NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster
Student Name Capella University NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1 Prof. Name Date Abstract Background: Stress and depression are commonly found mental health issues in patients undergoing long-term hemodialysis due to chronic kidney disease (CKD). These patients may suffer from an actual or perceived loss of quality of life (QoL) due to the lifelong treatment they are under care of (Ghaffari et al., 2019). Thus, requires quality improvement initiatives to promote patients’ safety and improve their QoL. Purpose: The purpose of this poster presentation is to address the mental health issues using cognitive behavioral therapy (CBT) as a change strategy. Limitations/challenges: There are some challenges in implementation of CBT, so stress management training is explained as an adjuvant change strategy for reducing depressive symptoms in hemodialyzed patients to improve their quality of life. Methods: Six Sigma model’s DMAIC approach is used as a quality improvement (QI) method to promote continuous improvement. Conclusion: The Six Sigma is an effective QI method but shows some limitations which can be addressed effectively to improve quality healthcare. CBT and stress management training (SMT) have been successful in reducing stress and depression from hemodialyzed patients ultimately improving their QoL. Quality Improvement Methods Quality improvement is a framework that is used to improve the care quality. It is based on standardized methods and processes which helps in achieving desirable outcomes and improves organizational care for patients’ benefits (Centers for Medicare & Medicaid Services, 2021). The DMAIC is a Lean Six Sigma approach that is used as a guideline to improve care quality for patients’ satisfaction (Ahmed, 2019). The process begins with defining a problem. In hospitals, dialysis dependent patients are more likely to suffer from stress and depressive symptoms which leads them to either have poor quality of life or make a perception about it (Ghaffari et al., 2019). Next step is to measure the effectiveness of existing interventions that is being done to reduce stress in hemodialyzed patients and analyze the problems in those interventions. One the problems are identified; new improvement strategies that is CBT and stress management training are implemented in the system. For continuous improvement, the control step is used to evaluate the concerns of these strategies for future integration and improvement. Challenges of the Six Sigma Approach Several barriers hinder the implementation of Six Sigma approach for CKD patients. As this is a 5 steps process, some stakeholders consider it as a complex cycle and can be time consuming. Another commonly found barrier is lack of knowledge about the methods, implementation and process (Deniz & Çimen, 2018). To address these challenges it is essential that top level executives play their part in supporting healthcare providers by introducing the strategy in their organization, training them related to its use and accompanying them throughout the process to ensure their concerns are addressed adequately. Moreover, it is essential to develop an insight that every action is undertaken for patients’ satisfaction in terms of reducing stress and improving their quality of life. (Deniz & Çimen, 2018; Rathi et al., 2022). Change Strategy Foundation Approximately, 1/4th of CKD patients who are on long-term dialysis treatment suffer from depressive disorders. This depression can lead to severe morbidities eventually can cause death (Nataatmadja et al., 2020). This statistic prepares a foundation for the proposed change strategy which is cognitive behavioral therapy (CBT). CBT is described as a patient-provider interaction to identify the impacts of psychological thoughts on patients’ behaviors (Nakao et al., 2021). A research states that CBT has been effective in reducing symptoms of depression and stress among hemodialyzed patients (Zegarow et al., 2020). Another study conducted on hemodialyzed patients in Turkey Kidney Foundation to see the effectiveness of CBT showed significant improvements in patients’ cognitive function, social interaction, and improved their overall quality of health (Tuna et al., 2021). Evidence to Support QI Method Quality improvement is a continuous process and requires methods which are based on continuity hence, literature explains that six sigma model is a continuous cycle which is developed for identifying the problem, finding solutions, eveluating the results and repeating the steps to get desired outcomes (Ahmed, 2019). Furthermore, research concludes the use of six sigma as a succesful QI method for dialysis dependant patients suffering from anxiety and depression as it helped in reducing the incidence (Yang et al., 2021). Therefore it is evident that despite of the challenges, with adequate management, six sigma approach is useful for the population of this study. Challenges of Change Strategy There are some limitations of CBT, like: To address these challenges, it is essential that top tier management plays an important role in terms of resource