NURS FPX 4900 Assessment 1 Assessing the Problem: Leadership Collaboration Communication Change Management and Policy Considerations CG

Introduction

Hello and welcome. This is going to be a video of reflection for my capstone.

This is for class. NURS FPX 4900 Assessment 1 enjoy. This capstone project was created to address heart disease within my family.

Heart And Cardiovascular Diseases

This is about my grandmother and my mother.

They are my patients. My grandmother previously had a heart attack and a stroke which has left her with mobility and vision issues. She has had chronic hypertension related to nonadherence to her medication regimens and lifestyle habits.

My mother, who is also her caregiver, struggles with hypertension as well, is pre-diabetic, has insomnia, and chronic insomnia for years, and has been experiencing caregiver burnout for years as well. They both lack consistency, urgency, and discipline to follow recommendations to manage their disease process successfully. Over time this has led to the worsening of the condition with other complications that stem from this disease.

My goal with this capstone project is to effectively bring awareness to the issue and create an intervention to inspire change. The desired outcome would be for the patients to accept the need for a change and make a consistent effort towards improving their lifestyle habits for a change to be effective and continuous as an intervention. I have created a brochure covering the primary categories that if modified, will significantly impact the patient’s life.

These categories are attainable to adjust in. The change is not expected to happen overnight, but the objective is to make minor changes daily. With repetition, reminders, and reevaluation, the patients will be able to build a solid foundation that they can build upon that will result in significant sustainable changes.

Focusing on consistency and micro adjustments will result in a 180-degree turn which is sustainable change. Instead of having a temporary change that will result in a 360-degree turn, that 360 is a circle that will leave the patients where they started. See how I started here.

Now I have ended here. So we want 180, we want change. The categories of the brochure covered were medication, safety and adherence, dash diet, exercise, stress management, fall prevention, and resolution, as well as community resources available for the patient and caregiver.

We have had multiple meetings over the past few weeks. I’ve tried to teach in small doses over multiple times in a day or multiple interactions every day. The meetings were primarily held in the patient’s house and on the go or in the car or in the store or in the hospital, just wherever the patient was because the patient, patient, the caregiver is always on the move.

And I was on the move with them because there were no excuses, right? I also did microdoses because I noticed that by giving too much information at once, nothing would ever be grasped or understood. It would be too overwhelming for them. So small doses have successfully worked.

Senior Health

I try to base the teaching on whatever was happening that day. For example, if we were taking my grandmother’s blood pressure and it was high, or if it wasn’t high blood pressure being taken. I would take advantage of showing them that education by the American Heart Association and the CDC, the proper positioning on how to take blood pressure, where your arm should be, where the cuff should be, and cuff size.

I would also take advantage of this moment to remind you about medication adherence. Have you taken your hypertensive medications today? Did you? You take them twice a day, as prescribed, instead of every other day, as you usually do. So I just tried to adapt the teaching to whatever I saw happening at that time.

The meetings usually took one to three hours depending on what was happening that day. There are so many interruptions and demands of the caregiver, especially unexpected events and guests always arrive at the patient’s home, which makes it very challenging. Having the patient’s attention for more than a few minutes was a struggle and it required patience, kindness, and consistency.

When presenting the intervention to the family, the caregiver agreed that this was an issue and that there was a constant unfortunate event happening due to the mismanagement of the disease. They recognized the adverse effects it has had on the family and the safety implications involved. The caregiver verbally recognized that they had not previously acknowledged the long-term effects of this disease process and the lack of compliance with the doctor’s recommendations.

The caregiver also verbalized recognizing the urgency of the problem and how it is time to make adjustments as they are exhausted in dealing with the repercussions of this issue. The intervention was helpful and well-received. The patients and caregivers appreciated reading the information in their language and speech Spanish.

They felt like they were able to comprehend it better than ever previously explained. I found it interesting how the patients paid more attention to the visuals and the pictures and they drew lessons and explanations from the pictures that I never even imagined that they would because I didn’t. So it just shows the impact of visuals.

