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A professional environment and relevant data, and develop a change str

  •  a professional environment and relevant data, and develop a change strategy  and discuss how to implement it successfully. 3-5 PAGES
    Introduction
  • TYPE 1 AND TYPE 2 DIABETES

1

Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

Change Strategy and Implementation

Learner’s Name

School of Nursing and Health Sciences, Capella University

NURS-FPX6021 Biopsychosocial Concepts for Advanced

Nursing Practice I

Instructor's Name

April, 2022

2

Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

Change Strategy and Implementation

Patients often present with respiratory issues of varying severity; these can range from

breathing difficulties to dry or wet coughs. Patients that do present with these issues are admitted

to the pulmonary ward to treat the issue at hand. Chronic obstructive pulmonary disorder

(COPD) is one of the primary issues among these. Each patient receives treatment based on the

severity of his or her condition. The treatment can include prescribing antibiotics, non-invasive

ventilation, and pulmonary rehabilitation. Pulmonary rehabilitation involves a program of

exercise and education specifically designed to help individuals with pulmonary issues such as

COPD (NHS, 2016a).

The treatment for COPD is aimed at improving the physical health of patients admitted

to the ward. However, it does not take into consideration the mental health of these individuals.

There exists a strong positive correlation between COPD and anxiety and depression (Pooler &

Beech, 2014), which means that patients who present with COPD are likely to be comorbid with

anxiety, depression, or both. Further, COPD patients who are comorbid with depression and

anxiety are statistically more likely to be hospitalized; these patients are also likely to require

longer periods of hospitalization and face a greater risk of mortality after they are discharged.

Considering these factors, it is necessary to address mental health issues simultaneously with

physical issues to ensure that these patients can manage their overall health more effectively.

Left untreated, both anxiety and depression can lead to significant implications for compliance to

medical treatment (Pooler & Beech, 2014).

Anxiety and COPD

Some of the symptoms associated with COPD overlap with those associated with anxiety.

Dyspnea or shortness of breath is particularly distressing for patients and is common to both

COPD and anxiety. A COPD patient with anxiety might interpret dyspnea in an exaggerated

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Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

manner, often correlating this symptom with an inability to breathe or even an imminent death

(Heslop, Newton, Baker, Burns, Carrick-Sen, & De Soyza, 2013). Anxiety might not be the

cause of dyspnea in COPD patients, but it can be viewed as an indicator of acute exacerbation in

such patients (Pooler & Beech, 2014).

Depression and COPD

As mentioned above, there exists a significant correlation between COPD and depression.

The effect that depression has on COPD patients is different from the effect produced by anxiety.

Depression has been significantly linked to a perceived decrease in quality of life as well as in

physical activity. Pooler and Beech (2014) also note that depression is likely to be

underdiagnosed and undertreated for individuals with COPD.

Patients who suffer from COPD and depressive symptoms are less likely to follow

through on their recommended physical therapy. Consequently, their COPD becomes

aggravated, requiring them to receive further treatment. For most patients, particularly in cases of

acute exacerbation, further treatment would require hospitalization. However, this might cause

patients to feel that they are unable to care for themselves; they may experience inferiority or a

diminished sense of autonomy. As a result, patients are often stuck within this cycle of

deteriorating health, leading to a decline in the state of their mental health. The only effective

method to treat patients in such a situation is to address both their physical and psychological

issues (Dursunoğlu et al., 2016).

Change Strategies

Both depression and anxiety require attention from a mental health professional to

adequately and effectively help patients. Cognitive behavioral therapy (CBT) has been proven to

be an effective method of managing anxiety, depression, and a range of other mental health

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conditions. In a typical CBT session, a patient and a therapist work together to break down one

of the patient’s problems into its separate parts. Some of these parts could be how the patient

thinks about the problem, how he or she feels physically about it, and how he or she acts in

response to it. The patient and the therapist then evaluate these parts and figure out what might

be unhelpful or unrealistic as well as the effect that these parts have on each other and on the

patient (NHS, 2016b).

By identifying these parts, the therapist can figure out a plan of action for the patient to

change thoughts and behaviors that are counterproductive. The patient will then be asked to

practice these changes in his or her life and report back on whether he or she was able to enact

the changes and how effective they were. By using this method, the patient would eventually be

able to apply the skills that he or she has learned in the sessions to his or her life. This would

help the patient manage his or her issues even after the course of treatment is complete (NHS,

2016b). For example, individuals with COPD and anxiety might be able to better manage their

anxiety by not associating shortness of breath with more catastrophic outcomes.