allocation. However, there is another strategy as well which can be implemented in the form of support groups for these patients. This intervention is stress management training (SMT). SMT in support group is explained as patients with similar conditions sit together and discuss their stressors to work together and help each other (Ghasemi Bahraseman et al., 2021). A controlled-trial study showed that patients who received stress management training had improved perceptions about their lives and had knowledge of more coping strategies than the control group. They had low stress, more confidence, and improved problem-solving skills (Ghasemi Bahraseman et al., 2021). Knowledge Gaps and Unknowns It is essential that the data collected at the measure stage is explicit in explaining the problem and root causes of the problem. Data gaps/missing information will impact next stages of the cycle where poor analysis would be done. Clear and detailed information will help to improve the analysis of the problem hence assist in finding effective solutions. Moreover, six sigma is a singular standard pathway and doesn’t have space for adding other methods. Thus, every information added in this cycle should cover all aspects of patients. Uncertainty of any information can break the pathway. Some of the knowledge gaps identified during this presentation are missing information about individual causes of depression and stress. Generalized data used for this assessment couldn’t
NURS FPX 6021 Assessment 2 Change Strategy and Implementation
Student Name Capella University NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1 Prof. Name Date Change Strategy and Implementation Diabetes is a chronic disease that involves the maintenance of blood glucose levels. If these levels are not maintained in their normal ranges for a longer period can result in various organ failures. One of those is kidney failure – acute and chronic, also called diabetic nephropathy. Patients with acute kidney failure can make a full recovery through pharmacological and nursing care, however, those who end up with chronic renal failure may require long-term hemodialysis management. While patients who are on long-term dialysis may suffer from various physical sides effects like low blood pressure, bloating, muscle cramps, weight gain, nausea and vomiting, dizziness, and infection at the fistula site. They are prone to mental effects as well because of their dependency on a dialysis machine and healthcare providers. These effects include but are not limited to pain, stress, anxiety, depression, and sleeping disorders which may lead to an actual or perceived loss of quality of life which make them end up in different stages of grief (Dąbrowska-Bender et al., 2018). Although patients’ families and social relationships play a great role in improving their quality of life, healthcare providers need to bring a change in the healthcare environment so that patients’ mental health is enhancedand a good quality of life is perceived. Data Table of Clinical Outcomes The data table below presents the current and expected outcomes of stress and perception of quality of life in patients on long-term dialysis treatment at Florida Memorial Hospital (FMH). This data is collected from the hemodialysis unit of the hospital, and then it is analyzed in data management software. The data is HIPAA compliant because This data has missing information about the causes of these stressful and depressive symptoms for the patients. Additional data would have been useful in developing effective change strategies and implementing them to address the root causes of the problem. Current Outcomes Expected Outcomes 70% of dialysis-dependent patients have the perspective that their quality of life is lost because they are unable to participate in social activities due to extensive treatment. More than 50% of dialysis-dependent patients will show involvement in social activities and improve their perspective on the quality of life. Almost half of the patients who are on long-term dialysis dependent encounter stress and depressive symptoms, which lead to poor quality of life. Most of the patients will be able to manage their stress and depressive symptoms to improve their quality of life (Lim & Lee, 2022) Poor relationship between patients and healthcare providers is observed in most cases. The relationship between patients and providers improved and patients can now share their concerns comfortably. Long-term Hemodialysis Relation with Stress, Depression, and Quality of Life Patients with CKD and on long-term hemodialysis are affected in various aspects of their lives, which include their lifestyle, healthy well-being, occupational and social roles, and personal development. Since they are unable to perform at their best in all these aspects of life due to dialysis treatment, they consider themselves to have poor quality of life and end up with stress and depressive disorders (Ghaffari et al., 2019). Depression affects approximately ¼ of people who are diagnosed with CKD, and people who are going through dialysis treatment have almost 15% higher chances of getting depressive symptoms