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: Depression (Major Depressive Disorder)

Depression or Major Depressive Disorder (MDD) and related depressive symptoms are a common mood disorder and mental illnesses with a significant impact on the individual and society. Unlike other mood disorders that are short-lived and the individual is able to regain their normal moods within a short period of time, depression is characterized by a persistent feeling of sadness, anger, and loss of interest in the individual’s everyday activities. The low moods associated with depression, and the feelings of sadness and loss last for more than two weeks (American Psychiatric Association, 2022). Additionally, depression is characterized by difficulties with making major life decisions, memory loss, externalizing behaviors, changes in appetite and weight, as well as negative thought patterns, and feelings of low energy.

Patient to Work with During Practicum

The patient identified to work with throughout the practicum period is Mike T., a 43-year-old immigrant man from the Caribbean. He had immigrated to the United States four years ago from Haiti. He has been managing Type 2 diabetes mellitus (T2DM) for the last five years, as well as chronic pain in his left leg following an injury he sustained while escaping a gang attack back in Haiti. Mike has also lost two of his close family members: his wife and his son. He has not known the whereabouts of his living relatives since he left Haiti. He currently lives with his 22-year-old daughter, who works at a fast-food outlet. Mike has been coming regularly for his insulin shots. He recently got diagnosed with major depressive disorder (MDD), which has greatly affected his overall moods, relationship with his current nurse, as well as how he takes care of himself, including coming for diabetes management sessions. He is yet to start treatment for depression due to his concerns about the safety of using many medications, as well as the current financial situation he is in. Top of Form

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

Depression can develop due to a complex interaction among a number of causal factors that range from biological psychological, to social factors. Some people are genetically predisposed to developing depression. According to the World Health Organization (WHO) (2023), depression can also develop due to traumatic psychological and social experiences and situations, including the loss of loved ones, unemployment, and violence. Mike’s depression can be linked to his loss of close family relatives, specifically his wife and son. He has also experienced a lot of gang violence abuse in his home country of Haiti, which is also the reason he has lost contact with his other relatives. He is also experiencing major financial difficulties. The physical health of individuals is also a risk factor for the development of depression as it has been identified to be a comorbid mental health condition with a majority of medical conditions (Gold et al., 2020). Mike was diagnosed with diabetes, which he has been managing despite the financial difficulties he is facing. The difficulties faced while attempting to access diabetes care in Haiti may have further contributed to the development of depression. He also has chronic pain in his left leg. Pain is a major risk factor for the development of depression and a low quality of life.

Depression or major depressive disorder, is a common mental and mood disorder that affects people of all ages and gender. A majority of individuals in the United States, especially immigrants, experience episodes of depressive symptoms and have been diagnosed with depression. Notably, as of 2019, over 2.8 percent of the U.S. population had severe symptoms of depression, while 4.2 percent showed moderate symptoms, with 11.5 percent experiencing mild symptoms in the past 2 weeks (Villarroel & Terlizzi, 2020). Age-wise, 21 percent of people aged between 18 and 29 years experienced varied levels of depressive symptoms, with 18.4 percent of those aged 45–64 and 65 and over experiencing depression. An estimated 16.8 percent of people aged between 30 and 44 years are noted to have experienced depression in 2019 (Villarroel & Terlizzi, 2020). As of 2021, an estimated 21.0 million adult Americans, or 8.3 percent of the U.S. adult population, had at least one experienced a major depressive episode. Recent events, such as the COVID-19 pandemic, have led to a higher risk and prevalence of depression and comorbid mental illnesses, including anxiety, stress, and addictions (Fazeli et al., 2020).

Further, depression has a significant impact on the physical and mental health of the patients. The most notable significance of depression is its impact on the daily living of the patient. Depression affects how the patient feels, thinks, and behaves, with significant emotional and behavioral problems. Depression may cause a reduced quality of life due to impaired functioning (Fazeli et al., 2020). Depression is also a risk factor for loss of interest in life and suicide (World Health Organization (WHO), 2023). Besides affecting the individual patient, depression can affect individuals close to the patient, affecting not only the patient but also their family dynamics. Additionally, depression contributes highly to the burden of disease and adds to the higher costs of care (König et al., 2020).

Relevance of Depression to Practice as a Baccalaureate-prepared Nurse

Depression is relevant to practice as a baccalaureate-prepared nurse in a number of ways. A baccalaureate is expected to provide sufficient care to all patients with varying health conditions. Depression is a common mental disorder that a nurse will always come across during their practice. It is a comorbid condition with a majority of medical conditions. In this case, depression is relevant in practice as a BSN-prepared nurse as it will help design care that meets the patient’s physical, mental, psychological, social, and spiritual needs. It will help relate the patient’s current health and financial status and previous experiences to their mental health disorder. Understanding depression, including its risk factors, prevalence rates, and impacts on physical and emotional health, can help a BSN-prepared to effectively provide sufficient care to patients. It also helps design patient and community education programs promoting physical and mental health. Furthermore, as depression is a major comorbid condition in health problems that requires a multidisciplinary approach to manage, it can help a BSN-prepared nurse to develop interprofessional collaboration competencies, including communication and care coordination skills essential in daily nursing practice.

