04 Jan A professional environment and relevant data, and develop a change str
- a professional environment and relevant data, and develop a change strategy and discuss how to implement it successfully. 3-5 PAGES
Introduction - TYPE 1 AND TYPE 2 DIABETES
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Change Strategy and Implementation
Learner’s Name
School of Nursing and Health Sciences, Capella University
NURS-FPX6021 Biopsychosocial Concepts for Advanced
Nursing Practice I
Instructor's Name
April, 2022
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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
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Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.
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
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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
Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.
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Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.
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
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Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.
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).
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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).
https://nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/treatment/
NHS. (2016b). Cognitive behavioral therapy (CBT).
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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Change Strategy and Implementation
Alexandra Sanders
Capella University
NURS-FPX6021 Biopsychosocial Concepts for Advanced Nursing Practice 1
Dr. Katie Hooven
November 2021
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Change Strategy and Implementation
An overwhelming 10.5 percent of the American population has been diagnosed with
diabetes (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.) Diabetes is a
chronic metabolic disease characterized by elevated blood glucose levels that can lead over time
to severe damage to the heart, blood vessels, eyes, kidneys, and nerves (World Health
Organization [WHO], 2021). When blood glucose levels run too high, diabetes occurs. There are
three main types of diabetes: type I, type II, and gestational. In type I, the body does not produce
insulin. People with type I are placed on insulin and a proper diet and exercise to live productive
lives. Type II diabetes is the most common form of diabetes. In type II, bodies do not use insulin
properly. A proper diet and exercise regimen helps treat type II along with insulin or oral
medication. Gestational diabetes occurs in women who are pregnant who have never had a
diagnosis of diabetes. It is treated much like type II (American Diabetic Association [ADA],
2021).
Diabetes is very underrated as a global health issue. It is considered the greatest epidemic
in human history, affects the highest number of people globally, and costs the most money in
treatment and research (Zimmet, 2017). Nearly 422 million people worldwide have diabetes, the
majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed
to diabetes each year (World Health Organization [WHO], 2021). Globally the target goal is to
stop the rise in diabetes and obesity by 2025. Several factors come into play to improve quality
of life and longevity when dealing with diabetes and patients with diabetes. Patients need to
understand what diabetes is and how it affects their bodies; they need support from family,
friends, and healthcare staff. One of the most critical factors in diabetes is understanding the
ramifications of being non-compliant with their diabetes.
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Kidney Disease and Diabetes
Chronic kidney disease (CKD) is a common diagnosis in patients with diabetes. CKD can
be a devastating diagnosis and lead to shorter life spans and poor quality of life (McFarlane et
al., 2018). Damage to the kidneys can lead to kidney failure and ultimately need for dialysis or
transplant. Ensuring that blood glucose levels are kept under control, eating a healthy diet, and
maintaining a healthy weight can help decrease the chances of a diabetic developing CKD (The
Cleveland Clinic, n.d.).
Depression and Diabetes
Being diagnosed with diabetes can lead to emotions of stress, grief, and frustration. These
emotions can trigger depression. In newly diagnosed patients, depression is commonly seen but
can also affect patients who have had diabetes a long time. Emotional issues can lead to poor
diet, lack of exercise, and higher blood glucose levels (The Cleveland Clinic, n.d.). Patients with
diabetes are more likely to suffer from depression than a patient without diabetes.
Change Strategies
When patients are diagnosed with diabetes, they must understand and make an effort to
learn more about diabetes and its diagnosis. Education is the foundation for the management and
care of diabetes and is an essential part of health planning. It involves the patient and their
family, diabetes care team, community, and decision-makers in the education process (Rashed et
al., 2016). Healthcare providers should enhance the quality of patient care by providing
multimedia diabetes health education (Huang et al., 2016). Teaching patients about a healthy
diet, exercise, taking medications, and reducing stress are some of the critical components to
controlling diabetes (Centers for Disease Control and Prevention [CDC], 2021). The Diabetes
Knowledge Questionnaire ( DKQ-24) is a tool used to test patients' knowledge of diabetes. In
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one, 50 patients took the DKQ-24, and they got sixty percent of the questions correct. The
majority of these participants had had prior diabetes education. The study showed that providing
adequate education is imperative to reduce the burden of this condition (Formosa & Muscat,
2016). For patients to understand diabetes, a multidisciplinary team is necessary. The team would
consist of a primary care physician, nurse educator, dietician, and patient family. If indicated, an
endocrinologist and podiatrist could be added to the team.
Diabetic foot care is one of the number one needs of a diabetic patient. Proper footwear
and proper care of the feet can decrease the chances of diabetic foot ulcers and potential loss of
limbs. A nurse and or podiatrist can teach about foot care. A dietician and diabetic education are
crucial members of the team. They help pave the way for proper nutrition and food selection and
teach how food affects blood glucose levels. Teaching how to check blood glucose levels and
how to take medication are essential roles of these clinicians. Having this multidisciplinary team
helps the primary care physician and the patient to manage diabetes better.
