NURS FPX 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

Identification of Patient Healthcare Issue 

This capstone project aims to tackle type 2 diabetes in my mother case. My mother is 60 years old patient, who experienced excessive thirst, tingling sensation in his toes and fingers, and unintentional weight loss around a year ago. After that, I took her to the laboratory for a fasting blood glucose test. Her laboratory investigations were conducted, and her fasting blood glucose was 280 mg/dL (higher than the normal range of 70-100 mg/dL) with HbA1c 10%. This showed that my mother was suffering from type 2 diabetes. Her treatment occurred in Alhambra Hospital Medical Center, where I worked as a registered nurse.

Her history showed she was a hypertensive patient, effectively controlled by medication medication adherence was the only factor that maintained his blood pressure. However, her sedentary lifestyle, lacking physical activity, alcoholism, and unhealthy diet is a crucial factor that needs to be addressed. Another important issue in my mother’s case is our middle-class background, where financial responsibilities doesn’t allow her to effectively manage the disease condition. 

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

Type 2 diabetes is a common health problem experienced by older people. In 2019, about 19.3% of the population aged 65-99 suffered from diabetes. Moreover, the incidence rates of type 2 diabetes in elderly people will increase to 195.2 million and 276.3 million by 2030 and 2045, respectively (Sinclair et al., 2020). This shows that type-2 diabetes is highly relevant to our professional practice, which many older people experience later in their aging lives. Furthermore, diabetes is a significant healthcare issue that impacts patients’ quality of life. 

Diabetes, if left untreated, leads to various complications, such as eye blindness, peripheral neuropathy, kidney damage, and mental health issues (Centers for Disease Control and Prevention, 2022). As a baccalaureate-prepared nurse, this problem is relevant to my nursing practice personally and professionally. Many diabetes cases are admitted regularly due to their high prevalence, and I provide nursing care treatment to them daily. Moreover, it relates to me personally as my mother is a diabetic patient. Therefore, I am on a grave mission to provide care, treatment, and support to my mother in improving his diabetes. 

Evidence-Based Approach to Guide Nurses

Nurses play a significant role in managing chronic conditions like diabetes as they are primary caretakers who monitor consistent changes in patients’ health, deliver medication, and provide supportive care. Managing diabetes requires a multifaceted approach of medication adherence, lifestyle modification, and constant monitoring of blood glucose levels. Nurses can educate patients on modifying their lifestyles, particularly patients like my mother, who indulge in unhealthy eating habits and alcohol consumption. This is possible by providing counseling sessions and educating patients on self-management behaviors where they are actively involved in improving their lifestyles, such as enhancing their intake of fruits and vegetables instead of processed food (Hermanns et al., 2020).

Additionally, they can collaborate with dieticians to create healthy meal plans that consider patient preferences to make a patient-centered care plan. These actions can be introduced into my mother’s life, and her lifestyle can be modified by providing her with DSMES programs. This will educate her about the harmful impact of consuming alcohol and processed food in her daily life and empower her to take care of her health. Furthermore, her meal plans can be created considering her preferences and cravings to deliver patient-centered care. 

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

Nurses can manage patients’ diabetes by regularly monitoring their blood glucose levels. They can monitor their glucose levels remotely by using a remote monitoring approach. In remote monitoring, patients and healthcare providers coordinate remotely to manage their health conditions. Remote monitoring of blood glucose levels can facilitate patients and nurses as patients need to update their HbA1c levels at home without visiting the hospital (Shehav-Zaltzman et al., 2020). Moreover, nurses can use their time productively by caring for more patients when the monitoring is conducted remotely. Additionally, nurses can engage with diabetic patients in promoting medication adherence to anti-diabetic drugs to regulate their blood glucose levels.

By supporting my mother in providing her medication regularly on time, I can help my mother promote medication adherence to her anti-diabetic drugs. Lastly, nurses can provide supportive care to chronic patients of diabetes by connecting them with social support groups for diabetes and physical activity platforms like fitness centers and gyms to improve their physical activity and health conditions (Saffari et al., 2019). This will help my mother be physically more active by engaging her with fitness clubs or support groups where she can connect with people who are also fighting with diabetes and increase her motivation and dedication in managing her diabetes. 

Criteria to Evaluate Evidence

These sources of evidence can be evaluated based on CRAAP criteria. These criteria test sources’ currency, relevance, authority, accuracy, and purpose. All the sources of evidence used fulfill the CRAAP criteria, as all articles were published in the past five years and are relevant to diabetes care. Furthermore, the authors mainly specialize in chronic care and have sound medical knowledge. Lastly, the results are accurate and statistically proven to draw valuable outcomes in improving diabetes. Moreover, these evidence-based sources aim to improve health outcomes in diabetics and long-term management of diabetes.