Current Evidence on Depression Guiding Nursing Actions

There is a lot of evidence from peer-reviewed literature and professional sources that describes and guides nursing actions related to the management of depression. Regardless of the amount of evidence, the reliability of the data evidence varies across sources. Some of the ways to know if the data is unreliable include the lack of consistency in the data, poor data collection and analysis methods, lack of presentation of the populations and size of sample populations, and failure to provide any supporting sources for the data. Additionally, despite the availability of reliable evidence, implementing evidence-based practice in addressing depression still faces multiple barriers, especially in caring for immigrant populations. Evidence from research identifies the growing burden of depression as a major issue affecting practitioners, researchers, and policymakers, arguing that the diversity in both culture and views of depression among various ethnic and immigrant groups in the U.S. further complicates research and evidence-based care (Proudman et al., 2021). From a general perspective, a majority of potential barriers to implementing EBP in nursing practice is the lack of sufficient preparedness and reading for graduate nurses to evaluate and implement EBP (Rahmayanti et al., 2020).

In another article, Markova et al. (2020) on immigration, culture, and help-seeking behaviors among immigrants note that culture determines the sources of help utilized by patients with maintenance of the culture of origin associated with seeking traditional and informal help sources, while the adoption of mainstream culture improved help-seeking from formal sources. The evidence from this article can help nurses understand the influence of culture on care preferences among patients and how to design care around these preferences.

There is also sufficient evidence to guide nurses’ actions in the treatment of depression. For instance, an article by Guidi and Fava (2021) explored the combination of pharmacological and psychotherapeutic treatment modalities and found that sequential integration of psychotherapy after a phase of pharmacotherapy, especially antidepressants, reduced the risk of relapse and recurrence in MDD. Additionally, the sequential model helped manage residual symptoms and improved the patient’s psychological well-being. This study’s findings can help nurses provide both medication-based care and psychotherapy combined or in phases to reduce the risk of relapse after treatment.

Effect of State Board Nursing Practice Standards and/or Organizational or Governmental Policies on Depression Care

State Board Nursing practice standards and governmental policies have a significant impact on how care for depression is provided especially for immigrants in the U.S. The American Psychological Association (APA) provides the major guidelines for the management of depression in adults. The application of such guidelines in patient care enables nurses to understand the patient population, compare and combine various treatment options, and ensure the best outcomes, including patient safety and satisfaction (Buelt & McQuaid, 2023).

However, government policies and nursing standards may have a limiting effect on how care for depression is provided and accessible to certain populations. For instance, policies that limit the scope of practice for BSN-prepared nurses when dealing with patients with depression and other comorbid conditions, such as limited prescription prescriptive authority, reduce the availability of healthcare professionals to provide care to depression patients amid the growing burden of depression. Juárez et al. (2019) argue that although certain immigration policies do not directly target healthcare systems, they have a significant effect on migrant health, including access to health services, including mental healthcare. The article suggests the need to consider a Health in All Policies approach to ensuring safer health for migrants. This makes it necessary for nurses to advocate a universal approach to general immigration policies to ensure that policies outside of the health system provide favorable conditions that promote migrants’ overall health. Research evidence shows that the engagement of nurses in policy processes results in more patient-focused policies. For instance, Myers (2020) argues that nurses’ involvement in policy advocacy and policy-making results in policy changes that address barriers to healthcare access and improve population health. Benton et al. (2020) also note that nurses can offer more substantial contributions through advocacy for the recognition of depression and other conditions, as well as socioeconomic factors that hinder access to care, leading to policy changes that support the implementation of universal health coverage.

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

Leadership is essential especially when it comes to delivering sufficient and sustainable mental health care. Available research has related the outcomes of care as well as the professionalism in healthcare practice to effective healthcare leadership (Flodgren et al., 2019). As treatment of depression is complicated, especially among migrant populations, there is a need for excellent leadership to help overcome the barriers to delivering related care. As a BSN-prepared nurse managing an immigrant patient with depression and other conditions, I anticipate that the leadership will be supportive in the delivery of necessary care, including collaborative multidisciplinary care, as well as in the allocation of necessary resources. Caring for the patient will require a collaborative team that is culturally sensitive and utilizes open communication throughout the care period. The care plan will require the patient to make changes and adjustments in his lifestyle, including eating and social habits. He will be required to join a social support club for both diabetes and depression support. Therefore, a transformational change strategy will be adopted to help address the problem.

