Student Name
Capella University
NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1
Prof. Name
Date
Change Strategy and Implementation
Renal failure occurs when the kidneys are unable to efficiently remove waste products and excess fluids from the bloodstream, leading to systemic complications (Nagendra et al., 2023). This analysis focuses on developing a patient-centered care plan for Mrs. Smith, a 52-year-old diagnosed with Type II Diabetes Mellitus and Acute Renal Failure (Capella University, 2024). The strategy emphasizes evidence-based interventions and interprofessional collaboration to optimize patient safety, equity, and outcomes.
Data Table
The table below summarizes the current clinical status of Mrs. Smith, the desired outcomes, and strategies based on guidelines from the American Diabetes Association (ADA) and the North American Nursing Diagnosis Association (NANDA). All data comply with Health Insurance Portability and Accountability Act (HIPAA) standards, ensuring patient confidentiality.
Table 1: Clinical Outcomes Assessment
| Clinical Outcome | Current State | Desired State | Target Improvement |
|---|---|---|---|
| Blood Glucose Levels | Fasting: 125 mg/dL; Postprandial: 140 mg/dL; occasional spikes 200–350 mg/dL. 60% of patients have insulin spikes | Fasting 80–130 mg/dL; Postprandial <180 mg/dL | 50% reduction in insulin spikes (Lin et al., 2021) |
| Renal Function | Mild leg edema; early signs of renal damage in blood tests. 30% of patients have renal issues | No edema; improved renal function; normal urine output | 20% improvement in renal function (ADA, 2022) |
| Self-Care and Social Support | Inconsistent dietary adherence; dependent on daughter for evening care; limited social interaction. 40% of patients unable to self-care | Consistent dietary management; increased social engagement | 95% of patients able to self-care (Martens et al., 2021) |
| Medication Adherence | Financial constraints affect adherence; 70% of patients face similar issues | Consistent medication adherence; financial barriers removed | 90% of patients receive financial assistance (Laursen et al., 2021) |
Areas of Ambiguity/Uncertainty
Additional information on Mrs. Smith’s diet, physical activity, and adherence patterns is necessary to identify factors contributing to her blood glucose fluctuations. A more detailed understanding of her financial constraints and social support network will allow for tailored interventions that address barriers to self-care and overall well-being (Lin et al., 2021).
Change Strategies for Desired Outcomes
For Mrs. Smith, implementing Continuous Glucose Monitoring (CGM) is critical to maintain optimal glycemic control, complemented by comprehensive diabetes education focusing on diet and lifestyle modifications (Martens et al., 2021). At the population level, standardizing CGM and dietary education can reduce insulin spikes by 50% across diabetic patients.
To improve renal function, diuretics should be administered as prescribed while regular monitoring identifies early signs of dysfunction. Collaborative care with nephrologists and timely interventions aim for a 20% improvement in renal health (ADA, 2022). Enhancing dietary management and social engagement will require coordination with dietitians and social workers, while community support groups and educational workshops aim to improve self-care capacity to 95% for the broader patient population (Do et al., 2020).
Addressing financial barriers involves connecting Mrs. Smith with assistance programs and simplifying her medication regimen. Broadly, establishing community partnerships can ensure 90% of patients receive financial support, improving medication adherence and health outcomes (Laursen et al., 2021). A multidisciplinary team—including endocrinologists, dietitians, nurses, social workers, and nephrologists—will regularly review progress and adjust care plans as needed. Challenges may include resistance to lifestyle changes and financial limitations, which can be mitigated through family engagement and community resources (Sugandh et al., 2023).
Justification of the Change Strategies
CGM is essential for real-time monitoring of blood glucose, enabling timely insulin adjustments and preventing hypoglycemia or hyperglycemia (ADA, 2022). Evidence shows that dietary education improves glycemic control, reducing the risk of complications (Martens et al., 2021). Diuretics are effective for managing edema and protecting renal function (Afify et al., 2023). Financial assistance programs directly impact medication adherence, addressing a common barrier to optimal care (Kvarnström et al., 2021).
Alternative approaches, such as dietary modifications for renal function and mental health support to improve adherence, are also crucial for holistic care (Karakuş et al., 2021; Bingham et al., 2020). Incorporating these perspectives ensures patient-centered, evidence-based interventions that consider potential barriers.
Quality Improvement in Safety and Equitable Care through Change Strategies
CGM improves patient safety by providing real-time blood glucose data, allowing immediate interventions to prevent diabetic emergencies like ketoacidosis (Martens et al., 2021). Diuretics manage fluid retention and enhance renal function, reducing the risk of further kidney damage (Afify et al., 2023). Comprehensive dietary management and social engagement foster improved self-care, leading to fewer complications and better overall outcomes.
Financial support strategies promote equitable care by removing barriers to medication adherence, ensuring 90% of patients have access to necessary treatments regardless of economic constraints (Kvarnström et al., 2021). These approaches also support the Quadruple Aim by improving patient experience and reducing provider burnout through preventive care and interprofessional collaboration (Clark et al., 2022).
How Change Strategies Will Utilize Interprofessional Considerations
The success of CGM and diabetes education relies on collaboration among endocrinologists, nurses, dietitians, and social workers (Martens et al., 2021; Ernawati et al., 2021). This team ensures proper patient training, consistent care, and timely intervention. Distributing responsibilities across the team enhances provider well-being, reduces burnout, and ensures a supportive work environment (Ernawati et al., 2021). Effective implementation assumes the availability of trained professionals and sufficient resources for CGM technology and educational programs (Nurchis et al., 2022).