However, CBT has certain drawbacks. It requires patients to be willing to confront their

emotions and anxieties, which can be uncomfortable. Further, CBT requires patients’

commitment to the process and their cooperation to help themselves get better. The therapy can

be guided, but ultimately the outcome of therapy is determined by the patients’ participation

(NHS, 2016b). On a practical level, it can be difficult for hospitals to accommodate an adequate

number of therapists for patients or to provide an efficient therapist-to-patient ratio.

To address this, it would be necessary for group therapy sessions to be conducted in

conjunction with one-on-one sessions. This would enable a wider range of individuals to access

the necessary treatment for their psychological condition, and it might be less intimidating for

Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

5

Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

them if it is a group activity. Further, nurses could be trained in CBT, or those trained in CBT

could be hired to facilitate more one-on-one sessions. Patients who are provided with access to

these treatment options in addition to the treatment they receive for their COPD will have a

higher quality of life and be able to manage both their physical and mental conditions more

effectively than before (Howard & Dupont, 2014).

Pharmacological interventions can also be used to treat anxiety and depression.

Treatment doses vary based on the severity of the disorder and can have a variety of side effects.

Most antidepressants are not contraindicated; however, caution is necessary while prescribing

certain types such as tricyclic antidepressants. Benzodiazepines have the potential to cause

respiratory depression and should not be administered to COPD patients who retain CO2.

Standard antidepressants such as selective serotonin reuptake inhibitors can often have side

effects such as headaches, tremors, gastrointestinal distress, and either psychomotor activation or

sedation. These side effects occur during the initial phase of treatment and can be problematic

when coupled with the existing conditions of COPD patients. In contrast, CBT and group therapy

are nonpharmacological interventions and would not result in contraindications. It is also

difficult to implement the pharmacological treatment of depression and anxiety on the level of

policy as the medication and doses required would be based on the needs of individual patients.

Further, patients who suffer from COPD might be unwilling to take medication for depression or

anxiety along with the medication that they might already be taking. This could possibly result

from the stigma that surrounds mental illnesses or the reluctance of patients to accept their

diagnosis (Tselebis et al., 2016).

Data Table

Current Outcomes Change Strategies Expected Outcomes

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Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

Patients who suffer from COPD do not have adequate access to mental health facilities: a) Many COPD patients

experience anxiety resulting from dyspnea.

b) Patients with COPD are likely to experience depressive symptoms that have been positively correlated with the worsening of COPD symptoms.

To ensure that patients receive the care they need, certain measures are necessary: • Therapists should be

made available to COPD patients.

• Nurses should be trained in CBT, or nurses who are trained in CBT should be hired.

• Group therapy sessions should be conducted regularly for COPD patients who are comorbid with anxiety, depression, or both.

Patients who suffer from COPD will have adequate access to mental health facilities and will be able to manage both their physical and mental conditions more effectively than before: a) Patients who are

comorbid with COPD and anxiety will be able to distinguish between their anxiety and an aggravation of their COPD symptoms (Howard & Dupont, 2014).

b) Patients who are comorbid with COPD and depression will be better prepared to manage both their COPD and their depressive symptoms (Dursunoğlu et al., 2016).

7

Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

References

Dursunoğlu, N., Köktürk, N., Baha, A., Bilge, A. K., Börekçi, Ş., Çiftçi, F., . . . Turkish Thoracic

Society-COPD Comorbidity Group. (2016). Comorbidities and their impact on chronic

obstructive pulmonary disease. Tüberküloz ve Toraks, 64(4), 289–298.

Heslop, K., Newton, J., Baker, C., Burns, G., Carrick-Sen, D., & De Soyza, A. (2013).

Effectiveness of cognitive behavioural therapy (CBT) interventions for anxiety in patients

with chronic obstructive pulmonary disease (COPD) undertaken by respiratory nurses:

The COPD CBT CARE study: (ISRCTN55206395). BMC Pulmonary Medicine, 13(1).

Howard, C., & Dupont, S. (2014). ‘The COPD breathlessness manual’: A randomised controlled

trial to test a cognitive-behavioural manual versus information booklets on health service

use, mood and health status, in patients with chronic obstructive pulmonary disease. npj

Primary Care Respiratory Medicine, 24.

NHS. (2016a). Chronic obstructive pulmonary disorder (COPD).

https://nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/treatment/

NHS. (2016b). Cognitive behavioral therapy (CBT).

https://nhs.uk/conditions/cognitive-behavioural-therapy-cbt/

Pooler, A., & Beech, R. (2014). Examining the relationship between anxiety and depression and

exacerbations of COPD which result in hospital admission: A systematic

review. International Journal of Chronic Obstructive Pulmonary Disease, 9(1), 315–330.

Tselebis, A., Pachi, A., Ilias, I., Kosmas, E., Bratis, D., Moussas, G., & Tzanakis, N. (2016).

