Leadership, Collaboration, Communication, Change Management, and Policy Considerations
A stroke happens when the blood supply is reduced or interrupted to the brain, preventing the brain from getting enough nutrients and oxygen (Khouri et al., 2017). This can lead to the death of brain cells. A stroke is a medical emergency that needs immediate medical attention. In 2016, one in every six deaths from cardiovascular diseases was because of stroke. In the United States, someone gets a stroke every forty seconds, while someone dies of a stroke every four minutes (CDC, 2021). Annually, every 795,000 individuals have a stroke (CDC, 2021). Stroke is an expensive condition to manage, and it results in morbidity and mortality.
Blacks have twice as many chances of getting strokes compared to whites (CDC, 2021). Hence, stroke in African-American adults is the chosen healthcare problem to be assessed. The patient in this assessment is Mr. Jacobs, a 68-year-old African-American male diagnosed with hypertension ten years ago. He recently suffered a stroke four months ago, which left him paralyzed on the left side of his body. After suffering this stroke, the patient was diagnosed with the importance of adhering to the antihypertensives prescribed. The patient, however, stated that he did not receive any education on lifestyle modifications. Despite suffering from a stroke, the patient still leads a sedentary lifestyle; he is a chronic smoker who does not exercise and takes a lot of beer. These are the significant risk factors for stroke development (Khouri et al., 2017).
Evidence from Peer-Reviewed Literature
Stroke prevention aims to reduce stroke incidence by targeting specific risks or multiple risk factors (Boehme et al., 2017). These strategies can be employed at the individual, community, or population level. In some cases, as in the utilization of anti-platelets, the aim may be to utilize an intervention that will reduce the risk for ischemic stroke among individuals who have a higher risk instead of managing a specific risk factor (Boehme et al., 2017). Stroke prevention is done at three broad levels. Primordial prevention deals with a healthy lifestyle and is applied at a group level. Primordial prevention aims to reduce the population’s stroke risk factors (Boehme et al., 2017). The second level of stroke prevention is primary prevention. This aims to enhance the risk factor profiles of persons who do not have a stroke history to prevent a first cerebrovascular event (Boehme et al., 2017). The final level of prevention is secondary prevention. This is the most targeted type of prevention. This will be the focus of my assessment. This prevention is employed after a patient has suffered from a stroke to prevent reoccurrence. This will involve the use of antiplatelets and the management of hypertension. Primordial prevention includes smoke cessation, a healthy diet, enhanced physical activity, and weight control (Boehme et al., 2017).
Primary and secondary prevention focuses on specific lifestyle risk factors for stroke, while tertiary prevention of stroke involves using medications to prevent the reoccurrence of stroke events. The information by Boehme et al. (2017) is reliable since it has been published in a reputable journal, Circulation Research. This article has also been peer-reviewed, and the language is scientific. The barriers noted in ineffective stroke care include lack of resources, lack of public information, lack of training, and lack of coordination among healthcare professionals. There is a lack of resources for effective stroke care. Hence, it is critical to increase the number of stroke units, introduce care coordinators, and improve public training to extend to stroke care and prevention (Gache et al., 2014). Patients should have better knowledge of the symptoms of a stroke, which will allow them to recognize these symptoms early and help prevent stroke complications. Poor coordination among healthcare professionals is also a barrier that lowers the quality and increases the cost of stroke care. Poor coordination involves a lack of follow-up, conflicting information from healthcare professionals, and delayed information exchange (Gache et al., 2014). Care coordination is essential to improve the quality of stroke care. Nurses have a critical role in stroke prevention. Their primary role is to improve medical and behavioral risk factors (Parappilly et al., 2018). This will involve educating patients on stroke risk factors, increasing patient knowledge of stroke risk factors, and improving medication adherence, preventing stroke reoccurrences. Nurses can use the health belief model to educate patients to make healthy lifestyle choices and improve their medication adherence (Guilford et al., 2017). This can be important in stroke prevention. The patients can take charge of their health, enhancing healthcare outcomes.
