Category: NURS-FPX6021

NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster Name Capella university NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1 Prof. Name Date Abstract  This quality improvement initiative, rooted in the Plan-Do-Check-Act (PDCA) cycle, addresses the intricate biopsychosocial complexities surrounding diabetes and renal failure management, with Mrs. Smith’s case as a focal point. The project aims to optimize patient outcomes through a collaborative approach involving Continuous Glucose Monitoring (CGM) implementation, comprehensive education, and financial aid strategies. By integrating interprofessional teamwork, encompassing endocrinologists, nurses, dietitians, and social workers, the effectiveness and efficiency of the intervention are bolstered. The project anticipates benefits such as enhanced patient well-being, improved care quality, and streamlined healthcare processes, contributing to broader population health advancements. This initiative aims to drive sustained improvements in patient care and overall healthcare delivery through continuous assessment and adaptation. Quality Improvement Methods To promote continuous improvement in managing diabetes and renal failure, particularly for patients like Mrs. Smith, we propose utilizing the PDCA cycle. This method involves four key steps: planning the intervention, implementing the plan, checking the results, and acting on what is learned to refine the process. In Mrs. Smith’s case, PDCA can be applied to monitor and adjust her blood glucose levels and renal function. For instance, the initial plan may involve introducing CGM and diuretics (Yi et al., 2023). The “do” phase would implement these interventions, while the “check” phase involves regular monitoring of blood glucose and renal function tests. The “act” phase would use the gathered data to tweak the intervention, ensuring continuous improvement. This cyclical approach ensures that adjustments can be made based on real-time data, thereby addressing her care’s physiological (biological) and behavioral (psychosocial) aspects. The PDCA cycle promotes continuous improvement by providing a structured yet flexible framework that can be repeatedly refined (Yi et al., 2023). Limitations of PDCA Despite its strengths, the PDCA cycle presents several challenges. One significant limitation is the potential for resistance to change, particularly from patients who may find new technologies like CGM intimidating or cumbersome. To mitigate this, comprehensive education and support systems need to be established. Patients should be thoroughly educated about the benefits and use of CGM, and support from healthcare professionals should be readily available to address any concerns (Sugandh et al., 2023). Additionally, financial barriers may hinder the consistent implementation of interventions, especially for patients like Mrs. Smith, who face economic constraints. Connecting patients to financial assistance programs can help overcome this barrier (Du et al., 2022). Furthermore, adapting the PDCA cycle to manage biopsychosocial considerations requires a multidisciplinary approach, integrating input from endocrinologists, nephrologists, dietitians, and social workers to comprehensively address all aspects of the patient’s condition. This collaboration ensures that interventions are holistic and patient-centered. By anticipating these challenges and proactively developing strategies to address them, the PDCA cycle can effectively facilitate continuous quality improvement in managing complex conditions like diabetes and renal failure (Du et al., 2022). Evidence-Supported QI Methods Evidence supports the effectiveness of the PDCA cycle in managing diabetes and renal failure in patients like Mrs. Smith. CGM has been shown to significantly improve glycemic control by providing real-time feedback, enabling timely interventions and adjustments to insulin therapy (Martens et al., 2021). Studies demonstrate that CGM users experience fewer episodes of hypoglycemia and better overall glucose management, which directly supports the “check” and “act” phases of the PDCA cycle. Furthermore, the use of diuretics to manage renal function is backed by guidelines from the American Diabetes Association (ADA), which recommends diuretics for patients with edema and early-stage renal damage to prevent further deterioration (Afify et al., 2023). This evidence reinforces the planning and implementation stages of the PDCA cycle, ensuring that the interventions are both evidence-based and practical. The most valuable evidence for our project includes the ADA guidelines and the research by Martens et al. (2021), as these sources provide robust data supporting the integration of CGM and diuretics into the care plan. This evidence informs the specific QI approach by validating the chosen interventions and ensuring they are aligned with best practices for managing diabetes and renal failure, thereby enhancing patient outcomes like Mrs. Smith’s. Identify Knowledge Gap  While evidence supports the effectiveness of CGM and diuretics, there may be gaps in understanding how these interventions translate into long-term outcomes for patients like Mrs. Smith. Additionally, the optimal frequency and duration of CGM usage in managing blood glucose levels still need to be clarified in specific contexts. Further research could explore the impact of socioeconomic factors on medication adherence and its interaction with financial assistance programs in improving health outcomes for diabetic patients (Kvarnström et al., 2021).  