Patient, Family, or Population Health Problem Solution Essay

Patient, Family, or Population Health Problem Solution Essay

The interaction with Mr. KJ, so far, has been progressing well and is within the scope of set objectives and timelines. As part of improving the health of Mr. KJ by providing a solution, I developed an educational brochure. This intervention was tailored to the patient’s technology, care coordination, patient safety, community resource utilization, and care coordination needs. I trust that this intervention will make an important contribution to care for Mr. KJ after my faculty’s approval. The purpose of this paper is to describe this intervention concerning nursing leadership, change management, communication, collaboration, healthcare policies, health technologies, community resources, patient safety, cost of care, and quality of care.

Summary of the Patient Health Problem

The patient, Mr. KJ, is a 54-year-old African American male recently diagnosed with stage 1 hypertension. He is just started his first clinic visit where pharmacotherapy has been initiated. He has also received patient education from his physician and has his next appointments scheduled to happen in the same clinic. As a part of nursing care, Mr. KJ received various interventions to facilitate his care. Part of his care coordination and health promotion has been influenced by my project. I selected this patient problem primarily because of three reasons. He is a patient with whom we had formed a good clinician-patient relationship and this was a good determinant of productive future engagements. He had just been diagnosed with hypertension during his unplanned visit and would need good nursing care coordination to ensure that he gets safe and quality care. Therefore, I saw this as an opportunity to learn and apply my coordination and leadership skills. His health problem is relevant to my future practice because it is one of the costliest and most common causes of mortality in the United States. Hypertension is significant comorbidity that determines the outcomes of care for many patients. Therefore, it is only wise that I practice nursing care coordination and leadership with a patient with hypertension from the start of his care.

Impact of Nursing Leadership and Change Management

Nursing leadership, apart from creating effective environments and relationships, inspires care stakeholders to achieve outcomes. KJ is the key stakeholder in his care and thus would need to be engaged and empowered to ensure patient-centered care (Faleti, 2018). Nursing leadership played an influential role in the development of the educational brochure. Aside from informing the patient and improving his health literacy concerning hypertension, this education brochure would also inspire him to take part in his own care and make patient-centered initiatives. Future collaborations and interactions will require that he gets empowered and equipped through awareness of his disease so that his care coordination gets better even when under the care of new healthcare professionals. The need to set these foundations was driven by nursing leadership to create a positive environment and inspire key stakeholders.

Change is an integral part of any care coordination and nursing process. Communication is an important strategy for change management that inspired the development of the educational brochure. Communication promotes positive interactions and planning for change management. Effective and timely communication ensures that all stakeholders are kept up-to-date with the processes and procedures. The educational brochure developed would provide the patient with key partners in his care and processes that he will need to contact in cases of need for change. Understanding change management enabled me to plan for the brochure development and align nursing leadership and engage key stakeholders the hypertension care. These strategies are meant to ensure change readiness. Nursing ethics, especially beneficence, ensured that this intervention was meant to benefit the patient and not other stakeholders. Therefore, it was tailored to meet some presumed patient interests such as health literacy and clinical decision-making.

Communicating and Collaborating Strategies

Collaboration and communication are closely related care coordination strategies that would benefit the care for this patient. Various care stakeholders will be involved directly and indirectly in KJ’s care. Important players in the care for KJ will be his family and himself. Best care collaboration strategies will ensure that these stakeholders are actively involved in KJ’s care. Including the input of KJ and his family in his care is important for various reasons (Lakhani et al., 2018). Including the input of the patient will improve the patient experience. Patient experience improvement will promote patient satisfaction which will enhance care quality (Bombard et al., 2018). Patient input gathering will reduce the cost of care because it will ensure that interventions are tailored to meet patient needs thus reducing expenditure on unnecessary intervention. Patient input involvement will increase their chances of participation in their care thus promoting adherence to interventions and positive outcomes (Wutzke et al., 2018). This involvement would improve their health literacy

Some of the communication and collaboration strategies that would improve Mr. KJ’s care are shared decision-making, patient education, and patient navigation. Patient navigation will help the patient connect through different resources and healthcare professionals by improving communication and selecting the next best action of care. Patient education will enlighten the patient about the different systems that are involved in their care thus improving their decision-making. Shared decision-making will incorporate their input in the next actions in care (Menear et al., 2020). For example, as a nurse, I will explain to Mr. KJ about his condition (patient education), help him understand the best available community resources and care specialists (patient navigation), and ensures that the final decision for care coordination includes what he thinks is best and would work for him (shared decision making). Therefore, these three strategies are intertwined but can work independently.

