Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations
Approximately 38 million Americans have type 2 diabetes, an incurable condition marked by increased circulating blood glucose stages, of whom 90–95% are type 2 diabetics (CDC, 2023). A strategy emphasizing leadership, collaboration, interaction, and deliberate change management throughout all treatment stages is necessary to treat this widespread illness effectively.
Physicians need to commit resources, educate personnel, and give priority to based on research diabetic care. Medical facilities must evaluate and optimize these characteristics to improve consequences for the millions of US citizens who have type 2 diabetes. A comprehensive approach that includes communication between providers and patients, interdisciplinary teamwork, realistic change administration, and supporting policies is necessary for successful administration.
Definition of Patient Health Problem
52-year-old man Karev has had unmanaged diabetes of type 2 for five years. He suffered from lethargy, poor eyesight, and slow-healing wounds after seeing his doctor for primary care. Karev’s father died at the age of 65 from cardiovascular disease, and his mother had type 2 diabetes. Karev has inadequate diabetic management, with hemoglobin A1C readings averaging 8.9%, although being on metformin and glipizide treatment.
Having a BMI of 32, he is overweight and finds it difficult to cut down on salt, refined sugars, and fats that are saturated in his diet. Karev has not experienced any severe consequences regarding his Type 2 diabetes, although he was hospitalized once for ketoacidosis due to diabetes. He has a greater chance of developing peripheral neuropathy, kidney failure, and heart attack; nonetheless, if the condition is not effectively managed, go ahead with drug changes, better eating habits, physical activity, weight reduction, and constant observation.
NURS FPX 4900 Assessment 1 Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations
Following two hours of watching Karev’s contacts with healthcare professionals and their collaboration with him on diabetic self-care, it is clear that he needs more information and involvement about lifestyle modifications and close commitment to medications and monitoring his glucose levels. Karev is going to require continuous support as well as finances to take charge of his chronic illness and enhance his long-term wellness results (Tri Rima Setyawati et al., 2023).
Relevance of Problem
Type 2 diabetes is a common and complicated health condition that is particularly important to my job as a baccalaureate-prepared nurse. Because of its many consequences and complications, it necessitates careful clinical surveillance, counseling for patients on changes to their lifestyles, adherence to medicines, and a comprehensive approach to therapy. https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000001040.
With my background in consumer campaigning, promotion of health, clinical research, and teamwork, I will be prepared to assist individuals like Karev in successfully managing their diabetes of any kind. Since type 2 diabetes accounts for approximately 90% of instances, I will deal with several people who have this condition. I can control this complex illness with expertise, coordinate services, conduct scientifically sound decisions, and provide individuals with type 2 diabetes with informed guidance because of my schooling in nursing.
Analysis of Evidence
The academic literature provides enough evidence that uncontrolled blood glucose levels are associated with severe hazards associated with type 2 diabetes. According to review experts’ recommendations, a multimodal treatment method is necessary to maintain an A1C of under seven percent (Oh et al., 2022).
The research implies that pharmaceuticals may not be adequate for people such as Karev, who have a previous record of inadequate glucose management and hospitalization linked to hyperglycemia. Compared to metformin alone, a randomized controlled study revealed that combined use of metformin plus an exercise program focused on weight reduction and increasing aerobic activity led to a significantly better A1C.
Furthermore, a comprehensive review of research revealed nurses’ critical role in treating type 2 diabetes by offering counseling, learning, and integrated care throughout contexts to enhance performance (Juanamasta et al., 2021). When this data is applied to Karev’s situation, it becomes clear that he needs a customized treatment plan that includes medicine to optimize his blood sugar levels and an appointment with a nutritionist to support weight reduction and a lower-carb diet.
To assist in managing this chronic illness, it might be helpful to participate in a monitored fitness program, to follow up closely to improve adherence to medicines and glucose tracking, and to get regular nurse counseling on lifestyle changes (Dankoly et al., 2020). Nurses such as myself can provide complete, scientifically sound therapies that are individualized to the patient’s requirements by depending on the most current research in the field. These therapies aim to lower risks connected to inadequately managed diabetes, particularly type 2 diabetes, avoid serious consequences, and regulate hyperglycemia.
Evaluation of Evidence
I will evaluate the type 2 diabetes therapy information using credible and valid standards. The degree and standard of the documentation, the repeatability of the findings across investigations, and the proof’s relevance to the patient demographic and therapeutic situation are all crucial factors to consider. Evaluating potential hazards or adverse effects and their influence on patient treatment contributes to both efficiency and enhanced standard of life (Salanova et al., 2021).
Compared to one-off research, findings reproduced across numerous studies and situations provide more trustworthy data to direct nursing treatments for patients like Karev. I may assess the investigation’s clinical significance, universality, and utility for providing the best possible clinical nursing treatment for type 2 diabetes by carefully using these requirements to evaluate the data.
