthfulness and absence of bias (Accuracy), and the intentions behind information creation (Purpose) (Lowe et al., 2021). Applying this test, I ensured that the evidence used in hypertension management is current, trustworthy, accurate, and aligned with healthcare best practices, promoting effective clinical decisions and enhancing patient outcomes. This systematic approach guides the selection of reliable sources, supporting informed healthcare practices for Claudia. 

Barriers to EBP and Theoretical Guiding Framework 

Nevertheless, several hindrances influence the application of evidence-based practices (EBP). These include time constraints, lack of resources, resistance to change, and inadequate knowledge and skills in critically appraising and applying research findings (Pitsillidou et al., 2021). These barriers can hinder nurses from integrating the best available evidence into their clinical decision-making processes, potentially compromising patient care outcomes. A theoretical framework that guides nurses in mitigating these barriers and implementing EBP is the Promoting Action on Research Implementation in Health Services (PARIHS) framework.

PARIHS emphasizes three critical aspects – the nature of evidence, which assesses the quality, applicability, and accessibility of resources; the context in which the evidence is to be implemented, such as organizational culture, leadership commitment, and availability of resources, and facilitation, which includes the process of enabling change and overcoming barriers (Bergström et al., 2020). By using this framework, nurses can thoroughly assess the relevance of evidence and evaluate organizational readiness and support for change. Finally, by completing an evaluation, they develop effective strategies to mitigate barriers and integrate evidence-based interventions into patient care. 

State Board Nursing Practice Standards and Policies 

Practice standards from nursing boards, organizational protocols, and governmental healthcare policies shape the management and care for HTN patients like Claudia. The American Nurses Association (ANA) practice standards for chronic disease management emphasize comprehensive patient care, patient education, and advocacy, directly impacting disease management (ANA, 2020). Following these standards, nurses can provide hypertension management for Claudia by focusing on patient education related to medication adherence, lifestyle modifications, and stress management. Nurses are also expected to advocate for resources to mitigate financial barriers affecting Claudia’s access to medication and healthy food. 

Additionally, the American Heart Association (AHA) and the American Medical Association (AMA) provide guidelines to improve cardiovascular health. The practice guidelines help in managing hypertension and improving patient outcomes by maintaining optimal blood pressure and reducing hospital readmission rates (Abdalla et al., 2023). For Claudia, nurses should adhere to these organizational guidelines, ensuring the patient receives evidence-based care, limit variability, and enhance patient outcomes. 

Capella 4900 Assessment 1

Finally, the Affordable Care Act (ACA), as a governmental policy, expands access and affordability to preventive services and chronic disease management, directly affecting care for cardiovascular diseases and hypertension (Jiang et al., 2023). For Claudia, the ACA facilitates access to affordable healthcare services, including routine check-ups and medication. By reducing financial barriers, the ACA ensures Claudia can maintain regular contact with healthcare providers, enhancing adherence to hypertension management plans.

These policies impact the nursing scope of practices, nurses’ ability to perform more comprehensive assessments, patient education, and chronic disease management for Claudia. This expansion enables nurses to take a more proactive role in hypertension management, promoting early intervention and ongoing support for patients like Claudia. Thus, empowering nurses to take more responsibilities, improve patient outcomes, and provide holistic, patient-centered care. The literature emphasizes the role of nurses in policy-making to improve health outcomes. Nurses advocate for patient-centered policies and encourage the development of health policies grounded in evidence-based practices (Pitsillidou et al., 2021). Their involvement in policy-making helps bridge the gap between clinical practice, research, and legislature, ensuring that healthcare systems provide holistic care to patient needs, leading to improved health outcomes, prevention of illness, and reduced hospital readmissions. 

Leadership, Collaboration, Communication, and Change Management

Critical aspects that influence Claudia’s care include the role of leadership, effective communication, interprofessional collaboration, and evolution. Leadership plays a pivotal role in addressing Claudia’s hypertension by fostering a culture of patient-centered care and continuous improvement. Regardless, they are essential in advocating for necessary resources to implement interventions seamlessly (Rousseau & Ten Have, 2023). They are also critical for promoting a collaborative environment and leveraging evidence-based practices. Leaders in Claudia’s case, can employ two significant strategies – transformational leadership and collaborative models. 

Transformational leadership, in Claudia’s case, involves inspiring and empowering her to innovate and manage her health conditions on her own. A leader could foster a culture where nurses are motivated to engage patients in shared decision-making about the treatment plan, promoting patient’s active involvement (Bahlman‐van Ooijen et al., 2022). By supporting continuous education on the updated hypertension management techniques and empowering nurses to advocate for Claudia’s comprehensive care needs, transformational leadership drives improved patient outcomes and enhances the patient experience. Simultaneously, leaders can implement novel care models, such as collaborative care teams where interprofessional team members work closely to address their holistic health needs (Bahlman‐van Ooijen et al., 2022). This approach ensures comprehensive support and coordination across different aspects of Claudia’s care, from medication management to lifestyle modifications and social support.

Collaboration and Communication 

Effective collaboration and communication are crucial in addressing Claudia’s hypertension problem. By fostering interdisciplinary collaboration through regular team meetings involving nurses, physicians, pharmacists, and social workers, the leaders can ensure that all aspects of Claudia’s care are discussed comprehensively, allowing for coordinated interventions and timely adjustments to her treatment plan. Similarly, clear communication channels must be established to prioritize patient-centered care by involving Claudia in care planning discussions. This shared decision-making approach empowers the patient to voice their preferences, concerns, and challenges, fostering a collaborative partnership in managing health conditions effectively (Bahlman‐van Ooijen et al., 2022). Regular check-ins through phone calls and personalized communication methods can further strengthen the patient-provider relationship and support Claudia’s ongoing adherence to treatment goals.

