Assessment Of The Problem Leadership, Collaboration, Communication, Change Management, and Policy Considerations Essay

Assessment Of The Problem Leadership, Collaboration, Communication, Change Management, and Policy Considerations Essay

Capstone projects prepare nurses to function as change agents in healthcare institutions. They help nursing students familiarize themselves with research processes, quality improvement, and evidence-based practice change. In addition, capstone projects help nursing students identify problems in clinical settings and lay strategies to address these problems. These problems may affect units such as the emergency department and critical care unit, populations such as the elderly, or specific individuals. Identifying evidence-based interventions to address these problems also promotes better population outcomes. This paper identifies a patient, family, or population health problem relevant to nursing practice, analyzes literature describing nursing interventions, explains the effects of nursing practice standards and government policies that could affect the problem, and proposes relevant leadership strategies.

A Patient, Family, and Population Health Problem

The problem selected is Catheter-acquired urinary tract infections (CAUTIs) in critical care units. CAUTIs refer to the ascension of bacteria through the urethra leading to urinary tract infection. Organs affected are the urethra, ureters, bladder, and kidney in severe cases. The problem affects critical care unit patients because they report a high catheter utilization rate. The focus is on patients in the intensive care unit prone to infections due to their immunocompromised states and high catheterization rates. The female population is significantly affected and reports significantly higher rates of CAUTIs. Statistics show that about 25% of patients in critical care are catheterized at some point in their hospital stay, out of which about 30% develop CAUTIs (Clarke et al., 2021). CAUTIs are common in hospital settings and are the most common of all hospital-acquired hospitals. Over 80% of hospital-acquired urinary tract infections are preventable (Clarke et al., 2020). Hospital-acquired infections such as CAUTIs and Ventilator-associated pneumonia are significant to the nursing profession because they represent a failure in professional practices. Li et al. (2019) note that the most common causes are women’s gender, prolonged catheter use (more than ten days), diabetic patients, and poor insertion, care, and removal practices. Catheter insertion and care are primarily a nurse’s roles hence their significance to my practice as a baccalaureate-prepared nurse. Over 80% of these infections are preventable through safe insertion (including correct indications), care, and removal practices. CAUTIs also lead to bacteremia and systemic infections, with a 10% mortality (Clarke et al., 2021).

Nursing Actions Related to the Problem

According to Clarke et al. (2021), CAUTI preventive interventions depend on the major causes of CAUTIs. Nurses’ education programs are evidence-based strategies used by nurses to manage CAUTIs. These interventions focus on improving professionals’ knowledge and practices, such as correct indications, insertion, care, and removal of catheters. Aseptic techniques are required in insertion, care, and removal, and nurses are taught the procedure and interventions to maintain asepsis. Some catheters inserted are not warranted, and most patients are catheterized when they do not meet the criteria for insertion. Informing the nurses of these practices improves their practices, significantly reducing CAUTIs and their associated consequences. According to Jones et al. (2021), staff education increases confidence and vigilance and translates into changes in practices leading to quality patient outcomes with decreased CAUTIs prevalence and associated mortality.

Patient education is also an evidence-based intervention used to address CAUTIs. Patient education helps educate patients on areas such as care for catheters. Patient education is especially important for conscious patients and those discharged with the catheter. Patient education focuses on ensuring patients’ self-efficacy and improving their participation in care delivery to promote quality outcomes. MacEwan et al. (2022) note that common patient education topics include risks associated with indwelling urinary catheters, hand hygiene, maintenance care, and support. Patient assessment is also necessary to identify and include other needs in care delivery. Collins (2019) shows that patient education and support are vital to helping self-catheterize safely to produce quality outcomes and prevent infections. Thus, this intervention is integral to the prevention of CAUTIs.