Barriers to Evidence-Based Practices

In implementing the aforementioned evidence-based practices, several potential barriers may be encountered. For instance, the patients may show indifferent attitudes or negligent behavior in practicing self-management of diabetes. They may lack the motivation to quit alcohol and implement a healthy lifestyle (Adu et al., 2019). Moreover, nurses and patients may experience technological barriers in conducting remote monitoring, and they may experience communication barriers due to glitches in technology. Patients may need help to comply with medication therapy, as non-adherence to pharmacological treatment can hinder the achievement of regulated blood glucose levels with medication.

Patients may face barriers in connecting with support groups for geographical or personal reasons. These barriers must be considered while choosing an evidence-based approach to treating diabetes in older patients. Considering my mother’s case of diabetes, she has an intense craving for alcohol and fast foods, and she may struggle to manage her diabetes in the long run. Furthermore, she can face barriers like losing motivation to be consistently physically active as she has been living a sedentary lifestyle. Lastly, technological barriers can also be encountered in my mother’s case, where remote monitoring can be disrupted, causing a loss of adequate monitoring of her blood glucose levels.

State Board Nursing Practice Standards/Organizational or Governmental Policies’ Impact on Diabetes

The California Board of Registered Nursing has several guidelines and policies that can profoundly impact diabetes. It has crafted a Nursing Practice Act (NPA), which comprises various guidelines and regulations for nurses to follow in their nursing practices, including diabetes care. These policies include providing high-quality care and safe care treatment to patients.

This is possible by providing focused care to patients with diabetes in monitoring, medication management, and supportive care. Furthermore, the NPA provides regulations on promoting educational programs to improve nursing practices (California Board of Registered Nursing, 2019). By continuously educating nurses on diabetes care, such as accurately monitoring blood pressure and blood glucose levels, providing evidence-based self-management education, and consistent patient education, they can improve patients’ health in diabetes. 

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

The organizational policies and guidelines of the American Diabetes Association on diabetes care are great tools that can potentially improve diabetes. These guidelines include blood glucose monitoring, diabetes self-management education and support (DSMES) programs, and medication management. By implementing these guidelines on diabetes management, diabetes can be effectively managed, and positive outcomes can be obtained (ADA, n.d.).

Lastly, the Affordable Care Act (ACA) has policies on covering healthcare insurance of patients with pre-existing conditions like diabetes, which can result in better affordability of diabetes management in middle-class and low-income people as diabetes care costs can result in financial constraints. This policy is helpful in positively impacting patients with diabetes as it financially assists them in managing their health condition (Furmanchuk et al., 2021). 

Impact of Policies on Nursing Scope of Practice

These policies and regulations profoundly impact the nursing scope of practice as nurses can provide better care treatments to patients by implementing the nursing board’s policies of safe patient care. Furthermore, nurses will be available when patients have health insurance coverage and can practically manage diabetes in intricate supervision, enhancing their scope of practice. Lastly, nurses can improve their experience through continuous care delivery and improve their nursing practices when these policies are consistently implemented. 

Leadership Strategies and Improved Outcomes for Diabetes

Various leadership strategies exist in literature, such as transformational leadership, autocratic leadership, situational leadership, and coaching leadership. In healthcare systems, transformational leadership can be effective in improving diabetes outcomes, delivering patient-centered care, and enhancing patient experience. In transformational leadership, healthcare professionals such as head nurses seek team members’ valuable insights and wisdom, encourage them to set a compelling vision, and empower them to make decisions based on patient health conditions.

Through transformational leadership, nurses closely monitor patients and can immediately take action to improve diabetes and save the patient’s life from adverse life events. This improves diabetes care and promotes patient-centered care when nurses provide treatment according to the patient’s health needs and choices (Haoyan et al., 2023). 

In diabetes care, there is a pressing need for leadership as it can direct nurses on effective care of chronic management of diabetes. Without leadership, nurses cannot streamline their care treatments for all patients with diabetes, and emergencies may arise. Moreover, collaboration and communication are required in diabetes care as it requires a multidisciplinary approach involving physicians, dieticians, pharmacists, nurses, and physical fitness experts. Therefore, effective communication and collaboration among interdisciplinary teams can result in attaining the desired goals of better-managed blood glucose levels and improved quality of life for patients (Miller-Rosales & Rodriguez, 2021). 

