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

Chronic Kidney Disease (CKD) is described as the gradual decrease of kidney function, which is characterized by low glomerular filtration (GFR) and other abnormalities in the kidney’s structure (Chen et al., 2019). The disease impacts several aspects of an individual’s life, including daily living, social and occupational roles, and psychological well-being. The complete deterioration of kidney function requires long-term hemodialysis treatment and recurrent hospitalization, aggravating psychological tensions among the patients.

This assessment presents data from North Texas Medical Center, where patients undergoing hemodialysis suffer from depression and stress disorders due to frequent hospitalization. The paper covers a data table indicating current and desired patient outcomes, proposes change strategies to attain desired outcomes, justifies these strategies and their role in improving the quality of care, and discusses the integral function of interprofessional teams for successful implementation. 

Data Table of Current and Desired Clinical Outcomes 

Table 1 in the appendix represents the clinical outcomes related to patients diagnosed with CKD undergoing hemodialysis three times a week at North Texas Medical Center. The data presented complies with the Health Insurance Portability and Accountability Act (HIPAA), established to protect patients’ privacy, maintain information security, and preserve confidentiality (Edemekong et al., 2022). The data table doesn’t disclose patients’ personal health information; instead, it presents generalized data, complying with the HIPAA rule. Uncertainty exists in the causes of re-hospitalization, which requires detailed patients’ medical records and comprehensive patient histories. Additionally, we required qualitative data on the perceptions of quality of life and stressors to intervene using a targeted approach and refine strategies for mitigating post-hospitalization stress in CKD patients. 

Change Strategies for Managing Stress in CKD Patients 

Depression and anxiety are commonly found secondary disorders among the CKD population, with an estimated occurrence of 25%. These disorders lead to poor health outcomes, consequently resulting in the progression of the disease towards end-stage renal disorder (ESRD) and death (Nagar et al., 2021). Since transitioning from pre-dialysis to post-dialysis management and recurrent hospital admissions is stressful for CKD patients, it requires evidence-based interventions to address the issue and bring quality changes within the organization. Through this assessment, we plan to target quality of life scores and psychosocial support as vital clinical outcomes through comprehensive psychosocial support programs. The organization should establish structured and holistic psychosocial support programs to improve the emotional well-being of CKD patients.

These programs should include strategies like patient-to-patient mentoring, support groups, and educational interventions for effective stress management. Peer mentors support patients by providing insights into each other’s experiences, helping to address psychological and emotional consequences in CKD patients due to long-term treatments and recurrent hospitalizations (McKeaveney et al., 2021). Similarly, interventions by social support groups that encourage participation in social activities and interaction may result in improved quality of life through socialization (McKeaveney et al., 2021). Finally, group educational programs are essential to address patients’ CKD-related knowledge gaps and enhance patients coping with stress and anxiety about the disease and its poor implications through stress reduction techniques and lifestyle modifications (Seery & Buchanan, 2022). 

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Implementing these programs includes a multifaceted approach, where multidisciplinary collaboration is pivotal. It fosters an interconnectedness between nephrologists, mental health specialists, and social workers. This collaboration aims to create a holistic framework for patient care, improving care coordination and patient safety (Pawłowicz-Szlarska et al., 2022). Simultaneously, the organization should implement a patient-centric approach through comprehensive education initiatives. These involve developing informative materials and workshops, providing CKD patients with insights into the psychological consequences of their condition, and instilling coping mechanisms to reduce stressful situations (Seery & Buchanan, 2022). Moreover, incorporating routine psychosocial assessments into regular appointments ensures ongoing monitoring, permitting healthcare providers to modify interventions based on patient needs. 

Nevertheless, several challenges arise while implementing comprehensive psychosocial support programs. These challenges include stigma related to mental health, resistance to change, and resource constraints. To overcome stigma, the organization should launch educational awareness campaigns (Shahwan et al., 2022) focusing on the significance of mental well-being in CKD patients. Resistance to change can be addressed by gradually introducing psychosocial services and interprofessional collaboration. This ensures that the staff is not overburdened and that effective task delegation is performed.