Impact of State Board Nursing Practice Standards

State-board nursing practice standards and federal policies had some impact on developing the educational brochure. Nursing scope of practice and state board regulation enabled me to ensure the extent the nurses can apply their training and education in care coordination. The need for physician interdependence in hypertension care was incorporated into the intervention by allowing the patient to contact their primary physician in cases of medical concerns relating to their prescriptions. The Affordable Care Act ensured that I am confident in educating the patient about the utilization of the best available and affordable insurance packages. At the start, the patient was concerned about his current insurance plans covering his treatment for his hypertension in the future. ACA policy also ensured that I instilled a sense of confidence in his right to acquire relevant information during the process of seeking the care the ACA policy requires.

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The educational intervention will empower the patient to seek more information regarding his condition and the best available guidelines in the country. This brochure provided useful links for the patient to always use whenever in need of additional information regarding hypertension and best practices. A research study by Angier et al ( 2020) found that the ACA through Medicaid expansion improved diagnosis rates of hypertension cases. Huguet et al. in 2021 also found that the time and frequency of hypertension diagnosis and the rate of gaining insurance for newly diagnosed hypertensive patients improved as a result of ACA. These patients were also more like to receive antihypertensive medications faster as compared with other patients using different insurance types.

Impact of the Intervention on Cost, Safety, and Quality

The development of the educational intervention ensured that I considered patient safety, cost of care, and quality of care. All these aspects are expected to be achieved through this form of patient education and engagement. Educational brochures have been applied in various settings to improve patients’ health literacy and enhance their engagement (Jansen et al., 2021; Schoberer et al., 2018). This intervention incorporated complication prevention as a safety improvement strategy. As part of patient communication, this intervention will improve patient engagement thus experience and satisfaction that will subsequently improve quality by patient-centered approach. Through health prevention, this intervention is expected to reduce the costs of care. Organizing Mr. KJ’s care through this intervention will enhance patient navigation by reducing time for information access and utilization of community resources.

Technology, Care Coordination, and the Utilization of Community Resources

These three concepts of care can be incorporated into care for hypertensive patients simultaneously. Technology provides an avenue for access to community resources. Some technologies are in themselves important community resources. For example, social media and online social support organizations provide an essential connection to other patients with hypertension that can offer good peer support to Mr. KJ. Technology can also be used for care coordination by enabling communication with various stakeholders and community resources and healthcare professionals, and the patient. Smartphone technology and telemonitoring allow for remote collaboration between the patient of their caregivers to conduct patient navigation and shared decision-making (Kitt et al., 2020). For example, a nurse may want to connect the patient to a community resource such as a local pharmacy for refilling prescriptions to cut on transport and other costs. In such a case, the nurse can simply follow up with the patient through phone or text message to provide direction and communication with the local pharmacy. The community resource, in this case, the local pharmacy, will play a big role in the patient’s care by cutting transport and facilitation costs by availing auxiliary services to the patient.

Conclusion

The educational brochure developed was tailored using patient-specific needs. It aims at educating and inspiring the patient to promote patient engagement. The development of this intervention incorporated patient safety, costs of care, and quality of care through nursing leadership, change management, and care coordination skills. The use of technology, utilization of community resources, and care coordination are three strategies that will facilitate the long-term care of the patient in an interdependent fashion. Key policies such as the affordable care act have been incorporated into the development of educational intervention. Key collaboration and communication strategies that will enhance the best patient outcomes for this patient include patient education, patient navigation, and shared decision-making. The evaluated evidence-based sources have documented the benefits of the use of this intervention in health prevention and promotion.

