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 

Acute Kidney Failure (AKF), also known as renal failure, is a serious concern, especially for diabetic patients. AKF is a condition of the kidney’s inability to filtrate waste inside the human body (Kaur et al., 2023). Often, AKF leads to the need for recurrent hospitalization to manage kidney failure, hemodialysis, or ICU care for increased blood glucose levels. This can further cause infections due to a weak immune system.

It has a profound impact on patients, causing traumatic stress and anxiety due to recurrent and over-hospitalization (Pickkers et al., 2021). A study shows that hemodialysis to manage fluid and waste causes severe psychiatric conditions, including depression, suicidal thoughts, or anxiety (Khoury et al., 2023). This assessment aims to propose change strategies for patients with AKF in the ICU, my current care setting, to reduce traumatic stress and anxiety in patients with AKF. A data table will depict the current state, desired outcomes, and change strategies.  

Table for Current and Desired States Clinical Outcomes 

Clinical Outcome	Current State	Desired Outcome
Mortality and Morbidity	High mortality and morbidity rates (16-50%) among AKF patients with diabetes in the ICU are recorded. It is due to more extended stays, leading to infections.	The desired outcome is to reduce mortality and morbidity rates among AKF patients with diabetes by 10%. Tight glycemic control protocols and educational interventions can help decrease morbidity and mortality rates in AKF patients in the ICU (Khairoun et al., 2021).
Psychiatric Issues	High incidence of depression, anxiety, and traumatic stress among AKF patients in ICU. It leads to an extra burden on body organs like the heart, adversely impacting treatment and health outcomes.	The aim is to improve mental health issues among AKF patients by up to 70% by reducing traumatic stress and anxiety related to treatment or chronic disease management. Psychological support services through counseling, therapies, mindfulness, and stress reduction programs can help reduce and manage psychiatric conditions associated with hospitalization or chronic disease management.
Quality of Life	Poor quality of life reported by AKF patients with diabetes due to weak immunity affecting daily life activities, recurrent hospitalization, dialysis, and prolonged stay at the hospital.	The desired outcome is to enhance the quality of life among AKF patients with diabetes through comprehensive kidney education, self-management strategies, and symptom and pain management optimization.
Medication Adherence	Current adherence rates among AKF patients are low, with many patients experiencing challenges in consistently taking prescribed medications. It leads to further complications in diabetic patients, increasing mortality rates.	The desired outcome is to improve medication adherence rates among AKF patients to ensure optimal management of their condition. Collaborate with healthcare providers, pharmacists, and caregivers to create a supportive and coordinated approach to medication management (Bano et al., 2023).

Areas of Ambiguity or Uncertainty

The above data is collected within the security and privacy guidelines of HIPPA (Health Insurance Portability and Accountability Act) (U.S. HHS, 2022). The current status of the ICU related to AKF patients with diabetes is discussed after obtaining permission from the authorities to ensure no unauthorized data is disclosed. The data have areas of ambiguities and uncertainties. First of all, the information about mortality or morbidity outcomes of patients with other diseases in the ICU is unknown, so comparison among them is not possible for targeted interventions.

Additionally, demographics and social determinants play a notable part in the disease impact on a patient; for instance, diabetes-induced renal failure can vary among different racial and ethnic groups. Moreover, the lack of information on patients with diabetes-induced-renal failure, such as education, financial position, and accessibility factors, impact intervention strategies (Quiñones & Hammad, 2020). Detailed analysis of these factors can help improve patient outcomes in a personalized care manner and enhance organizational performance. 

Proposes of Change Strategies to Achieve Outcomes

The paper addresses the complex situation of diabetes-induced renal failure in the ICU that causes psychiatric concerns and increases mortality or morbidity rates. As displayed in the table, the aim is to achieve desired outcomes through psychological support and enhance quality of life by disease recovery. Changing ICU care delivery practices through training and educational programs can achieve outcomes. 