Change Strategy Foundation  The project is anchored in successful change strategies such as CGM, financial assistance for medication adherence, diuretics, and comprehensive education (Kvarnström et al., 2021). These strategies are informed by evidence-based practices and guidelines from reputable sources like the ADA and NANDA (ADA, 2022; NANDA, 2020). Successful implementation of CGM and medication assistance programs has been demonstrated in similar QI projects, showcasing their effectiveness in improving patient outcomes. For instance, CGM helps maintain blood glucose levels within the target range, reducing spikes from 200-350 mg/dL to 80-130 mg/dL fasting and less than 180 mg/dL postprandial (Lin et al., 2021). These strategies are relevant and appropriate for this QI project as they address specific clinical needs such as controlling blood glucose levels, managing renal function, and ensuring medication adherence in patients like Mrs. Smith, ensuring a comprehensive and evidence-based approach to quality improvement (Lin et al., 2021). Potential Challenges and Solutions  Implementing CGM and financial assistance programs faces challenges such as initial costs and patient acceptance. To address this, patients and healthcare providers will receive comprehensive training sessions and ongoing support. Collaborating with financial aid organizations and community organizations can help mitigate financial barriers. Resistance to change and adherence issues arise, requiring tailored educational interventions and close monitoring of patient progress. Regular feedback and quality improvement assessments will help identify and address emerging challenges throughout the implementation process

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 Patients with kidney failure often experience re-hospitalizations. These readmissions significantly affect their quality of life and well-being. The stress from dealing with multiple illnesses and undergoing complex treatments during these frequent hospital stays is a significant concern for their overall health. In this proposal, I suggest implementing a change strategy at Antelope Valley Hospital, where I currently work, to address traumatic stress in kidney failure patients. The plan includes analyzing current and desired outcomes through a data table and outlining strategies for improving the quality of care and patient outcomes. Data Table of Clinical Outcomes  Clinical Outcomes Current State Desired State Mortality Rate Currently, the hospital data shows that 30% of patients have died within 3-6 months of discharge due to complicated states and recurrent hospital stays.  The desired state is to decrease the mortality rate to 15%. According to Wu et al. (2023), early identification of complications and comprehensive discharge care can reduce mortality rates.  Mental Illnesses At present, 55% of patients with kidney failure are displaying signs of traumatic stress, anxiety, and depression as a result of repeated hospitalizations. These symptoms are adversely affecting their healing process and overall well-being. The desired goal is to decrease this ratio to 30% through mental health support programs and trauma-informed care (Shouket, 2024) Medication Compliance About 90% of patients are encountering medication non-compliance. Improve medication compliance rate to 80%. Dijkstra et al. (2021), elaborate that patient education, complete supervision from care providers, and medication scheduling can result in improved adherence among kidney failure patients.  Quality of Life Approximately 45% of patients have decreased quality of life due to stress and recurrent hospital stays.  Our goal is to improve the quality of life for kidney disease patients and only 5% of cases remain. To achieve this, we intend to create a supportive atmosphere, encourage social interactions, and cater to patients’ psychosocial requirements (Arms & McCumber, 2023). NURS FPX 6021 Assessment 2 Change Strategy and Implementation The data is sourced from Antelope Valley Hospital’s Health Management Information Systems (HIMS). We ensured the data collection and reporting complied with the Health Insurance Portability and Accountability Act (HIPAA). Theodos and Sittig (2020) mention that this act focuses on protecting patients’ medical information. The data’s uncertainties and ambiguities necessitate acquiring additional information for clarity. The additional information should be related to factors such as patient’s socioeconomic status and social support networks, which influence their health outcomes. Furthermore, comparing the experiences of kidney failure patients with those without kidney diseases but facing similar levels of hospitalization-related stress could shed light on the unique challenges faced by the our concerned population.  