They seem to have more impact than words. I previously spent years sharing similar information and data with them, but I’ve never witnessed the positive acceptance and response that I did while presenting my intervention. They found it easy to follow and they decided to even blow it up into a poster to keep it in the common areas of the house as daily reminders.

Healthy Living

The patients and I discussed how to apply the suggested changes immediately. There’s no time like the present. The caregiver has already decreased the use of salt with cooking and has exchanged sugary snacks for healthy alternatives based on the dash diet presented in the brochure by the CDC.

The caregiver has also begun to practice stress management suggestions in hopes of decreasing the caregiver burnout and fatigue. Because if you take care of yourself, you will be able to take care of others better. And they also plan to try to increase movement.

So the caregiver plans to take walks while my grandmother takes a nap. My grandmother has already begun the wheelchair exercises. She does this one.

She likes this one. So we’re gonna try to expand that. But there were multiple pictures in the brochure.

She also does the chest expansion one. So increased movement is most definitely a plus to win in my book. A medication calendar was made to put on the wall to follow all the prescriber’s instructions.

The patients have learned how to properly take their blood pressure, and they’re putting that into practice daily. Furthermore, the caregiver plans to contact three of the community resources listed to inquire about the needed services. The transportation, the Meals on Wheels, and the aging and disability office.

They shared the difficulty of sticking to new changes during a crisis. So they aim to apply these suggestions from the brochure under normal circumstances. But like, there’s always something going on, and they see that there could potentially be a struggle because, during a crisis or an emergency, our body tends to revert back to its old habits.

This week has been specifically challenging because my grandmother has been admitted to the hospital with heart failure and pulmonary complications. In general, the patient does not have a routine or structure, but especially with this occurrence has made it very challenging to practice new suggestions. So.

So we also have a goal of putting some kind of routine together so we can attach the new intervention or the new practices with a habit like if you’re brushing your teeth. Oops, now it’s time to take my medication. Because when you’re pairing something new with a habit that you’re already going to do, it makes it easier for it to be sustainable long term.

The caregiver verbalized the challenge of maintaining the lifestyle modifications because of how they were raised. And the culture encourages the unhealthy behaviors they are trying to adjust. Although the patient has not had much time to put these changes into practice in the short period of days that they have been practicing, their Caregiver and patient convey a positive effect it’s had.

Practicing healthier habits and behaviors has made them feel happier and gives them a sense of healthiness. Also, the environment has been more hopeful. In an optimistic mental shift after a healthy meal or movement, the patients feel increased health and happiness.

Medical Health

The intervention did come with anticipated adverse effects as well. The patients state that the biggest obstacle besides adjusting old habits is addressing family and friends. The culture applauds being rebellious to medical recommendations and living in the present moment.

Many friends and family have opposed the changes that are needed. They seem to feel offended, neglected, and criticized when the patients don’t indulge in unhealthy meals, excessive alcohol consumption, and sweets. The family has also discouraged coordinating care with physical therapy or speech therapy.

Physical Therapy

Psychologists, and neurologists, deem it to be excessive, excessive, unnecessary and an inconvenience and they have been discouraging my patients from practicing this. So maintaining an environment of positivity and for the patients to have self-motivation and try to ignore the opposing opinions of their loved ones will be a daily struggle for them. But I know they got this.

The patients must instill the recommended changes and it will contribute to better disease management and prevent further worsening of heart disease. It is a preventative measure from suffering further complications and safety hazards related to heart disease, improving their quality of life. In the long term.

The patient will be able to measure effectiveness by keeping a record of baseline vitals like blood pressure, heart rate, and respiratory rate and also keeping a record of how they feel. How do you feel about your health today? How does your mental health feel? What’s your energy level? I feel like keeping track of these things. You’re able to measure the effective effectiveness as well as when you have your baseline blood work and feedback from your doctor every time you go back.

That’s a good way to measure as well. To create my intervention, I first researched the disease process and treatments. I only use evidence-based information to inform my research.