Conclusion
Integrating CGM, diabetes education, and financial assistance will improve Mrs. Smith’s health outcomes while enhancing patient safety, equity, and interprofessional collaboration. These strategies support self-care, prevent complications, and foster the well-being of both patients and healthcare providers.
References
ADA. (2022). American diabetes association. Diabetes.org. https://diabetes.org/
Afify, H., Morales, U. G., Asmar, A., Alvarez, C. A., & Mansi, I. A. (2023). Association of thiazide diuretics with diabetes progression, kidney disease progression, cardiovascular outcomes, and death among patients with diabetes who initiate statins. The American Journal of Cardiology, 203, 274–284. https://doi.org/10.1016/j.amjcard.2023.07.057
Bingham, J. M., Black, M., Anderson, E. J., Li, Y., Toselli, N., Fox, S., Martin, J. R., Axon, D. R., & Silva-Almodóvar, A. (2020). Impact of telehealth interventions on medication adherence for patients with type 2 diabetes, hypertension, and/or dyslipidemia: A systematic review. Annals of Pharmacotherapy, 55(5), 637–649. https://doi.org/10.1177/1060028020950726
Capella University. (2024). Capella university: Online accredited degree programs. Capella.edu. https://www.capella.edu/
Clark, A., Jung, E., Prusky, C., Shah, B. R., & Halperin, I. J. (2022). An evaluation of virtual care for gestational diabetes using the quadruple aim framework: assessment of patient and provider experience, cost and clinical outcomes. Canadian Journal of Diabetes, 47(3), 236–242. https://doi.org/10.1016/j.jcjd.2022.12.002
NURS FPX 6021 Assessment 2 Change Strategy and Implementation
Do, J. Y., Kim, S. W., Park, J. W., Cho, K. H., & Kang, S. H. (2020). Is there an association between metformin use and clinical outcomes in diabetes patients with COVID-19? Diabetes & Metabolism, 47(4). https://doi.org/10.1016/j.diabet.2020.10.006
Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of diabetes self-management education (DSME) in type 2 diabetes mellitus (T2DM) patients: Systematic literature review. Journal of Public Health Research, 10(2), 198–202. https://doi.org/10.4081/jphr.2021.2240
Karakuş, K. E., Sakarya, S., Yeşiltepe Mutlu, G., Berkkan, M., Muradoğlu, S., Can, E., Gökçe, T., Eviz, E., & Hatun, Ş. (2021). Benefits and drawbacks of continuous glucose monitoring (CGM) use in young children with type 1 diabetes: A qualitative study from a country where the CGM is not reimbursed. Journal of Patient Experience, 8(1). https://doi.org/10.1177/23743735211056523
Kvarnström, K., Westerholm, A., Airaksinen, M., & Liira, H. (2021). Factors contributing to medication adherence in patients with a chronic condition: A scoping review of qualitative research. Pharmaceutics, 13(7). https://doi.org/10.3390/pharmaceutics13071100
Laursen, J., Melo, J. B., Haddock, B. L., Larsson, H., Frimodt-Møller, M., Andersen, U. L., & Rossing, P. (2021). Acute effects of dapagliflozin on renal oxygenation and perfusion in type 1 diabetes with albuminuria: A randomized, double-blind, placebo-controlled crossover trial. EClinical Medicines, 37. https://doi.org/10.1016/j.eclinm.2021.100895
Lin, R., Brown, F., James, S., Jones, J., & Ekinci, E. (2021). Continuous glucose monitoring: A review of the evidence in type 1 and 2 diabetes mellitus. Diabetic Medicine, 38(5). https://doi.org/10.1111/dme.14528
Martens, T., Beck, R. W., Bailey, R., Ruedy, K. J., Calhoun, P., Peters, A. L., Pop-Busui, R., Philis-Tsimikas, A., Bao, S., Umpierrez, G., Davis, G., Kruger, D., Bhargava, A., Young, L., McGill, J. B., Aleppo, G., Nguyen, Q. T., Orozco, I., Biggs, W., & Lucas, K. J. (2021). Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin. JAMA, 325(22). https://doi.org/10.1001/jama.2021.7444
NURS FPX 6021 Assessment 2 Change Strategy and Implementation
Nagendra, L., Fernandez, C. J., & Pappachan, J. M. (2023). Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives. World Journal of Transplantation, 13(5), 208–220. https://doi.org/10.5500/wjt.v13.i5.208
NANDA. (2020, October 6). NANDA International Nursing Diagnoses | NANDA International, Inc. NANDA. https://nanda.org/publications-resources/publications/nanda-international-nursing-diagnoses/
Nurchis, M. C., Sessa, G., Pascucci, D., Sassano, M., Lombi, L., & Damiani, G. (2022). Interprofessional collaboration and diabetes management in primary care: A systematic review and meta-analysis of patient-reported outcomes. Journal of Personalized Medicine, 12(4). https://doi.org/10.3390/jpm12040643
Sugandh, F. N. U., Chandio, M., Raveena, F. N. U., Kumar, L., Karishma, F. N. U., Khuwaja, S., Memon, U. A., Bai, K., Kashif, M., Varrassi, G., Khatri, M., Kumar, S., Sugandh, F., Chandio, M., Raveena, F. N. U., Kumar, L., Karishma, F. N. U., Khuwaja, S., Memon, U. A., & Bai, K. (2023). Advances in the management of diabetes mellitus: A focus on personalized medicine. Cureus, 15(8), 1–13. https://doi.org/10.7759/cureus.43697