Change Management 

Change management strategies must focus on implementing evidence-based practices and adapting care delivery to meet patients’ evolving needs (Pitsillidou et al., 2021). Implementing evidence-based guidelines and personalized care plans tailored to Claudia’s needs will be essential. Nurse leaders should facilitate continuous training on hypertension management and foster a culture that values patient-centered care. Addressing barriers such as financial constraints and promoting lifestyle modifications through community partnerships will also be critical. Finally, ongoing monitoring and feedback loops will ensure the care plan remains responsive to Claudia’s health needs, driving sustainable improvements in her hypertension management and overall well-being (Rousseau & Ten Have, 2023). 

Conclusion 

In conclusion, I spent two practicum hours with Claudia and her family to understand the patient’s condition, directives, and needs, which need to be addressed through this capstone project. This part of the capstone project concludes that Claudia is facing difficulties managing her hypertension due to financial constraints and poor lifestyle habits. Thus, several evidence-based nursing actions are pivotal in improving her outcomes. Along with these, adherence to nursing board standards and policies is crucial. These standards and policies guide Claudia’s nursing scope of practice, playing an essential role in enhancing patient outcomes. Effective leadership, coordination, change management, and communication are imperative to deliver comprehensive care to Claudia’s needs, ensuring sustained progress in her hypertension management and overall health.

References

Abdalla, M., Bolen, S., Brettler, J. W., Egan, B. M., Ferdinand, K. C., Ford, C. D., Lackland, D. T., Wall, H. K., & Daichi Shimbo. (2023). Implementation strategies to improve blood pressure control in the United States: A scientific statement from the American Heart Association and American Medical Association. Hypertension, 80(10). https://doi.org/10.1161/hyp.0000000000000232 

ANA. (2020). Nursing scope of practice. American Nurses Association; nursingworld.org. https://www.nursingworld.org/practice-policy/scope-of-practice/

Bahlman‐van Ooijen, W., van Belle, E., Bank, A., de Man‐Van Ginkel, J., Huisman‐de Waal, G., & Heinen, M. (2022). Nursing leadership to facilitate patient participation in fundamental care: An ethnographic qualitative study. Journal of Advanced Nursing, 79(3). https://doi.org/10.1111/jan.15329 

Bergström, A., Ehrenberg, A., Eldh, A. C., Graham, I. D., Gustafsson, K., Harvey, G., Hunter, S., Kitson, A., Rycroft-Malone, J., & Wallin, L. (2020). The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature. Implementation Science, 15(1). https://doi.org/10.1186/s13012-020-01003-0 

Capella 4900 Assessment 1

Dijkstra, N. E., Vervloet, M., Sino, C. G. M., Heerdink, E. R., Nelissen-Vrancken, M., Bleijenberg, N., Bruin, M. de, & Schoonhoven, L. (2021). Home care patients’ experiences with home care nurses’ support in medication adherence. Patient Preference and Adherence, 15, 1929–1940. https://doi.org/10.2147/PPA.S302818 

Gedam, R., Sawant, S., & Gholap, G. (2022). Effect of nurse-led educational program on knowledge of lifestyle modification among patients with hypertension in selected hospital. International Journal of Nursing Research, 08(04), 42–46. https://doi.org/10.31690/ijnmi.2022.v07i04.001 

He, S., Park, S., Fujii, Y., Lange, S. J., Kraus, E. M., Wall, H. K., Therrien, N., & Jackson, S. (2023). State-Level hypertension prevalence and control among adults in the U.S. American Journal of Preventive Medicine, 66(1), 46–54. https://doi.org/10.1016/j.amepre.2023.09.010 

Iqbal, A. M., & Jamal, S. F. (2023, July 20). Essential hypertension. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539859/

Jiang, G. Y., Urwin, J. W., & Wasfy, J. H. (2023). Medicaid expansion under the Affordable Care Act and association with cardiac care: A systematic review. Circulation: Cardiovascular Quality and Outcomes, 16(6). https://doi.org/10.1161/circoutcomes.122.009753 

Lowe, M. S., Macy, K. V., Murphy, E., & Kani, J. (2021). Questioning CRAAP. Journal of the Scholarship of Teaching and Learning, 21(3). https://doi.org/10.14434/josotl.v21i3.30744 

Capella 4900 Assessment 1

Novilla, M. L. B., Goates, M. C., Leffler, T., Novilla, N. K. B., Wu, C. Y., Dall, A., & Hansen, C. (2023). Integrating social care into healthcare: A review on applying the social determinants of health in clinical settings. International Journal of Environmental Research and Public Health, 20(19), 6873. https://doi.org/10.3390%2Fijerph20196873 

Park, C., Wang, G., Ng, B. P., Fang, J., Durthaler, J. M., & Ayala, C. (2020). The uses and expenses of antihypertensive medications among hypertensive adults. Research in Social and Administrative Pharmacy, 16(2), 183–189. https://doi.org/10.1016/j.sapharm.2019.05.002

Pitsillidou, M., Roupa, Z., Farmakas, A., & Noula, M. (2021). Factors affecting the application and implementation of evidence-based practice in nursing. Acta Informatica Medica, 29(4), 281. https://doi.org/10.5455/aim.2021.29.281-287

Rousseau, D. M., & Ten Have, S. (2022). Evidence-based change management. Organizational Dynamics, 51(3), 100899. https://doi.org/10.1016/j.orgdyn.2022.100899