Change Strategies for Clinical Outcomes Focusing on mental health concerns and enhancing medication adherence are crucial clinical goals for kidney failure patients at Antelope Valley Hospital. As such, our objective is to reach these desired outcomes by implementing a psychological support program and initiatives to improve medication adherence. Comprehensive Psychological Support Programs The initiative will integrate a mental health team into patient care, offering psychological support. Key components will be educational programs, peer support networks, and counseling sessions. According to Shouket (2024), these efforts aim to alleviate chronic illnesses’ psychological and emotional burdens, ultimately enhancing patients’ quality of life. Critical factors for effectively executing this strategy at Antelope Valley Hospital include adequate training and education for healthcare professionals, pooling mental health resources within the community, and developing clear protocols for information sharing within the interdisciplinary team. However, the team should consider the challenges of staff resistance due to workload, resource constraints for hiring teams and expanding support programs, and stigmatization associated with mental health support-seeking behaviors. Comprehensive training programs highlighting the benefits of integrating mental health care will overcome staff resistance. Moreover, planned resource allocation and budgeting are imperative to avoid intentional resource constraint issues. Finally, awareness and educational campaigns will help destigmatize mental help-seeking behaviors (Muhorakeye & Biracyaza, 2021).  Medication Adherence Initiatives To implement these initiatives, a team of pharmacists, nurses, and physicians would collaborate to optimize medication regimens. Their purpose would be to provide medication-related instructions, simplify medication schedules, and address barriers to medication adherence (Dijkstra et al., 2021). This strategy not only helps in improving medication adherence but also reduces patients’ anxiety and stress associated with managing complex medication regimens. Initiatives include a standardized medication reconciliation process, electronic medication reminders and pill organizers to support patients, and culturally sensitive medication utilization and management education. The team would phase challenges such as lack of coordination among patients and providers and financial barriers among the patient population. To bridge coordination gaps, we will develop effective communication channels within the team and with patients. Moreover, collaboration with private and public insurers will help address cost barriers for needy patients.  Change Strategies Justification  Evidence from the literature supports the integration of psychological interventions for chronic disease patients. Studies have demonstrated that mental health interventions such as psychoeducation and peer-support programs lead to better patient emotional and psychological outcomes, reducing symptoms’ severity and improving satisfaction (Longley et al., 2023; Shouket, 2024). These strategies enhance patients’ recovery and improve their well-being during treatment and multiple hospital admissions. However, conflicting perspective in the literature describes the stigma interlinked with mental health services, which prevents patients from actively participating in these initiatives (Muhorakeye & Biracyaza, 2021). Such a perspective highlights the importance of community-based awareness programs for early identification and treatment to augment patients’ psychological well-being.  Additionally, medication adherence initiatives such as patient education, electronic reminders and pill organizers, and medication reconciliation processes are supported by literature as best strategies to improve medication compliance. Taibanguay et al. (2019) emphasize the impact of comprehensive education about medication utilization and management, allowing patients to understand the importance, eventually increasing their medication compliance. Similarly, reminders and pill organizers are effective for patients with complex medication therapies and chronic conditions requiring long-term management through medications (Dijkstra et

NURS FPX 6021 Assessment 1 Concept Map Name Capella university NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1 Prof. Name Date Intensive Care Unit  St. Anthony Medical Center Home Health Agency  Narrative This narrative explains the concept maps developed for a patient, Mrs. Smith, in two different healthcare settings, the Intensive Care Unit (ICU) and St. Anthony Medical Center Home Health Agency. In this narrative, we cover the additional evidence that provides linkages between the concept maps for a comprehensive understanding of each concept map and its significance in nursing care. Moreover, we discuss the value and relevance of the evidence used to create these concept maps. Lastly, we detail how interprofessional collaboration is imperative to achieve desired outcomes for the patient in all healthcare settings.  Additional Evidence  First Concept Map An ICU nurse receives a 52-year-old female patient with a history of Type II Diabetes Mellitus. She is currently presenting complaints of increased fasting glucose levels, peripheral edema, blurred vision, tiredness and weakness, decreased urine output, shortness of breath, and nausea. Physicians have diagnosed her with Acute Renal Failure (ARF) and high blood glucose levels. The concept map covers three primary nursing diagnoses for this patient – altered nutrition: less than body requirements, impaired gas exchange, and excess fluid volume.  