Student Name
Capella University
NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1
Prof. Name
Date
Change Strategy and Implementation
Acute Kidney Failure (AKF), also referred to as renal failure, is a critical condition particularly concerning for patients with diabetes. AKF occurs when the kidneys are unable to adequately filter waste products from the bloodstream, resulting in toxin accumulation (Kaur et al., 2023). This condition often necessitates frequent hospitalization, hemodialysis, or ICU admission due to uncontrolled blood glucose levels, which in turn increases susceptibility to infections and further complications.
AKF has profound psychological and physical impacts on patients. Frequent hospital admissions can trigger traumatic stress and anxiety, exacerbating health outcomes (Pickkers et al., 2021). Research indicates that hemodialysis not only manages fluid and waste levels but also contributes to psychiatric conditions such as depression, anxiety, and suicidal ideation (Khoury et al., 2023). The focus of this assessment is to develop change strategies for AKF patients in the ICU, aiming to reduce traumatic stress and improve mental and physical health outcomes.
Table for Current and Desired States Clinical Outcomes
| Clinical Outcome | Current State | Desired Outcome |
|---|---|---|
| Mortality and Morbidity | ICU patients with diabetes experiencing AKF show high mortality and morbidity rates (16–50%) due to extended hospital stays, increasing infection risks. | Reduce mortality and morbidity rates by 10% through strict glycemic control protocols and patient education, improving ICU outcomes (Khairoun et al., 2021). |
| Psychiatric Issues | High prevalence of depression, anxiety, and traumatic stress adversely affecting overall health, including cardiovascular strain. | Improve mental health outcomes by up to 70% using psychological support services, including counseling, mindfulness programs, and therapies. |
| Quality of Life | Patients report poor quality of life due to recurrent hospitalizations, dialysis, weak immunity, and limitations in daily activities. | Enhance quality of life through patient education, self-management strategies, and optimized symptom and pain management. |
| Medication Adherence | Low adherence to prescribed medications, resulting in further complications and increased mortality. | Improve adherence by collaborating with healthcare providers, pharmacists, and caregivers to create a coordinated and supportive medication management plan (Bano et al., 2023). |
Areas of Ambiguity or Uncertainty
The data for ICU AKF patients with diabetes was collected under HIPAA compliance (U.S. HHS, 2022). However, uncertainties remain, such as mortality or morbidity outcomes for ICU patients with other conditions, limiting comparative interventions.
Social determinants of health, including education, financial status, and access to care, influence the progression and management of diabetes-induced renal failure (Quiñones & Hammad, 2020). Moreover, racial and ethnic variations may affect disease severity and response to interventions. Addressing these factors can help tailor personalized care plans, enhancing outcomes and overall organizational efficiency.
Proposes of Change Strategies to Achieve Outcomes
The primary goal is to reduce psychiatric burdens while improving care delivery in the ICU for diabetic patients with renal failure. Achieving these outcomes requires modifying ICU practices through education, staff training, and patient-centered interventions.
Psychological Support Initiative
To address traumatic stress and anxiety, a psychiatric team comprising counselors, therapists, and social workers should provide targeted interventions. Stressors often include isolation, complications, and uncertainty regarding treatment (Seery & Buchanan, 2022). One-on-one counseling sessions can offer personalized coping strategies and positive perspectives on disease management.
Group therapy sessions further improve morale by allowing patients to share experiences, validate feelings, and learn effective coping strategies (Malhotra & Baker, 2022). Educational strategies, involving family and friends, strengthen patient support networks. Calming therapies, such as music or pet-assisted interventions, help reduce stress and anxiety associated with the ICU environment (Mansouri et al., 2020).
Disease Recovery Program
Improving ICU care delivery positively affects multiple outcomes, including morbidity, mortality, and patient satisfaction. Holistic management of AKF involves strict glycemic control, education on diabetes management, and optimization of comorbid conditions (AlHaqwi et al., 2023).
