NURS FPX 4900 Assessment 2 PS

Assessing the Problem; Patient, Family, or Population Health Problem Solution, Considerations

Introduction

Diabetes is hyperglycemia which if stay consistent or chronic leads to microvascular complications. Its interventions approaches are multisectoral including, pharmaceutical, dietary, lifestyle, and managemental interventions. The costs of the health care system are immense expending billions of dollars annually. There are many strategies to prevent diabetics from going into complications.  

NURS FPX 4900 Assessment 2 PS

Root Cause Analysis

The global evidence supports the narrative that diabetes is an emerging epidemic. It is impacting almost every age group, ethnicity, and region across the world. The main issues of diabetes are hyperglycemia, high cholesterol, weight, and later complications. The complications of diabetes are divided into microvascular and macrovascular complications. Microvascular complications include the damage of the small blood vessels. It causes mainly neuropathy, nephropathy, and retinopathy. The macrovascular complications include cardiovascular disease, stroke, and peripheral artery disease (Papatheodorou et al., 2018). The health care costs and the rate of rehospitalization are also high in diabetics (Comino et al., 2015). The morbidity of diabetes affects the quality of life of people to large extent (Corrêa et al., 2017). These factors require early and immediate measures for the screening, diagnosis, and therapeutic interventions of diabetes. 

Solution Of The Problem

The interventions of diabetes and the management of its complications are multisectoral. In-hospital care settings the nurses are the stakeholder of the health care provisions. It is the role of nurses to provide safe, quality, and efficient care to the patients. In the case of diabetics, individual-centered care practice is required. It is due to tot eh fact that every diabetic has a different set of complications associated with it. Nurses can implement various resources of the health care practice to enhance the quality of care and patients’ health outcomes.

Leadership

The health care practice for diabetic care requires a person-centered or patient-centered approach to interventions. The leadership model based on the theory of transformational leadership provides the qualities of leading in such a situation. Leadership is a complex phenomenon that requires practice skills, knowledge, and vision (Williams, 2011). The autocratic leadership takes hold of the situation and provides the necessary information rather than depending on the team members. (Williams, 2011). The reasoning approach of the model is based on the analysis of the current health and the previous intervention outcomes. The situational leader will analyze the current health and issue effective strategy (9 Lynch, 2015). As the issue of different ethnicity, language difference reported as a barrier to effective care can be minimized in this model (Fitriani et al., 2018). The transactional leader will manage and find a mutual coordination system. The hyperglycemia of the diabetics is fluctuating which will deem suitable for a similar situation leadership. The frequent diagnosis of the blood glucose profile, cholesterol levels, hypertension, weight, eye checkup, kidney clearance rate, foot sensation, and neuropathy analysis is required. If the diabetic is having a deviation from the normal range, it will require immediate measures. The transactional leader will coordinate with the team and patient for the further implementation strategy. It will generate a patient satisfactory and evidence-based knowledge implementation practice with positive health outcomes.  Transformational leadership puts an example of coordination and mutual work for patient safety and quality health. It supports and motivates the team workers to take transformations steps (Huynh et al., 2018). 

NURS FPX 4900 Assessment 2 PS

Communication And Collaboration

Communication is an important part of safe, efficient, and quality health care provisions. The patient needs to communicate with the health care provider about the practices and knowledge of the previous practice. The intake of medicine, diet, and physical activity requires complete addressing of the issue and adherence to the provided guidelines (Esfahani, E. and Sadeghi, 2020). The language of communication is required for effective communication with the patients (Dickinson et al., 2017). The intervention of diabetes requires multiple sectorial involvements. It also requires interprofessional collaboration and communication to enhance health quality information. It will ensure safe, efficient, and quality health care (Snyder et al., 2020).  

