Leadership, Collaboration, Communication, Change Management, and Policy Considerations
Nurses engage in various activities to optimize patient care. They should demonstrate effective leadership and collaborative strategies to improve the quality of care. Also, policy formulation allows them to champion the rights of patients and optimize care. This paper discusses Alzheimer’s disease (AD), the role of nurses in managing AD, nursing standards, and collaborative and leadership techniques for dealing with AD.
Patient, Family, or Population Health Problem
Problem Summary
ALZ.org (n.d.) indicates that Alzheimer’s disease is an incurable disease that impairs an individual’s cognitive, social, and behavioral functioning. The disease can be classified into stages based on the presenting signs and symptoms. During the preclinical stage, an individual is devoid of any signs and symptoms. The mild stage is marked by memory loss, poor judgment, anxiety, and inability to handle money (Schachter & Davis, 2022). The moderate stage presents with manifestations such as marked memory loss, diminished attention span, disturbed thought processes, and amnesia (Schachter & Davis, 2022). The severe stage presents with an inability to recognize family members, bowel and bladder incontinence, immobility, and weight loss (Schachter & Davis, 2022).
Patient Identification
J.S.S. is a sixty-nine-year-old African-American female diagnosed with AD three years ago. The patient is my aunt. She is in the company of her spouse. Examination reveals perceptual-motor difficulties, muscle twitches, and diminished impulse control, as evidenced by the indiscriminate use of vulgar language. Her attention span has deteriorated over the past year. Also, she has been experiencing difficulty recognizing close family members over the past six months. According to her spouse, the patient has been restless and wanders at night over the past month. Further history reveals that she is not adherent to her medications.
Context Data
According to ALZ.org (n.d.), AD is the most common type of dementia, accounting for up to 80 percent of dementia cases. Further reports reveal that AD affects approximately 5.8 million people in the USA (CDC.gov, 2020). The prevalence of the disease is expected to triple by 2060. As people age, their likelihood of contracting AD rises. For instance, CDC.gov (2020) indicates that the cases of AD among adults aged 65 years and older doubles every 5 years. The disease has significant mortality rates. For example, CDC.gov (2020) reports that AD is the sixth leading cause of mortalities among adults in the USA. Furthermore, it is the fifth leading cause of mortalities among individuals aged 65 years and older. CDC.gov (2020) reports ethnic disparities in AD infections. The disease affects fourteen percent of African Americans aged 65 years and above. It affects twelve percent of Hispanics aged 65 years and above. On the other hand, it affects ten percent of non-Hispanic whites aged 65 years and above (CDC.gov, 2020). AD impacts healthcare costs. The annual cost of managing the disease is at least $159 billion. The annual cost is expected to exceed $500 billion by 2040 (CDC.gov, 2020).
Poorly managed AD impacts patient safety, outcomes, and quality of life. To begin with, patients with severe AD are unable to accomplish their activities of daily living. They require close monitoring, which may disrupt the routine of other family members. In addition, Mok et al. (2020) report that it increases the risk of developing a variety of mental health issues, such as anxiety, hallucinations, paranoia, delusions, and depression. Furthermore, it puts patients at risk for consequences such as aspiration pneumonia (Mok et al., 2020)
Relevance to a Baccalaureate-Prepared Nurse
Nurses are key stakeholders involved in the care and prevention of Alzheimer’s disease. They play an essential role in educating and counseling patients and their families. This optimizes public understanding of AD and the available coping mechanisms. As such, patients and their families manage the disease adequately. Also, nurses are essential to the screening process. Screening facilitates the diagnosis of AD and forms the basis of prompt management. Furthermore, nurses are important stakeholders involved in the safe administration of drugs. Safe medication administration ensures that patients with AD receive their treatment based on the treatment plan. This optimizes patient outcomes. To provide adequate management of AD, nurses embrace patient-centeredness and holistic care.