Medication adherence is essential for reducing complications. Collaboration among nurses, physicians, and pharmacists ensures adherence through patient education and tailored regimens (Aremu et al., 2022). Staff training on ICU environmental factors—such as noise, lighting, hygiene, and interruptions—can further reduce stress and improve patient outcomes (Souza et al., 2022).
Potential Difficulties
Several challenges may hinder implementation:
- Resource Constraints: Limited equipment, supplies, and funding may affect the creation of a calm, supportive ICU environment. Highlighting the benefits of resource allocation can encourage administrative support (Haque et al., 2021).
- Staffing Levels: Low nurse-to-patient ratios and insufficient psychological staff can delay interventions. Recruiting qualified personnel is critical (Jeong, 2023).
- Resistance to Change: ICU staff and patients may resist new care protocols. Targeted training on the benefits of coordinated care can mitigate resistance (Khaleghi et al., 2020).
Justification for Specific Change Strategies
Evidence emphasizes the importance of addressing mental health alongside physical health in comorbid conditions. Psychological support programs improve outcomes through peer support, therapies, and counseling (Seery & Buchanan, 2022). Training and education enhance staff performance, promoting seamless care integration and facilitating recovery (Khaleghi et al., 2020).
Patient-centered approaches increase satisfaction and reduce adverse outcomes, improving both patient health and organizational efficiency (AlHaqwi et al., 2023). Failure to implement these strategies risks higher morbidity, mortality, and costs.
Ways Strategies that Lead to Quality Improvement
The psychological support and disease recovery programs improve ICU care by creating a safe, equitable, and patient-centered environment. Addressing social determinants and demographic factors ensures more efficient care management. These initiatives align with the Quadruple Aim framework, improving patient experience, community health, cost-effectiveness, and staff well-being (Rangachari, 2023).
Training staff and optimizing care practices enhance both patient satisfaction and clinical outcomes, ultimately reducing hospital costs related to prolonged admissions and poor medication adherence (Bano et al., 2023).
Assumptions upon Which the Explanation Is Based
These strategies assume standardized, evidence-based, patient-centered practices in the ICU. Collaboration between patients and interdisciplinary teams promotes safety, reduces errors, and improves satisfaction (AlHaqwi et al., 2023).
Ways Strategies that Ensure Successful Implementation
Implementation relies on interdisciplinary collaboration among nurses, physicians, pharmacists, and psychologists. Staff education, patient-centered interventions, and shared decision-making improve adherence, mental health support, and care efficiency (Tong & Adler, 2022; Matusov et al., 2022).
These strategies promote ethical, equitable care, enhancing recovery from diabetic kidney failure while managing stress and anxiety in ICU patients. Patient engagement and interdisciplinary guidance allow self-management, improving overall outcomes.
Conclusion
In conclusion, these change strategies address the multifaceted challenges of diabetic patients with renal failure in the ICU. By integrating psychological support, patient-centered care, and staff education, the proposed interventions aim to reduce anxiety, improve care delivery, and enhance overall patient outcomes. Evidence-based practices and interdisciplinary collaboration form the foundation for a safer, equitable, and patient-centered ICU environment.