References

Angier, H., Huguet, N., Ezekiel-Herrera, D., Marino, M., Schmidt, T., Green, B. B., & DeVoe, J. E. (2020). New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion. Family Medicine and Community Health, 8(4), e000607. https://doi.org/10.1136/fmch-2020-000607

Bombard, Y., Baker, G. R., Orlando, E., Fancott, C., Bhatia, P., Casalino, S., Onate, K., Denis, J.-L., & Pomey, M.-P. (2018). Engaging patients to improve quality of care: a systematic review. Implementation Science: IS, 13(1). https://doi.org/10.1186/s13012-018-0784-z

Faleti, Y. (2018, February 6). Elements of Nurse Leadership. Stevenson.edu. https://www.stevenson.edu/online/about-us/news/nurse-leadership

Huguet, N., Larson, A., Angier, H., Marino, M., Green, B. B., Moreno, L., & DeVoe, J. E. (2021). Rates of undiagnosed hypertension and diagnosed hypertension without anti-hypertensive medication following the Affordable Care Act. American Journal of Hypertension, 34(9), 989–998. https://doi.org/10.1093/ajh/hpab069

Jansen, C. J. M., Koops van ’t Jagt, R., Reijneveld, S. A., van Leeuwen, E., de Winter, A. F., & Hoeks, J. C. J. (2021). Improving health literacy responsiveness: A randomized study on the uptake of brochures on doctor-patient communication in primary health care waiting rooms. International Journal of Environmental Research and Public Health, 18(9), 5025. https://doi.org/10.3390/ijerph18095025

Kitt, Fox, & Tucker. (2020). Digital Health: New Approaches in Hypertension Management. Journal of Cardiology and Cardiovascular Sciences, 4(1). https://www.cardiologyresearchjournal.com/articles/digital-health-new-approaches-in-hypertension-management-1-1186.pdf

Lakhani, A., McDonald, D., & Zeeman, H. (2018). Perspectives of self-direction: a systematic review of key areas contributing to service users’ engagement and choice-making in self-directed disability services and supports. Health & Social Care in the Community, 26(3), 295–313. https://doi.org/10.1111/hsc.12386

Menear, M., Dugas, M., Careau, E., Chouinard, M.-C., Dogba, M. J., Gagnon, M.-P., Gervais, M., Gilbert, M., Houle, J., Kates, N., Knowles, S., Martin, N., Nease, D. E., Jr, Zomahoun, H. T. V., & Légaré, F. (2020). Strategies for engaging patients and families in collaborative care programs for depression and anxiety disorders: A systematic review. Journal of Affective Disorders, 263, 528–539. https://doi.org/10.1016/j.jad.2019.11.008

Schoberer, D., Eglseer, D., Halfens, R. J. G., & Lohrmann, C. (2018). Development and evaluation of brochures for fall prevention education created to empower nursing home residents and family members. International Journal of Older People Nursing, 13(2), e12187. https://doi.org/10.1111/opn.12187

Wutzke, S., Rowbotham, S., Haynes, A., Hawe, P., Kelly, P., Redman, S., Davidson, S., Stephenson, J., Overs, M., & Wilson, A. (2018). Knowledge mobilization for chronic disease prevention: the case of the Australian Prevention Partnership Centre. Health Research Policy and Systems, 16(1), 109. https://doi.org/10.1186/s12961-018-0379-9

