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NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

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    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: 

    • It requires trained professionals to deal with mental health issues which means management will have to train existing healthcare workers and hire mental health experts too. 
    • Hiring experts will require financial resources. 
    • CBT can be hamrful for patients as well if it exacerbates the symptoms due to active confrontation with the thoughts. 

    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 provide the individual factors that are impacting every individual patients otherwise specific interventions would have been developed for each patient. 

    Interprofessional Team Benefits

    The interprofessional team that will work for impementation of CBT and SMT include, administrators, managers, doctors, and nurses.

    For succesful implementation, collaborative practices are essential so that patient-centered goal can be achieved by interprofessionals expertise (McLaney et al., 2022). Administrators and managers will take the role of resource allocation while doctors and nurses will be the frontline staff in conducting the cbt and stress management training for dialysis depedant patients.   

    Overall Project Benefits

    The sources of evidence used in this presentation recommends the use of CBT and SMT for the patients who are on long-term dialysis because of CKD. These strategies helps in improving their quality of life and enhancing patient’s safety (Nakao et al., 2021). 

    The Six Sigma approach will help nurses, doctors and other administrators to effectively implement these intervention in their hospitals. Furthermore, it helps to evaluate the results so that if results are suboptimal, they can be further improved to optimize the desired outcomes. This is how a continuous quality improvement plan is undertaken through interprofessional collaboration. 

    References

    Ahmed, S. (2019). Integrating DMAIC approach of Lean Six Sigma and theory of constraints toward quality improvement in healthcare. Reviews on Environmental Health34(4), 427–434. https://doi.org/10.1515/reveh-2019-0003 

    Centers for Medicare & Medicaid Services. (2021). Quality Measurement and Quality Improvement. Retrieved April 6, 2023, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement- 

    Deniz, S., & Çimen, M. (2018). Barriers of six sigma in healthcare organizations. Management Science Letters, 885–890. https://doi.org/10.5267/j.msl.2018.6.009 

    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. https://doi.org/10.30476%2FIJCBNM.2019.81324.0

    NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster 

    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). https://doi.org/10.1186/s40359-021-00678-4  

    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. https://doi.org/10.1177/08404704211063584 

    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). https://doi.org/10.1186/s13030-021-00219-w 

    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. https://doi.org/10.1093/ndt/gfaa346  

    NURS FPX 6021 Assessment 3 Quality Improvement Presentation Poster

    Rathi, R., Vakharia, A., & Shadab, M. (2022). Lean six sigma in the healthcare sector: A Systematic Literature Review. Materials Today: Proceedings50, 773–781. https://doi.org/10.1016/j.matpr.2021.05.534 

    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. https://doi.org/10.1016/j.ejpsy.2021.01.001 

    Yang, L., Wang, H., Cao, J., Qian, Y., Gu, Y., & Chu, C. (2021). Effects of Six sigma methodology on depression and anxiety of patients with end-stage renal disease. Annals of Palliative Medicine10(4), 4375–4383. https://doi.org/10.21037/apm-21-254 

    Zegarow, P., Manczak, M., Rysz, J., & Olszewski, R. (2020). The influence of cognitive-behavioral therapy on depression in dialysis patients – meta-analysis. Archives of Medical Science16(6), 1271–1278. https://doi.org/10.5114/aoms.2019.88019