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NURS FPX 6021 Assessment 2 Change Strategy and Implementation

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    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


    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 

    • it is taken from the data security office with signed permission.
    • it does not reveal the identity of any individual patient (Database FMH, 2023). 

    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 Change Strategies 

    Cognitive Behavioral Therapy (CBT) 

    Healthcare providers need to build a trustworthy rapport with patients so that they can express their concerns effectively. CBT is a form of patient-provider relationship where patients are assisted in a tailored manner to express their thoughts and beliefs about their quality of life. The focus of the therapy is to amend negative thoughts, and harmful behaviors, induce stress management skills, and foster resilience through mindfulness techniques. Thus, it is justified as being the least harmful and most beneficial for effective results.

    A study that investigated CBT on dialysis patients showed a significant improvement in various aspects of the patients’ lives, for example, enhanced cognitive function, increased social interaction, and improved overall quality of health (Tuna et al., 2021). Although CBT can be helpful for these patients, there are other perspectives as well that need to be highlighted to achieve desired outcomes. Stress management in support groups can be used as an adjuvant strategy with cognitive behavioral therapy. 

    Support Groups and Stress Management Training

    Stress management improves various mental health problems and enhances individuals’ performance levels by activating positive beliefs. Through this training, patients can learn several preventive measures to include in their routine before they get hit by negative thoughts (Sultan et al., 2022). Stress management training (SMT) done in the form of support groups helps every individual member work together to produce desired outcomes. A study showed that patients who received stress management therapy had improved self-efficacy levels (improved perception about themselves and their lives), and they used more coping strategies than the control group. Furthermore, the evaluation of the study recognized lower levels of stress, increased self-confidence and social support, and improved problem-solving skills in patients who received SMT as compared to others (Ghasemi Bahraseman et al., 2021). 

    Quality Improvement by Change Strategies 

    These change strategies are helpful in quality improvement in terms of patient safety and equitable care. CBT and stress management through support groups help in identifying damaging thoughts that have negative impacts on patients’ actions, thus, improving their abilities to cope with stress and enhancing their physical and mental performance. These desired outcomes eventually enhance patients’ health and maintain their safety through a prospering quality of life (Nakao et al., 2021).

    Equitable care is defined as the provision of care while keeping aside all geographic, cultural, social, and economic statuses (Dzau et al., 2022). In support groups, these personal characteristics get subdued, and all the individual members of the focus group are provided with the same training and coping methods. This explanation is based on the assumption that every change that is planned for healthcare organizations and patient care environments is for patients’ benefit and eventually leads to care quality improvement, patient safety, and positive health outcomes. 

    Interprofessional Perspectives of Change Strategies

    To implement any change in a healthcare organization, interprofessional teams must work together collaboratively to ensure successful results are obtained. Effective interprofessional strategies are critical for the implementation of change strategies (McLaney et al., 2022). For effective implementation of  CBT and stress management training in dialyzed patients, it is essential that stakeholders of the hospital work together. Doctors, mental health therapists, and nurses take the lead in learning about CBT and various coping strategies so that they can effectively convey their learning to patients and their families in the form of training and therapy sessions.

    Administrators and the budget department should plan for hiring new therapists and introducing technologies for better execution of the plan. Quality control auditors take part after the implementation takes place to evaluate the outcomes of these change strategies.  The above explanation is based on an assumption that healthcare professionals are committed to working together for patient-centered care using collaborative methods. 


    Changes are part of healthcare systems and are essential for patients’ benefit. There are various healthcare problems that require effective change implementation. To bring successful changes, effective strategies are essential. In the case of hemodialyzed patients suffering from mental health challenges, CBT and stress management training have proven to be effective strategies. However, interprofessional collaboration is imperative to effectively use these change strategies for improving the quality of care, and patient safety, and to bring positive outcomes for patients’ health. 


    Dąbrowska-Bender, M., Dykowska, G., Żuk, W., Milewska, M., & Staniszewska, A. (2018). The impact on quality of life of dialysis patients with renal insufficiency. Patient Preference and Adherence, 12, 577–583. 

    Dzau, V. J., Mate, K., & O’Kane, M. (2022). Equity and quality—improving health care delivery requires both. JAMA327(6), 519.  

    Ghaffari, M., Morowatisharifabad, M. A., Mehrabi, Y., Zare, S., Askari, J., & Alizadeh, S. (2019). What are the hemodialysis patients’ style in coping with stress? A directed content analysis. International Journal of Community Based Nursing and Midwifery, 7(4), 309.

    Ghasemi Bahraseman, Z., Mangolian Shahrbabaki, P., & Nouhi, E. (2021). The impact of stress management training on stress-related coping strategies and self-efficacy in hemodialysis patients: A randomized controlled clinical trial. BMC Psychology9(1).  

    NURS FPX 6021 Assessment 2 Change Strategy and Implementation

    Lim, K. A., & Lee, J. H. (2022). Factors affecting quality of life in patients receiving Hemodialysis. Iranian Journal of Public Health. 

    McLaney, E., Morassaei, S., Hughes, L., Davies, R., Campbell, M., & Di Prospero, L. (2022). A framework for interprofessional team collaboration in a hospital setting: Advancing team competencies and behaviours. Healthcare Management Forum35(2), 112–117. 

    Nakao, M., Shirotsuki, K., & Sugaya, N. (2021). Cognitive–behavioral therapy for management of mental health and stress-related disorders: Recent advances in techniques and technologies. BioPsychoSocial Medicine15(1). 

    Nataatmadja, M., Evangelidis, N., Manera, K. E., Cho, Y., Johnson, D. W., Craig, J. C., Baumgart, A., Hanson, C. S., Shen, J., Guha, C., Scholes-Robertson, N., & Tong, A. (2020). Perspectives on mental health among patients receiving dialysis. Nephrology Dialysis Transplantation36(7), 1317–1325.  

    Natale, P., Palmer, S. C., Ruospo, M., Saglimbene, V. M., Rabindranath, K. S., & Strippoli, G. F. M. (2019). Psychosocial interventions for preventing and treating depression in dialysis patients. Cochrane Database of Systematic Reviews. 

    NURS FPX 6021 Assessment 2 Change Strategy and Implementation

    Sultan, S., Munir, R., & Kanwal, F. (2022). Managing mental health problems and quality of life among dialysis patients through stress management intervention. Foundation University Journal of Psychology6(1). 

    Tuna, Ö., Balaban, Ö. D., Mutlu, C., Şahmelikoğlu, Ö., Bali, M., & Ermis, C. (2021). Depression and cognitive distortions in hemodialysis patients with end-stage renal disease: A case-control study. The European Journal of Psychiatry35(4), 242–250. 

    Zegarow, P., Manczak, M., Rysz, J., & Olszewski, R. (2020). The influence of cognitive-behavioral therapy on depression in dialysis patients – a meta-analysis. Archives of Medical Science16(6), 1271–1278.