Audits and checklists have also been used widely and recommended by the agency for healthcare research and quality (AHRQ). Hernandez et al. (2019) note that checklists are designed to ensure that catheter insertion is correctly indicated. They also help ensure patients’ catheters are not in situ for more than ten days. Nurses rely heavily upon evidence-based practices to improve their practices in healthcare and produce quality population outcomes. For the data utilized to be reliable, the resources must be current (produced within the last five years), peer-reviewed, and from a reputable database. Sources from reputable websites such as the CDC, WHO, and Healthy People 2030 can also be considered.

Challenges to implementing these evidence-based practices include a lack of nurses’ knowledge and commitment to these changes. Despite the CDC and other agencies’ recommendations for preventing these interventions, they are hardly implemented or accurately followed (Atkins et al., 2020). In addition, there is a lack of standardized education and education opportunities for patients and their families to enhance CAUTI prevention (MacEwan et al., 2022). Other challenges include limited resources, reluctant organizational leadership, and a culture that does not support change (Atkin et al., 2020). Addressing these challenges can help improve CAUTI prevention efforts.

Nursing Theory or Conceptual Framework

Nursing theories and conceptual frameworks can be used to guide actions in nursing. Nurse-driven protocols are robust frameworks for developing, implementing, and evaluating nursing interventions, especially for preventing CAUTIs. Nurse-driven protocols are medically approved and call upon collaborative vetting with healthcare providers and leaders to address an established need (Lockhart, 2020). The next step occurs when leaders work together to identify and analyze data-driven indicators, such as score measures, to guide the team in problem-solving. The next step is to gain organizational leaders’ and staff’s buy-in through activities such as the remuneration of employees and professional presentations. These NDPs provide incredibly easy ways of implementing change interventions and form the vital conceptual framework for the change because it has successfully led to the implementation of care bundles (Lockhart, 2020). The first step is identifying the change, followed by identifying data-driven indicators to inform the choices, developing intervention, gaining organizational leaders’ buy-in, and leading change implementation.

State Board Nursing Practice Standards/ Organizational/ Government Policies

Nursing practice standards and government and organizational policies regulate nursing practices. The standards for nursing practice by the American Nurses Association state that nurses assess, recognize and intervene in patient problems to ensure quality outcomes. The practice by nurses is regulated by the state board nursing practice act. The NPA stipulates that all registered nursing interventions should be under the licensure of a physician, dentist, or clinical psychologist. Russell and Watters (2019) note that nursing practice standards guide nurses’ practices in detecting and preventing errors in healthcare. According to the researchers, a nurse-led CAUTI prevention algorithm based on the nursing practice standards can help reduce CAUTIs in healthcare and promote better patient outcomes. The program utilized nurses’ and other healthcare providers’ knowledge to prevent CAUTI.

Nurses’ Roles in Policy Making

Nurses play vital roles in all stages of policy development. They collect and store patient data, such as problems and changes in health patterns, that inform healthcare decisions (Mason et al., 2020). They also act as patient advocates by airing patient problems to leaders and lawmakers to ensure patient care changes. Mason et al. (2020) note that nurses in leadership positions also influence policy development by airing concerns at the executive level that affect care delivery at the organization and unit levels. Nurses in legislative positions have greater advantages and influence policy development through bills at the state and national levels. Nurses are also vital team members that evaluate care and current policies to determine the need for change. Thus, nurses play vital roles in policy making.

Local, State, and Federal Policies or Legislations on the Nurses’ Scope of Practice

The nurses’ scope of practice in healthcare problems is affected by various policies at various administrative policies. Policies at the state and federal levels require nurses to keep accurate records of patient care interventions. They also require nurses to assess patients, recognize problems, inform the care team, and develop nursing interventions to manage them. In CAUTIs prevention, nurses are also mandated to teach peers about preventive measures and ensure that their practices meet the set standards and interventions for preventing and managing CAUTIs (Dhar et al., 2021). Catheter-acquired urinary tract infections are particularly important to nursing because nurses insert, care for, and remove most urinary catheters. The current organizational policy stipulates mandatory assessment and reporting of CAUTIs in the facility. Thus, local, state, and federal policies significantly influence the nurses’ scope of practice in CAUTI prevention and management.

