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NURS-FPX6021 u02a1 - Change Strategy and Implementation Learner: Jessica , Ramos

OVERALL COMMENTS Hi Jessica,

This plan could be used with any improvement plan to improve patients' lives with diabetes. This topic needs to be

discussed nationally. Providing a solid change strategy and how to implement it is essential for success. One

improvement that needs to be made is in your table, your first table was excellent, but the requirements state that a

table needs to include the current outcomes, change strategies, and expected outcomes. Please see assessment

example 2. Please highlight any changes you make so I can capture all of your hard work.

Dr. Martha

RUBRICS

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CRITERIA 1

Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes.

COMPETENCY

Design patient-centered, evidence-based, advanced nursing care for achieving high-quality patient outcomes.

NON_PERFORMANCE: Does not develop a data table.

BASIC:

Develops a data table, but the table is either not accurate or does not reflect the current or desired states of

one or more clinical outcomes.

PROFICIENT:

Develops a data table that accurately reflects the current and desired states of one or more clinical

outcomes.

DISTINGUISHED:

Develops a data table that accurately reflects the current and desired states of one or more clinical

outcomes. Identifies areas of ambiguity or uncertainty where additional data could help to improve clarity.

Comments:

This grading section requires the learner to create a data table to show at least one clinical outcome. Please

note that you failed to develop a data table as specified in the assessment’s instructions. Please add a section

that addresses this on your grading rubric.

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CRITERIA 2

Propose change strategies that will help to achieve the desired state of one or more clinical outcomes.

COMPETENCY

Develop change strategies for improving the care environment.

NON_PERFORMANCE: Does not describe change strategies.

BASIC:

Describes change strategies, but does not fully relate how the strategies will help to achieve the desired

state of one or more clinical outcomes.

PROFICIENT:

Proposes change strategies that will help to achieve the desired state of one or more clinical outcomes.

DISTINGUISHED:

Proposes change strategies that will help to achieve the desired state of one or more clinical outcomes.

Acknowledges potential difficulties and discusses how those challenges will be met.

Comments:

Great job proposing change strategies that would help achieve clinical outcomes. I especially appreciate that

you recognized the importance of addressing the issues with diabetes including depression. You also

acknowledged potential difficulties.

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CRITERIA 3

Justify the specific change strategies used to achieve desired outcomes.

COMPETENCY

Develop change strategies for improving the care environment.

NON_PERFORMANCE:

Does not justify the specific change strategies used to achieve desired outcomes.

BASIC:

Provides a weak or flawed justification of how the specific change strategies will help achieve desired

outcomes.

PROFICIENT: Justifies the specific change strategies used to achieve desired outcomes.

DISTINGUISHED:

Justifies the specific change strategies used to achieve desired outcomes. Impartially considers other

perspectives.

Comments:

Jessica, most of the references that you selected containing the evidence used as the basis for your map

were relevant. However, I noted that a few were more than 5 years old. How could you revise your references

to change this?

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CRITERIA 4

Explain how change strategies will lead to quality improvement with regard to safety and equitable care.

COMPETENCY

Apply quality improvement methods to practice that promote safe, equitable quality of care.

NON_PERFORMANCE:

Does not explain how change strategies will lead to quality improvement with regard to safety and equitable

care.

BASIC:

Explains change strategies used, but the rationale for how they will lead to quality improvement with

regard to safety and equitable care is unclear or missing.

PROFICIENT:

Explains how change strategies will lead to quality improvement with regard to safety and equitable care.

DISTINGUISHED:

Explains how change strategies will lead to quality improvement with regard to safety and equitable care.

Identifies assumptions upon which the explanation is based.

Comments:

Please see the comment on your paper. You need to support your thoughts with evidence. How would the

change strategy that you chose lead to safety and equitable care?

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CRITERIA 5

Explain how change strategies will utilize interprofessional considerations to ensure successful implementation.

COMPETENCY

Evaluate the efficiency and effectiveness of interprofessional care systems in achieving desired health care

improvement outcomes.

NON_PERFORMANCE:

Does not explain how change strategies will utilize interprofessional considerations to ensure successful

implementation.

BASIC:

Explains change strategies used, but the rationale for how they will utilize interprofessional considerations

to ensure successful implementation is unclear or missing.

PROFICIENT:

Explains how change strategies will utilize interprofessional considerations to ensure successful

implementation.

DISTINGUISHED:

Explains how change strategies will utilize interprofessional considerations to ensure successful

implementation. Identifies assumptions upon which the explanation is based.

Comments:

Jessica, please see the comments on your paper. You were able to explain the change strategy that you

selected but could not explain who and how interprofessional collaboration could be used with the strategy.

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CRITERIA 6

Communicate change plan in a way that makes the data and rationale easily understood and compelling.