Potential Barriers
Adopting evidence-based treatment for individuals with type 2 diabetes, such as Karev, may face obstacles. The implementation of suggested treatments may be hampered by clinicians’ lack of comprehension of current recommendations, organizational procedures, and resources and low patient adherence resulting from insufficient health literacy or budgetary restrictions.
Employing a chronic care model framework acknowledges that providing the best possible care for insulin patients necessitates an educated, engaged patient and a proactive, organized medical team working within an evidence-based structure that fosters patient-provider cooperation (Timpel et al., 2020). Motivational questioning is proper for empathetic communication, identifying obstacles to patient self-care, and developing solutions that work for both parties. Proactively overcoming these typical obstacles encourages the best possible type 2 diabetes care that aligns with mathematical models and a solid body of scientific research.
State Board Nursing Practice and Policies
The treatment of patients with uncontrolled type 2 diabetes, like Karev, is significantly impacted by the nursing practice laws of my state and the organizational policies of the medical system where I work. I must regularly use the latest research and consult clinical guidance by the state Board of Nursing’s performance standards.
For instance, our health structure just incorporated guidelines, which mandate self-checking blood sugar for insulin-using patients, adjusting treatment, and reinforcing lifestyle modifications if A1C is higher than target, and examination in addition to preventive care for difficulties associated with diabetes (American Association of Diabetes Educators, 2020).
Quality standards developed by the Centres for Medicare and Medicaid Services (CMS) evaluate the proportion of diabetic patients with yearly A1C lab testing, foot examinations, and progressive vision tests (Rodríguez et al., 2020). This promotes organizational attention to these procedures.
I can deliver to high-risk diabetic patients the kind of monitoring and preventive treatment they need by adhering to CMS, state, and organizational rules for regular testing and instructions for patients on managing their diabetes (Bus et al., 2020). These regulations, which emphasize uniform procedures, could not resolve the unique commitment challenges individuals like Karev encounter. Karev and I still need to work together on individualized treatments that are based on his exceptional abilities and way of living. I must promote and include patient-centered concerns in the diabetic treatment plan, even when nursing standards and guidelines rightly direct nurses toward evidence-based treatments.
Impact of Policy on Nursing Scope of Practice
My nursing field of practice is impacted by organizational and state regulations for treating diabetes, which specify the particular care procedures and treatments that fall within my purview. Policies dictate, for instance, that I must do yearly assessments of my eyes and feet, educate patients about diabetes management, nutrition, exercise, and pharmaceuticals, identify any obstacles to patient commitment, and work with other healthcare professionals to optimize the therapy plan.
Nevertheless, as an RN, I am not authorized to make some prescription modifications; instead, I am an advanced practice clinician with prescribing power. I can make an effective contribution to the excellent medical team treating complicated chronic conditions, such as unmanaged type 2 diabetes, by acknowledging the limitations of my academic and professional competence and using my specialized abilities in patient information, independence, and managing care.
Leadership Strategies
The nurse may employ a transformational leadership style to motivate and enable individuals, such as Karev, to take responsibility for their chronic diseases. This entails paying careful attention to the patient to comprehend their viewpoint fully, offering appropriate educational materials for their needs and abilities, and working together to establish reasonable objectives for self-care.
To promote small, gradual gains in diabetes management, the nurse may, for instance, give out brochures on suitable goal-setting regarding food modifications, physical exercise, and medication adherence (Schrauben et al., 2022). The nurse may also use evidence-based practice by using professional standards as a source of information for treatment planning. The nurse may provide prudent guidance within the practice parameters by participating in ongoing training on effective insulin dosage techniques.
To reduce problems with diabetes, employing electronic health record reminders ensures the nurse implements procedures for necessary tests and examinations. Encouraging collaboration between disciplines enables the registered nurse to coordinate the therapeutic strategy by communicating regularly with everyone on the care team.
Additionally, the nurse may help patients find neighborhood services and assistance programs that address care-related barriers (Williams et al., 2021). The registered nurse plays a critical role in providing top-notch patient-centered diabetic care via these managerial methods, which focus on empowering clients, optimizing collaborated treatment, and attending to interpersonal requirements.
Collaboration, Communication & Change Management
If you are Karev’s carer, using an innovative leadership strategy is crucial to promoting and motivating him to participate actively in his medical self-management. Establishing the basis of straightforward communication centered on understanding, instruction, and cooperative objectives enables patients to become active participants in their treatment.
Furthermore, using an interprofessional team strategy is crucial in cultivating strong teamwork to integrate diabetic therapy for patients. Strategies involve ongoing interaction to guarantee that everyone in the care team agrees with the therapy goals and timelines. Coordinating the treatment plan and immediately fixing issues are made possible by holding frequent case conferences to discuss elevated-risk patients (Upchurch et al., 2021).