I really admire how peer review literature goes through such a rigorous process to ensure credibility and high-quality care. It is vital to recommend solutions that will make a positive impact specific to the disease process and that is recent peer-reviewed evidence. Recent technology made it possible to access this data, statistics, and studies.

I only recently used peer-reviewed data and government websites like the Center for Disease and Control, CDC. I also was able to access state websites that provided details about the New Jersey Board of Nursing standards as well as their scope of practice for nurses. It is important for me to use the nursing process to assess my patient’s needs and lifestyles in a holistic form from head to toe, from inside to outside.

Learning about leadership styles and change management options impacted my research the most. I believe that the delivery of the information is more impactful than the information itself. It is imperative in the clinical setting to deliver patient teaching in a simple, comprehensive way that the patient and their family will understand while keeping ethics and culture in mind.

Technology has also enabled access to pictures, and incredible graphics in the patient’s language. Without current technological advances, it would have taken me weeks to research and compile all this information. I struggled to locate information in Spanish, which I found a little bizarre like it’s a very common language in my state.

In the future, I would like government websites or even other credible websites that provide information and resources to patients to have information available in multiple languages, which should not be a challenge as technology has made translating easier. It should be more effortless to access, especially if there’s a particular culture or ethnicity that is a higher risk. The information should be available in those languages to teach the at-risk population in their native language.

Health Policies Positively Influence My Patients. I’ve learned about so many policies that are specific to heart disease. The government funds many policies and programs that collaborate with organizations specific to the at-risk population. I would really like to see this information be generously shared with the at-risk patients as many patients are not aware of the resources that are available to them.

Eldercare

As a baccalaureate nurse, I have learned how policies influence change and the process needed to instill change within an organization. During my capstone, I’ve come to the conclusion that a policy should be created that requires providers to spend a specific amount of time with a patient to deliver culturally sensitive care and teaching to patients. Most providers are in a rush and the patients have no idea what’s happening with their own health.

Enough time is not taken to effectively communicate with these patients, much less to teach them how to improve their health. Before patients leave the doctor’s office or hospital, they should know the problem, the solution, and the public resources available to them. Everyone from the doctor to the nurse to the discharge planner to the social worker.

They speak really fast to the patients, they get all the signatures they need and they run out. And everyone wonders why the mortality rate is so high in preventable diseases. A policy should enforce these requirements for everyone on the patient’s interprofessional team.

In addition, there should be a policy requiring follow-up with the patient whether it’s a phone call or a telehealth appointment. A follow-up would include answering any additional questions or enforcing the teaching. Given there is such a lack of policies for a successful paper-patient continuum of care, it impacts readmissions, adherence to treatments, and the comprehension of the teaching provided.

Virtual Reality

This capstone project has exceeded my expectations. I enjoyed how I could complete what I have learned through the entire program and compile. I compiled everything I learned in this program and put into practice something that I’m passionate about.

I did not expect such a positive response from my patients because in the past I have not had such a positive response. However, I learned that if I adjusted the way I taught my patients and the approach this is possible. This enforces the need to not only build rapport with your patients but also assess the best way that they will be receptive to the teaching that they need.

In my practice, I will be sure to customize my teaching delivery to each patient’s needs. During this BSN program, I have professionally grown and personally, I have seen the importance of continued education. I’ve learned why practicing nursing ethically is obligatory in all situations.

I have seen how collaboration and communication are not an option but a requirement to deliver the best care to the patient. I’ve learned the different roles nurses can work and how they influences the patient. And I never knew nurses could have such an impactful, powerful impact on research and policy setting.

Mental Health

I’ve learned how to advocate for my patients with data and presentations instead of just talking to them blue in the face. I’ve learned how to approach management if I desire to change and what I need to present to them, how to research benchmarks and statistics, and how this influences future research guidelines, government policies, and goals. I never knew all the resources and policies that were available and that supported patients, especially in my town.

Conclusion

There are so many community resources that nobody really knows about and they can benefit from. I’ve seen how technology advances and an informatics nurse can benefit patients. And no matter what a nurse is doing, what position they’re in, whether it’s in technology, in the community and care coordination, inpatient, or outpatient, I’ve just seen how they can have a positive influence in a patient’s life.