COMPETENCY

Communicate effectively with diverse audiences, in an appropriate form and style, consistent with

organizational, professional, and scholarly standards.

NON_PERFORMANCE:

Does not communicate change plan in a way that makes the data and rationale easily understood and

compelling.

BASIC:

Communicates the data and rationale of a change plan, but the approach is somewhat unclear or is not very

compelling.

PROFICIENT:

Communicates change plan in a way that makes the data and rationale easily understood and compelling.

DISTINGUISHED:

Communicates change plan in a way that makes the data and rationale easily understood and compelling.

Acknowledges potential difficulties and discusses how those challenges will be met.

Comments:

You did a good job discussing your change plan. You were able to discuss the rationale used in the plan

adequately.

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Supplemental Feedback

CRITERIA 7

Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style.

COMPETENCY

Communicate effectively with diverse audiences, in an appropriate form and style, consistent with

organizational, professional, and scholarly standards.

NON_PERFORMANCE:

Does not integrate relevant sources to support assertions; does not correctly format citations and references

using current APA style.

BASIC:

Sources lack relevance or are poorly integrated, or citations or references are incorrectly formatted.

PROFICIENT:

Integrates relevant sources to support assertions, correctly formatting citations and references using current

APA style.

DISTINGUISHED:

Integrates relevant sources to support assertions, correctly formatting citations and references using current

APA style. Citations are free from all errors.

Comments:

Please write a conclusion. Also, see the comments on your paper to improve your writing and APA formatting.

Writing is one of the hardest part of the MSN program.

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SUPPLEMENTAL CRITERIA 1

Purpose Compose a text that articulates meaning relevant to the main topic, scope, and purpose of the prompt

BEGINNING: This text is unrelated to the assignment prompt.

DEVELOPING:

This text is related to the assignment prompt but does not demonstrate an understanding of the main topic,

scope, and purpose.

SKILLED:

This text responds to the assignment prompt and appropriately addresses the main topic, scope, and

purpose.

ADVANCED:

This text presents a focused response to the assignment prompt and demonstrates a thorough

understanding of the main topic, scope, and purpose.

Comments:

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SUPPLEMENTAL CRITERIA 2

Organization Develop text using organization, structure, and transitions that demonstrate understanding of relationship between main and subtopics

BEGINNING:

This text does not include a thesis statement and is organized inappropriately for the assignment.

DEVELOPING:

The thesis statement in this text is unclear and/or the text is presented in paragraphs with unclear main

idea(s) and/or transitional phrases.

SKILLED:

This text includes a thesis statement and is organized into paragraphs, with clear main ideas and effective

transitional phrases.

ADVANCED:

This text reflects a strong thesis statement. Additionally, this text is organized with skillful transitions into

paragraphs with clear main ideas, sufficient evidence, analysis, and linking information.

Comments:

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SUPPLEMENTAL CRITERIA 3

Evidence Integrate into text appropriate use of scholarly sources and evidence

BEGINNING: This text included plagiarized information.

DEVELOPING:

This text lacks synthesis of information from sources and/or the credibility of the sources is questionable,

with many flaws in APA citation style.

SKILLED:

The included evidence was integrated and synthesized from outside sources, most of which are scholarly,

with minimal flaws in APA citation style.

ADVANCED:

The evidence in this text was integrated and synthesized from credible, scholarly, and professionally sound

sources, with minimal flaws in APA citation style.

Comments:

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SUPPLEMENTAL CRITERIA 4

Tone Apply in text the standard writing conventions for the discipline, including structure, voice, person and tone

BEGINNING: Text uses language inappropriate for the intended audience.

DEVELOPING:

This text does not meet writing conventions for the discipline and lacks appropriate voice, person, and/or

tone for the intended audience.

SKILLED:

This text meets writing conventions for the discipline and there were minimal issues in appropriate use of

voice, person, or tone for the intended audience.

ADVANCED:

This text exhibits strict adherence to writing conventions for the discipline and uses appropriate voice,

person, and tone for the intended audience.

Comments:

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SUPPLEMENTAL CRITERIA 5

Sentence Structure Produce text with minimal grammar, usage, spelling, and mechanical errors

BEGINNING:

Text meaning is unclear due to errors in sentence structure, grammar, usage, word choice, spelling, or

mechanics in 75% or more of text.

DEVELOPING:

Text meaning is interrupted due to sentence structure, grammar, usage, word choice, spelling, or mechanical

errors in 25%-75% or more of text.

SKILLED:

Text conveys clear meaning with minimal issues in grammar, usage, word choice, spelling, or mechanical

errors in 10%-25% of text.

ADVANCED:

Text complexity and concision conveys clear meaning, with grammar, usage, word choice, spelling, or

mechanical errors in 10% or less of text.