Nursing Practice Standards/ Government Policies
One government policy that can influence stroke prevention is the Affordable Care Act (ACA). Former President Obama signed this act into law in 2010. This aimed to reduce the costs of healthcare services, expand healthcare insurance, and implement healthcare models that enhance care coordination (Li & Stith, 2020). ACA is critical in stroke prevention to reduce readmission acts. This act can guide nurses to design healthcare models that enhance care coordination after discharge and reduce healthcare costs. This will help nurses implement care delivery models that enhance medication adherence and patient knowledge of stroke. This will help to prevent mortality and morbidity rates. The Affordable Care Act will also ensure that many patients with previous attacks can access care services at affordable rates. Nurses can thus serve these effectively, reducing the reoccurrence rates of strokes and preventing complications.
Care coordination after discharge is critical with primary care providers and rehabilitation centers to prevent stroke reoccurrence. Care coordination can only be achieved if healthcare professionals can exchange patient information. One policy that will influence the exchange of information is The Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA regulates the sharing of patient health information without the patient’s consent (Cohen & Mello, 2018). Nurses and other healthcare professionals must thus involve the patient in care coordination. This will allow for the efficient exchange of patient information to improve care coordination.
Patients must be at the center of the care coordination process to enhance care coordination and implementation of patient-centered care. Nurse leaders must ensure shared values. This will allow nurses to find meaningful work and have the ability to express their values, which will improve work engagement (Bergstedt & Wei, 2020). Improved work engagement will promote the implementation of patient-centered care, enhancing healthcare outcomes. Allowing effective communication and the ability of nurses to associate their work with the mission, values, and mission of the healthcare organization will improve healthcare outcomes (Bergstedt & Wei, 2020). This will allow healthcare workers and nurses to find meaning in their work since their self-values have meaning. Supporting nurses’ values will lead to them being more engaged. Nurse leaders should bring values from the boardroom to the bedside and vice-versa (Bergstedt & Wei, 2020). This will allow nurses to mobilize resources and help prevent stroke reoccurrence. An empowered work environment will encourage nurses to share ideas that will improve patient engagement and enhance the quality of care.
The patient in this assessment is Mr. Jacobs, a 68-year-old African-American male diagnosed with hypertension ten years ago. He recently suffered a stroke four months ago, which left him paralyzed on the left side of his body. After suffering this stroke, the patient was diagnosed with the importance of adhering to the antihypertensives prescribed. The patient, however, stated that he did not receive any education on lifestyle modifications. Despite suffering from a stroke, the patient still leads a sedentary lifestyle; he is a chronic smoker who does not exercise and takes a lot of beer. I selected this patient since I have seen many stroke patients in my nursing unit. Stroke has resulted in mortalities and morbidities in these patients. I hope to learn why many patients do not adhere to lifestyle medications recommended to them by their physicians.
I presented information to this patient in a simple language that he could understand. I used YouTube videos to show him the danger of stroke. I also directed him to the CDC website to see the stroke-related statistics. This can help improve his adherence to lifestyle modifications and behavioral interventions. I used democratic leadership to encourage the patient to take charge of his health. I looked at the strengths and weaknesses of the patient and encouraged him to focus more on his strengths. I listened to his opinion and guided him effectively. The barrier I had with this patient was reluctance to stop his unhealthy habit of smoking and drinking. He, however, promised that he would reduce cigarette smoking and alcohol intake. I educated the patient that smoking and alcohol use are risk factors for stroke attack. I informed him that if he does not change his ways, he may suffer another stroke attack.
