Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations

Assessing the Problem

Nurses offer their care at individual, group, family, and population levels. General principles may be similar at every level but specific interventions may vary slightly. Nursing care across the human lifespan takes into account the various modifiable and nonmodifiable determinants of health and wellness. In this capstone project, I chose a young female patient whom I know very well and have interacted with together with her family in the process of training. The purpose of this paper is to assess this patient’s health problem and propose nursing leadership, communication, change management, and collaboration skills that would apply to manage her health problem.

Patient Health Problem

Amie is a 3-year-old white female patient who has visited the child wellness clinic in our facility severally because of her recurrent illness. Amie is the firstborn and the only child to a 25-year-old mother and 28-year-old both who recently graduated from college with degrees and master’s degrees in respective courses. The father is working as a banker while the mother just landed a job a few months ago as a part-time bar attendant in the same city. Amie was diagnosed with cystic fibrosis after his fourth clinic visit. During the first hospital visit, Amie had pneumonia that was treated and home-based care given. A month later her mother accompanied her to the clinic because of concerns about unexplained weight loss. Her mother was worried that her pneumonia which was previously treated as the cause of her loss of weight. On the third visit, two months later, Amie was referred to an otorhinolaryngologist because of symptoms of sinus problems. He was treated and discharged.

On the fourth visit, Amie came for a regular checkup visit and is found to have deteriorating health. Diagnostic workups revealed she had cystic fibrosis and a multidisciplinary team is to be formed to care for her. Amie has had several health problems that have necessitated clinic visits. Her family genogram reveals a history of cystic fibrosis. The parents are unaware of any chronic or genetic diseases in their families. This diagnosis of cystic fibrosis has left the parents astounded. Their journey with their daughter has not been an easy one and they are fortunately not willing to give up. The parents have consented to participate in my capstone projects as they go on forward with the further care for Amie

Patient Health Problem

Cystic fibrosis, though a rare disease, has established risk factors. This is a genetic passed down from generation to the next through phenotypic parents or carrier parents. The inheritance of this disease follows an autosomal recessive pattern. The diagnosis can be made at the point of newborn screening or for some socioeconomic reasons, diagnosis is made after a series of multiorgan manifestations in toddlers and young children. The diagnosis of Amie was made after a series of clinical presentations that would not otherwise be explained from clinical presentation, past medical history, or family history. About 35000 persons in the United States are affected by systemic fibrosis (Centers for Disease Control and Prevention, 2021). A review study by Shteinberg et al. (2021) found that cystic fibrosis can occasionally affect only one organ system leading to difficulty in making an early diagnosis because other disease entities will be explored first. In Amie’s case, the respiratory system presented with several manifestations before the diagnosis of cystic fibrosis was made.

According to Scotet et al. (2020), cystic fibrosis (CF) is no longer considered as life-threatening as it was about a century ago. CF was initially viewed as a disease in the pediatric population. With the advancement of health care, the survival of patients with CF has been prolonged. Clinical manifestations and complications of the disease are seen in the elderly. Pediatric patients diagnosed with CF can live to see their fifth decade of life. Oates & Schechter (2021) reported the inequalities and care outcomes for patients with CF that go back more than 20 years ago. CF is a lifelong disease and requires significant financial input to afford the treatments. Amie’s diagnosis comes at a time when they have used a lot of finances in the treatment for other complications in the previous visit. Psychological impacts have been felt by Amie’s parents who are yet to come to acceptance with the disorder diagnosis.

Analysis of Evidence

My analysis of the health problem has been backed by credible evidence-based sources. Four literature sources backed up my argument to support Amie’s condition and associated circumstances at diagnosis as a health problem. Three literature studies by Oates & Schechter (2021), Scotet et al. (2020), and Shteinberg et al. (2021) and a website source by the Centers for Disease Control and Prevention (2021) provided relevant information to support the existence my patient’s health problem. These sources were selected because of their relevance to the health problem, and because they are credible. Their credibility was explained by the qualifications of their authors who showed expert capabilities in their respective topics. The source by CDC was deemed credible because it was authorized by a corporate government organization in charge of health prevention and promotion in the United States. The structure of the journal articles was systematic and organized in a scholarly manner. They were published in reputable journals and peer-reviewed. Therefore, I considered their findings credible for use in my description of my patient’s health problem. Sources that do not meet these above qualifications would be deemed unreliable.

Evidence-based practice utilized credible sources of research evidence to guide practice. Nursing theories and conceptual frameworks are also derived based on practice evidence. Nursing care for patients with CF goes up to the care at the end of life. A recent research study by Cathcart et al. (2020) explored the effectiveness of a multidisciplinary team (MDT) stargates in end-of-life care for CF patients. In their study, Cathcart et al. reported the crucial role of various care professionals in this type of care. Health policies such as advance care plans for the patient at the terminal care should be discussed. Nurse involvement in the making of these policies is important to enhance their patient advocacy roles. Nursing conceptual frameworks should, therefore, be holistic and patient-centered.