This gradual integration also ensures that patients understand the benefits of mental health support, motivating them towards the services to bring quality changes. Additionally, limited resources can be improved by optimizing existing assets, collaborating with external stakeholders for funding, and introducing telehealth services to extend the program’s reach. Ongoing monitoring of dashboard metrics and collection of qualitative data through patient feedback ensure the evaluation of the effectiveness of the intervention in the care system, representing the outcomes and providing guidance for future actions. 

Justification of the Change Strategies

CKD patients encountering stress and depressive symptoms due to long-term treatment and recurrent hospitalizations justify the need for holistic psychosocial support programs (Nagar et al., 2021). The purpose of these programs is to interlink the mental and physical well-being of the patients, acknowledging the impact of disease progression on patients’ overall health. Chronic health conditions significantly impact an individual’s day-to-day living, social relationships, and emotional well-being. These conditions precipitate several physical, psychological, and social consequences, requiring support to mitigate these challenges.

Through interprofessional collaboration with mental health experts, introducing peer mentorships, establishing support groups, and providing education on stress management and lifestyle modifications, organizations can address the emotional burden that often accompanies chronic illnesses (Akyirem et al., 2022), improving patients’ quality of life, augmenting treatment adherence, and rocketing patients’ overall well-being. However, conflicting perspectives advocate the allocation of resources to address immediate and emergency medication needs instead of investing in mental health support and educational interventions (Wu et al., 2023).

Additionally, some critics show concern about the stigmatization associated with mental health support services, which may potentially lead to patient reluctance to engage. Thus, a balanced approach is crucial, where the importance of mental health services should be kept equal to the physical needs of the patients. Moreover, the goal should be to promote destigmatization through patient awareness (Shahwan et al., 2022). Promoting these psychosocial support programs as an inclusive and patient-centered approach is vital to improve clinical outcomes and enhance patient well-being. 

Quality Improvement by Change Strategies 

Comprehensive psychosocial support programs influence the quality of care, especially by preserving the safety of CKD patients. Since patients’ psychological and emotional well-being plays a crucial role in treatment adherence and engagement in healthcare processes, this strategy aims to enhance patient understanding of treatment plans, reduce errors, and promote self-management behaviors (McKeaveney et al., 202). This analysis assumes that improved mental well-being impacts better patient participation, ultimately reducing patient safety risks.

Similarly, these programs recognize and address the mental health disparities and aim to eradicate the stigma associated with mental health services, ensuring equitable care. Educational programs through telehealth services, for instance, may overcome geographical barriers. These programs ensure that patients in underserved areas have equal access to mental health support and stress management strategies (Molfenter et al., 2021). The assumption is to reduce healthcare disparities and foster an equitable healthcare landscape. 

Besides, the goal of this strategy is to impact quadruple healthcare aims. The strategy potentially improves patient experiences by enhancing an individual’s emotional well-being. Moreover, better mental health may improve population health outcomes by fostering patient engagement and adherence to treatment plans, which is essential in CKD patients. Lastly, the strategy could result in long-term cost savings by preventing recurrent hospitalizations and complications in CKD patients, leading to overall patients’ well-being. 

Interprofessional Perspectives of Change Strategies

The proposed change strategy optimizes interprofessional collaboration by reducing communication gaps through interprofessional collaboration. For this purpose, the change strategy establishes ongoing training sessions and clear and accessible communication platforms, such as structured communication portals. These portals will ensure that all patient health information is within a single platform accessible to all healthcare providers and patients, improving effective communication among stakeholders (Robinson, 2020). However, the explanation assumes that interprofessional teams show readiness to change and adaptability to new protocols. Simultaneously, the strategy prioritizes staff well-being through workload considerations and effective task delegation. Assumptions include acknowledging the impact of psychosocial stress on healthcare professionals and the willingness to participate in support initiatives.