References
AlHaqwi, A. I., Amin, M. M., AlTulaihi, B. A., & Abolfotouh, M. A. (2023). Impact of patient-centered and self-care education on diabetes control in a family practice setting in Saudi Arabia. International Journal of Environmental Research and Public Health, 20(2), 1109. https://doi.org/10.3390/ijerph20021109
Aremu, T. O., Oluwole, O. E., Adeyinka, K. O., & Schommer, J. C. (2022). Medication adherence and compliance: Recipe for improving patient outcomes. Pharmacy, 10(5), 106. https://doi.org/10.3390/pharmacy10050106
Bano, T., Haq, N., Nasim, A., Saood, M., Tahir, M., Yasmin, R., … Shafi, M. (2023). Evaluation of medication errors in patients with kidney diseases in Quetta, Pakistan. PloS One, 18(8), e0289148. https://doi.org/10.1371/journal.pone.0289148
Haque, W. Z., Demidowich, A. P., Sidhaye, A., Golden, S. H., & Zilbermint, M. (2021). The financial impact of an inpatient diabetes management service. Current Diabetes Reports, 21(2). https://doi.org/10.1007/s11892-020-01374-0
Jeong, E. (2023). Impact on health outcomes of hemodialysis patients based on the experience level of registered nurses in the hemodialysis department: A cross-sectional analysis. Frontiers in Health Services, 3, 1154989. https://doi.org/10.3389/frhs.2023.1154989
Kaur, A., Sharma, G. S., & Kumbala, D. R. (2023). Acute kidney injury in diabetic patients: A narrative review. PMC, 102(21), e33888–e33888. https://doi.org/10.1097/md.0000000000033888
Khaleghi, S., Moghaddam, A. S., Abdolshahi, A., Shokri, A., Raei, M., & Kavari, S. H. (2020). Training needs assessment of nurses working at intensive care unit with the aim of designing the in-service training program. Iranian Journal of Public Health. https://doi.org/10.18502/ijph.v49i11.4744
Khoury, R., Ghantous, Z., Ibrahim, R., Ghossoub, E., Madaghjian, P., Karam, E. G., … Karam, S. (2023). Anxiety, depression and post-traumatic stress disorder in patients on hemodialysis in the setting of the pandemic, inflation, and the Beirut blast: A cross-sectional study. BMC Psychiatry, 23(1). https://doi.org/10.1186/s12888-023-04798-6
Malhotra, A., & Baker, J. (2022). Group therapy. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549812/
NURS FPX 6021 Assessment 2 Change Strategy and Implementation
Mansouri, S., Jalali, A., Rahmati, M., & Salari, N. (2020). Educational, supportive group therapy and the quality of life of hemodialysis patients. BioPsychoSocial Medicine, 14(1). https://doi.org/10.1186/s13030-020-00200-z
Matusov, Y., Matthews, A., Rue, M., Sheffield, L., & Pedraza, I. F. (2022). Perception of interdisciplinary collaboration between ICU nurses and resident physicians during the COVID-19 pandemic. Journal of Interprofessional Education & Practice, 27, 100501. https://doi.org/10.1016/j.xjep.2022.100501
Pickkers, P., Darmon, M., Hoste, E., Joannidis, M., Legrand, M., Ostermann, M., … Schetz, M. (2021). Acute kidney injury in the critically ill: An updated review on pathophysiology and management. Intensive Care Medicine, 47(8), 835–850. https://doi.org/10.1007/s00134-021-06454-7
Quiñones, J., & Hammad, Z. (2020). Social determinants of health and chronic kidney disease. Cureus, 12(9). https://doi.org/10.7759/cureus.10266
Rangachari, P. (2023). The untapped potential of the quadruple aim of primary care to foster a culture of health. International Journal of General Medicine, 16, 2237–2243. https://doi.org/10.2147/IJGM.S416367
Seery, C., & Buchanan, S. (2022). The psychosocial needs of patients who have chronic kidney disease without kidney replacement therapy: A thematic synthesis of seven qualitative studies. Journal of Nephrology, 35(9). https://doi.org/10.1007/s40620-022-01437-3
NURS FPX 6021 Assessment 2 Change Strategy and Implementation
Souza, R. C. da S., Calache, A. L. S. C., Oliveira, E. G., Nascimento, J. C. do, Silva, N. D. da , & de Brito Poveda, V. (2022). Noise reduction in the ICU. JBI Evidence Implementation. https://doi.org/10.1097/xeb.0000000000000311
Tong, L.-L., & Adler, S. G. (2022). Diabetic kidney disease treatment: new perspectives. Kidney Research and Clinical Practice, 41(Suppl 2), S63–S73. https://doi.org/10.23876/j.krcp.21.288
U.S. HHS. (2022, October 19). Summary of the HIPAA security rule. HHS.gov. https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html