Health Policies and State Board Nursing Practice Standards

Registered nurses and advected practice registered nurses have essential roles in caring for patients with CF. According to a study by Gathercole (2019) that explored the nurse role and patient perspectives in the coordination of care for pediatric patients, child education and learning posed barriers to seeking care and vice versa was true. The importance of considering family routines in the community management of these patients was important. The standards set by the MDT aforementioned are effective in implementing this bidirectional relationship in the management of patients with CF

Nurses have the needed care coordination skills to enable a seamless flow of care from clinicians to patients. Disease diagnosis and treatment are part of this care coordination. Sometimes, care providers, such as nurses may be required to prescribe medication and medical devices to improve the quality of life of patients. However, this freedom is limited in some states despite the recommendations by the institution of medicine (IOM) more than a decade ago. Policies allowing their full practice authority to medically treat CF patients in the community should be allowed by state boards of nursing. Well-documented standards based on evidence-based practice should be used to make nurses coordinate this care in staff-limited settings. Coordination of the care and connecting patients to available community resources should be guided by well-laid down staid board nursing standards.

Nursing Leadership Strategies to Improve Outcomes

Nurses are at the center of the coordination of care for patients with CF. Their leadership qualities in collaboration, communication, and change management are required in coordinating the care. some leadership strategies by nurses in the coordination include but are not limited to integration of social needs into patient care, communication across disciplines, and policy change advocacy. The nurse as the leader in the multidisciplinary team should ensure the patient’s social and economic health determinants are taken into account for positive health outcomes. Taking this role in the community makes the nurse the leader and influences the direction of care for patients. The aims are to reduce hospital readmission rates and improve access to care in the community for patients with CF (Warchol et al., 2019). Integrating the social needs of the patients in clinical care makes the nurse a transformational and visionary leader in multidisciplinary care.

Social needs integration would require engaging and bringing on board all stakeholders in the care for this patient (National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020– et al., 2021). The nursing leadership should thus ensure equity and diversity in the care for these patients with chronic disease in the community and during their care in the clinical settings. Treating them similarly to other patients would not be culturally sensitive. Recognizing the diversity of culture and its influence on nursing care would improve the patient experience and satisfaction of care thus quality care.

Policies are at the center of care models adopted by clinicians in the clinical and community settings. Nurses have the potential to influence policy change through participation to enhance a favorable environment for care delivery. the national academy of medicine recommends the advocacy of policy change by the nurse to influence their care. These policies should aim to promote health care equity and diversity. Legislative testimonies and direct participation in the legislative process at the state level can be used by a nurse and can have far-reaching impacts on their care delivery.

Conclusion

Amie is a 3-year-old patient who has visited a clinic severally for various respiratory tract-related complications. I am familiar with her parents and they have consented to participate in my capstone project. Amies was diagnosed with cystic fibrosis and is to start care. I have used various credible evidence-based sources used to support and argue her condition and the situations surrounding her diagnosis as a health problem. Her required care would take a multidisciplinary approach where the nurse will ideally play the central role. Health policies and state board of nursing standards have also been identified as essential determinants of her care. therefore, good ensuring leadership will ensure good communication across disciplines, integrate social needs and ensure health equity.

References

Cathcart, F., Wood, J., & Madge, S. (2020). Improving end-of-life care for adults with cystic fibrosis: an improvement project. BMJ Open Quality9(3), e000861. https://doi.org/10.1136/bmjoq-2019-000861

Centers for Disease Control and Prevention. (2021, January 26). Cystic fibrosis. Cdc.Gov. https://www.cdc.gov/genomics/disease/cystic_fibrosis.htm

Gathercole, K. (2019). Managing cystic fibrosis alongside children’s schooling: Family, nurse and teacher perspectives. Journal of Child Health Care: For Professionals Working with Children in the Hospital and Community23(3), 425–436. https://doi.org/10.1177/1367493518814930

{National Academies of Sciences, Engineering, and Medicine, National Academy of Medicine, Committee on the Future of Nursing 2020–}, Flaubert, J. L., Le Menestrel, S., Williams, D. R., & Wakefield, M. K. (2021). The role of nurses in improving health equity. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK573898/

Oates, G. R., & Schechter, M. S. (2021). Social inequities and cystic fibrosis outcomes: We can do better. Annals of the American Thoracic Society18(2), 215–217. https://doi.org/10.1513/AnnalsATS.202010-1274ED

Scotet, V., L’Hostis, C., & Férec, C. (2020). The changing epidemiology of cystic fibrosis: Incidence, survival, and impact of the CFTR gene discovery. Genes11(6), 589. https://doi.org/10.3390/genes11060589

Shteinberg, M., Haq, I. J., Polineni, D., & Davies, J. C. (2021). Cystic fibrosis. Lancet397(10290), 2195–2211. https://doi.org/10.1016/s0140-6736(20)32542-3

Warchol, S. J., Monestime, J. P., Mayer, R. W., & Chien, W.-W. (2019). Strategies to reduce hospital readmission rates in a non-Medicaid-expansion state. Perspectives in Health Information Management16(Summer), 1a. https://www.ncbi.nlm.nih.gov/pubmed/31423116

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