Ensuring patients have support from family and mutual trust for the healthcare team aids
in giving a positive outlook for the patient regarding the diabetes diagnosis and necessary
lifestyle changes. The support leads to compliance from the patient also. Noncompliance in
diabetes can lead to kidney disease, heart disease, loss of eyesight, and loss of limbs, to name a
few (Lofty et al., 2017).
Teaching patients about checking blood glucose levels regularly, the importance of taking
medications, coping mechanisms, and overall understanding and managing the disease will help
patients to lead healthier lives. It is crucial to know a patient's educational level when teaching
begins and to assess learning frequently. Difficulties may arise if patients are unable to
comprehend teaching. In these cases, the educators will need to work with the patient and
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understand how they best learn and apply the education in a form that is understandable to the
patient.
Treating the depression may necessitate placing the patient on medications. Including
psychotherapy may also be helpful. Support groups may also be beneficial. Feeling physically
good with diabetes is half the battle and feeling mentally sound is the other half (American
Diabetic Association [ADA], 2021). Not all patients are willing to admit they need help, and not
all accept help. They may be embarrassed or not inclined to share their feelings with others. This
may cause a challenge in getting help.
Current Outcomes Change Strategies Expected Outcomes Patients who are diagnosed with diabetes do have adequate education regarding kidney disease and treatment for depression:
a) Many patients do not know the signs and symptoms of kidney disease
b) Many patients with diabetes experience depressive symptoms that are related to poor blood glucose control
To ensure patients receive the care they need, specific measures should be met:
Signs and symptoms of kidney disease should be discussed with patients.
Support groups need to be accessible to patients who could benefit from the help
Medications for depression & urine home kits for testing
Patients with diabetes will have appropriate access to healthcare providers and support groups to help with their physical and mental well-being :
a) Patients will have Blood work drawn every 2-3 months to assess kidney function and blood glucose averages (Centers for Disease Control and Prevention [CDC], 2021)
b) Patients with depression will have help through medication, therapy, and support groups (American Diabetic Association [ADA], 2021).
Conclusion
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Diabetes, if not appropriately managed, can lead to heart and kidney issues, blindness,
loss of limbs, and even death. When patients are appropriately educated on diabetes and the other
risk factors related to the disease, they are more likely to live longer. Helping patients who
develop depression due to the stress and emotional toll diabetes can have on them improves their
quality of life. All patients should have access to the healthcare and education they deserve,
regardless of socioeconomic status. Assuming a patient does not want or can not afford
treatments or medications places that patient in a position for increased complications. Making
care easy to access and understand will help all patients suffering from diabetes and its
comorbidities.
Having an open and trusting relationship with their healthcare provider will enable a
patient to feel free to discuss issues and concerns. They may not want to take medications for
depression or seek out support groups due to the stigma attached to reaching out for help
(Martinez et al., 2017). A patient with an interprofessional team caring for them will have the
best chance of succeeding and managing their diabetes.
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References
American Diabetic Association. (2021). The path to understanding diabetes starts here.
https://www.diabetes.org/. https://www.diabetes.org/diabetes
Centers for Disease Control and Prevention. (2021, August 10). Diabetes education and support.
https://www.cdc.gov. https://www.cdc.gov/diabetes/managing/education.html
Formosa, C., & Muscat, R. (2016). Improving diabetes knowledge and self-care practices.
Journal of the American Podiatric Medical Association, 106(5), 352–356.
https://doi.org/10.7547/15-071
Huang, M.-C., Hung, C.-H., Yu, C.-Y., Berry, D. C., Shin, S.-J., & Hsu, Y.-Y. (2016). The
effectiveness of multimedia education for patients with type 2 diabetes mellitus. Journal
of Advanced Nursing, 73(4), 943–954. https://doi.org/10.1111/jan.13194
Lofty, M., Adeghate, J., Kalasz, H., Singh, J., & Adeghate, E. (2017). Chronic complications of
diabetes mellitus: a mini review. Current Diabetes Reviews, 13(1), 3–10.
https://www.ingentaconnect.com/content/ben/cdr/2017/00000013/00000001#expand/coll
apse
Martinez, L. R., Xu, S., & Hebl, M. (2017). Utilizing education and perspective taking to
remediate the stigma of taking antidepressants. Community Mental Health Journal, 54(4),
450–459. https://doi.org/10.1007/s10597-017-0174-z
McFarlane, P., Cherney, D., Gilbert, R. E., & Senior, P. (2018). Chronic kidney disease in
diabetes. Canadian Journal of Diabetes, 42, S201–S209.
https://doi.org/10.1016/j.jcjd.2017.11.004
National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Diabetes Statistics.
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