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4 Instructions: Patient, Family, or Population Health Problem Solution
• PRINT
• Develop an intervention (your capstone project), as a solution to the patient, family, or population problem you’ve defined. Submit the proposed intervention to the faculty for review and approval. This solution needs to be implemented (shared) with your patient, family, or group. You are not to share your intervention with your patient, family, or group or move on to Assessment 5 before your faculty reviews/approves the solution you submit in Assessment 4. In a separate written deliverable, write a 5-7 page analysis of your intervention.
Please submit both your solution/intervention and the 5-7 page analysis to complete Assessment 4.
Introduction
In your first three assessments, you applied new knowledge and insight gleaned from the literature, from organizational data, and from direct consultation with the patient, family, or group (and perhaps with subject matter and industry experts) to your assessment of the problem. You’ve examined the problem from the perspectives of leadership, collaboration, communication, change management, policy, quality of care, patient safety, costs to the system and individual, technology, care coordination, and community resources. Now it’s time to turn your attention to proposing an intervention (your capstone project), as a solution to the problem.
Preparation
In this assessment, you’ll develop an intervention as a solution to the health problem you’ve defined. To prepare for the assessment, think about an appropriate intervention, based on your work in the preceding assessments, that will produce tangible, measurable results for the patient, family, or group. In addition, you might consider using a root cause analysis to explore the underlying reasons for a problem and as the basis for developing and implementing an action plan to address the problem. Some appropriate interventions include the following:
• Creating an educational brochure.
• Producing an educational voice-over PowerPoint presentation or video focusing on your topic.
• Creating a teaching plan for your patient, family, or group.
• Recommending work process or workflow changes addressing your topic.
Plan to spend at least 3 direct practicum hours working with the same patient, family, or group.
In addition, you may wish to complete the following:
• Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete and how it will be assessed.
• Conduct sufficient research of the scholarly and professional literature to inform your work and meet scholarly expectations for supporting evidence.
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: (a) develop an intervention as a solution to the problem and (b) submit your proposed intervention, with a written analysis, to your faculty for review and approval.
Part 1
Develop an intervention, as a solution to the problem, based on your assessment and supported by data and scholarly, evidence-based sources.
Incorporate relevant aspects of the following considerations that shaped your understanding of the problem:
• Leadership.
• Collaboration.
• Communication.
• Change management.
• Policy.
• Quality of care.
• Patient safety.
• Costs to the system and individual.
• Technology.
• Care coordination.
• Community resources.
Part 2
Submit your proposed intervention to your faculty for review and approval.
In a separate written deliverable, write a 5–7 page analysis of your intervention.
• Summarize the patient, family, or population problem.
• Explain why you selected this problem as the focus of your project.
• Explain why the problem is relevant to your professional practice and to the patient, family, or group.
In addition, address the requirements outlined below. These requirements correspond to the scoring guide criteria for this assessment, 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 the role of leadership and change management in addressing the problem.
o Explain how leadership and change management strategies influenced the development of your proposed intervention.
o Explain how nursing ethics informed the development of your proposed intervention.
o Include a copy of the intervention/solution/professional product.
• Propose strategies for communicating and collaborating with the patient, family, or group to improve outcomes associated with the problem.
o Identify the patient, family, or group.
o Discuss the benefits of gathering their input to improve care associated with the problem.
o Identify best-practice strategies from the literature for effective communication and collaboration to improve outcomes.
• Explain how state board nursing practice standards and/or organizational or governmental policies guided the development of your proposed intervention.
o Cite the standards and/or policies that guided your work.
o Describe research that has tested the effectiveness of these standards and/or policies in improving outcomes for this problem.
• Explain how your proposed intervention will improve the quality of care, enhance patient safety, and reduce costs to the system and individual.
o Cite evidence from the literature that supports your conclusions.
o Identify relevant and available sources of benchmark data on care quality, patient safety, and costs to the system and individual.
• Explain how technology, care coordination, and the utilization of community resources can be applied in addressing the problem.
o Cite evidence from the literature that supports your conclusions.
• Write concisely and directly, using active voice.
• Apply APA formatting to in-text citations and references.
Additional Requirements
• Format: Format the written analysis of your intervention using APA style. APA Style Paper Tutorial [DOCX] is provided to help you in writing and formatting your paper. Be sure to include:
o A title page and reference page. An abstract is not required.
o 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.
Portfolio Prompt: Save your intervention to your ePortfolio. After you complete your program, you may want to consider leveraging your portfolio as part of a job search or other demonstration of your academic and professional competencies.
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.
o Define the role of leadership and change management in addressing a patient, family, or population health problem.
• Competency 3: Transform processes to improve quality, enhance patient safety, and reduce the cost of care.
o Explain how a proposed intervention to address a patient, family, or population health problem will improve the quality of care, enhance patient safety, and reduce costs to the system and individual.
• Competency 4: Apply health information and patient care technology to improve patient and systems outcomes.
o Explain how technology, care coordination, and the utilization of community resources can be applied in addressing a patient, family, or population health problem.
• Competency 5: Analyze the impact of health policy on quality and cost of care.
o Explain how state board nursing practice standards and/or organizational or governmental policies guided the development of a proposed intervention.
• Competency 6: Collaborate interprofessionally to improve patient and population outcomes.
o Propose strategies for communicating and collaborating with a patient, family, or group to improve outcomes associated with a patient, family, or population health problem.
• Competency 8: Integrate professional standards and values into practice.
o Write concisely and directly, using active voice.
o Apply APA formatting to in-text citations and references.

