Assessment 1 Instructions

Assessment 1 Instructions

The Health Problem and the Population

 Type two diabetes is one of the leading lifestyle medical conditions in the world. Type two diabetes is a health problem common in adults above the age of 45 years (Bellou et al., 2018). Men are at high risk of being diagnosed with type two diabetes than females. The risk factors of type two diabetes include being overweight or obese, having a family history of diabetes, physical inactivity, high cholesterol levels, race, smoking, and drinking alcohol (Bellou et al., 2018). Age is also a risk factor, with people above 45 years being at high risk of developing diabetes. In the USA, diabetes mellitus is the 7th leading cause of death and affects approximately 29.1 million people (Bellou et al., 2018).

The prevalence rate of type two diabetes is high in males above the age of 45 years. Therefore, type two diabetes mellitus in older male adults is the chosen health problem to be assessed. In this case, the patient is Mr. Paul, a 65-year-old African-American male diagnosed with type two diabetes mellitus three years ago. After being diagnosed with the medical condition, Mr. Paul claims that he was taught how to use his medication and the importance of adhering to the medications. He, however, claims that he was not educated on lifestyle modification. Despite being diagnosed with diabetes, the patient claimed that he continued his sedentary lifestyle where he could smoke daily, take alcohol and eat food with fats. He also claims that he does not perform any exercise.

Evidence from Peer-Reviewed Literature

There is enough evidence showing the relationship between lifestyle and type 2 diabetes mellitus. Zhang et al. (2020) investigated the association of at least three lifestyle factors with diabetes and the health outcome of the factors among diabetes patients. The researchers found out that participants who adopted a healthy lifestyle had a reduced risk of type two diabetes (Zhang et al., 2020). The participants with the healthiest lifestyle had a 75% lower risk of diabetes incidence (Zhang et al., 2020). According to Zhang et al., more than 14 studies where more than one million participants were used showed more evidence that a healthy lifestyle was associated with decreased incidence of type two diabetes. Therefore, the work of Zhang and colleagues, together with the 14 studies used in their work, prove that adopting a healthy lifestyle reduces the risk of type 2 diabetes (Zhang et al., 2020). Healthy exercises, as found out by Zhang et al., also reduce the adverse effects of type 2 diabetes. The study of Zhang et al. insisted on the importance of dealing with all risk factors associated with type two diabetes instead of concentrating only on lifestyle modification (Zhang et al., 2020). Effective management of diabetes requires nurses to focus on all aspects such as nutrition and other risk factors.

Zhang, Du, and Ma (2017), in their work, reported on current lifestyle factors that increased the risk of type 2 diabetes. According to the researchers, factors such as food consumption, economic factors, people’s behaviors, and lifestyle factors played an essential role in the increase in type two diabetes cases (Zhang, Du, and Ma, 2017). Eating food with many fats and feeding on a lot of cereals was associated with an increase in type two diabetes. Other factors identified by Zhang, Du, and Ma that increase the adverse effect of type two diabetes included smoking, consumption of sugar-sweetened food and beverage in high quantities, and omitting meals such as breakfast (Zhang, Du, and Ma, 2017). Zhang, Du, and Ma also highlighted insufficient physical inactivity and poor sleep patterns as causes of increasing type 2 diabetes and complications. Zhang, Du, and Ma (2017) support the existing evidence that an unhealthy lifestyle increases the adverse effects of type two diabetes. The unhealthy lifestyle stated by Zhang, Du, and Ma include a high intake of carbohydrates and fats, a sedentary lifestyle, and obesity (Zhang, Du, and Ma, 2017). Effective prevention and management of diabetes should therefore include lifestyle management.

Studies have also been conducted on the nursing management of patients with type two diabetes. Valenzuela-Suazo, Guerrero-Núñez, and Cid-Henríquez (2018) in their study described the features of nursing care of patients with type two diabetes. The focus of the research was based on primary nursing care and on the theory of bureaucratic caring. According to Valenzuela-Suazo et al. (2018), nursing care of patients with type two diabetes should include education of the patient, physical aspect of the patient, the legal aspect, the economic aspects, and the social-cultural aspects of the patient (Valenzuela-Suazo, Guerrero-Núñez, and Cid-Henríquez, 2018). Focusing on all these factors improves the outcomes when caring for a patient with diabetes. Evidence also indicates that there is a need to be consistent in implementing clinical interventions to improve the outcomes of patients with type 2 diabetes. Kitsiou, Paré, Jaana, and Gerber (2017) suggested that with modern technology, telemonitoring and the use of mHealth interventions are some of the best ways of type 2 management self–management (Kitsiou, Paré, Jaana & Gerber, 2017). Patient education is essential in ensuring self-management of type two diabetes. The evidence from the research shows that teaching diabetic patients is one of the management components. Patient education should focus on nutrition and lifestyle modification.