Part 2: Documenting Practicum Hours

The two practicum hours will be spent with Mike T., a 43-year-old with diabetes who has been diagnosed with depression. I selected the patient because he is an immigrant diagnosed with depression and is also managing diabetes. Depression is also a major mental illness comorbid with a majority of medical conditions with an impact on both physical and emotional well-being. I would also like to understand the challenges immigrants face within the healthcare system. I will present the idea of depression to the patient in a way that is sensitive to his culture, as well as using open communication. Noting that the patient is an immigrant, I expect to face cultural barriers during our interactions. However, I employ a more collaborative and transformative leadership approach during my practicum hours.

References

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders. Diagnostic and Statistical Manual of Mental Disorders. https://doi.org/10.1176/APPI.BOOKS.9780890425787

Buelt, A., & McQuaid, J. R. (2023). Comparing Clinical Guidelines for the Management of Major Depressive Disorder. American Family Physician, 107(2), 123–124. https://www.aafp.org/pubs/afp/issues/2023/0200/editorial-major-depressive-disorder-guidelines.html

Fazeli, S., Mohammadi Zeidi, I., Lin, C. Y., Namdar, P., Griffiths, M. D., Ahorsu, D. K., & Pakpour, A. H. (2020). Depression, anxiety, and stress mediate the associations between internet gaming disorder, insomnia, and quality of life during the COVID-19 outbreak. Addictive Behaviors Reports, 12. https://doi.org/10.1016/J.ABREP.2020.100307

Flodgren, G., O’Brien, M. A., Parmelli, E., & Grimshaw, J. M. (2019). Local opinion leaders: Effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews, 2019(6). https://doi.org/10.1002/14651858.CD000125.PUB5/MEDIA/CDSR/CD000125/IMAGE_N/NCD000125-AFIG-FIG03.PNG

Gold, S. M., Köhler-Forsberg, O., Moss-Morris, R., Mehnert, A., Miranda, J. J., Bullinger, M., Steptoe, A., Whooley, M. A., & Otte, C. (2020). Comorbid depression in medical diseases. In Nature Reviews Disease Primers (Vol. 6, Issue 1). https://doi.org/10.1038/s41572-020-0200-2

Guidi, J., & Fava, G. A. (2021). Sequential Combination of Pharmacotherapy and Psychotherapy in Major Depressive Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry, 78(3), 261–269. https://doi.org/10.1001/JAMAPSYCHIATRY.2020.3650

Juárez, S. P., Honkaniemi, H., Dunlavy, A. C., Aldridge, R. W., Barreto, M. L., Katikireddi, S. V., & Rostila, M. (2019). Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis. The Lancet Global Health, 7(4), e420–e435. https://doi.org/10.1016/S2214-109X(18)30560-6

König, H., König, H. H., & Konnopka, A. (2020). The excess costs of depression: a systematic review and meta-analysis. Epidemiology and Psychiatric Sciences, 29, e30. https://doi.org/10.1017/S2045796019000180

Markova, V., Sandal, G. M., & Pallesen, S. (2020). Immigration, acculturation, and preferred help-seeking sources for depression: Comparison of five ethnic groups. BMC Health Services Research, 20(1), 1–11. https://doi.org/10.1186/S12913-020-05478-X/TABLES/6

Proudman, D., Greenberg, P., & Nellesen, D. (2021). The Growing Burden of Major Depressive Disorders (MDD): Implications for Researchers and Policy Makers. PharmacoEconomics, 39(6), 619–625. https://doi.org/10.1007/S40273-021-01040-7/FIGURES/2

Rahmayanti, E. I., Kadar, K., & Saleh, A. (2020). Readiness, Barriers and Potential Strengths of Nursing in Implementing Evidence-Based Practice. International Journal of Caring Sciences, 13(2), 1203–1211.

Villarroel, M. A., & Terlizzi, E. P. (2020). Symptoms of Depression Among Adults: United States, 2019. NCHS Data Brief, 379.

World Health Organization (WHO). (2023, March 31). Depressive disorder (depression). WHO. https://www.who.int/news-room/fact-sheets/detail/depression

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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

In this assessment, you’ll assess the patient, family, or population health problem 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.
Complete this assessment in two parts.

Part 1
Use Assessment 01 Supplement: Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations [PDF] Download Assessment 01 Supplement: Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations [PDF]to 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 subject matter and industry experts of your choice. The hours you spend meeting with them should take place outside of regular work hours. Use the Practicum Focus Sheet [PDF] Download 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.
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.