Peer-Reviewed Literature
As earlier stated, nurses are key stakeholders in managing AD. They accomplish this by focusing on the modifiable risk factors of AD. Patient and family education about these risk factors optimizes AD management and improves patient outcomes. The modifiable risk factors are divided into four thematic areas (Hope, 2020). Medical factors entail hypertension, diabetes mellitus, hyperlipidemia, and medications such as anticholinergics (Hope, 2020). Psychosocial factors include depression, isolation, loneliness, and diminished social connections. Lifestyle factors entail aspects such as cigarette smoking, alcohol consumption, and a sedentary lifestyle (Hope, 2020). Nutritional factors include aspects such as poor dieting. Also, nurses educate patients and their families on the merits of adhering to the treatment plan. This entails the correct identification of medications, strategies for optimizing adherence to the treatment plan, potential adverse effects, seeking medical attention, and what to do in the event of missed doses (Hope, 2020). Furthermore, nurses participate in the patient screening process. This is crucial since it facilitates diagnosis and serves as the foundation for creating patient-centered treatment plans. Additionally, nurses assist in the judicious administration of medications. Safe medication administration reduces medical errors such as hypersensitivity reactions and adverse effects. It also enables patients to benefit optimally from their treatment plans. The evidence is consistent with what I see in my nursing practice.
Determining the Reliability of Data
A variety of techniques can be utilized to assess the validity and reliability of data. Firstly, the credibility of data is determined by its source. Articles from peer-reviewed journals, government websites, and educational institutions provide reputable and credible data. Secondly, Esparrago-Kalidas (2021) reports that the credibility of an article can be evaluated by assessing its currency, relevance, accuracy, authority, and purpose. Using this criterion, the article must be updated based on the current evidence. Also, the goals of the article should align with the inquiries guiding the research.
Barriers to the Implementation of Evidence-Based Practice
Multiple variables impede the implementation of evidence-based AD management techniques into practice. Firstly, Pitsillidou et al. (2021) report that evidence-based practice is hampered by organizational challenges such as inefficient resource allocation. To address nursing shortages, resources should be set aside for nurse recruitment and training (Pitsillidou et al., 2021). Recruitment of more nurses optimizes the management of AD by averting nurse burnout and fatigue. By so doing, the quality of care, such as screening, medication administration, and patient education, is improved. Furthermore, evidence-based practice is hampered by a culture that values individualism over collaboration (Pitsillidou et al., 2021). An interdisciplinary team approach is key to the management of AD. Examples of stakeholders that should collaborate effectively include nurses, physicians, and pharmacists. Evidence-based practice is also impeded by the absence of cultural congruence. This is relevant due to the ethnic disparities observed in the prevalence of the disease.
Effectiveness of Nursing Standards or Policies
Three types of nursing standards influence the management of Alzheimer’s disease. Firstly, MO.gov (n.d.) indicates that the standards of practice include issues such as diagnosis, designing treatment plans, and assessing patients. This is relevant because it allows nurses to make accurate diagnoses and establish treatment plans tailored to the needs of each patient. In addition, the professional performance standard promotes evidence-based practice, healthcare ethics, teamwork, and open communication (MO.gov, n.d.). Furthermore, the guidelines for specialty practice promote the delivery of quality care by advocating for appropriate referrals of patients.
Role of Nurses in Policy Making
Nurses can be involved in formulating policies that impact patient care and the quality of care for patients with AD. To accomplish this, they collaborate with interdisciplinary team members at various levels. For example, they could collaborate with elected officials such as senators to introduce legislation that promotes the security and welfare of AD patients. In addition, nurses participate in workplace panels to develop organizational policies that target patients with AD. Nurses leverage these opportunities to formulate policies that promote high-quality care, efficiency, and patient safety.
Nursing Theory or Conceptual Framework
My practicum fits within the framework of Abdellah’s 21 Nursing Problems Theory. The theory analyzes patient evaluation and the formulation of holistic nursing care plans (Nursingtheory.org, n.d.). According to the theory, healthcare providers should focus on the patient’s physical and psychosocial needs (Nursingtheory.org, n.d.) Furthermore, the theory explores how people interact with one another to form therapeutic connections. It advocates for patient-centered and all-encompassing care.