Comments:

Running head: CHANGE STRATEGY AND IMPLEMENTATION 1

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Change Strategy and Implementation

Learner’s Name

Capella University

Biopsychosocial Concepts for Advanced Nursing Practice I

Change Strategy and Implementation

April, 2019

CHANGE STRATEGY AND IMPLEMENTATION 2

Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

Change Strategy and Implementation

Patients often present with respiratory issues of varying severity; these can range from

breathing difficulties to dry or wet coughs. Patients that do present with these issues are admitted

to the pulmonary ward to treat the issue at hand. Chronic obstructive pulmonary disorder

(COPD) is one of the primary issues among these. Each patient receives treatment based on the

severity of his or her condition. The treatment can include prescribing antibiotics, non-invasive

ventilation, and pulmonary rehabilitation. Pulmonary rehabilitation involves a program of

exercise and education specifically designed to help individuals with pulmonary issues such as

COPD (NHS, 2016a).

The treatment for COPD is aimed at improving the physical health of patients admitted

to the ward. However, it does not take into consideration the mental health of these individuals.

There exists a strong positive correlation between COPD and anxiety and depression (Pooler &

Beech, 2014), which means that patients who present with COPD are likely to be comorbid with

anxiety, depression, or both. Further, COPD patients who are comorbid with depression and

anxiety are statistically more likely to be hospitalized; these patients are also likely to require

longer periods of hospitalization and face a greater risk of mortality after they are discharged.

Considering these factors, it is necessary to address mental health issues simultaneously with

physical issues to ensure that these patients can manage their overall health more effectively.

Left untreated, both anxiety and depression can lead to significant implications for compliance to

medical treatment (Pooler & Beech, 2014).

Anxiety and COPD

Some of the symptoms associated with COPD overlap with those associated with anxiety.

Dyspnea or shortness of breath is particularly distressing for patients and is common to both

COPD and anxiety. A COPD patient with anxiety might interpret dyspnea in an exaggerated

CHANGE STRATEGY AND IMPLEMENTATION 3

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manner, often correlating this symptom with an inability to breathe or even an imminent death

(Heslop, Newton, Baker, Burns, Carrick-Sen, & De Soyza, 2013). Anxiety might not be the

cause of dyspnea in COPD patients, but it can be viewed as an indicator of acute exacerbation in

such patients (Pooler & Beech, 2014).

Depression and COPD

As mentioned above, there exists a significant correlation between COPD and depression.

The effect that depression has on COPD patients is different from the effect produced by anxiety.

Depression has been significantly linked to a perceived decrease in quality of life as well as in

physical activity. Pooler and Beech (2014) also note that depression is likely to be

underdiagnosed and undertreated for individuals with COPD.

Patients who suffer from COPD and depressive symptoms are less likely to follow

through on their recommended physical therapy. Consequently, their COPD becomes

aggravated, requiring them to receive further treatment. For most patients, particularly in cases of

acute exacerbation, further treatment would require hospitalization. However, this might cause

patients to feel that they are unable to care for themselves; they may experience inferiority or a

diminished sense of autonomy. As a result, patients are often stuck within this cycle of

deteriorating health, leading to a decline in the state of their mental health. The only effective

method to treat patients in such a situation is to address both their physical and psychological

issues (Dursunoğlu et al., 2016).

Change Strategies

Both depression and anxiety require attention from a mental health professional to

adequately and effectively help patients. Cognitive behavioral therapy (CBT) has been proven to

be an effective method of managing anxiety, depression, and a range of other mental health

CHANGE STRATEGY AND IMPLEMENTATION 4

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conditions. In a typical CBT session, a patient and a therapist work together to break down one

of the patient’s problems into its separate parts. Some of these parts could be how the patient

thinks about the problem, how he or she feels physically about it, and how he or she acts in

response to it. The patient and the therapist then evaluate these parts and figure out what might

be unhelpful or unrealistic as well as the effect that these parts have on each other and on the

patient (NHS, 2016b).

By identifying these parts, the therapist can figure out a plan of action for the patient to

change thoughts and behaviors that are counterproductive. The patient will then be asked to

practice these changes in his or her life and report back on whether he or she was able to enact

the changes and how effective they were. By using this method, the patient would eventually be

able to apply the skills that he or she has learned in the sessions to his or her life. This would

help the patient manage his or her issues even after the course of treatment is complete (NHS,

2016b). For example, individuals with COPD and anxiety might be able to better manage their

anxiety by not associating shortness of breath with more catastrophic outcomes.

However, CBT has certain drawbacks. It requires patients to be willing to confront their

emotions and anxieties, which can be uncomfortable. Further, CBT requires patients’

commitment to the process and their cooperation to help themselves get better. The therapy can

be guided, but ultimately the outcome of therapy is determined by the patients’ participation

(NHS, 2016b). On a practical level, it can be difficult for hospitals to accommodate an adequate

number of therapists for patients or to provide an efficient therapist-to-patient ratio.