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Leadership Strategies in Improving Patient Outcomes, Patient-Centered Care, and Patient Experiences

Proposed Leadership strategies include staff education, communicating clear vision and goals, and reward and recognition. Leaders must be organized; communicating the vision, goals, and objectives is the first leadership strategy for success. Staff education/training is both a leadership and change management strategy. The strategy helps staff understand and appreciate the change. According to Haaranen and Saarti (2020), staff education increases their knowledge and skills and boosts their confidence while promoting quality outcomes and better patient health experiences.

Recognition and reward are other important leadership strategy. The strategy refers to some monetary incentives given to employees for participating in the change. Recognition is an important cognitive reward for good behavior. This leadership strategy can help gather the support of even the reluctant stakeholders. Gaughan et al. (2021) note that rewards and recognition are widely used to motivate best-performing employees in organizational efforts to reduce infections. Thus, staff education and rewards and recognition are vital strategies that can be used to promote quality outcomes, patient-centered care, and improve patient experiences.

Communication and Collaboration Strategies

Communication strategies will entail utilizing formal and informal communication methods. Formal methods include emails and letters, while informal methods include social media groups. Utilizing both platforms to communicate change will ensure that the change reaches many individuals in the facility. Soliciting feedback is another communication and change management strategy. Asking for feedback is an important strategy that helps stakeholders feel valued and participate in improving patient outcomes (Lewis & Sahay, 2019).

Collaboration strategies include shared decision-making and communicating clear roles. All the healthcare stakeholders, such as patients, nurses, leaders, and other healthcare providers, will be allowed to participate in decision-making. Their participation will ensure their needs are addressed and met hence better outcomes. Shared decision-making helps stakeholders feel part of the change and own it, increasing their collaboration (Hamann & Heres, 2019). individuals participate in change when they understand their roles. Communicating roles eliminates delays caused by role confusion hence better outcomes. These communication and collaboration strategies will thus help improve outcomes, patient-centered care, and patient experiences.

Change Management Strategies

The change management strategies required include early and timely communication of the proposed change and clear role communication. For stakeholders to participate in the change, they must understand their roles and how to perform them (Bansal & King, 2019). For example, understanding that nurses must educate patients helps them prepare and equip themselves with materials and knowledge to enhance their roles. Soliciting feedback is an important change management strategy. It will help determine the stakeholders’ attitude toward the problem and its interventions and will help determine resistance and ways to manage it (Lewis & Sahay, 2019). Feedback provided helps improved proposed change hence better outcomes.

Conclusion

Catheter-acquired urinary tract infections are the problem of interest for the capstone change project. They are significant to nursing due to their effects on patient outcomes, including mortalities. CAUTIs are preventable through interventions such as patient and staff education. Nurse-driven protocols provide a crucial conceptual framework that will help implement the change in the facility to prevent CAUTIs and their consequences. Leadership strategies such as staff education, communication strategies, collaboration strategies such as shared decision-making, and change strategies such as early and timely communication and soliciting feedback will help improve patient outcomes, enhance patient-centered care delivery, and improve patient experiences during the management of the problem.

References

Atkins, L., Sallis, A., Chadborn, T., Shaw, K., Schneider, A., Hopkins, S., Bunten, A., Michie, S., & Lorencatto, F. (2020). Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioral analysis of interventions. Implementation Science, 15, 1-22. https://doi.org/10.1186/s13012-020-01001-2

Bansal, A., & King, D. R. (2022). Communicating change following an acquisition. The International Journal of Human Resource Management, 33(9), 1886-1915.