Nursing Practice Standards

The nursing practice standards may slightly differ from one state to another, but the majority of the states have similar standards. Every state has got its own Nursing Practice Act that guides the nurses working in the states. The Nursing Act in each state ensures that only competent and qualified nurses are employed to provide nursing services. In Texas, for example, the mission of the nursing board is to “protect and promote the welfare of the people of Texas by ensuring that each person holding a license as a nurse in the state is competent to practice safely” (Texas Board of Nursing, 2019). Ideally, nurses in each state should be aware of their Nurse Practice Act and ensure they work within their scope of practice.

Enforcement of the practice standards in nursing improves the quality of nursing care. Qualified and competent nurses are employed, which improves the quality of care. The nurses also practice within their scope of practice which ensures efficiency and improves patient outcomes. The practice standards are created considering ethical principle which also protects the rights the patients. Implementation of the practice standards in each state improves the quality of care given to diabetic patients since there will be no gaps in the management of diabetes (Texas Board of Nursing, 2019). The patient outcomes will improve, and there will also be a reduction of medical errors. Well-developed standards and policies improve the nursing care process, which is key in managing type two diabetes, especially on lifestyle modification.

Leadership Strategies to Improve Patient Outcomes

Diabetes is common, and a lot of patients in hospitals suffer from the condition. The condition is chronic, and therefore effective and long-term leadership strategies are best for ensuring the condition is managed. A multidisciplinary approach is one of the best leadership strategies to improve the outcomes of patients with type two diabetes. The approach involves the collaboration of nurses, physicians, pharmacists, nutritionists, physiotherapists, and social workers in caring and managing for patients with diabetes (Buggy & Moore, 2017). Many aspects such as adherence to medication, nutrition, physical exercise, counseling on smoking, and taking alcohol are all used in managing patients. Nurses also alone cannot provide the services to diabetic patients, and their collaboration with other health workers improves patient outcomes (Buggy & Moore, 2017).

The other strategy is adapting the use of mHealth and electronic health records (EHR). Type 2 diabetes is a chronic disease, and therefore the use of EHR and mHealth will help in monitoring the progress of the patients for long periods (Lyles ET AL., 2017). This included the effectiveness of medication and improvement based on interventions that focus on lifestyle factors. MHealth also helps in patient self-management. With EHR and MHealth, there will be efficiency and effectiveness in managing patients with type 2 diabetes (Lyles ET AL., 2017).

Part 2: Assessment of the Problem

Mr. Paul, a 65-year-old African-American male, was diagnosed with type two diabetes mellitus three years ago. The patient has been struggling to maintain his blood glucose level within the normal range for the past three years. The patient noted that his blood glucose levels have been increasing despite adhering to his medication. Mr. Paul has increased his weight and still smokes and takes alcohol because he claims he was not told to stop. He also does not perform any physical activity. On assessment, the patient was aware of his condition but lacked knowledge on lifestyle modification to manage his condition.

An essential aspect of the management of Mr. Paul is patient education to help him manage his condition. Diabetes is a chronic condition, and therefore patients should have continuous education on how to live with their conditions. Continuous education on adherence to medication and lifestyle modification reduces the adverse effects of type two diabetes. The complication of the disease is also reduced since the patient is able to manage himself. Based on middle-range theory, effective communication with patients is essential in the management of diabetes. Nurses should have effective communication skills when educating patients and relatives on their conditions. During nurse-patient education, the nurse should prioritize lifestyle modification as the best strategy for managing type two diabetes. In this case, Mr. Paul should accept to modify his lifestyle, such as perform some physical activity on a daily basis and stop smoking to improve the outcomes. Mr. Paul should also stick to his medication and plan of care.

Barriers that may arise include the patient’s not cooperating, the high cost of management due to lack of health insurance by the patient, and stress resulting from racial abuse of the patient. Collaboration of health care providers in the provision of care helps in dealing with some of the challenges such as stress and ensuring cooperation. Allowing the patient to express his feeling also helps in dealing with barriers to improve patient outcomes. Collaborating with social workers ensure that the financial issue of the patient are solved which ensure the patient gets the right quality of care. The change management strategy used is creating a sense of urgency supported by scope of practice standards and evidence in the nursing field.