Second Concept Map  The patient is now discharged from the ICU and transitions to the Home Care Agency, where a nurse receives her with a recent history of hospitalization for ARF and high blood glucose levels. While the patient reported an improved fasting glucose level, increased urinary output, decreased peripheral edema, and enhanced well-being, she identified concerns such as reduced family interaction and limited cooking abilities. Based on the patient’s subjective data, we have developed nursing diagnoses on the risk of social isolation, risk of medication noncompliance, and risk of malnutrition.  Relevance and Value of Evidence The sources of evidence employed in making the concept map are relevant and provide valuable insights related to ARF and its complications.  The article by Ramakrishnan and Shankar (2020) offers valuable insights into the nutritional support strategies for patients with AKI in critical care settings. This applies to our scenario as Mrs. Smith was admitted to the ICU. It offers evidence-based recommendations to support healthcare providers in delivering appropriate nutritional support and improving patients’ quality of care. Koratala et al. (2022) provide information about fluid overload leading to pulmonary edema. Since Mrs. Smith is suffering fluid overload, this resource helps diagnose pulmonary edema as a common complication. Understanding diagnostic approaches outlined in the article can assist in timely and appropriate assessment to improve Mrs. Smith’s outcomes.  Another study that explores factors contributing to respiratory distress in ARF patients is essential to identify and manage her conditions, such as shortness of breath during her hospitalization (Panitchote et al., 2019).  Chadwick (2022) study highlights the importance of leg elevation in managing peripheral edema, a symptom presented by Mrs. Smith. The study explains that leg elevation can help reduce swelling by improving circulation and easing discomfort. Thus, this study is valuable and relevant to provide strategies for symptomatic management.  NURS FPX 6021 Assessment 1 Concept Map Patil and Salunke (2020) explain the relationship between fluid overload and ARF.  For Mrs. Smith, who is diagnosed with ARF and is presenting signs of fluid overload, this article provides essential information on the nursing assessment and management strategies for her condition. This information is valuable for effective patient care and effective treatment plans.  The article by Arms and McCumber (2023) is valuable as it provides information on assessing and managing social isolation. This issue is relevant in Mrs. Smith’s case as she is experiencing limited social support. The articles offer direction for home health nurses to intervene effectively in the risks of social isolation, enhancing patients’ overall well-being.  Dijkstra et al. (2021) are valuable resources for healthcare professionals to support patients with medication non-compliance. Understanding these concepts helps the home health agency support Mrs. Smith with managing medication regimens effectively.  Interprofessional Strategies  Interprofessional interventions in our concept maps will provide more comprehensive care and improve patient outcomes (McLaney et al., 2022). For example, nurses collaborating with physicians for medication management, dietitians for nutritional plans, physical therapists for chest physiotherapy and activities, and community workers to leverage community resources in patient care ensures a holistic approach to addressing Mrs. Smith’s needs and preferences for managing ARF and diabetes. However, several knowledge gaps and uncertain areas exist, such as the effectiveness of these strategies and the impact of patient’s socioeconomic factors. Moreover, effective coordination and communication among the team members remains a significant uncertain area, which can lead to poor execution of these strategies, eventually impacting patient outcomes.  References  Arms, T., & McCumber, S. (2023). Social isolation: Levels of response for nurse practitioners. The Journal for Nurse Practitioners, 19(1), 104391. https://doi.org/10.1016/j.nurpra.2022.06.016  Chadwick, S. E. (2022). The use of leg elevation in the treatment of chronic peripheral oedema. British Journal of Community Nursing, 27(Sup10), S28–S32. https://doi.org/10.12968/bjcn.2022.27.Sup10.S28  Dijkstra, N. E., Vervloet, M., Sino, C. G. M., Heerdink, E. R., Nelissen-Vrancken, M., Bleijenberg, N., De Bruin, M., & 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  NURS FPX 6021 Assessment 1 Concept Map Koratala, A., Ronco, C., & Kazory, A. (2022). Diagnosis of fluid overload: From conventional to contemporary concepts. Cardiorenal Medicine, 12(4), 141–154. https://doi.org/10.1159/000526902  McLaney, E., Morassaei, S., Hughes, L., Davies, R., Campbell, M., & Di Prospero, L. (2022). A framework for interprofessional team collaboration in a hospital setting: Advancing team competencies and behaviours. Healthcare Management Forum, 35(2), 112–117. https://doi.org/10.1177/08404704211063584  Panitchote, A., Mehkri, O., Hastings, A., Hanane, T., Demirjian, S., Torbic, H., Mireles-Cabodevila, E., Krishnan, S., & Duggal, A. (2019). Factors associated with acute kidney injury in acute respiratory distress syndrome. Annals of Intensive Care, 9(1), 74. https://doi.org/10.1186/s13613-019-0552-5  Patil, V. P., & Salunke, B. G. (2020). Fluid overload and acute kidney injury. Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 24(Suppl 3), S94–S97. https://doi.org/10.5005/jp-journals-10071-23401  NURS FPX 6021 Assessment 1 Concept Map Ramakrishnan, N., & Shankar, B. (2020). Nutrition support in critically