Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations
Patient health problem is an ailment that can have effect on the mental, physical or medical health of the patient. It can be any disease or any form of injury either acute or chronic one require medical attention. Diabetes is a chronic disease resulting from body’s inability to produce adequate insulin or properly utilize the insulin. There are two major types; Type 1 diabetes characterized by the immune system attacking cells that produce insulin and Type 2 diabetes characterized by the body being unable to use the insulin produced or producing enough insulin. The complications include cardiovascular disease, neuropathy, retinopathy, kidney damage, and increased susceptibility to infections. According to an estimate by Center of Disease Control and Prevention (CDC), among the U.S. population overall, 29.7 million people or 8.9% of the U.S. population had diagnosed diabetes (CDC, 2024).
The assessment evaluates the current evidence based practice as well as state and government policies in relation to the nursing practice. Other topics that will be covered include communication and interprofessional collaboration and leadership strategies.
Identification of a Patient’s Health Problem
During my practicum, I was required to spend two hours with a patient of diabetes and get acquainted with the patient’s perceived experience of the disease and its effect on the quality of life. I spent two hours with Mr. Mathew. He told me about his concern of diabetes. Mr. Mathew is a 45 years’ male of Caucasian origin diagnosed with diabetes for the last twenty years. He first developed symptoms of diabetes at the age of twenty-five. He considers family
history and work and life stress as possible causes for developing the disease due to stress arising from corporate workplace. He changed the lifestyle but the fight against diabetes continues.
Mr. Mathew is now at the risk of diabetes related diseases such as include cardiovascular disease, neuropathy, retinopathy and kidney damage (Usman et al., 2021). He sometimes experiences a tingling or a burning sensation in the hands and feet, blurry vision, long standing wounds and being prone to getting infections if his high blood sugar level is not well controlled.
Relevance of the Problem
Since diabetes is one of the most common patient related health problems, research is of considerable interest to the nursing studies. As mentioned in the earlier sections, there is high incidence of diabetes in the US. Other than the increased morbidity and mortality in the people, it has been known to be one of the biggest contributors to the high cost of health care in the American system. As per a detailed data described by National Institute of Health (NIH), the cost imposed by diabetes management on the US healthcare system is around 412.9 billion USD annually (Parker et al., 2023).
Emphasis should be on diabetes as a nursing student since nurses are the main caregivers of diabetic patients. Patients such as Mr. Mathew deserve the highest level of care that can be offered in the healthcare. Nurses are in charge of the administration of diabetes care by offering the patients information about their condition and formulating treatment plan and ways to manage the condition. They also help in bringing change of behavior (Bhat et al., 2020). They observe the patients for any adverse effects and also attempt to oversee that the medications are being taken correctly.
Analyzing Evidence Based Practices to Define and Guide Nursing Actions
Evaluation of research studies from peer reviewed publications reveal that Cognitive Behavioral Therapy (CBT) is an effective method. CBT is directed at altering maladaptive cognitive processes that are linked with stress and other behaviors that are linked with diabetes. Past research has indicated that CBT has been effective in reducing stress and improving the health behaviors which would be helpful in managing diabetes. Nurses can also offer further information and support about the use of CBT techniques which are useful in the management of such disorders (Yang et al., 2020).
In diabetes management, it is relevant that the management plan is in line with the existing and more credible evidence based practices. They are helpful in improving the theoretical knowledge and the competencies of the health care professionals and the nursing staff in the health care organizations. This is helpful for the management of patients like Mr. Mathew. Below are some of the best and evidence based practices that may be useful in enhancing the patients’ experiences.
A study by Sørensen et al. (2020) pointed out that the nurse case management of diabetes was effective in the reduction of the elevated blood sugar level in the randomly selected adult patients. The same findings were revealed by Tamura et al. (2020) where the study noted that the enhanced role of nurses in the management of patients of diabetes was useful in enhancing the quality of care and outcomes of elderly patients.
In a study by Powers et al. (2020), it was concluded that patient education and the resultant self-management can help in improving the blood sugar level of patients in the long run. García-Molina et al. (2020) conducted an implementation of a nurse lead intervention plan for diabetes in general practice. This method revealed a marked decrease of blood pressure and
thus, the possibility of diabetes related complications in the patients was minimized. However, it is important to note that there is need for further studies to be carried out in order to support the study.
Reliability of the Sources
Credible sources were used in evidence based studies for diabetes to ensure that quality information. The study related search engines were Google scholar, Science direct and Pub Med.
In order to check the credibility of the evidence gathered, the information collected was checked on the basis of the CRAAP test designed by Sarah Blakeslee (Kalidas, 2021). This test helps in evaluation of the reliability and validity of information while searching for articles that have been reviewed by peers for academic or work use. It is helpful in the assessment of the sources on the base of Credibility (it determines the level of authenticity of information), Relevance (does the information fit the criteria of need in the study), Authority (Is the source authentic and genuine?), Accuracy (Is the information true?) and Purpose (the information that is found is relevant to the purpose of the study).
