Patient, Family, or Population Health Problem Solution

Patient, Family, or Population Health Problem Solution

My practicum hours have been focused on a patient diagnosed with depression who was also undergoing diabetes management. Depression, particularly major depressive disorder (MDD), is a common mental health illness affecting both the young and the old. The main symptoms of depression include persistent feelings of low moods or sadness, feelings of anger, and a loss of interest in the everyday activities that were once interesting to the individual, as well as having prolonged periods of low energy. Individuals with depression may find it hard to make serious decisions in their lives, and they also may experience memory loss besides exhibiting externalizing behaviors. Unlike other mood disorders, the symptoms associated with depression, such as periods of low moods and sadness, last for over two weeks. Due to these changes in moods, depressed individuals also have major changes in their appetite.

I selected an individual with depression as my patient, with depression as the health problem of focus, for several reasons. Firstly, the patient is a legal immigrant. Notably, working with this patient presents the practical challenge of working with patients and individuals from diverse cultural backgrounds. As such, this particular case will help me develop my cultural competencies as a nurse. Secondly, depression is identified as a common comorbid mental health condition with a majority of medical conditions (Gold et al., 2020). Coincidentally, the patient has diabetes. This creates a need to employ a multidisciplinary approach in the management of depression. This further creates another opportunity to develop my interdisciplinary collaborative competencies.

Moreover, depression bears a lot of relevance to my professional practice and to the patient. From a professional practice perspective as a BSN-prepared nurse, managing depression in an immigrant patient helps me develop my nursing skills to manage diverse patients with various health conditions. Noting that mental issues will also be common comorbid conditions in healthcare settings, focusing on depression will help me improve my skills to care for patients both physically and mentally. To the patient, depression is a mental illness that not only affects their mental health but also their physical health. The patient will be able to understand how their mental health affects their physical health and how depression can complicate their current diabetic condition and even result in developing suicidal thoughts.

Proposed Intervention for Depression

I propose to implement a combined psychosocial and pharmacological intervention for the immigrant patient with depression. Although this intervention is developed specifically for an immigrant patient with depression and an existing case of diabetes, it can be applied to manage comorbid depression in patients with other conditions. I will start the patient on fluoxetine  (Prozac or Sarafem) to be taken orally daily at a dose of 20mg, preferably in the morning. Additionally, I will employ non-pharmacological strategies to further support the management of depression. Specifically for this patient, I will provide family psychoeducation and mindfulness therapy with the aim of managing underlying factors. Current research has explored the impact of combined therapy of mindfulness and fluoxetine (Chandra et al., 2020). The application of mindfulness therapy for depression in patients with diabetes has been associated with improved self-management and a better quality of life (Patra et al., 2023).

The intervention is delivered through a brochure as a teaching tool with a focus on providing the patient with an overview of depression, the prescribed medication, aspects of pharmacology, and the communication and collaboration strategies that the patient is a part of. The brochure will also educate the patient on how the treatment plan will improve the safety and quality of care and their overall mental and physical health. It will also educate the patient on how various aspects of health leadership and technology, current policies, and existing community resources can be utilized to improve care coordination and adherence to the care intervention to ensure better mental and physical outcomes.

Role of Leadership and Change Management in Addressing Depression

The management of depression in an immigrant patient with diabetes requires that the patient make some major changes in their behaviors, way of thinking, lifestyle, and self-care. The major changes that will be required are considered during the development of the intervention. Both leadership and change management strategies influenced the development of my proposed intervention. Leadership was considered to be essential to the development of the intervention. Change is difficult. However, evidence shows that leaders are important drivers of change as they provide sufficient support for developing essential collaborations and pooling resources necessary for addressing certain issues in healthcare, including disparities (Domínguez et al., 2020). On the other hand, change management helps overcome the paradoxes of change by helping to overcome possible resistance to intended changes.

Leadership influenced the development of the proposed intervention, helping set patient care goals and guiding the achievement of such goals. Leadership also influenced the multidisciplinary team to explore patient preferences and design delivery of patient-centered care for an immigrant patient, as well as helped manage the collaboration between the multidisciplinary team members. Additionally, leadership was influential in maintaining the team morale throughout the period of developing the intervention and ensured that all aspects of the intervention adhered to the ethics principles in nursing. On the other hand, aspects of change management were considered to help overcome resistance to the change in behaviors and practices. Most importantly, nursing ethics informed the development of the intervention by ensuring that all decisions made during the development of the intervention were based on ethical principles of autonomy, beneficence, non-maleficence, and justice, as well as the patient’s individual cultural and religious beliefs and values.

Communication and Collaboration Strategies with the Patient to Improve Depression Outcomes

The patient of focus during the practicum session is Mike T., a 43-year-old immigrant from Haiti. Mike currently has type 2 diabetes mellitus (T2DM) and chronic pain in his left leg. He was recently diagnosed with depression. The data informing all care decisions and the development of proposed interventions will be collected from the patient. There are many benefits of gathering the patient’s input associated with depression. A major benefit is that it helps gain first-hand perspective from the patient regarding their understanding of their current health condition, their treatment preferences, their beliefs, and their views on depression. Additionally, I will ensure I understand the underlying factors that contribute to the development of depression, the barriers the patient endures trying to access related healthcare conditions, as well as his currently available support systems.

The literature identifies effective communication as necessary for effective teamwork and collaboration and for ensuring patient safety within healthcare settings (Fuchshuber & Greif, 2022). There are multiple best-practice strategies for effective communication that improve patient care outcomes. A major best practice is active listening. According to Jonsdottir and Fridriksdottir (2019), active listening is a major component of communication that can help identify individual concerns and understand individuals’ emotions while allowing others to be heard and appreciated. Having mutual respect and sharing goals and perspectives is also identified as an element of effective communication, especially in multicultural teams (Tingvold & Munkejord, 2021). Other best practices for effective communication and collaboration include establishing a safe and trustful relationship, inclusive decision-making, and problem-solving (Fuchshuber & Greif, 2022). Others include open, culturally sensitive language.