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

Diabetes management also requires change management within the lifestyles and medication behaviors as consistent healthy changes made in life can subsequently control blood glucose levels and enhance life expectancy in diabetic patients. Additionally, empowering patients to manage their diabetes actively requires change management techniques to make informed decisions and take ownership of their health (Cardoso Barbosa et al., 2021). Therefore, these aspects of care must be considered to improve diabetes outcomes in patients like my mother. Lastly, I have documented two hours spent communicating with my mother in the Capella Academic Portal Volunteer Experience Form for future reference. 

Conclusion

The patient health problem discussed in this assessment is type 2 diabetes in a 60-year-old male Jackson. Communication with Jackson and his family reveals that he has been a hypertensive patient but recently experienced diabetes symptoms. The laboratory investigation further confirmed the diagnosis. Moreover, his lifestyle habits require modification to improve his diabetes and manage his condition. The evidence-based guidelines for nurses include educating patients on DSMES, remote monitoring of blood glucose levels and medication adherence, and connecting patients with relevant support groups. Moreover, the Nursing Board of California, ADA, and ACA have policies that impact diabetes positively and enhance the nursing scope of practice. Lastly, transformational leadership can improve diabetes health outcomes, deliver patient-centered care, and enhance patient experience. 

References

ADA. (n.d.). Support for your health journey | ADA. https://diabetes.org/tools-resources 

Adu, M. D., Malabu, U. H., Malau-Aduli, A. E. O., & Malau-Aduli, B. S. (2019). Enablers and barriers to effective diabetes self-management: A multi-national investigation. PLOS ONE, 14(6), e0217771. https://doi.org/10.1371/journal.pone.0217771  

California Board of Registered Nursing. (2019). Nursing practice act. https://www.rn.ca.gov/practice/npa.shtml 

Centers for Disease Control and Prevention. (2022). Prevent diabetes complications. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/managing/problems.html#:~:text=Common%20diabetes%20health%20complications%20include 

Cardoso Barbosa, H., De Queiroz Oliveira, J. A., Moreira Da Costa, J., De Melo Santos, R. P., Gonçalves Miranda, L., De Carvalho Torres, H., Pagano, A. S., & Parreiras Martins, M. A. (2021). Empowerment-oriented strategies to identify behavior change in patients with chronic diseases: An integrative review of the literature. Patient Education and Counseling, 104(4), 689–702. https://doi.org/10.1016/j.pec.2021.01.011 

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

Furmanchuk, A., Liu, M., Song, X., Waitman, L. R., Meurer, J. R., Osinski, K., Stoddard, A., Chrischilles, E., McClay, J. C., Cowell, L. G., Tachinardi, U., Embi, P. J., Mosa, A. S. M., Mandhadi, V., Shah, R. C., Garcia, D., Angulo, F., Patino, A., Trick, W. E., & Markossian, T. W. (2021). Effect of the affordable care act on diabetes care at major health centers: Newly detected diabetes and diabetes medication management. BMJ Open Diabetes Research & Care, 9(1), e002205. https://doi.org/10.1136/bmjdrc-2021-002205

Haoyan, X., Waters, D., Jinling, H., Qiongling, L., & Sien, L. (2023). Quantitative systematic review of the transformational leadership style as a driver of nurses’ organisational commitment. Nursing Open, 10(7). https://doi.org/10.1002/nop2.1671  

Hermanns, N., Ehrmann, D., Finke‐Groene, K., & Kulzer, B. (2020). Trends in diabetes self‐management education: Where are we coming from and where are we going? A narrative review. Diabetic Medicine, 37(3). https://doi.org/10.1111/dme.14256 

Miller-Rosales, C., & Rodriguez, H. P. (2021). Interdisciplinary primary care team expertise and diabetes care management. The Journal of the American Board of Family Medicine, 34(1), 151–161. https://doi.org/10.3122/jabfm.2021.01.200187 

Saffari, M., Lin, C.-Y., Chen, H., & Pakpour, A. H. (2019). The role of religious coping and social support on medication adherence and quality of life among the elderly with type 2 diabetes. Quality of Life Research, 28(8), 2183–2193. https://doi.org/10.1007/s11136-019-02183-z 

Shehav-Zaltzman, G., Segal, G., Konvalina, N., & Tirosh, A. (2020). Remote glucose monitoring of hospitalized, quarantined patients with diabetes and COVID-19. Diabetes Care, 43(7), dc200696. https://doi.org/10.2337/dc20-0696  

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

Sinclair, A., Saeedi, P., Kaundal, A., Karuranga, S., Malanda, B., & Williams, R. (2020). Diabetes and global ageing among 65-99-year-old adults: Findings from the international diabetes federation diabetes atlas, 9th edition. Diabetes Research and Clinical Practice, 162, 108078. https://doi.org/10.1016/j.diabres.2020.108078