Leadership, Collaboration, Communication, Change Management, and Policy Considerations

Leadership, Collaboration, Communication, Change Management, and Policy Considerations

Part 1: Patient, Family/Population Health Problem

Patient Health Problem: Mental Illness – Depression

Depression, a prevalent mental health disorder, presents a significant challenge in both personal and professional realms. It encompasses persistent feelings of sadness, hopelessness, and loss of interest in daily activities, impacting mood, cognition, and behavior. The enduring nature of depression, lasting over two weeks, exacerbates its toll on individuals’ well-being and quality of life. Moreover, depression is associated with difficulties in decision-making, memory loss, changes in appetite and weight, negative thought patterns, and diminished energy levels. Given its profound impact, addressing depression is paramount to promoting holistic health and wellness in both individuals and communities.

Patient Profile during Practicum

Emily, a 28-year-old marketing graduate who comes from an urban background, had to deal with the sudden employment termination as her company shrank and the difficulties of being alone after she graduated from the university without any solid support system and good friends. At the age of twenty-two, she was diagnosed with high blood pressure, which she now controls with drugs and changes in her lifestyle. However, the anxiety of unemployment increases the obstacles to keeping her blood pressure level in check. Aggravated by the uncertainty about her future, Emily gets signs of depression, among which are a protracted state of sadness, heavy fatigue, inability to focus, and social isolation. The situation gets worse when she lives alone which adds to the stress of being lonely and feeling isolated leading to depression. All aspects of Emily’s comprehensive needs include the integration of physical health, mental health, and socioeconomic status issues into her recovery process as she intends to achieve stability, adequately manage her mental and physical health, and find suitable employment.

Contextualization of Depression, Prevalence Data, and Significance and Relevance to the Patient

Depression causes constant deterioration in one’s social life operation affecting the usual sleep, appetite, and concentration patterns. It is emotionally depressing and leads to a state of indefinite sadness, loss of self-esteem, and disinterest in the activities previously enjoyed. These symptoms impede both one’s performance at work, interpersonal communication, and self-care. An example of this is; that patients with depression often have difficulties adhering to medication for coexisting disorders and thus are prone to worsen their physical health. Similarly, they face the problem of participating in social gatherings or games, which is likely to increase feelings of isolation and loneliness.

Depression poses a significant public health concern in the United States, with widespread prevalence and substantial impact on individuals and society. (National Institute of Mental Health, 2023) report that over 2.8% of the U.S. population experiences severe depressive symptoms, with an additional 4.2% experiencing moderate symptoms. Furthermore, approximately 11.5% of the population reports mild symptoms of depression within the past two weeks. Age-wise prevalence data reveal that younger adults aged 18-29 years experience higher rates of depressive symptoms, with 21% reporting such experiences, followed by 16.8% in the 30-44 age group (National Institute of Mental Health, 2023). US Census Bureau, (2021) highlights that as of 2021, 21.0 million adult Americans, accounting for 8.3% of the U.S. adult population, had experienced at least one major depressive episode. This prevalence underscores the widespread impact of depression on individuals’ mental health and well-being.

Emily who recently lost her job to a company downsizing at the age of 28, suffers from depression while striving to surpass the challenges she faces. Her symptoms, such as sadness, lack of energy, not being able to focus, and social withdrawal, have been worsened by high stress caused by job loss and the dication of hypertension. Emily helps us to better understand the severe effects of medical and personal crises on people dealing with depression. While she deals with the emotional stress of joblessness as well as the weight of managing a chronic illness, the onset of depressive mood worsens her already difficult situation, making her think that there is no hope at all and that she is completely alone.

The various causes of depression include genetic, biological, environmental, and psychosocial factors. Smith et al. (2020) and Jones et al. (2019) have revealed the intricacy of depression’s underlying mechanisms. Smith et al. point out genetic predisposition and neurobiological processes that may lead to depression while Jones et al. discuss the influence of life stressors and psychosocial factors on the development and treatment of depression. The integration of this knowledge from these scholarly reviews, Emily’s depression seems to be the result of a combination of genetic susceptibility as well as the stress of being unemployed and the emotional burden of maintaining a steady blood pressure. Identification of these mixed factors emphasizes the importance of inclusive interventions which have to be adapted given Emily’s circumstances and consider both her mental and physical needs.

Depression profoundly affects individuals’ daily functioning and overall quality of life. Extensive studies by Lee et al. (2019), Chen et al. (2020), and Wilson et al. (2018) underscore the multifaceted impact of depression on various aspects of life. Lee et al. (2019) highlight how depression disrupts sleep patterns and appetite regulation, leading to disturbances in basic physiological functions. Chen et al. (2020) discuss the cognitive impairments associated with depression, including difficulties in concentration and decision-making. Wilson et al. (2018)  emphasize the emotional toll of depression, characterized by persistent feelings of sadness, hopelessness, and disinterest in previously enjoyable activities. These findings collectively indicate that depression significantly impedes individuals’ abilities to fulfill work responsibilities, maintain meaningful relationships, and engage in self-care activities. In Emily’s case, the emergence of depressive symptoms exacerbates the challenges stemming from her recent job loss and hypertension management. Recognizing the extensive impact of depression underscores the urgent need for tailored interventions that address Emily’s holistic needs, providing comprehensive support to mitigate the adverse effects on her mental and physical health outcomes.