Psychological Support Initiative 

A psychiatric team comprising counselors, therapists, and social workers to address the traumatic stress and anxiety that diabetic patients with renal failure in the ICU face. The common reasons for these emotions are isolation, complications leading to feeling lost, and dissatisfaction (Seery & Buchanan, 2022). The psychological team in the ICU can help patients with one-to-one sessions in which they can show a positive perspective of their condition and management techniques. Another strategy in the psychological initiative is group therapy, which improves patients’ morale, reducing the feeling of isolation.

Group therapy allows similar cases to validate feelings, enhance understanding, and share coping strategies (Malhotra & Baker, 2022). Psychological support will also involve educational strategies to manage their conditions effectively by involving the patient’s family and friends. Moreover, several calming strategies suitable for individual patients, like pet or music therapy, can help reduce stress, feelings of isolation, and anxiety associated with the ICU environment or treatment (Mansouri et al., 2020). 

Disease Recovery Program 

Different outcomes are interrelated; for instance, changing ICU care delivery practices can improve patient satisfaction and reduce morbidity or mortality rates. Diabetic patients suffering from kidney failure and facilitating themselves with dialysis or medication adherence in the ICU require holistic and careful considerations for recovering from diabetic symptoms, pain, and symptom management. It is possible through a change in the ICU environment. Staff training and educational programs are essential to achieve the outcomes (Khaleghi et al., 2020). A patient-centered approach for patients with renal failure is practical; it involves managing multiple factors that can impact their health.

Tight glycemic control protocols, education on diabetes management to tackle weak immune systems, and training on optimizing comorbid conditions like renal failure of diabetic patients can improve care delivery practices (AlHaqwi et al., 2023). Medication adherence is an essential aspect of managing diabetic-related pain and symptoms. Patient education and nurse-staff collaboration are essential to developing medication adherence and regimens and preventing complications (Aremu et al., 2022). The outcomes are also achievable through staff training and collaboration about renal and diabetes health, pain, and symptom management in the ICU. Training on managing environmental stressors like lights, noise, hygiene, and interruptions in the ICU can help reduce stress and anxiety in patients and staff members, enhancing productivity and outcomes (Souza et al., 2022).  

Potential Difficulties

To implement these strategies, there are a few expected difficulties like resource constraints, staffing level, and resistance to change. Resource constraints include equipment, supplies, and funding to create a clean, calm environment that holistically delivers care. Conducting meetings on the seriousness of the issue and benefits of resource allocation in ICU can bring change in funding or allocation policy. It will significantly enhance patient satisfaction and reduce stress and outcomes (Haque et al., 2021). Staffing levels can also pose difficulty; hiring a psychological team that still needs to be present in the ICU can delay or challenge the implementation of psychological initiatives.

A low nurse-patient ratio and recruiting a skilled psychological team can help achieve outcomes (Jeong, 2023). Lastly, resistance to change in ICU care delivery practices by staff and patient medication adherence is expected and poses a potential challenge. However, training on the benefits of coordinated care and environmental changes on staff performance and workload can tackle resistance and educate patients, encouraging adaptation sooner rather than later (Khaleghi et al., 2020). 

Justification for Specific Change Strategies 

Several studies highlight the impact of comorbid diseases on mental health, highlighting the importance of addressing mental health while treating physical health issues. The psychological support team can help manifest better outcomes through peer support, therapies, and counseling (Seery & Buchanan, 2022). Studies also support training and education to improve staff performance in managing complicated diseases and disease recovery. Studies show that training and education can assist in changing patient-centered care integration and modifying environmental factors, facilitating seamless processes and disease recovery (Khaleghi et al., 2020).

Research shows that a patient-centered approach enhances patient satisfaction and improves outcomes (AlHaqwi et al., 2023). Failure to implement psychological support, training, and educational programs for diabetes-related kidney failure patients and ICU staff will have adverse outcomes. It results in higher rates of illness and death, lower standards of living, complicated health, and raised costs for patients and health organizations.