State Board Nursing Practice Standards or Governmental Policies
The American Nurses Association establishes standards for nursing practice. These guidelines have an impact on the care and management of AD patients. As mentioned before, the standards are classified into three major areas. To begin with, MO.gov (n.d.) states that standards of practice address topics such as diagnosis, treatment planning, and patient evaluation. This is significant because it enables nurses to make accurate diagnoses and develop treatment regimens that are personalized to the needs of each patient. In addition, the professional performance standard promotes evidence-based care, teamwork, and open communication (MO.gov, n.d.). Furthermore, the specialist practice guidelines support the delivery of quality treatment by advocating for appropriate patient referrals. As a result of the themes, quality care is promoted while patient outcomes are improved.
As aforementioned, nurses can play a role in developing policies that affect patient care and the quality of care for patients with Alzheimer’s disease. To accomplish this, they work on multiple levels with members of the interdisciplinary team. They could, for example, work with political authorities such as senators to create legislation that promotes the safety and well-being of people living with Alzheimer’s. Furthermore, nurses participate in workplace committees to design organizational policies that target patients with Alzheimer’s disease. Nurses make use of these possibilities to develop policies that promote high-quality treatment, efficiency, and patient safety.
The National Alzheimer’s Project Act (NAPA) seeks to combat Alzheimer’s disease and other dementias. The Act calls for more funding for Alzheimer’s disease research and care (HHS.gov, n.d.). Furthermore, the Act’s main objective is to lessen the economic effect of Alzheimer’s disease on patients and their families (HHS.gov, n.d.). The NAPA impacts the scope of nursing practice. It directs nurses to remain dedicated to the successful care and prevention of AD. Also, it requires nurses to collaborate effectively with patients and their families in the management of AD. Nurses should be involved in accurate data collection, reporting, and dissemination while educating the general public.
Leadership Strategies
Leadership is essential in AD management. Good leadership will make it easier to set goals, delegate roles, allocate resources, and evaluate the efficacy of AD management. This could be accomplished in numerous ways. To begin, UAGC.edu (2022) reports that open communication will allow leaders to express group goals as well as a road plan for achieving those goals. In addition, UAGC.edu (2022) reports that leaders should demonstrate the appropriate distribution of duties to avoid misunderstanding and disagreement. Furthermore, leaders must maintain a collaborative decision-making style.
Nurses and other multidisciplinary team members should use a variety of tactics to increase interdisciplinary collaboration. These techniques include closed-loop communication, responsibility, and a clear description of duties (Uzarski & Broome, 2019). Appropriate change management tactics for optimizing AD management include cautious designing a roadmap, transparency, candor, open communication, monitoring, and assessment (Krakoff, n.d.).
Part Two
The patient is a sixty-nine-year-old African-American female diagnosed with AD three years ago. She is my aunt. She is in the company of her spouse. Examination reveals perceptual-motor difficulties, muscle twitches, and diminished impulse control as evidenced by indiscriminate use of vulgar language. Her attention span has deteriorated over the past year. Also, she has been experiencing difficulty recognizing close family members over the past six months. According to her spouse, the patient has been restless and wanders at night over the past month. Further evaluation reveals that she is not adherent to her medications.
I spent five hours with the patient and other family members. This provided an opportunity to engage the patient and explore various aspects of her disease. I highlighted the need to adhere to the treatment plan. Non-adherence was attributed to forgetfulness by the patient and her spouse. We agreed that the patient’s daughter would be actively involved in the treatment process to optimize adherence to the treatment plan. Also, we explored strategies such as alarms to optimize adherence to the treatment plan.
References
ALZ.org. (n.d.). What is Alzheimer’s Disease? https://www.alz.org/alzheimers-dementia/what-is-alzheimers
CDC.gov. (2020). Alzheimer’s Disease and Related Dementias. https://www.cdc.gov/aging/aginginfo/alzheimers.htm#:~:text=Alzheimer’s%20disease%20is%20the%20most,thought%2C%20memory%2C%20and%20language.
Esparrago-Kalidas, A. J. (2021). The Effectiveness of CRAAP Test in Evaluating Credibility of Sources. International Journal of TESOL & Education, 1(2), 1–14. https://i-
jte.org/index.php/journal/article/view/25
Hope, K. (2020). Disease and Mild Cognitive Impairment. British Journal of Nursing, 29(8), 460–469.