My devotion has grown and I’ve learned to be a more competent nurse who is equipped to deliver the safest, highest quality patient care. Now I see the value and the necessity of becoming a baccalaureate-prepared nurse. I have also witnessed how many common mistakes are made in the clinical setting and it makes me aware of things that I need to look out for on my own unit.

I have personally learned how to advocate for myself, my family members, and my patients. It has made me feel capable that I know how to advocate suitably. Advocacy can only make a difference if done tactfully.

I have so much to learn and I would like to perfect what I’ve learned so it can become like second nature to me. As I gain more clinical experience and continue my education, I will be a better me for my patients. I made it through.

Thank you very much for taking the time to read my presentation. Have a wonderful day.

References

• Birch, K., Ling, A., & Phoenix, B. (2020). Psychiatric nurse practitioners as leaders in behavioral health integration. The Journal for Nurse Practitioners, 17(1). 
• ‌Campbell, C., Ordunez, P., Giraldo, G., Rodriguez, A., Lombardi, C., Khan, T., Padwal, R., Tsuyuki, T., & Varghese, C. (2021): A global program to reduce cardiovascular disease burden: Experience implementing in the Americas and opportunities in Canada. The Canadian Journal of Cardiology, 37(5), 744–755. 
• DeFilippis, M., Stefanescu, C., & Reza, N. (2020). Adapting the educational environment for cardiovascular fellows-in-training during the COVID-19 pandemic. Journal of the American College of Cardiology, 75(20), 2630–2634. 
• Nicholls, J., Nelson, M., Astley, C., Briffa, T., Brown, A., Clark, R., Colquhoun, D., Gallagher, R., Hare, L., Inglis, S., Jelinek, M., O’Neil, A., Tirimacco, R., Vale, M., & Redfern, J. (2020). Optimizing secondary prevention and cardiac rehabilitation for atherosclerotic cardiovascular disease during the COVID-19 pandemic: A position statement from the cardiac society of Australia and New Zealand (CSANZ). Heart, Lung and Circulation, 29(7), e99–e104. 
• Pallazola, A., Davis, M., Whelton, P., Cardoso, R., Latina, M., Michos, D., Sarkar, S., Blumenthal, S., Arnett, K., Stone, J., & Welty, K. (2019). A clinician’s guide to healthy eating for cardiovascular disease prevention. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 3(3), 251–267. 
• Pereira, C., Silva, N., Carvalho, S., Zanghelini, F., & Barreto, M. (2022). Strategies for the implementation of clinical practice guidelines in public health: An overview of systematic reviews. Health Research Policy and Systems, 20(1). 
• Stollenwerk, D., Kennedy, L., Hughes, L., & O’Connor, M. (2019). A Systematic Approach to Understanding and Implementing Patient-Centered Care. Family Medicine. 
• ‌White, C., Rossi, P., Bittner, A., Driscoll, A., Durant, W., Granger, B., Graven, J., Kitko, L., Newlin, K., & Shirey, M. (2020). Addressing social determinants of health in the care of patients with heart failure: A scientific statement from the American heart association. Circulation, 141(22). 
• Wood, A., Mahmud, E., Thourani, H., Sathananthan, J., Virani, A., Poppas, A., Harrington, R. A., Dearani, A., Swaminathan, M., Russo, M., Blankstein, R., Dorbala, S., Carr, J., Virani, S., Gin, K., Packard, A., Dilsizian, V., Légaré, F., Leipsic, J., & Webb, G. (2020). Safe reintroduction of cardiovascular services during the COVID-19 pandemic. Journal of the American College of Cardiology, 75(25), 3177–3183. 
• Yasin, M., Kerr, S., Wong, A., & Bélanger, H. (2019). Factors affecting nurses’ job satisfaction in rural and urban acute care settings: A PRISMA systematic review. Journal of Advanced Nursing, 76(4), 963–979.