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Patient, Family, or Population Health Problem Solution Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Define the role of leadership and change management in addressing a patient, family, or population health problem and includes a copy of intervention/solution/professional product.	Does not describe leadership and change management strategies, and does not include a copy of the intervention/solution/professional product.	Attempts to describe leadership and change management strategies, and/or does not include a copy of the intervention/solution/professional product.	Defines the role of leadership and change management in addressing a patient, family, or population health problem and includes a copy of the intervention/solution/professional product.	Defines the role of leadership and change management in addressing a patient, family, or population health problem. Provides an articulate, cogent explanation of the influence that leadership strategies, change management strategies, and nursing ethics had on the development of an intervention and includes a copy of the intervention/solution/professional product.
Propose strategies for communicating and collaborating with a patient, family, or group to improve outcomes associated with a patient, family, or population health problem.	Does not describe communication and collaboration strategies.	Attempts to describe communication and collaboration strategies.	Proposes strategies for communicating and collaborating with a patient, family, or group to improve outcomes associated with a patient, family, or population health problem.	Proposes clear, best-practice strategies, well-supported in the literature, for communicating and collaborating with a patient, family, or group to improve outcomes associated with a patient, family, or population health problem. Presents a strong case for the benefits of obtaining input from a patient, family, or group.
Explain how state board nursing practice standards and/or organizational or governmental policies guided the development of a proposed intervention.	Does not describe state board nursing practice standards and/or organizational or governmental policies applicable to the development of a proposed intervention.	Attempts to explain how state board nursing practice standards and/or organizational or governmental policies guided the development of a proposed intervention.	Explains how state board nursing practice standards and/or organizational or governmental policies guided the development of a proposed intervention.	Provides an articulate, cogent explanation of how specific state board nursing practice standards and/or organizational or governmental policies guided the development of a proposed intervention. Describes credible research on the effectiveness of these standards and/or policies in improving outcomes.
Explain how a proposed intervention to address a patient, family, or population health problem will improve the quality of care, enhance patient safety, and reduce costs to the system and individual.	Does not explain how a proposed intervention to address a patient, family, or population health problem will improve the quality of care, enhance patient safety, and reduce costs to the system and individual.	Provides an explanation, dependent upon unsubstantiated assumptions, of how a proposed intervention to address a patient, family, or population health problem will improve the quality of care, enhance patient safety, and reduce costs to the system and individual.	Explains how a proposed intervention to address a patient, family, or population health problem will improve the quality of care, enhance patient safety, and reduce costs to the system and individual.	Provides an articulate, cogent explanation of how a proposed intervention to address a patient, family, or population health problem will improve the quality of care, enhance patient safety, and reduce costs to the system and individual. Conclusions are well-supported by credible evidence. Cites specific, relevant, and available sources of benchmark data.
Explain how technology, care coordination, and the utilization of community resources can be applied in addressing a patient, family, or population health problem.	Does not describe technology, care coordination, and community resources that can be applied in addressing a patient, family, or population health problem.	Attempts to explain how technology, care coordination, and community resources can be applied in addressing a patient, family, or population health problem.	Explains how technology, care coordination, and the utilization of community resources can be applied in addressing a patient, family, or population health problem.	Provides an articulate, cogent explanation of how technology, care coordination, and the utilization of community resources can be applied in addressing a patient, family, or population health problem. Conclusions are well-supported by specific, credible evidence.
Write concisely and directly, using active voice.	Does not write concisely and directly, using active voice.	Writes passively, with a tendency toward wordiness.	Writes concisely and directly, using active voice.	Writes concisely and directly. Conveys precise and unequivocal meaning through clear and consistent use of active voice.
Apply APA formatting to in-text citations and references.	Does not apply APA formatting to in-text citations and references.	Applies APA formatting to in-text citations and references incorrectly and/or inconsistently, detracting noticeably from good scholarship.	Applies APA formatting to in-text citations and references.	Exhibits strict and nearly flawless adherence to APA formatting of in-text citations and references.