NURS FPX 4900 Assessment 2 PS

Change Management

The change management theories describe that in the health care settings managers of change are nurses and they are responsible for it. They bridge the health care practices using the organizational resources, promote patient-oriented outcomes, and implement the strategies of change. They also make a coordinated, motivated, and positive workplace environment. Creating a long-term vision helps to change the culture of the organization (Campbell, 2008). Kotter’s model of change provides the basics of making a long-term change. The elements of the Kotters change are creating a sense of urgency, coalition guidance, development of a vision, communication of that vision, empowering the actions, creating short-term wins, consolidate the outcomes and formulate more change (Rajan and Ganesan, 2017).  The development of a vision is necessary for supporting a change. Making a clear strategic plan for the change causes promotion of the whole group. It incorporates positives change in the organization. It enhances interprofessional coordination and provides safe efficient health care. The patient-oriented care and family support in decision making also provide a supportive attitude for the patients (Small et al., 2016).   The involvement of stakeholders in the change incorporates the latest measures at the grassroots level (Rajan and Ganesan, 2017). 

Intervention Strategy

The national and international collaborative programs and policies help to identify the approach required for accurate patient care. The American Diabetes Association is a major organization working to prevent the risk of complications of diabetes and improve the quality of life of such patients. American Diabetes Association in assistance with the European Association has strongly advocated person-centered care with active self-care management activities approach. This requires the people having diabetes to learn about the knowledge of the disease, its progression, risk factors, and motivation and skill development to manage those disease implications. The outcomes have been found effective in improving the quality of life and HbA1C marker concentration in diabetics in a short term (Rutten et al., 2020).

NURS FPX 4900 Assessment 2 PS

Decision-making is a crucial part of health care therapy. The patient and their family members often find it difficult to decide in critical situations. The shared decision-making (SDM) process between the nurses and the patients enhances the coordination among them. It also builds the trust of patients and their family members. This approach promotes patient-centered care, medication, therapy, and coordination decisions. Evidence is necessary in case of making a clinical decision in a medicine provision. It also minimizes the risk of medication errors. The integrated consultation enhances the knowledge building and provisions of evidence-based health care practices. This method is deemed beneficial for diabetes care as it considers the patient’s preference and treatment options. It is the most accurate for the ethics of health care provisions as it is based on the shared opinion of the patient or the family. The health care and clinical settings diabetic care policies have advocated shared decision making as an effective and outcome-oriented approach (Tamhane et al., 2015).

National Standards for self-management and care have also established self-management education and support programs. This program provides diabetics education about the management of their condition in terms of glycemic control, cholesterol control, weight management. The psychological implications of diabetes may lead to behavioral changes. This program also addresses the behavioral aspects of diabetes. Several evidence-based studies have confirmed the applications and effectiveness of self-management awareness. It facilitates knowledge, skills, and diabetes care activities. The implementation requires sustainable behavior for productive outcomes. It also supports technology related use with effective outcomes (Beck et al., 2017). 

NURS FPX 4900 Assessment 2 PS

Quality Care Improvement 

The NHS provided guidelines of the diabetic care for DSN focuses only on the quality-of-care practice by the clinicians. The financial constraints limit the quality of care but the NHS provided a solution of the cost-effectiveness also improve the rate of implementation of these guidelines. The main interventions suggested by the NHS are making the goal of ‘improving the outcomes’, “improving self-management, and promoting the ‘integrated and inter-professional care practice (Middleton, 2012). The self-management includes dietary and lifestyle intervention. The integrated care 

Cost-Effectiveness

Diabetes education and self-management is a cost-effective health care practice. It reduces the cost of hospitalization admission for the patients and his family (Gillett et al., 2010). It also decreases the number of medicines used for the patient, as it has been proved to have positive outcomes. American Diabetes Association also provides diabetes insurance plans for the patients to fund the costs of medication. 

Resources Required

The intervention strategies require resources from the community and individual fronts. The provisions and affordability of medication, food is not that good indicators of the quality of care. The interventions can be affected negatively by the lack of knowledge of the intervention strategies, resource unavailability, and health care system involvement. The national public sector policies for social uplifting can enhance the public power to invest in their health and resources (Berkowitz et al., 2016).  The resources for the implementation of self-management of the strategy of intervention are the policy and general guidelines of diabetes care. Education program for the patients to achieve the vision of the program. Education of the health care resources. 

NURS FPX 4900 Assessment 2 PS

References 

Papatheodorou, K., Banach, M., Bekiari, E., Rizzo, M., and Edmonds, M. (2018). Complications of diabetes 2017.

Lynch, B. (2015). Partnering for performance in situational leadership: a person-centred leadership approach. International Practice Development Journal, 5.