HHS.gov. (n.d.). NAPA – National Alzheimer’s Project Act. https://aspe.hhs.gov/collaborations-committees-advisory-groups/napa
MO.gov. (n.d.). Standards of Nursing Practice. https://health.mo.gov/living/lpha/phnursing/standards.php.
Mok, V. C. T., Pendlebury, S., Wong, A., Alladi, S., Au, L., Bath, P. M., Biessels, G. J., Chen, C., Cordonnier, C., Dichgans, M., Dominguez, J., Gorelick, P. B., Kim, S. Y., Kwok, T., Greenberg, S. M., Jia, J., Kalaria, R., Kivipelto, M., Naegandran, K., … Scheltens, P. (2020). Tackling challenges in care of Alzheimer’s disease and other dementias amid the COVID-19 pandemic, now and in the future. Alzheimer’s and Dementia, 16(11), 1571–1581. https://doi.org/10.1002/alz.12143
Nursing-Theory.org. (n.d.). 21 Nursing Problems by Faye Abdellah. https://nursing- theory.org/theories-and-models/abdellah-twenty-one-nursing-problems.php
Pitsillidou, M., Roupa, Z., Farmakas, A., & Noula, M. (2021). Factors Affecting the Application and Implementation of Evidence-based Practice in Nursing. Acta Informatica Medica, 29(4), 281–287. https://doi.org/10.5455/aim.2021.29.281-287
Schachter, A. S., & Davis, K. L. (2022). Alzheimer’s disease. Dialogues in clinical neuroscience, 2:2, 91-100. https://doi.org/10.31887/DCNS.2000.2.2/asschachter
UAGC.edu. (2022). 4 Leadership Styles in Business: Leadership Style Quiz. https://www.uagc.edu/blog/4-leadership-styles-in-business
Uzarski, D., & Broome, M. E. (2019). A Leadership Framework for Implementation of an Organization’s Strategic Plan. Journal of Professional Nursing, 35(1), 12–17. https://doi.org/10.1016/j.profnurs.2018.09.007
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Question 
In a 5-7 page written assessment, define the patient, family, or population health problem that will be the focus of your capstone project. Assess the problem from a leadership, collaboration, communication, change management, and policy perspective. Plan to spend approximately 2 direct practicum hours meeting with a patient, family, or group of your choice to explore the problem and, if desired, consulting with subject matter and industry experts. Document the time spent (your practicum hours) with these individuals or groups in the Capella Academic Portal Volunteer Experience Form.
Leadership, Collaboration, Communication, Change Management, and Policy Considerations
Introduction
Nurses in all professional roles work to effect positive patient outcomes and improve organizational processes. Professional nurses are leaders in problem identification, planning, and strategy implementation—skills that directly affect patient care or organizational effectiveness.
Too often, change agents jump to the conclusion that an intervention will promote the envisioned improvement. Instead, the ideal approach is to determine which interventions are appropriate, based on an assessment and review of credible evidence. Interventions could be patient-facing or involve a change in policy and process. In this assessment, you’ll identify and make the case for your practicum focus area, then explore it in depth from a leadership, collaboration, communication, change management, and policy perspective.
This assessment lays the foundation for the work that will carry you through your capstone experience and guide the practicum hours needed to complete the work in this course. In addition, it will enable you to do the following:
Develop a problem statement for a patient, family, or population that’s relevant to your practice.
Build a body of evidence that will inform your approach to your practicum.
Focus on the influence of leadership, collaboration, communication, change management, and policy on the problem.
Preparation
In this assessment, you’ll assess the health problems of the patient, family, or population that will be the focus of your capstone project. Plan to spend approximately 2 hours working with a patient, family, or group of your choice to explore the problem from a leadership, collaboration, communication, change management, and policy perspective. During this time, you may also choose to consult with the subject matter and industry experts about the problem (for example, directors of quality or patient safety, nurse managers/directors, physicians, and epidemiologists).
To prepare for the assessment, complete the following:
Identify the patient, family, or group you want to work with during your practicum. The patient you select can be a friend or a family member. You’ll work with this patient, family, or group throughout your capstone project, focusing on a specific healthcare problem.
Begin surveying the scholarly and professional literature to establish your evidence and research base, inform your assessment, and meet scholarly expectations for supporting evidence.