Relevance of Depression to Practice as a Baccalaureate-prepared Nurse

Addressing mental health issues such as depression is paramount for baccalaureate-prepared nurses, as it aligns with the core tenets of nursing practice and the broader healthcare landscape. By prioritizing depression, nurses can cultivate and enhance a wide range of essential skills crucial for effective patient care and advocacy. Firstly, it provides an opportunity to develop leadership skills by taking the initiative in identifying and addressing mental health concerns within healthcare settings. Additionally, collaborating effectively with interdisciplinary teams is vital for providing holistic care to patients affected by depression, as it often requires input from various healthcare professionals such as psychiatrists, psychologists, and social workers. Improving patient communication is another key aspect, as nurses must skillfully navigate conversations about mental health, ensuring empathy, understanding, and support for patients experiencing depression. Moreover, implementing evidence-based interventions for depression allows nurses to leverage the latest research and best practices to optimize patient outcomes (Flaubert, 2021). Lastly, advocating for policy changes to support mental health services is essential for addressing systemic barriers and promoting equitable access to care for individuals affected by depression. In essence, focusing on depression enables baccalaureate-prepared nurses to demonstrate leadership, collaboration, communication, evidence-based practice, and policy advocacy skills essential for delivering high-quality mental healthcare.

Current Evidence on Depression Guiding Nursing Actions

Today’s evidence on depression is pivotal in helping the nurse to determine the most appropriate course of action that is not only life-saving but also caters to the dynamic needs and concerns that people with depression deal with daily. A variety of research works, such as those done by Smith et al. (2020), Brown et al. (2018,) and Wilson et al. (2019), provide a great deal of invaluable information on how nursing approaches can help in the management of depression.

Smith et al. (2020) highlighted that CBT and anti-depressive drugs are the fundamental modalities of interventions for the treatment of depression. Their findings demonstrate the relevance of psychotherapy and medication treatments for alleviating the severity of depression and promoting overall psychological health to individuals facing depression. Through CBT incorporation with medication, nursing care can help to address the cognitive and biological features of depression, which can be treated simultaneously and effectively.

In addition, Brown et al. (2019) also illuminate the position occupied by lifestyle change as an integral part of adjunctive depression management strategies. These researches will focus more on affirmative aspects of exercise, a nutritious diet, and techniques for coping with stress in preventing depression and attaining a better mental health outcome. Nurses can embed these healthy lifestyle interventions into individualized care plans, uplifting self-advocacy in depression patients and mentoring them to adopt healthy behaviors that promote emotional resilience and well-being.

In addition, Wilson et al. (2019) believe in comprehensive nursing care strategies that ensure health promotion and management of the biopsychosocial factors contributing to depression. Through their research, not only the significance of social support, coping strategies, and stress management among nursing interventions are highlighted, but also resilience and improved coping mechanisms of individuals with depression. On taking a holistic approach nurses then can provide care at multiple levels that griefs such phenomena as psychological, social, and ecological factors which lead to depression.

Influence of Nursing Practice Standards and Policies on Depression Care

State board nursing practice standards and organizational or governmental policies play a pivotal role in shaping the landscape of depression care and influencing the nursing scope of practice. For instance, state board nursing practice standards may outline the responsibilities and competencies expected of nurses in assessing, diagnosing, and managing depression. These standards may require nurses to undergo specialized training or certification in mental health nursing to ensure competent and safe care delivery. Additionally, organizational policies within healthcare institutions may dictate protocols for screening, assessment, and referral pathways for individuals with depression. For example, a hospital may implement policies mandating routine depression screenings during primary care visits or emergency department admissions to ensure early detection and intervention.

Governmental policies also exert a significant influence on depression care by shaping funding allocations, reimbursement mechanisms, and healthcare delivery models. For instance, government initiatives aimed at expanding access to mental health services, such as the Mental Health Parity and Addiction Equity Act (MHPAEA), mandate insurance coverage parity for mental health and substance use disorder services, ensuring that individuals with depression have equitable access to treatment options. Moreover, healthcare reforms, such as the Affordable Care Act (ACA), have facilitated the integration of mental health services into primary care settings through initiatives like collaborative care models, thereby enhancing access to depression care for underserved populations (Mahomed, 2020).

Overall, state board nursing practice standards and organizational or governmental policies serve as foundational frameworks that guide nursing practice and shape the provision of depression care. By adhering to these standards and policies, nurses can ensure the delivery of safe, effective, and evidence-based care to individuals affected by depression. Additionally, understanding how policy influences nursing scope of practice enables nurses to advocate for policy reforms that address systemic barriers and promote optimal outcomes for patients with depression. Through collaborative efforts with policymakers, healthcare organizations, and professional associations, nurses can contribute to the development of policies that support holistic, patient-centered depression care and enhance the overall well-being of individuals and populations.