A deliberate, systematic approach to removing obstacles is ensured when Kotter’s change model is used to direct practice changes in diabetes treatment. To promote changes around adopting evidence-based diabetic recommendations, it is imperative to establish urgency, organize a group of supporters, construct an objective, and recruit buy-in (Williams et al., 2021).
Practical training and role-modeling of new procedures are necessary to provide personnel with new information on neighborhood assistance suggestions, patient motivational interviews, and insulin control. It is also critical to plan how to integrate policy modifications and continuously enhance quality to integrate alterations into organizational culture.
Conclusion
The intricate and diverse factors surrounding providing evidence-based nursing assistance to an individual with poorly managed type 2 diabetes are best shown by the current situation. Essential tactics include using the most recent research to inform care decisions, identifying and resolving compliance issues, utilizing nursing abilities as leaders to strengthen patients through interprofessional cooperation, and implementing modifications to procedures gradually through intentional change management. A broad viewpoint encompassing clinical expertise, effective interpersonal interaction, thoughtful management, and dealing with change enables nurses to substantially influence complicated medical interactions and health outcomes.
References
American Association of Diabetes Educators. (2020). An Effective Model of Diabetes Care and Education: Revising the AADE7 Self-Care Behaviors®. The Diabetes Educator, 46(2), 014572171989490.
Bus, S. A., Lavery, L. A., Monteiro‐Soares, M., Rasmussen, A., Raspovic, A., Sacco, I. C. N., & Netten, J. J. (2020). Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2019 update). Diabetes/Metabolism Research and Reviews, 36(S1).
CDC. (2023, April 18). Type 2 diabetes. Centers for Disease Control and Prevention.
Dankoly, U. S., Vissers, D., El Farkouch, Z., Kolasa, E., Ziyyat, A., Rompaey, B. V., & Maamri, A. (2020). Perceived Barriers, Benefits, Facilitators, and Attitudes of Health Professionals Towards Multidisciplinary Team Care in Type 2 Diabetes Management: a Systematic Review. Current Diabetes Reviews, 16(6).
Joseph, J. J., Deedwania, P., Acharya, T., Aguilar, D., Bhatt, D. L., Chyun, D. A., Di Palo, K. E., Golden, S. H., & Sperling, L. S. (2022). Comprehensive Management of Cardiovascular Risk Factors for Adults With Type 2 Diabetes: A Scientific Statement From the American Heart Association. Circulation, 145(9).
Juanamasta, I. G., Aungsuroch, Y., Gunawan, J., Suniyadewi, N. W., & Nopita Wati, N. M. (2021). Holistic Care Management of Diabetes Mellitus: An Integrative Review. International Journal of Preventive Medicine, 12(1), 69.
Oh, S. H., Park, J., Lee, S. J., Kang, S., & Mo, J. (2022). Reinforcement learning-based expanded personalized diabetes treatment recommendation using South Korean electronic health records. Expert Systems with Applications, 206, 117932.
Rodríguez, H. P., Fulton, B. D., & Phillips, A. Z. (2020). The Early Impact of the Centers for Medicare & Medicaid Services State Innovation Models Initiative on 30-Day Hospital Readmissions Among Adults With Diabetes. Medical Care, 58, S22–S30.
Salanova, V., Sperling, M. R., Gross, R. E., Irwin, C. P., Vollhaber, J. A., Giftakis, J. E., & Fisher, R. S. (2021). The SANTÉ study at 10 years of follow‐up: Effectiveness, safety, and sudden unexpected death in epilepsy. Epilepsia, 62(6), 1306–1317.
Schrauben, S. J., Rivera, E., Bocage, C., Eriksen, W., Amaral, S., Dember, L. M., Feldman, H. I., & Barg, F. K. (2022). A Qualitative Study of Facilitators and Barriers to Self-Management of CKD. Kidney International Reports, 7(1), 46–55.
Timpel, P., Lang, C., Wens, J., Contel, J. C., & Schwarz, P. E. H. (2020). The managed care model – developing an evidence-based and expert-driven chronic care management model for patients with diabetes. International Journal of Integrated Care, 20(2), 2.
Upchurch, G. R., Escobar, G. A., Azizzadeh, A., Beck, A. W., Conrad, M. F., Matsumura, J. S., Murad, M. H., Perry, R. J., Singh, M. J., Veeraswamy, R. K., & Wang, G. J. (2021). Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. Journal of Vascular Surgery, 73(1), 55S83S.
Williams, J., Sachdev, N., Kirley, K., Moin, T., Duru, O. K., Brunisholz, K. D., Sill, K., Joy, E., Aquino, G. C., Brown, A. R., O’Connell, C., Rea, B., Craig-Buckholtz, H., Witherspoon, P. W., & Bruett, C. (2021). Implementation of Diabetes Prevention in Health Care Organizations: Best Practice Recommendations. Population Health Management, 25(1).