In addition, you may wish to complete the following:
Review the assessment instructions and scoring guide to ensure that you understand the work you’ll be asked to complete and how it will be assessed.
Review the Practicum Focus Sheet: Assessment 1 [PDF], which provides guidance for conducting this portion of your practicum.
Note: As you revise your writing, check out the resources listed on the Writing Center’s Writing Support page.
Instructions
Complete this assessment in two parts.
Part 1
Define the patient, family, or population health problem that will be the focus of your capstone project. Assess the problem from a leadership, collaboration, communication, change management, and policy perspective and establish your evidence and research base to plan, implement, and share findings related to your project.
Part 2
Connect with the patient, family, or group you’ll work with during your practicum. During this portion of your practicum, plan to spend at least 2 hours meeting with the patient, family, or group and, if desired, consulting with your chosen subject matter and industry experts. The hours you spend meeting with them should take place outside of regular work hours. Use the Practicum Focus Sheet [PDF] provided for this assessment to guide your work and interpersonal interactions. Document the time spent (your practicum hours) with these individuals or groups in the Capella Academic Portal Volunteer Experience Form.
Capella Academic Portal
Complete the NURS-FPX4900 Volunteer Experience Form in the Capella Academic Portal. In the Volunteer Experience comments field, describe your relationship to the patient, family, or group.
The BSN Capstone Course (NURS-FPX4900 ) requires the completion and documentation of nine (9) practicum hours. All hours must be recorded in the Capella Academic Portal. Please review the BSN Practicum Campus page for more information and instructions on how to log your hours.
Requirements
The assessment requirements, outlined below, correspond to the scoring guide criteria, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.
Define a patient, family, or population health problem that’s relevant to your practice.
Summarize the problem you’ll explore.
Identify the patient, family, or group you intend to work with during your practicum.
Provide context, data, or information that substantiates the presence of the problem and its significance and relevance to the patient, family, or population.
Explain why this problem is relevant to your practice as a baccalaureate-prepared nurse.
Analyze evidence from peer-reviewed literature and professional sources that describes and guides nursing actions related to the patient, family, or population problem you’ve defined.
Note whether the authors provide supporting evidence from the literature that’s consistent with what you see in your nursing practice.
Explain how you would know if the data are unreliable.
Describe what the literature says about barriers to the implementation of evidence-based practice in addressing the problem you’ve defined.
Describe research that has tested the effectiveness of nursing standards and/or policies in improving patient, family, or population outcomes for this problem.
Describe current literature on the role of nurses in policy making to improve outcomes, prevent illness, and reduce hospital readmissions.
Describe what the literature says about a nursing theory or conceptual framework that might frame and guide your actions during your practicum.
Explain how state board nursing practice standards and/or organizational or governmental policies could affect the patient, family, or population problem you’ve defined.
Describe research that has tested the effectiveness of these standards and/or policies in improving patient, family, or population outcomes for this problem.
Describe current literature on the role of nurses in policy making to improve outcomes, prevent illness, and reduce hospital readmissions.
Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of this problem.
Propose leadership strategies to improve outcomes, patient-centered care, and the patient experience related to the patient, family, or population problem you’ve defined.
Discuss research on the effectiveness of leadership strategies.
Define the role that you anticipate leadership must play in addressing the problem.
Describe collaboration and communication strategies that you anticipate will be needed to address the problem.
Describe the change management strategies that you anticipate will be required to address the problem.
Document the time spent (your practicum hours) with these individuals or group in the Capella Academic Portal Volunteer Experience Form.
Organize content so ideas flow logically with smooth transitions.
Apply APA style and formatting to scholarly writing.
Additional Requirements
Format: Format your paper using APA style. APA Style Paper Tutorial [DOCX] is provided to help you in writing and formatting your paper. Be sure to include:
A title page and reference page. An abstract is not required.
Appropriate section headings.
Length: Your paper should be approximately 5–7 pages in length, not including the reference page.
Supporting evidence: Cite at least five sources of scholarly or professional evidence that support your central ideas. Resources should be no more than five years old. Provide in-text citations and references in APA format.
Proofreading: Proofread your paper, before you submit it, to minimize errors that could distract readers and make it more difficult for them to focus on its substance.
Competencies Measured