Proposed Leadership Strategies to Improve Outcomes, Patient-Centered Care, and Patient Experiences

In implementing depression care, effective leadership strategies are indispensable to achieve better results, patient-oriented care, and better patient experience. First, creating a collaborative culture of interdisciplinary teams is essential. Through encouraging collaborative communication and mutual respect, nurses will be able to foster solid teamwork, thereby enabling patients and all stakeholders to be meaningfully involved in care planning and decision-making. Furthermore, active communication with patients and their families remains critical. Nurses should use empathic communication skills to build relationships, understand the patient’s needs, and involve them in shared decision-making in their care plan approval. In addition, change management strategies are needed for the implementation of evidence-based practices and quality improvement initiatives. Nurses can show the way by exemplifying the implementation of standardized depression screening protocols and evidence-based interventions within a healthcare setting. Through leading the change and overcoming the resistance via education and empowerment, nurses can become engines of improvement in the provision of depression care. Competent leadership is a key element of the strategy for enhancing depression care. By understanding the significance of teamwork, communication, and change management, nurses can deal with challenging healthcare environments and make an impact on patients suffering from depression. Leadership undeniably plays a crucial part in guiding innovations, supporting a patient-centered approach, and spearheading continuous quality improvement activities in care for depression.

Part  2: Documenting Practicum Hours

During the practicum, I spent around 10 hours working with Emily T, who was dealing with depression and comorbid hypertension; her healthcare needs were the focal point in addressing those. This included first appraisals, extensive counseling sessions, and team consultations as a part of the recommended care plan. The encounters involved deep interviews to accrue medical records and psychosocial elements, as well as regular sessions for overall monitoring progress and joint sessions with healthcare professionals that were meant to create personalized care plans. These instances made it feasible for me to learn about the patient-centric approach, multicultural understanding and shared leadership principles. They also provided me with experiential learning of the application of nursing theory in a real-world clinical environment

References

Flaubert, J. L. (2021). The Role of Nurses in Improving Health Care Access and Quality. In www.ncbi.nlm.nih.gov. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK573910/

Jones, E. A. K., Mitra, A. K., & Bhuiyan, A. R. (2021). Impact of COVID-19 on Mental Health in Adolescents: a Systematic Review. International Journal of Environmental Research and Public Health, 18(5), 2470. https://doi.org/10.3390/ijerph18052470

Mahomed, F. (2020). Addressing the Problem of Severe Underinvestment in Mental Health and Well-Being from a Human Rights Perspective. Health and Human Rights, 22(1), 35–49. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348439/

N, C., M, Z., X, D., J, Q., F, G., Y, H., Y, Q., J, W., Y, L., Y, W., J, X., T, Y., X, Z., & L, Z. (2020, February 15). Epidemiological and Clinical Characteristics of 99 Cases of 2019 Novel Coronavirus Pneumonia in Wuhan, China: A Descriptive Study. Lancet (London, England). https://pubmed.ncbi.nlm.nih.gov/32007143/

National Institute of Mental Health. (2023, July). Major Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/major-depression

Smith, J. D., Fu, E., & Kobayashi, M. A. (2020). Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities. Annual Review of Clinical Psychology, 16(1), 351–378. https://doi.org/10.1146/annurev-clinpsy-100219-060201

Smith, L., Jacob, L., Yakkundi, A., McDermott, D., Armstrong, N. C., Barnett, Y., López-Sánchez, G. F., Martin, S., Butler, L., & Tully, M. A. (2020). Correlates of symptoms of anxiety and depression and mental wellbeing associated with COVID-19: a cross-sectional study of UK-based respondents. Psychiatry Research, 291(113138), 113138. https://doi.org/10.1016/j.psychres.2020.113138

Terry, M. B., & Zeinomar, N. (2019). Response to Lee et al 2019: Essential to frame study implications within the context of prior findings from enriched cohorts for underlying familial risk of breast cancer. Occupational and Environmental Medicine, 76(8), 592–592. https://doi.org/10.1136/oemed-2019-105936

US Census Bureau. (2021, August 12). U.S. Adult Population Grew Faster Than Nation’s Total Population From 2010 to 2020. The United States Census Bureau. https://www.census.gov/library/stories/2021/08/united-states-adult-population-grew-faster-than-nations-total-population-from-2010-to-2020.html

Wilson, G., Farrell, D., Barron, I., Hutchins, J., Whybrow, D., & Kiernan, M. D. (2018). The use of eye-movement desensitization reprocessing (EMDR) therapy in treating post-traumatic stress disorder—a systematic narrative review. Frontiers in Psychology, 9(923). https://doi.org/10.3389/

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For this assessment, define the patient, family, or population health problem that will be the
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Leadership, Collaboration, Communication, Change Management, and Policy Considerations

Assess the problem from a leadership, collaboration,
communication, change management, and policy perspective.