Strategies to improve anxiety and depression in patients with COPD: A mental health

perspective. Neuropsychiatric Disease and Treatment, 12, 297–328.

,

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Change Strategy and Implementation

Alexandra Sanders

Capella University

NURS-FPX6021 Biopsychosocial Concepts for Advanced Nursing Practice 1

Dr. Katie Hooven

November 2021

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Change Strategy and Implementation

An overwhelming 10.5 percent of the American population has been diagnosed with

diabetes (National Institute of Diabetes and Digestive and Kidney Diseases, n.d.) Diabetes is a

chronic metabolic disease characterized by elevated blood glucose levels that can lead over time

to severe damage to the heart, blood vessels, eyes, kidneys, and nerves (World Health

Organization [WHO], 2021). When blood glucose levels run too high, diabetes occurs. There are

three main types of diabetes: type I, type II, and gestational. In type I, the body does not produce

insulin. People with type I are placed on insulin and a proper diet and exercise to live productive

lives. Type II diabetes is the most common form of diabetes. In type II, bodies do not use insulin

properly. A proper diet and exercise regimen helps treat type II along with insulin or oral

medication. Gestational diabetes occurs in women who are pregnant who have never had a

diagnosis of diabetes. It is treated much like type II (American Diabetic Association [ADA],

2021).

Diabetes is very underrated as a global health issue. It is considered the greatest epidemic

in human history, affects the highest number of people globally, and costs the most money in

treatment and research (Zimmet, 2017). Nearly 422 million people worldwide have diabetes, the

majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed

to diabetes each year (World Health Organization [WHO], 2021). Globally the target goal is to

stop the rise in diabetes and obesity by 2025. Several factors come into play to improve quality

of life and longevity when dealing with diabetes and patients with diabetes. Patients need to

understand what diabetes is and how it affects their bodies; they need support from family,

friends, and healthcare staff. One of the most critical factors in diabetes is understanding the

ramifications of being non-compliant with their diabetes.

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Kidney Disease and Diabetes

Chronic kidney disease (CKD) is a common diagnosis in patients with diabetes. CKD can

be a devastating diagnosis and lead to shorter life spans and poor quality of life (McFarlane et

al., 2018). Damage to the kidneys can lead to kidney failure and ultimately need for dialysis or

transplant. Ensuring that blood glucose levels are kept under control, eating a healthy diet, and

maintaining a healthy weight can help decrease the chances of a diabetic developing CKD (The

Cleveland Clinic, n.d.).

Depression and Diabetes

Being diagnosed with diabetes can lead to emotions of stress, grief, and frustration. These

emotions can trigger depression. In newly diagnosed patients, depression is commonly seen but

can also affect patients who have had diabetes a long time. Emotional issues can lead to poor

diet, lack of exercise, and higher blood glucose levels (The Cleveland Clinic, n.d.). Patients with

diabetes are more likely to suffer from depression than a patient without diabetes.

Change Strategies

When patients are diagnosed with diabetes, they must understand and make an effort to

learn more about diabetes and its diagnosis. Education is the foundation for the management and

care of diabetes and is an essential part of health planning. It involves the patient and their

family, diabetes care team, community, and decision-makers in the education process (Rashed et

al., 2016). Healthcare providers should enhance the quality of patient care by providing

multimedia diabetes health education (Huang et al., 2016). Teaching patients about a healthy

diet, exercise, taking medications, and reducing stress are some of the critical components to

controlling diabetes (Centers for Disease Control and Prevention [CDC], 2021). The Diabetes

Knowledge Questionnaire ( DKQ-24) is a tool used to test patients' knowledge of diabetes. In

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one, 50 patients took the DKQ-24, and they got sixty percent of the questions correct. The

majority of these participants had had prior diabetes education. The study showed that providing

adequate education is imperative to reduce the burden of this condition (Formosa & Muscat,

2016). For patients to understand diabetes, a multidisciplinary team is necessary. The team would

consist of a primary care physician, nurse educator, dietician, and patient family. If indicated, an

endocrinologist and podiatrist could be added to the team.

Diabetic foot care is one of the number one needs of a diabetic patient. Proper footwear

and proper care of the feet can decrease the chances of diabetic foot ulcers and potential loss of

limbs. A nurse and or podiatrist can teach about foot care. A dietician and diabetic education are

crucial members of the team. They help pave the way for proper nutrition and food selection and

teach how food affects blood glucose levels. Teaching how to check blood glucose levels and

how to take medication are essential roles of these clinicians. Having this multidisciplinary team

helps the primary care physician and the patient to manage diabetes better.