Bergstedt, K., & Wei, H. (2020). Leadership strategies to promote frontline nursing staff engagement. Nursing Management, 51(2), 48-53. https://doi.org/10.1097/01.numa.0000651204.39553.79
Boehme, A. K., Esenwa, C., & Elkind, M. S. (2017). Stroke risk factors, genetics, and prevention. Circulation Research, 120(3), 472-495. https://doi.org/10.1161/circresaha.116.308398
CDC. (2021, May 25). Stroke facts. Centers for Disease Control and Prevention. https://www.cdc.gov/stroke/facts.htm
Cohen, I. G., & Mello, M. M. (2018). HIPAA and protecting health information in the 21st century. JAMA, 320(3), 231. https://doi.org/10.1001/jama.2018.5630
Gache, K., Leleu, H., Nitenberg, G., Woimant, F., Ferrua, M., & Minvielle, E. (2014). Main barriers to effectively implementing stroke care pathways in France: A qualitative study. BMC Health Services Research, 14(1). https://doi.org/10.1186/1472-6963-14-95
Guilford, K., McKinley, E., & Turner, L. (2017). Breast cancer knowledge, beliefs, and screening behaviors of college women: Application of the health belief model. American Journal of Health Education, 48(4), 256-263. https://doi.org/10.1080/19325037.2017.1316694
Khouri, G., Ozark, S., & Ovbiagele, B. (2017). Common risk factors for stroke and medical prevention therapies. Oxford Medicine Online. https://doi.org/10.1093/med/9780199937837.003.0103
Li, X., & Stith, S. S. (2020). Health insurance and self‐assessed health: New evidence from Affordable Care Act repeal fear. Health Economics, 29(9), 1078-1085. https://doi.org/10.1002/hec.4026
Parappilly, B. P., Field, T. S., Mortenson, W. B., Sakakibara, B. M., & Eng, J. J. (2018). Effectiveness of interventions involving nurses in secondary stroke prevention: A systematic review and meta-analysis. European Journal of Cardiovascular Nursing, 17(8), 728-736. https://doi.org/10.1177/1474515118779732
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written assessment to be on “Stroke patients; Avoiding readmissions.” 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 perspectives on leadership, collaboration, communication, change management, and policy. Plan to spend approximately two direct practicum hours meeting with a patient, family, or group of your choice to explore the problem and consult with the subject matter and industry experts if desired. Document the time spent (your practicum hours) with these individuals or groups in the Core Elms Volunteer Experience Form.
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 directly affecting patient care or organizational effectiveness.
Too often, change agents conclude 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 a case for your practicum focus area, then explore it 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 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.
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 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. Throughout your capstone project, ‘you’ll work with this patient, family, or group, focusing on a specific healthcare problem.
Review 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 you understand the work you’ll be asked to complete and how it will be assessed.
Review the Practicum Focus Sheet: Assessment 1 [PDF] (attached to this file)., which guides conducting this portion of your practicum.
Complete this assessment in two parts.
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.
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 occur outside regular work hours. Use the Practicum Focus Sheet [PDF] for this assessment to guide your work and interpersonal interactions. Document the time spent (your practicum hours) with these individuals or groups in the Core Elms Volunteer Experience Form.
Complete the NURS-FPX4900 Volunteer Experience Form in CORE ELMS. Include a description of your relationship to the patient, family, or group in the Volunteer Experience comments field.
The assessment requirements below correspond to the scoring guide criteria, so 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, length, and supporting evidence.
Define a patient, family, or population health problem 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 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 implementing evidence-based practice in addressing your defined problem.
Describe research that has tested the effectiveness of nursing standards and 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 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 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 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 you anticipate will be needed to address the problem.
Describe the change management strategies you anticipate will be required to address the problem.
Document the time spent (your practicum hours) with these individuals or groups in the Core Elms Volunteer Experience Form.
Organize content so ideas flow logically with smooth transitions.
Apply APA style and formatting to scholarly writing.
Format: Format your paper using APA style. APA Style Paper Tutorial [DOCX] is provided to help you write and format 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 long, 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.
By completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
Competency 1: Lead people and processes to improve patient, systems, and population outcomes.
Define a patient, family, or population health problem relevant to personal and professional practice.
Competency 2: Make clinical and operational decisions based on the best evidence.
Analyze evidence from peer-reviewed literature and professional sources that describes and guides nursing actions related to a defined patient, family, or population problem.
Competency 5: Analyze the impact of health policy on quality and cost of care.
Explain how state board nursing practice standards and organizational or governmental policies could affect a defined patient, family, or population problem.
Competency 7: Implement patient-centered care to improve the quality of care and the patient experience.
Propose leadership strategies to improve outcomes, patient-centered care, and the patient experience related to a defined patient, family, or population problem. Document the practicum hours spent with these individuals or groups in the Core Elms Volunteer Experience Form.
Competency 8: Integrate professional standards and values into practice.
Organize content so ideas flow logically with smooth transitions.
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