References

Akyirem, S., Forbes, A., Wad, J. L., & Due-Christensen, M. (2022). Psychosocial interventions for adults with newly diagnosed chronic disease: A systematic review. Journal of Health Psychology, 27(7), 1753–1782. https://doi.org/10.1177/1359105321995916

Chen, T. K., Knicely, D. H., & Grams, M. E. (2019). Chronic kidney disease diagnosis and management. JAMA, 322(13), 1294–1304. https://doi.org/10.1001/jama.2019.14745

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Edemekong, P. F., Annamaraju, P., & Haydel, M. J. (2022). Health Insurance Portability and Accountability Act. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK500019/ 

McKeaveney, C., Noble, H., Carswell, C., Johnston, W., & Reid, J. (2021). Psychosocial well-being of patients with kidney failure receiving haemodialysis during a pandemic: A survey. Healthcare, 9(8), 1087. https://doi.org/10.3390/healthcare9081087

Molfenter, T., Heitkamp, T., Murphy, A. A., Tapscott, S., Behlman, S., & Cody, O. J. (2021). Use of telehealth in mental health (Mh) services during and after COVID-19. Community Mental Health Journal, 57(7), 1244–1251. https://doi.org/10.1007/s10597-021-00861-2 

Nagar, K., Vaidya, A., & Patel, K. (2021). Depression, anxiety and stress among the patient of chronic kidney disease at Nadiad city, A cross-sectional survey. medRxiv. https://doi.org/10.1101/2021.08.01.21261443 

Pawłowicz-Szlarska, E., Sawościan, M., Lipińska, K., Kendyś, K., & Nowicki, M. (2022). Interprofessional collaboration in the renal care settings: Experiences in the COVID-19 era. Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University, 31(7), 749–755. https://doi.org/10.17219/acem/146777 

Robinson, A. Z. (2020). A systematic review of structured communication among interprofessional teams. Walden University. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=9601&context=dissertations 

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Seery, C., & Buchanan, S. (2022). The psychosocial needs of patients who have chronic kidney disease without kidney replacement therapy: A thematic synthesis of seven qualitative studies. Journal of Nephrology, 35(9), 2251–2267. https://doi.org/10.1007/s40620-022-01437-3 

Shahwan, S., Goh, C. M. J., Tan, G. T. H., Ong, W. J., Chong, S. A., & Subramaniam, M. (2022). Strategies to reduce mental illness stigma: Perspectives of people with lived experience and caregivers. International Journal of Environmental Research and Public Health, 19(3), 1632. https://doi.org/10.3390/ijerph19031632

Wu, Q., Wu, L., Liang, X., Xu, J., Wu, W., & Xue, Y. (2023). Influencing factors of health resource allocation and utilisation before and after COVID-19 based on RIF-I-OLS decomposition method: A longitudinal retrospective study in Guangdong Province, China. BMJ Open, 13(3), e065204. https://doi.org/10.1136/bmjopen-2022-065204 

Appendix

Table 1

Current and Desired States of Multiple Clinical Outcomes in CKD Patients 

Clinical Outcome	Current State	Desired State
Hospitalization Rate	CKD patients are readmitted to the hospital monthly.	The hospitalization rates will reduce with only quarterly admissions.
Quality of Life Scores	Verified scales show a 30% physical and mental well-being reduction every three months.	The scales will represent a 10% increase in physical and mental well-being every three months.
Medication Adherence	Patients show inconsistent adherence to prescribed medications, one of the leading causes of hospital readmissions. The dashboard metrics represent only 55% of patients showing medication adherence.	Patients will show high adherence (90%) to home medications, optimizing treatment efficacy and reducing hospital admission rates.
Physical Activity/ Activity of Daily Living (ADL)	Only 5% of CKD patients can perform their ADLs. Moreover, patients show limited engagement in physical activities.	It is desired to increase the percentage to 20% for patients performing ADLs and show encouragement towards physical activity to improve overall health.
Psychosocial Support	Patients receive only minimal support with inadequate coping mechanisms.	Healthcare providers will foster a psychosocially supportive environment, including one-to-one counseling and stress management strategies
Care Coordination	The dashboard presents fragmented care with gaps in communication between healthcare providers.	Healthcare professionals provide coordinated care with minimal communication gaps.