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 al., 2021).

Moreover, the literature highlights the importance of medication reconciliation as a critical component of care, particularly during transitions from hospital to residence, increasing medication safety, simplifying complex regimens, and enhancing adherence (Stolldorf et al., 2021). Resources allocation is a primary conflicting perspective in implementing medication adherence initiatives. Adequate budgeting and resource allocation before the execution is essential to address this conflict and improve patient outcomes. 

Quality Improvement 

Medication adherence initiatives are more likely to improve patient safety. Medication adherence helps reduce medication errors, prevent adverse drug events, minimize patients’ stress related to complex medication regimens, and decrease the chances of missed doses. It prevents medication-related harm, ultimately enhancing patient safety (Taibanguay et al., 2019). Furthermore, medication reconciliation efforts help identify and resolve discrepancies, improving patient safety by ensuring accurate and up-to-date medications are administered to the patients (Stolldorf et al., 2021).

These initiatives enhance patient safety and clinical outcomes by improving treatment efficiency and reducing hospital readmissions. This aligns with the Quadruple Aim’s goal of improving population health. Similarly, comprehensive psychological support programs improve quality in terms of equitable care. These programs address the mental health needs of kidney failure patients suffering from traumatic stress, removing healthcare disparities in mental health services, socio-economic status, and stigmatization. This promotes equity in care delivery and improves healthcare accessibility (Jacoby & Li, 2022). Moreover, these support programs contribute to the Quadruple Aim’s focus on enhancing patient experience and satisfaction by fostering a supportive healthcare environment. 

Interprofessional Considerations of Change Strategies

Both the change strategies can effectively utilize interprofessional methods to achieve desired outcomes. The change in methodologies can foster collaboration among healthcare professionals from different disciplines, such as medication adherence initiatives requiring pharmacists, nurses, and physicians. At the same time, psychological support programs need mental health professionals, nurses, community leaders, and social workers. Successful implementation across interprofessional teams relies on clear communication channels, standardized protocols, and mutual respect.

For this purpose, interprofessional team meetings can facilitate communication, shared decision-making, and coordination of care plans (Leykum et al., 2023). Furthermore, these initiatives focus on the well-being of professionals through ongoing support and a culture of collaboration and appreciation to mitigate burnout and enhance job satisfaction among team members. The plan assumes that recognizing the expertise of each team member helps in the comprehensive management of patient’s needs and requirements, ultimately improving 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 

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

Jacoby, A., & Li, Y. (2022). Mental health care access and individual help-seeking during the COVID-19 pandemic. Community Mental Health Journal, 58(8), 1572–1583. https://doi.org/10.1007/s10597-022-00973-3 

Leykum, L. K., Noël, P. H., Penney, L. S., Mader, M., Lanham, H. J., Finley, E. P., & Pugh, J. A. (2023). Interdisciplinary team meetings in practice: An observational study of IDTS, sensemaking around care transitions, and readmission rates. Journal of General Internal Medicine, 38(2), 324–331. https://doi.org/10.1007/s11606-022-07744-6 

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Longley, R. M., Harnedy, L. E., Ghanime, P. M., Arroyo-Ariza, D., Deary, E. C., Daskalakis, E., Sadang, K. G., West, J., Huffman, J. C., Celano, C. M., & Amonoo, H. L. (2023). Peer support interventions in patients with kidney failure: A systematic review. Journal of Psychosomatic Research, 171, 111379. https://doi.org/10.1016/j.jpsychores.2023.111379 

Muhorakeye, O., & Biracyaza, E. (2021). Exploring barriers to mental health services utilization at Kabutare district hospital of Rwanda: Perspectives from patients. Frontiers in Psychology, 12. https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2021.638377 

Shouket, H. (2024). Psychological interventions for end-stage renal disease patients’ receiving hemodialysis. In Updates on Renal Replacement Therapy. IntechOpen. https://doi.org/10.5772/intechopen.112793 

Stolldorf, D. P., Ridner, S. H., Vogus, T. J., Roumie, C. L., Schnipper, J. L., Dietrich, M. S., Schlundt, D. G., & Kripalani, S. (2021). Implementation strategies in the context of medication reconciliation: A qualitative study. Implementation Science Communications, 2(1), 63. https://doi.org/10.1186/s43058-021-00162-5 

Taibanguay, N., Chaiamnuay, S., Asavatanabodee, P., & Narongroeknawin, P. (2019). Effect of patient education on medication adherence of patients with rheumatoid arthritis: A randomized controlled trial. Patient Preference and Adherence, 13, 119–129. https://doi.org/10.2147/PPA.S192008 

Theodos, K., & Sittig, S. (2020). Health information privacy laws in the digital age: HIPAA doesn’t apply. Perspectives in Health Information Management, 18(Winter), 1l. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883355/ 

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Wu, C., Zhang, Y., Nie, S., Hong, D., Zhu, J., Chen, Z., Liu, B., Liu, H., Yang, Q., Li, H., Xu, G., Weng, J., Kong, Y., Wan, Q., Zha, Y., Chen, C., Xu, H., Hu, Y., Shi, Y., … Li, G. (2023). Predicting in-hospital outcomes of patients with acute kidney injury. Nature Communications, 14(1), 3739. https://doi.org/10.1038/s41467-023-39474-6