Potential Barriers to Evidence Based Practices
There are factors that limit the use of evidence based practices on diabetes. A challenge in the implementation of evidence based practice is the patients’ inability to adhere to the medication therapy due to low health literacy or the fact that the chronicity of the disease leads to the patients abandoning the medication plan. This may make the studies inefficient (RobatSarpooshi et al., 2020). At times, cultural differences may also be a reason behind the non-adhering to the medical advice and thus may interfere with the success of the particular
study being conducted (Huang et al., 2020). Besides, the recruitment of participants for diabetic studies is a challenge because diabetes is common among old people who also have other diseases.
At times, the healthcare provider may also lack sufficient training in managing healthcare for diabetes, which may also contribute medication plan failure (Konstantinou et al., 2020). In addition, there are other methodological biases which may incline the present evidence on diabetes management, for instance, publication bias whereby only researches with positive findings are published. At times, a patient may present with psychological or even emotional barriers to change some aspects of normal life or medication therapy methods. This resistance to new evidence based studies can also act as barrier to efficacy of evidence based studies (Ortiz-Domenech & Cumba-Avilés, 2021). All these questions can be solved only by joining efforts of the researchers, health care providers, policymakers, and funding and charitable organizations. Hence, there is a necessity for coordinated efforts for improvement of more objective information.
State and Governmental Policies
The State Board Nursing Practice and the policies given by the state act as the framework of the care plan or interventions. American Nursing Association (ANA) is the main source of the practice standards of importance. It offers recommendations for the prevention, detection and treatment of diabetes while at the same time embracing the principles of healthcare that include doing good, avoiding harm, respecting patient’s right to self-determination and fairness. These are the most crucial guidelines concerning the nursing care and enhancing the patient safety and the result (American Nurses Association, 2019).
Health Information Technology (Health IT) Standards enables the flow of information between the various healthcare organizations to help in the improvement of the care coordination plan for the betterment of public health. The electronic data in the form of statistics helps in making a decision regarding change implantation or formulation of an intervention plan (Miandoab et al. , 2023).
Likewise, Mobile Health (mHealth) Policies foster the utilization of latest use of technology by the patients. This can be in form of devices such as glucose monitoring devices either single point or a continuous one or software and mobile applications. These are useful tools to give idea regarding the disease condition. They are also very useful for the patients who live in the rural areas or cannot come to the healthcare facility because of some medical or logistical problems (Ali Sherazi et al., 2022).
The state also develops the polices and plans concerning the diabetes in accordance with the information received from the healthcare facilities and the healthcare institutions. Some of the most important are the National Diabetes Prevention Program (NDPP). NDPP is a partnership program of CDC and the federal health agencies. It is to prevent or early identification of diabetes so that the incidence of this disease can be minimized. It is targeted to population that is vulnerable to develop diabetes, or due to environmental, lifestyle and genetic factors. It promotes behavioral modification through the addition of exercise and proper nutrition into one’s schedule (Ritchie et al., 2020).
Electronic Health Record (EHR) Incentive Programs is a policy for the creation of electronic record of the patient’s information and his or her health status. It is useful in replicating information in form of data or statistics whenever needed for intervention or policy
formulation. The meaningful use of EHR is incentivized and the healthcare professionals are given incentive for the same by Centers for Medicare & Medicaid Services (CMS) (Centers for Medicare & Medicaid Services, 2023).
Effect of Policies on Nursing Scope of Practice
ANA has advocated for the adoption of health information technology in the nursing practice which has expanded the roles of a nurse in managing and processing the patient data in order to enhance the quality of care. The use of Electronic Health Records (EHR) has changed the ways in which the nurses record and retrieve the details of their patients thus enhancing the co-ordination and delivery of health care services (Zarora et al., 2022). Mobile Health (mHealth) technologies have allowed nurses to perform patient monitoring from remote locations thus expanding their function in chronic disease management and patient counseling. With help of the National Diabetes Prevention Program (NDPP), nurses have been more engaged in preventive measures and handling of chronic illnesses, and have adopted use of technology in monitoring patient’s progress and also in providing education (Lim et al., 2019). Altogether, these policies and technologies have increased the nursing practice authority, demanding new competencies in health IT and patient-centered care from the nursing personnel. CMS has played a major role in shaping the nursing scope of practice by encouraging value-based care and the adoption of Health Information Technology (Health IT). Some of the CMS programs include payment reforms that offer incentives for outcomes and not volume of services; nurses play a crucial role in care coordination, patient and caregiver support, and chronic conditions.