Ways Strategies that Lead to Quality Improvement 

The psychological support and disease recovery initiatives for staff members aim to improve quality by ensuring a safe and equitable environment. As discussed, several factors can lead to inefficient care management in the ICU for diabetes-related renal kidney failure, such as social determinants and demographic characteristics. The psychological support in the ICU ensures that the traumatic stress and anxiety of patients are tackled in an empathetic and coordinated manner. This approach aligns with the Quadruple Aim framework that encourages enhanced patient experience and community health and reduces the cost and work-life of healthcare providers (Rangachari, 2023). Similarly, disease recovery programs through training and educating staff in the ICU through a patient-centered approach.

Additionally, adapting to change allows for an equitable and safe environment, reducing burden, stress, and adverse outcomes for healthcare providers. These strategies help manage costs associated with recurrent, prolonged hospital stays and poor medicine adherence (Bano et al., 2023). It also aligns with Quadruple Aim’s goal to improve the work-life of health personnel, leading to enhanced patient and community outcomes in a cost-effective manner (Rangachari, 2023).  

Assumptions upon Which the Explanation Is Based

The assumptions are the standardized and evidence-based practices that integrate a patient-centered, collaborative approach in the ICU for diabetes-related renal failure that can reduce errors, stress, and anxiety, promoting a safer and equitable environment. These practices allow increased engagement of patients and staff members, promoting satisfaction and enhancing outcomes (AlHaqwi et al., 2023). 

Ways Strategies that Ensure Successful Implementation

The suggested strategies can utilize interdisciplinary teams for psychological health and disease recovery. The patient-centered approach encourages health professionals from different backgrounds to provide comprehensive and holistic care to ICU patients with diabetes-related renal failure (Tong & Adler, 2022). Nurses, physicians, pharmacists, and psychologists collaborate to enhance work efficiency and communicate to improve medicine adherence by educating and developing a regimen to enhance patient satisfaction. Training for staff and patient education promotes interdisciplinary team contribution to achieving outcomes.

It allows for ethical and equitable care provision of the correct diagnosis, mental health support system, and medicine administration by nurses and other healthcare professionals in the ICU (Matusov et al., 2022). These change strategies allow for better management of a complex disease and allow for recovering diabetes-related issues, along with managing stress and anxiety. The diabetes-related kidney failure patients in the ICU can self-manage their health outcomes with the help of interdisciplinary team guidance and shared decision-making. 

Assumptions upon Which the Explanation Is Based

The assumptions for the explanation are based on the evidence that both strategies promote learning and improvement within their respective fields. The plan also allows the team to share accountability, promoting efficient roles from each health personnel in the ICU to manage diabetes-associated renal failure patients (Matusov et al., 2022). 

Conclusion

Conclusively, the proposed change strategies aim to address the complex challenges faced by diabetic patients with renal failure in the ICU, focusing on traumatic stress and anxiety while improving care delivery practices. These strategies are grounded on evidence-based practices and interdisciplinary efforts, promoting a safer, more equitable, satisfactory, and patient-centered environment.

References

AlHaqwi, A. I., Amin, M. M., AlTulaihi, B. A., & Abolfotouh, M. A. (2023). Impact of patient-centered and self-care education on diabetes control in a family practice setting in Saudi Arabia. International Journal of Environmental Research and Public Health, 20(2), 1109. https://doi.org/10.3390/ijerph20021109 

Aremu, T. O., Oluwole, O. E., Adeyinka, K. O., & Schommer, J. C. (2022). Medication adherence and compliance: Recipe for improving patient Outcomes. Pharmacy, 10(5), 106. https://doi.org/10.3390/pharmacy10050106 