To address this, it would be necessary for group therapy sessions to be conducted in

conjunction with one-on-one sessions. This would enable a wider range of individuals to access

the necessary treatment for their psychological condition, and it might be less intimidating for

CHANGE STRATEGY AND IMPLEMENTATION 5

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them if it is a group activity. Further, nurses could be trained in CBT, or those trained in CBT

could be hired to facilitate more one-on-one sessions. Patients who are provided with access to

these treatment options in addition to the treatment they receive for their COPD will have a

higher quality of life and be able to manage both their physical and mental conditions more

effectively than before (Howard & Dupont, 2014).

Pharmacological interventions can also be used to treat anxiety and depression.

Treatment doses vary based on the severity of the disorder and can have a variety of side effects.

Most antidepressants are not contraindicated; however, caution is necessary while prescribing

certain types such as tricyclic antidepressants. Benzodiazepines have the potential to cause

respiratory depression and should not be administered to COPD patients who retain CO2.

Standard antidepressants such as selective serotonin reuptake inhibitors can often have side

effects such as headaches, tremors, gastrointestinal distress, and either psychomotor activation or

sedation. These side effects occur during the initial phase of treatment and can be problematic

when coupled with the existing conditions of COPD patients. In contrast, CBT and group therapy

are nonpharmacological interventions and would not result in contraindications. It is also

difficult to implement the pharmacological treatment of depression and anxiety on the level of

policy as the medication and doses required would be based on the needs of individual patients.

Further, patients who suffer from COPD might be unwilling to take medication for depression or

anxiety along with the medication that they might already be taking. This could possibly result

from the stigma that surrounds mental illnesses or the reluctance of patients to accept their

diagnosis (Tselebis et al., 2016).

Data Table

Current Outcomes Change Strategies Expected Outcomes

CHANGE STRATEGY AND IMPLEMENTATION 6

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Patients who suffer from COPD do not have adequate access to mental health facilities: a) Many COPD patients

experience anxiety resulting from dyspnea.

b) Patients with COPD are likely to experience depressive symptoms that have been positively correlated with the worsening of COPD symptoms.

To ensure that patients receive the care they need, certain measures are necessary: • Therapists should be

made available to COPD patients.

• Nurses should be trained in CBT, or nurses who are trained in CBT should be hired.

• Group therapy sessions should be conducted regularly for COPD patients who are comorbid with anxiety, depression, or both.

Patients who suffer from COPD will have adequate access to mental health facilities and will be able to manage both their physical and mental conditions more effectively than before: a) Patients who are

comorbid with COPD and anxiety will be able to distinguish between their anxiety and an aggravation of their COPD symptoms (Howard & Dupont, 2014).

b) Patients who are comorbid with COPD and depression will be better prepared to manage both their COPD and their depressive symptoms (Dursunoğlu et al., 2016).

CHANGE STRATEGY AND IMPLEMENTATION 7

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References

Dursunoğlu, N., Köktürk, N., Baha, A., Bilge, A. K., Börekçi, Ş., Çiftçi, F., . . . Turkish Thoracic

Society-COPD Comorbidity Group. (2016). Comorbidities and their impact on chronic

obstructive pulmonary disease. Tüberküloz ve Toraks, 64(4), 289–298.

Heslop, K., Newton, J., Baker, C., Burns, G., Carrick-Sen, D., & De Soyza, A. (2013).

Effectiveness of cognitive behavioural therapy (CBT) interventions for anxiety in patients

with chronic obstructive pulmonary disease (COPD) undertaken by respiratory nurses:

The COPD CBT CARE study: (ISRCTN55206395). BMC Pulmonary Medicine, 13(1).

Howard, C., & Dupont, S. (2014). ‘The COPD breathlessness manual’: A randomised controlled

trial to test a cognitive-behavioural manual versus information booklets on health service

use, mood and health status, in patients with chronic obstructive pulmonary disease. npj

Primary Care Respiratory Medicine, 24.

NHS. (2016a). Chronic obstructive pulmonary disorder (COPD). Retrieved from

https://nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/treatment/

NHS. (2016b). Cognitive behavioral therapy (CBT). Retrieved from

https://nhs.uk/conditions/cognitive-behavioural-therapy-cbt/

Pooler, A., & Beech, R. (2014). Examining the relationship between anxiety and depression and

exacerbations of COPD which result in hospital admission: A systematic

review. International Journal of Chronic Obstructive Pulmonary Disease, 9(1), 315–330.

Tselebis, A., Pachi, A., Ilias, I., Kosmas, E., Bratis, D., Moussas, G., & Tzanakis, N. (2016).

Strategies to improve anxiety and depression in patients with COPD: A mental health

perspective. Neuropsychiatric Disease and Treatment, 12, 297–328.

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