Ensuring patients have support from family and mutual trust for the healthcare team aids

in giving a positive outlook for the patient regarding the diabetes diagnosis and necessary

lifestyle changes. The support leads to compliance from the patient also. Noncompliance in

diabetes can lead to kidney disease, heart disease, loss of eyesight, and loss of limbs, to name a

few (Lofty et al., 2017).

Teaching patients about checking blood glucose levels regularly, the importance of taking

medications, coping mechanisms, and overall understanding and managing the disease will help

patients to lead healthier lives. It is crucial to know a patient's educational level when teaching

begins and to assess learning frequently. Difficulties may arise if patients are unable to

comprehend teaching. In these cases, the educators will need to work with the patient and

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understand how they best learn and apply the education in a form that is understandable to the

patient.

Treating the depression may necessitate placing the patient on medications. Including

psychotherapy may also be helpful. Support groups may also be beneficial. Feeling physically

good with diabetes is half the battle and feeling mentally sound is the other half (American

Diabetic Association [ADA], 2021). Not all patients are willing to admit they need help, and not

all accept help. They may be embarrassed or not inclined to share their feelings with others. This

may cause a challenge in getting help.

Current Outcomes Change Strategies Expected Outcomes Patients who are diagnosed with diabetes do have adequate education regarding kidney disease and treatment for depression:

a) Many patients do not know the signs and symptoms of kidney disease

b) Many patients with diabetes experience depressive symptoms that are related to poor blood glucose control

To ensure patients receive the care they need, specific measures should be met:

 Signs and symptoms of kidney disease should be discussed with patients.

 Support groups need to be accessible to patients who could benefit from the help

 Medications for depression & urine home kits for testing

Patients with diabetes will have appropriate access to healthcare providers and support groups to help with their physical and mental well-being :

a) Patients will have Blood work drawn every 2-3 months to assess kidney function and blood glucose averages (Centers for Disease Control and Prevention [CDC], 2021)

b) Patients with depression will have help through medication, therapy, and support groups (American Diabetic Association [ADA], 2021).

Conclusion

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Diabetes, if not appropriately managed, can lead to heart and kidney issues, blindness,

loss of limbs, and even death. When patients are appropriately educated on diabetes and the other

risk factors related to the disease, they are more likely to live longer. Helping patients who

develop depression due to the stress and emotional toll diabetes can have on them improves their

quality of life. All patients should have access to the healthcare and education they deserve,

regardless of socioeconomic status. Assuming a patient does not want or can not afford

treatments or medications places that patient in a position for increased complications. Making

care easy to access and understand will help all patients suffering from diabetes and its

comorbidities.

Having an open and trusting relationship with their healthcare provider will enable a

patient to feel free to discuss issues and concerns. They may not want to take medications for

depression or seek out support groups due to the stigma attached to reaching out for help

(Martinez et al., 2017). A patient with an interprofessional team caring for them will have the

best chance of succeeding and managing their diabetes.

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References

American Diabetic Association. (2021). The path to understanding diabetes starts here.

https://www.diabetes.org/. https://www.diabetes.org/diabetes

Centers for Disease Control and Prevention. (2021, August 10). Diabetes education and support.

https://www.cdc.gov. https://www.cdc.gov/diabetes/managing/education.html

Formosa, C., & Muscat, R. (2016). Improving diabetes knowledge and self-care practices.

Journal of the American Podiatric Medical Association, 106(5), 352–356.

https://doi.org/10.7547/15-071

Huang, M.-C., Hung, C.-H., Yu, C.-Y., Berry, D. C., Shin, S.-J., & Hsu, Y.-Y. (2016). The

effectiveness of multimedia education for patients with type 2 diabetes mellitus. Journal

of Advanced Nursing, 73(4), 943–954. https://doi.org/10.1111/jan.13194

Lofty, M., Adeghate, J., Kalasz, H., Singh, J., & Adeghate, E. (2017). Chronic complications of

diabetes mellitus: a mini review. Current Diabetes Reviews, 13(1), 3–10.

https://www.ingentaconnect.com/content/ben/cdr/2017/00000013/00000001#expand/coll

apse

Martinez, L. R., Xu, S., & Hebl, M. (2017). Utilizing education and perspective taking to

remediate the stigma of taking antidepressants. Community Mental Health Journal, 54(4),

450–459. https://doi.org/10.1007/s10597-017-0174-z

McFarlane, P., Cherney, D., Gilbert, R. E., & Senior, P. (2018). Chronic kidney disease in

diabetes. Canadian Journal of Diabetes, 42, S201–S209.

https://doi.org/10.1016/j.jcjd.2017.11.004

National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Diabetes Statistics.

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