References

Bellou, V., Belbasis, L., Tzoulaki, I., & Evangelou, E. (2018). Risk factors for type 2 diabetes mellitus: an exposure-wide umbrella review of meta-analyses. PloS one, 13(3), e0194127. https://doi.org/10.1371/journal.pone.0194127

Buggy, A., & Moore, Z. (2017). The impact of the multidisciplinary team in the management of individuals with diabetic foot ulcers: a systematic review. Journal of wound care, 26(6), 324-339. https://doi.org/10.12968/jowc.2017.26.6.324

Kitsiou, S., Paré, G., Jaana, M., & Gerber, B. (2017). Effectiveness of mHealth interventions for patients with diabetes: an overview of systematic reviews. PloS one, 12(3), e0173160. https://doi.org/10.1371/journal.pone.0173160

Lyles, C. R., Ratanawongsa, N., Bolen, S. D., & Samal, L. (2017). mHealth and health information technology tools for diverse patients with diabetes.

Texas Board of Nursing. (2019). Nurse Practice Act. Retrieved from http://www.bon.texas.govYang, M. H., Kang, S. Y., Lee, J. A., Kim, Y. S., Sung, E. J., Lee, K.

Valenzuela-Suazo, S., Guerrero-Núñez, S., & Cid-Henríquez, P. (2018). Nursing Care for Persons with Diabetes Mellitus Type 2, According to the Theory of Bureaucratic Care. Aquichan, 18(1), 20-31. https://doi.org/10.5294/aqui.2018.18.1.3 

Zhang, N., Du, S. M., & Ma, G. S. (2017). Current lifestyle factors that increase risk of T2DM in China. European journal of clinical nutrition, 71(7), 832-838. https://www.nature.com/articles/ejcn201741

Zhang, Y., Pan, X. F., Chen, J., Xia, L., Cao, A., Zhang, Y. & Pan, A. (2020). Combined lifestyle factors and risk of incident type 2 diabetes and prognosis among individuals with type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies. Diabetologia, 63(1), 21-33. https://doi.org/10.1007/s00125-019-04985-9

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Assessment 1 Instructions

In a 5-7 page written assessment, define the patient, family, or population health problem that will be the focus of
your capstone project. Assess the problem from a leadership, collaboration, communication, change management,
and policy perspective. Plan to spend approximately 2 direct practicum hours meeting with a patient, family, or
group of your choice to explore the problem and, if desired, consulting with subject matter and industry experts.
Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer
Experience Form.

Introduction

Nurses in all professional roles work to effect positive patient outcomes and improve organizational processes.
Professional nurses are leaders in problem identification, planning, and strategy implementation—skills that directly affect patient care or organizational effectiveness.
Too often, change agents jump to a conclusion that an intervention will promote the envisioned improvement.
Instead, the ideal approach is to determine which interventions are appropriate, based on an assessment and review of credible evidence. Interventions could be patient-facing or involve a change in policy and process. In this
assessment, you’ll identify and make the case for your practicum focus area, then explore it in depth from a
leadership, collaboration, communication, change management, and policy perspective.
This assessment lays the foundation for the work that will carry you through your capstone experience and guide the practicum hours needed to complete the work in this course. In addition, it will enable you to do the following:

• Develop a problem statement for a patient, family, or population that’s relevant to your practice.
• Begin building a body of evidence that will inform your approach to your practicum.
• Focus on the influence of leadership, collaboration, communication, change management, and policy on the
  problem.

Preparation
In this assessment, you’ll assess the patient, family, or population health problem that will be the focus of your
capstone project. Plan to spend approximately 2 hours working with a patient, family, or group of your choice to
explore the problem from a leadership, collaboration, communication, change management, and policy perspective.
During this time, you may also choose to consult with subject matter and industry experts about the problem (for
example, directors of quality or patient safety, nurse managers/directors, physicians, and epidemiologists).
To prepare for the assessment, complete the following:

• Identify the patient, family, or group you want to work with during your practicum The patient you select can
  be a friend or a family member. You’ll work with this patient, family, or group throughout your capstone
  project, focusing on a specific health care problem.
• Begin surveying the scholarly and professional literature to establish your evidence and research base, inform
  your assessment, and meet scholarly expectations for supporting evidence.

In addition, you may wish to complete the following:

• Review the assessment instructions and scoring guide to ensure that you understand the work you’ll be asked
  to complete and how it will be assessed.
• Review the Practicum Focus Sheet: Assessment 1 [PDF], which provides guidance for conducting this portion
  of your practicum.

Note: Remember that you can submit all, or a portion of, your draft assessment to Smarthinking Tutoring for
feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24–48 hours for receiving feedback.