Bano, T., Haq, N., Nasim, A., Saood, M., Tahir, M., Yasmin, R., Ahmed, N., Razzaq, G., Qudos, S., Zarkoon, A. K., & Shafi, M. (2023). Evaluation of medication errors in patients with kidney diseases in Quetta, Pakistan. PloS One, 18(8), e0289148. https://doi.org/10.1371/journal.pone.0289148 

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Haque, W. Z., Demidowich, A. P., Sidhaye, A., Golden, S. H., & Zilbermint, M. (2021). The financial impact of an inpatient diabetes management service. Current Diabetes Reports, 21(2). https://doi.org/10.1007/s11892-020-01374-0 

Jeong, E. (2023). Impact on health outcomes of hemodialysis patients based on the experience level of registered nurses in the hemodialysis department: A cross-sectional analysis. Frontiers in Health Services, 3, 1154989. https://doi.org/10.3389/frhs.2023.1154989 

Kaur, A., Sharma, G. S., & Kumbala, D. R. (2023). Acute kidney injury in diabetic patients: A narrative review. PMC, 102(21), e33888–e33888. https://doi.org/10.1097/md.0000000000033888 

Khaleghi, S., Moghaddam, A. S., Abdolshahi, A., Shokri, A., Raei, M., & Kavari, S. H. (2020). Training needs assessment of nurses working at intensive care unit with the aim of designing the in-service training program. Iranian Journal of Public Health. https://doi.org/10.18502/ijph.v49i11.4744 

Khoury, R., Ghantous, Z., Ibrahim, R., Ghossoub, E., Madaghjian, P., Karam, E. G., Karam, G., Fares, N., & Karam, S. (2023). Anxiety, depression and post-traumatic stress disorder in patients on hemodialysis in the setting of the pandemic, inflation, and the Beirut blast: A cross-sectional study. BMC Psychiatry, 23(1). https://doi.org/10.1186/s12888-023-04798-6 

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Malhotra, A., & Baker, J. (2022). Group therapy. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549812/ 

Mansouri, S., Jalali, A., Rahmati, M., & Salari, N. (2020). Educational, supportive group therapy and the quality of life of hemodialysis patients. BioPsychoSocial Medicine, 14(1). https://doi.org/10.1186/s13030-020-00200-z 

Matusov, Y., Matthews, A., Rue, M., Sheffield, L., & Pedraza, I. F. (2022). Perception of interdisciplinary collaboration between ICU nurses and resident physicians during the COVID-19 pandemic. Journal of Interprofessional Education & Practice, 27, 100501. https://doi.org/10.1016/j.xjep.2022.100501 

Pickkers, P., Darmon, M., Hoste, E., Joannidis, M., Legrand, M., Ostermann, M., Prowle, J. R., Schneider, A., & Schetz, M. (2021). Acute kidney injury in the critically ill: An updated review on pathophysiology and management. Intensive Care Medicine, 47(8), 835–850. https://doi.org/10.1007/s00134-021-06454-7 

Quiñones, J., & Hammad, Z. (2020). Social determinants of health and chronic kidney disease. Cureus, 12(9). https://doi.org/10.7759/cureus.10266

NURS FPX 6021 Assessment 2 Change Strategy and Implementation 

Rangachari, P. (2023). The untapped potential of the quadruple aim of primary care to foster a culture of health. International Journal of General Medicine, 16, 2237–2243. https://doi.org/10.2147/IJGM.S416367 

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). https://doi.org/10.1007/s40620-022-01437-3 

Souza, R. C. da S., Calache, A. L. S. C., Oliveira, E. G., Nascimento, J. C. do, Silva, N. D. da , & de Brito Poveda, V. (2022). Noise reduction in the ICU. JBI Evidence Implementation, Publish Ahead of Print. https://doi.org/10.1097/xeb.0000000000000311 

Tong, L.-L., & Adler, S. G. (2022). Diabetic kidney disease treatment: new perspectives. Kidney Research and Clinical Practice, 41(Suppl 2), S63–S73. https://doi.org/10.23876/j.krcp.21.288 

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