Leadership Strategies
Various important strategies may be used in an effort to promote the management of diabetes as well as the patient outcomes. An important leadership approach in this case is the transformative leadership. It motivates the team to work and progress rather than to be ordered to do so. This in turn has a positive impact in the morale of the team. This strategy is effective in motivating the team to strive to achieve a certain goal or to achieve an organizational goal or objective (Smith-Miller et al., 2019). This means that all the decisions are made through the input of the team and not as a result of the decision made by an individual or the leader. It provides the team members with the sense of ownership and personal accountability that boosts the morale of the team members and their contribution to the goal. It is most similar to the democratic leadership style where all the members are involved and decisions are made after consulting all of them (Desse et al., 2022).
Regarding the case of Mr. Mathew, I will apply transformation and democratic and will encourage the culture of patient-centered and teamwork delivery of care. The team should ensure that Mr. Mathew is included in the decision making process. The team should come up with the kind of interventions that is going to be beneficial to Mr. Mathew and at the same time create an environment that is going to encourage him to go further.
In addition, to start with, one needs to ensure that the health care personnel who are attending to the diabetic patients have adequate information on the current practices in the management of diabetes and other related diseases. This is in order to be sure that the patients are provided with the best possible treatment that is available. Also, the enhancement of the cooperation and the coordination of the members of the health care team, including physicians, nurses, diabetes specialists, endocrinologists and dieticians, is also a factor in the development of
In addition, the patients should be enlightened of the disease, as well as the strategies that can be used in the control of high sugar level. This means that more patients will be on the right treatment plans and hence have less complications of the disease (Milky & Thomas, 2020). Thus, the benefits of telehealth and other remote monitoring devices are that the patients can get the advice of a professional even if the specialist is located far away. Exercise is very useful in preventing weight the complication related to diabetes. The other information that should be provided concerns the psychosocial impact of diabetes. The patients will be able to handle the psychological implications of the disease if only the need counseling and support group services are provided to the patients.
Need for Collaboration and Communication
The communication and the teamwork are the key issues in relation to the diabetes. Diabetes is a medical condition that is treated and managed by different players in the health care system such as the general physicians, cardiologists, nurses, dietitians among others. Thus, the idea of the coordinated care can be reached by the team members through the communication. Besides that, the component of patient-centered care is the relationship between the carer and the patient. It enables the patients to have information about their ailment and the care plan that has been developed by the medical practitioners (Dankoly et al., 2020). Also it is important that the patients are engaged in the process of the therapy plan and decision making. It will lead to the improved compliance.
Need for Change Management
Change management in diabetes can be defined as the process that seeks to transform people, teams and organizations from the status quo to the desired state for patients. Change management includes identifying the change required, finding the methods and tools for change, and ensuring people adopt change to ensure change is not only done, but also made to stick. The effective change management in diabetes can be done in various ways such as education of the healthcare team and the patients, work flow and stakeholders. The purpose is to develop a culture change where such a change will help in improving diabetes patient related outcomes (Bonet Olivencia et al., 2021).
Discussing change management, it is possible to refer to Lewin’s Change Theory. The theory is made up of three categories that include unfreezing, change and refreezing. Firstly, unfreezing is the process of awakening to the fact that change is necessary, and in diabetic care, this may happen when such things as noncompliance with the treatment plan or the failure to provide optimal outcomes with regards to patient care (Watts Hammons, 2022).
Also, the change stage involves the introduction of new ideas or methods in handling the challenges including the establishment of new structured education systems. This can be effectively achieved by increased interaction of the professionals and the stakeholders. The refreezing stage also guarantee that the change is cemented or made permanent. The new behavior replaces the old one as the new standard. From the Lewin’s theory, the stakeholders involved in the health care sector can be able to determine the areas of change when it comes to the management of diabetes and improvement of the patient’s status.
Practicum Hours
According to the nursing practicum, I attended to Mr. Mathew for two hours. We discussed the overall state of affairs of the healthcare quality and safety measures to treat diabetes. In the course of the assessment, we took into consideration the therapeutic use of drugs and therapeutic aids with a view to optimizing the cost and benefits for the patients. Moreover, communication with a multidisciplinary care coordination team was done with an aim of working in different patient needs. All in all, the information gained during this practicum was rather helpful while assessing the patient and the potential to identify further management of diabetes for Mr. Mathew.
Conclusion
Therefore, diabetes is a chronic disease that requires hard work from healthcare providers. Diabetes is not only a disease that should be treated with medications, but also a condition that requires patient education, alteration of the lifestyle and counseling. The major concern that is core to the coordinated care and improvement of the patient outcomes is the communication and integration of healthcare professionals, patients and carers. It is important to
improve the health of the patient and the quality of life. This assessment shows that through integrating a systems-based or patient-centered approach to the treatment of diabetes, healthcare professionals can greatly improve the quality of life of those, such as Mr. Mathew and reduce the burden of this disease.
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