than those getting treatments other than dialysis. Moreover, this depression increases the chances of morbidity and mortality for dialysis-dependent patients. The literature has identified that dialysis-dependent patients have an association with poor quality of life (QoL) and show minimal physical performance (Nataatmadja et al., 2020). To enhance patients’ coping levels, healthcare providers need to implement changes in the care environment. Change Strategies for Dialysis-Dependent Patients The goal of this assessment is to improve the quality of life of dialysis-dependent patients by reducing stress and depression using change strategies in the healthcare environment and introducing evidence-based coping strategies among them. The proposed strategy that healthcare providers should use is cognitive behavioral therapy (CBT) and support groups. Moreover, the usefulness of stress management training will be elaborated on as well (Natale et al., 2019). Cognitive behavioral therapy is described as an interaction between the therapist/healthcare provider and the patients to identify the impacts of psychological thoughts on the patients’ behaviors and attitudes. The study identifies that psychological intervention using CBT has been effective in reducing symptoms of depression and stress among hemodialyzed patients. It is relatively cheap, easy to carry out if professionals are trained adequately, and an effective non-pharmacotherapy (Zegarow et al., 2020). The information that is extracted from the therapy sessions helps the therapists suggest some of the actions that will counteract these thoughts. Patients then utilize those methods in their daily lives to alleviate their depressive symptoms. For example, a patient may be asked to repeat words like “I am healthy and I am perfect”. This constant assertion will fight the negative thoughts and eventually result in managing depressive symptoms and stress. NURS FPX 6021 Assessment 2 Change Strategy and Implementation Although cognitive behavioral therapy is useful for alleviating psychological symptoms, there are various drawbacks to this therapy. Since CBT is a mental health therapy, it requires professionals who are adequately trained to conduct these sessions with the patients. It can be a challenge for the hospital to train existing healthcare professionals from the scratch. Additionally, hiring more therapists will require proper planning of financial and organizational resources. Another challenge is that patients may experience aggravation of the disease or depressive symptoms because of an active confrontation with their thoughts. This might lead to painful or complicated situations for the patients’ health. To address these challenges, healthcare providers should conduct stress management training in support group discussions for the patients, where patients with similar conditions sit together and discuss their stressors to promote a culture of equality and work together to help each other with effective coping strategies (Ghasemi Bahraseman et al., 2021). Justification of the
NURS FPX 6021 Assessment 1 Concept Map
Student Name Capella University NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1 Prof. Name Date Concept Map: Patient InfoName: Walter B. Harris | Gender: Female | Age: 72 Vitals: Temp: 37 °C (98.6 °F), BP: 162/94, Pulse: 92, Respiratory rate: 26 and shallow Chief complaint: Shortness of breath (SOB) and difficulty breathing Medical history: Hypertension, hyperlipidemia, and chronic obstructive pulmonary disease (COPD) Nursing Diagnosis Impaired gas exchange related to destruction of the alveoli, narrowing of bronchioles, and trapping of air resulting in the loss of lung elasticity Subjective data: Difficulty breathing and SOBObjective data: Crackles and wheezing heard upon auscultation, dyspnea, tachypnea, nasal flaring, use of accessory muscles, late signs of cyanosis (Linton, 2015), and oxygen saturation is 90% on room air Nursing Diagnosis Ineffective airway clearance related to bronchoconstriction, increased mucus production Subjective data: The patient states she has been sleeping in a recliner chair for the past three nights because of difficulty breathingObjective data: Wheezing heard upon auscultation, dyspnea, tachypnea, and use of accessory muscles (Linton, 2015) Nursing Diagnosis Activity intolerance related to hypoxia (imbalance between oxygen supply and demand) Subjective data: “I find it difficult to breathe. I can’t catch my breath when I walk a few feet.” — Jane DoeObjective data: Late signs of cyanosis, crackles and wheezing heard upon auscultation, and use of accessory muscles (Linton, 2015) Nursing Interventions Independent intervention (II): Monitor the patient’s arterial blood gases, oxygen saturation, vital signs, and color and assess for manifestations such as restlessness, anxiety, lethargy, and confusion Rationale: This process will help detect potential hypoxemia or hypercapnia (LeMone et al., 2015) Collaborative intervention (CI): Supervise oxygen (O2) at 2 L/min through nasal cannula as ordered. Instruct the patient and kin not to increase the O2 level Rationale: Oxygen therapy is used to treat hypoxia and