State Board Nursing Practice Standards and Governmental Policies in Guiding Intervention Development

Nursing practice standards and governmental policies guided the development of my proposed intervention. These include the Nursing the Practice Act (NPA), the Affordable Care Act (ACA), and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy act. The NPA ensured the team members, especially nurses, were assigned roles aligning with their competencies. The ACA helped understand whether the patient, as a documented immigrant, qualified for the care under federal license coverage. The HIPAA Act was reviewed to help understand the requirements for handling health information and ensuring the safety and privacy of the patient. Research has explored some of these policies and found that they significantly help improve outcomes in diabetes management. For instance, the ACA has been noted to influence the expansion of programs such as Medicaid, covering both diabetes and depression, with an impact on healthcare access and delivery of preventative care (Monnette et al., 2020).

The proposed intervention is expected to improve the quality of care, enhance patient safety, and reduce costs to the system and the individual. The intervention employs a multidisciplinary approach and combines pharmacological and psychosocial therapies. Mindfulness therapy combined with fluoxetine has shown significant effects in managing depressive symptoms and preventing relapses (van der Feltz-Cornelis et al., 2021). Preventing relapses ensures quick recovery and reduced costs to patients and the system. Similarly, mindfulness is also effective in managing depressive symptoms. Recent research also shows that fluoxetine, when used in managing comorbid depression in patients with diabetes, significantly improves glycemic control (Brieler et al., 2023).

The available sources for benchmarking data on care quality, patient safety, and costs to the system and individual include the hospital’s archives and reports as well as national agencies such as the Centers for Medicare Services, the Agency for Healthcare Research and Quality (AHRQ), and the American Psychological Association.

Applying Technology, Care Coordination, and Community Resources in Addressing Depression

The proposed intervention makes use of healthcare technologies, care coordination, and community resources. Technologies such as telehealth services will be utilized for communication, the delivery of remote care, and the support of remote collaboration. Care coordination will help bring various healthcare professionals together to ensure the patient gets the right care at the right time and as needed. Additionally, community resources will be utilized to ensure the patient has access to the needed care. Additionally, mHealth technologies will be used to track the patient’s health data.

References

Brieler, J. A., Salas, J., Keegan-Garrett, E., & Scherrer, J. F. (2023). Achievement of glycemic control and antidepressant medication use in comorbid depression and type 2 diabetes. Journal of Affective Disorders, 324, 1–7. https://doi.org/10.1016/J.JAD.2022.12.066

Chandra, M., Raveendranathan, D., Johnson Pradeep R., Patra, S., Rushi, Prasad, K., & Brar, J. S. (2020). Managing depression in diabetes mellitus: A multicentric randomized controlled trial comparing the effectiveness of fluoxetine and mindfulness in primary care: Protocol for DIAbetes Mellitus ANd Depression (DIAMAND) study. Indian Journal of Psychological Medicine, 42(6_suppl). https://doi.org/10.1177/0253717620971200

Domínguez, D. G., García, D., Martínez, D. A., & Hernandez-Arriaga, B. (2020). Leveraging the power of mutual aid, coalitions, leadership, and advocacy during COVID-19. American Psychologist, 75(7), 909–918. https://doi.org/https://doi.org/10.1037/amp0000693

Fuchshuber, P., & Greif, W. (2022). Creating effective communication and teamwork for patient safety. The SAGES Manual of Quality, Outcomes and Patient Safety, 443–460. https://doi.org/10.1007/978-3-030-94610-4_23

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

Jónsdóttir, I. J., & Fridriksdottir, K. (2019). Active listening: Is it the forgotten dimension in managerial communication? International Journal of Listening, 34(3), 178–188. https://doi.org/10.1080/10904018.2019.1613156

Monnette, A., Stoecker, C., Nauman, E., & Shi, L. (2020). The impact of Medicaid expansion on access to care and preventive care for adults with diabetes and depression. Journal of Diabetes and Its Complications, 34(10), 107663. https://doi.org/10.1016/J.JDIACOMP.2020.107663

Patra, S., Patro, B. K., Padhy, S. K., & Mantri, J. (2023). Relationship of mindfulness with depression, self-management, and quality of life in type 2 diabetes mellitus: Mindfulness is a predictor of quality of life. Indian Journal of Social Psychiatry, 39(1), 70–76. https://doi.org/10.4103/IJSP.IJSP_436_20

Tingvold, L., & Munkejord, M. C. (2021). Shared goals, communication and mutual respect in multicultural staff teams: A relational coordination perspective. Nursing Open, 8(2), 957. https://doi.org/10.1002/NOP2.704

van der Feltz-Cornelis, C., Allen, S. F., Holt, R. I. G., Roberts, R., Nouwen, A., & Sartorius, N. (2021). Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta-analysis. Brain and Behavior, 11(2), e01981. https://doi.org/10.1002/

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Develop an intervention (your capstone project), as a solution to the patient, family, or population problem you’ve defined. Submit the proposed intervention to the faculty for review and approval.

Patient, Family, or Population Health Problem Solution

This solution needs to be implemented (shared) with your patient, family, or group. You are not to share your intervention with your patient, family, or group or move on to Assessment 5 before your faculty reviews/approves the solution you submit in Assessment 4. In a separate written deliverable, write a 5–7 page analysis of your intervention.