Williams, J. (2011). Good leadership can improve diabetes care for older people with diabetes. Journal of Diabetes Nursing, 15(2), p.69.

Huynh, H.P., Sweeny, K. and Miller, T. (2018). Transformational leadership in primary care: Clinicians’ patterned approaches to care predict patient satisfaction and health expectations. Journal of Health Psychology, 23(5), pp.743-753.

Hue , J.K., Guzman, S.J., Maryniuk, M.D., O’Brian, C.A., Kadohiro, J.K., Jackson, R.A., D’Hondt, N., Montgomery, B., Close, K.L. and Funnell, M.M. (2017). The use of language in diabetes care and education. The Diabetes Educator, 43(6), pp.551-564.

Comino, E.J., Islam, M.F., Tran, D.T., Jorm, L., Flack, J., Jalaludin, B., Haas, M. and Harris, M.F. (2015). Association of processes of primary care and hospitalisation for people with diabetes: a record linkage study. Diabetes Research and Clinical Practice, 108(2), pp.296-305.

Corrêa, K., Gouvêa, G.R., Silva, M.A.V.D., Possobon, R.D.F., Barbosa, L.F.D.L.N., Pereira, A.C., Miranda, L.G. and Cortellazzi, K.L. (2017). Quality of life and characteristics of diabetic patients. Ciencia & saude coletiva, 22, pp.921-930.

Fitriani, F., Betaubun, P., Pure, E.A., Tikon, D., Maturbongs, E.E., Cahyanti, T.W.A. and Waas, R.F. (2018). Relationship of employee ethnic background in Validation of Situational leadership Theory. Indian Journal of Public Health Research & Development, 9(2), pp.200-215.

Rutten, G.E., Van Vugt, H. and de Koning, E. (2020). Person-centered diabetes care and patient activation in people with type 2 diabetes. BMJ Open Diabetes Research and Care, 8(2), p.e001926.

Middleton, N. (2012). The role of the DSN in providing quality diabetes care within constrained finance. Journal of Diabetes Nursing, 16(5).

Tamhane, S., Rodriguez-Gutierrez, R., Hargraves, I. and Montori, V.M., 2015. Shared decision-making in diabetes care. Current diabetes reports, 15(12), pp.1-10.

NURS FPX 4900 Assessment 2 PS

Campbell, R.J., (2008). Change management in health care. The health care manager, 27(1), pp.23-39.

Beck, J., Greenwood, D.A., Blanton, L., Bollinger, S.T., Butcher, M.K., Condon, J.E., Cypress, M., Faulkner, P., Fischl, A.H., Francis, T. and Kolb, L.E. (2018). 2017 National standards for diabetes self-management education and support. The Diabetes Educator, 44(1), pp.35-50. Peimani, M., Nasli-Esfahani, E. and Sadeghi, R., 2020. Patients’ perceptions of patient–provider communication and diabetes care: A systematic review of quantitative and qualitative studies. Chronic illness, 16(1), pp.3-22.

Snyder, J.M., Ahmed-Sarwar, N., Gardiner, C. and Burke, E.S. (2020). Community pharmacist collaboration with a primary care clinic to improve diabetes care. Journal of the American Pharmacists Association, 60(3), pp.S84-S90.

Berkowitz, S.A., Hulberg, A.C., Hong, C., Stowell, B.J., Tirozzi, K.J., Traore, C.Y. and Atlas, S.J. (2016). Addressing basic resource needs to improve primary care quality: a community collaboration programme. BMJ quality & safety, 25(3), pp.164-172.

Gillett, M., Dallosso, H.M., Dixon, S., Brennan, A., Carey, M.E., Campbell, M.J., Heller, S., Khunti, K., Skinner, T.C. and Davies, M.J. (2010). Delivering the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cost effectiveness analysis. Bmj, 341.

Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C. and David, D. (2016). Using Kotter’s change model for implementing bedside handoff: a quality improvement project. Journal of nursing care quality, 31(4), pp.304-309.

Rajan, R. and Ganesan, R. (2017). A critical analysis of John P. Kotter’s change management framework. Asian Journal of Research in Business Economics and Management, 7(7), pp.181-203.