is prescribed for chronic and acute breathing problems (Rees, 2017). However, a sudden increase in the O2 level can lead to respiratory failure (Linton, 2015) II: Position the patient in an upright or high Fowler’s position (Linton, 2015) Rationale: This posture promotes lung ventilation (LeMone et al., 2015) II: Instruct and teach the patient to perform the pursed-lip breathing technique Rationale: This technique slows the respiratory rate and reduces air trapping and fatigue (LeMone et al., 2015) Expected Outcomes Arterial blood gases and vital signs will be consistent with patient norms, indicating improvement in gas exchange (Linton, 2015)The pursed-lip breathing technique will reduce dyspnea (Linton, 2015) Nursing Interventions II: Demonstrate pursed-lip and diaphragmatic breathing and encourage the patient to practice them periodically Rationale: These techniques reduce air trapping and fatigue and help maintain open airways (LeMone et al., 2015) II: Position the patient in an upright or high Fowler’s position Rationale: This posture promotes lung ventilation (LeMone et al., 2015) CI: Encourage deep breathing and the use of an incentive spirometer Rationale: Using an incentive spirometer prevents complications such as pneumonia and atelectasis (LeMone et al., 2015) CI: Collaborate with a respiratory therapist to teach the patient how to cough effectively Rationale: This technique helps open distal alveoli and remove secretions (LeMone et al., 2015) II: Provide emotional support to the patient Rationale: This intervention will be therapeutic, make the patient feel comfortable, and help her cope with the diagnosis (Kazanowski, 2017; LeMone et al., 2015) Expected Outcomes The patient will have open airways. Signs of clear and open airways are normal depth and rate of respiration, normal breathing sounds, and effective coughing of secretions (Linton, 2015) CONCEPT MAP Introduction This paper presents an evidence-based concept map illustrating a nursing care plan to achieve high-quality outcomes for a patient experiencing SOB and difficulty breathing. The concept map contains urgent diagnoses, possible nursing interventions, and opportunities for interprofessional collaboration as well as rationales and possible high-quality outcomes. The narrative justifies the value and relevance of the evidence used in the concept map and provides additional evidence, conflicting data, and the scope of interprofessional collaborations in achieving high-quality outcomes. Additional Evidence Jane Doe is a 72-year-old female experiencing SOB and difficulty breathing. The suspected diagnoses are based on the patient’s medical history and physical examination. The evidence used in the concept map is a combination of subjective (patient reported distress) and objective (symptoms or characteristics related to a condition observed in the patient) data obtained after an investigation. Doe also suffered from emphysema in the past. Fatigue, SOB, edema, and wheezing are common symptoms of COPD. The diagnoses in the concept map are related to various conditions related to COPD such as emphysema and chronic bronchitis. This evidence suggests that the client’s current distress could be related to COPD. However, symptoms such as wheezing, edema, SOB, and fatigue can also be observed in a person suffering from congestive heart failure (LeMone et al., 2015). Even though COPD and congestive heart failure have several risk factors and symptoms in common, the causes and treatments are different. Inter-professional Strategies An inter-professional collaboration between health care professionals, patients, and their caregivers is required for high-quality outcomes. Successful collaborations require positive reinforcement and mutual feedback in an objective and non-discriminatory setting (Amalakuhan & Adams, 2015). COPD will benefit from a combination of pharmacological and non-pharmacological interventions guided by an interprofessional collaborative practice. The concept map clearly identifies interventions that can be performed independently and those that need inter-professional collaboration. For instance, it is necessary to collaborate with a respiratory therapist to teach and assist a patient in coughing effectively. Similarly, referring the patient to a pulmonary rehabilitation program can help lower exertional dyspnea and the perceived intensity of breathlessness. NURS FPX 6021 Assessment 1 Concept Map The concept map also facilitates communication in an inter-professional team by identifying the types of nursing interventions required, thereby preventing conflict. Health care professionals must collaborate with caregivers and COPD patients to achieve high-quality outcomes. This collaboration should effectively optimize non-pharmacological interventions such as providing smoking cessation counseling for patients who find it difficult to quit the habit, promoting pulmonary rehabilitation programs, and administering appropriate vaccinations. Inter-professional collaborations should also focus on helping patients gradually incorporate more physical activity into their lifestyles and managing comorbidities common in COPD in addition to