Instructions

Complete this assessment in two parts.
Part 1
Define the patient, family, or population health problem that will be the focus of your capstone project. Assess the
problem from a leadership, collaboration, communication, change management, and policy perspective and
establish your evidence and research base to plan, implement, and share findings related to your project.
Part 2
Connect with the patient, family, or group you’ll work with during your practicum. During this portion of your
practicum, plan to spend at least 2 hours meeting with the patient, family, or group and, if desired, consulting with
subject matter and industry experts of your choice. The hours you spend meeting with them should take place
outside of regular work hours. Use the Practicum Focus Sheet [PDF] provided for this assessment to guide your work
and interpersonal interactions. Document the time spent (your practicum hours) with these individuals or group in
the Core Elms Volunteer Experience Form.

CORE ELMS

Complete the NURS-FPX4900 Volunteer Experience Form in CORE ELMS. Include a description of your relationship
to the patient, family, or group in the Volunteer Experience comments field.

Requirements
The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each
main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In
addition, note the additional requirements for document format and length and for supporting evidence.
Define a patient, family, or population health problem that’s relevant to your practice.

• Summarize the problem you’ll explore.
• Identify the patient, family, or group you intend to work with during your practicum.
• Provide context, data, or information that substantiates the presence of the problem and its significance and
• relevance to the patient, family, or population.
• Explain why this problem is relevant to your practice as a baccalaureate-prepared nurse.

Analyze evidence from peer-reviewed literature and professional sources that describes and guides nursing actions related to the patient, family, or population problem you’ve defined.

• Note whether the authors provide supporting evidence from the literature that’s consistent with what
  you see in your nursing practice.
• Explain how you would know if the data are unreliable.
• Describe what the literature says about barriers to the implementation of evidence-based practice in
  addressing the problem you’ve defined.
• Describe research that has tested the effectiveness of nursing standards and/or policies in improving
  patient, family, or population outcomes for this problem.
• Describe current literature on the role of nurses in policy-making to improve outcomes, prevent illness,
  and reduce hospital readmissions.
• Describe what the literature says about a nursing theory or conceptual framework that might frame
  and guide your actions during your clinical practicum.

Explain how state board nursing practice standards and/or organizational or governmental policies could
affect the patient, family, or population problem you’ve defined.

• Describe research that has tested the effectiveness of these standards and/or policies in improving
  patient, family, or population outcomes for this problem.
• Describe current literature on the role of nurses in policy-making to improve outcomes, prevent illness, and reduce hospital readmissions.
• Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of this problem.

Propose leadership strategies to improve outcomes, patient-centered care, and the patient experience related to the patient, family, or population problem you’ve defined.Discuss research on the effectiveness of leadership strategies.

• Define the role that you anticipate leadership must play in addressing the problem.
• Describe collaboration and communication strategies that you anticipate will be needed to address the problem.
• Describe the change management strategies that you anticipate will be required to address the problem.
• Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form.

Organize content so ideas flow logically with smooth transitions.
Apply APA style and formatting to scholarly writing.
Additional Requirements
Format: Format your paper using APA style. Use the APA Style Paper Template. An APA Style Paper Tutorial is also provided to help you in writing and formatting your paper. Be sure to include:

• A title page and reference page. An abstract is not required.
• A running head on all pages.
• Appropriate section headings.
• Length: Your paper should be approximately 5–7 pages in length, not including the reference page.
• Supporting evidence: Cite at least five sources of scholarly or professional evidence that support your central
  ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.
• Proofreading: Proofread your paper, before you submit it, to minimize errors that could distract readers and
  make it more difficult for them to focus on its substance.

Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies
through the following assessment scoring guide criteria:

• Competency 1: Lead people and processes to improve patient, systems, and population outcomes.
  Define a patient, family, or population health problem that’s relevant to personal and professional  practice.
• Competency 2: Make clinical and operational decisions based upon the best available evidence.               Analyze evidence from peer-reviewed literature and professional sources that describes and guides nursing actions related to a defined patient, family, or population problem.Competency 5: Analyze the impact of health policy on quality and cost of care.
  Explain how state board nursing practice standards and/or organizational or governmental policies could affect a defined patient, family, or population problem.
• Competency 7: Implement patient-centered care to improve quality of care and the patient experience. Propose leadership strategies to improve outcomes, patient-centered care, and the patient experience related to a defined patient, family, or population problem and document the practicum hours spent with these individuals or groups in the Core Elms Volunteer Experience Form.
• Competency 8: Integrate professional standards and values into practice.
  Organize content so ideas flow logically with smooth transitions.
  Apply APA style and formatting to scholarly writing.