Clarke, K., Hall, C. L., Wiley, Z., Tejedor, S. C., Kim, J. S., Reif, L., Witt, L. & Jacob, J. T. (2020). Catheter‐Associated Urinary Tract Infections in Adults: Diagnosis, Treatment, and Prevention. Journal of Hospital Medicine, 15(9), 552-556. https://doi.org/10.12788/jhm.3292

Collins, L. (2019). Intermittent self-catheterization: good patient education and support are key. British Journal of Nursing, 28(15), 964–966. https://doi.org/10.12968/bjon.2019.28.15.964

Dhar, S., Sandhu, A. L., Valyko, A., Kaye, K. S., & Washer, L. (2021). Strategies for effective infection prevention programs: structures, processes, and funding. Infectious Disease Clinics, 35(3), 531–551. https://doi.org/10.1016/j.idc.2021.04.001

Gaughan, A. A., Walker, D. M., DePuccio, M. J., MacEwan, S. R., & McAlearney, A. S. (2021). Rewarding and recognizing frontline staff for success in infection prevention. American Journal of Infection Control, 49(1), 123–125. https://doi.org/10.1016/j.ajic.2020.06.208

Haaranen, A., & Saarti, J. (2020). Enthusiastic academic and support service staff as an agent for change: A case study based on a project in African higher education institutes. Academic Conferences and Publishing International-ACPIL. https://doi.org/10.34190/EJEL.20.18.1.001

Hamann, J., & Heres, S. (2019). Why and how family caregivers should participate in shared decision-making in mental health. Psychiatric Services, 70(5), 418-421. https://doi.org/10.1176/appi.ps.201800362

Hernandez, M., King, A., & Stewart, L. (2019). Catheter-associated urinary tract infection (CAUTI) prevention and nurses’ checklist documentation of their indwelling catheter management practices. Nursing Praxis in New Zealand, 35(1). https://doi.org/10.36951/NgPxNZ.2019.004

Jones, K. M., Mantey, J., & Mody, L. (2021). Current Practices in Infection Prevention: A 3-year Survey of Michigan Nursing Homes’ Urinary Tract Infection Prevention Strategies. American Journal of Infection Control, 49(6), S7. https://doi.org/10.1016/j.ajic.2021.04.028

Lewis, L., & Sahay, S. (2019). Change and change management. In Movements in Organizational Communication Research (pp. 214–232). Routledge. https://doi.org/10.4324/9780203730089-12

Li, F., Song, M., Xu, L., Deng, B., Zhu, S., & Li, X. (2019). Risk factors for catheter‐associated urinary tract infection among hospitalized patients: A systematic review and meta‐analysis of observational studies. Journal of Advanced Nursing, 75(3), 517–527. https://doi.org/10.1111/jan.13863

Lockhart, L. (2020). Nurse-driven protocols. Nursing made Incredibly Easy, 18(5), 56. https://doi.org/10.1097/01.NME.0000694200.09075.69

MacEwan, S. R., Beal, E. W., Gaughan, A. A., Sieck, C., & McAlearney, A. S. (2022). Perspectives of hospital leaders and staff on patient education for the prevention of healthcare-associated infections. Infection Control & Hospital Epidemiology, 43(9), 1129–1134. https://doi.org/10.1017/ice.2021.271

Mason, D. J., Perez, A., McLemore, M. R., & Dickson, E. (2020). Policy & politics in nursing and health care-e-book. Elsevier Health Sciences.

Russell, J. A., & Watters, R. (2019). Implementation of a nurse-driven CAUTI prevention algorithm. Nursing Clinics, 54(1), 81–96. https://doi.org/10.1016/j.cnur.2018.11.001

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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 Capella Academic Portal 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: As you revise your writing, check out the resources listed on the Writing Center’s Writing Support page.

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 Capella Academic Portal Volunteer Experience Form.

Capella Academic Portal

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

The BSN Capstone Course (NURS-FPX4900 ) requires the completion and documentation of nine (9) practicum hours. All hours must be recorded in the Capella Academic Portal. Please review the BSN Practicum Campus page for more information and instructions on how to log your hours.

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.

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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 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 Capella Academic Portal 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. APA Style Paper Tutorial [DOCX] is 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.

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 group in the Capella Academic Portal 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.