quality, safety

nursing

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Assessing the problem: Dementia and Alzheimer’s Disease

Assessing the problem: Dementia and Alzheimer’s disease

As we age, it is common to be diagnosed with various medical diagnosis whether they be short or long-term illnesses. Some of the common diagnosis include dementia, diabetes, heart disease, neck or back pain. As a nurse, it is important to note risk factors diseases associated with age groups. In the elderly population, Alzheimer’s diagnosis increases by double after the age of 65 years old. (NIH, 2019). Distinct nursing interventions may assist and aid in treating a patient who has Alzheimer’s disease. There is no cure for Alzheimer’s disease but there are nursing therapies and treatments identified to help control and slow the progression of the cognitive changes associated with the disease. Nurses have various roles within healthcare thus having a crucial impact on health (Conroy, 2021). This paper focuses on identifying a patient’s and caregivers struggles, studying the present literature on nurses’ interventions regarding the affected patient’s problem.

Patient, Family, and Population Health Problem

Health Problem

Dementia is not a normal part of aging. Dementia is an impairment of a person’s memory, language, problem solving and or thinking capabilities. As stated by the Alzheimer’s organization, “Alzheimer’s disease is the most common cause of dementia” (alz.org). This disease is the cause for 60-80% of dementia cases. The condition additionally impairs different intellectual functions. Alzheimer’s disease is caused by brain cell damage. Alzheimer’s disease is progressive, but treatments are aimed to slow down progression of the disease. Symptoms of Alzheimer’s disease include disorientation, confusion, and incomprehension. As the disease progresses, extra signs and symptoms can also appear. (Alzheimer’s association Alz.org) Alzheimer’s illness is a disease that destroys an individual’s reminiscence (Tebbs, 2021).

Patient and Family

The patient for this evaluation is an elderly man in his mid-80s diagnosed with dementia due to Alzheimer’s disease. Some of the symptoms the patient presented included difficulty-making decisions, misplacing items easily, and difficulty expressing self. Aside from this, is starting to lose the ability to control bladder and bowel movements. He is at the current home nursing facility with his daughter who is his caregiver. His daughter states it has become difficult to care for him at home and she is considering placing her father in this nursing home. She states she wants him to receive the care he needs but is unsure if that is the best option since it’s an unfamiliar place for him but is the one that is closest to her home.

Relevance of Problem with Family and Patient

Alzheimer’s disease is not just a disease, which affects the patient but also causes increased caregiver burnout. This is because the disease causes struggles for those loved ones of the of the affected patient. Family members are often affected due to the emotional and physical demands along with the financial expenses. As the disease worsens, those affected lose their capacity to carry out activities of daily living and their ability to care for themselves. This creates the need for additional care that strains households financially, emotionally, and physically. As the nurse discussing with the patient and family and working with the healthcare team to find alternatives to provide care is part of the nursing role of advocacy.

Relevance of Health Problem with Baccalaureate-prepared Nurse

The baccalaureate-prepared nurse plays a vital role in Alzheimer’s disease patients. With diagnosis, a good history and physical examination and assessment is key. The physical examination pays provide deficits in the neurological exam and mental status exam. As nurses, we are often the healthcare provider that spends most time with patients and families. Therefore, it’s important as a BSN prepared nurse to assess changes to mood, behavior, nutrition, ADL’s, administration of medications and intervene when appropriate to keep patient safe and free from harm. In addition to being patients, advocate which is the epitome of the nursing role in order to provide high quality care (Kumar et al, 2021).

Literature Review

In the study by Theofanidis, dementia is one of the rising cases causing deaths in developed countries and increasing economic, social, and medical burdens. This study aims to synthesize and assess present clinical evidence for nursing practices. After reviewing 158 studies, the five domains were gained for nursing practices: chronic concession, despair, Memory impairment, Homecare needs, and Anxiety. Nurses provide care for sufferers with Alzheimer’s disease including providing care and support to their caregivers.

Coffey (2021) determined that obstacles consist of numerous elements that restrict the implementation of measures to address dementia in rural settings. As in advance elaborated, being concerned for patients with dementia may be tough for caregivers and families. This describes the want for large resources. The lack of those resources, particularly in rural areas, can avoid the powerful implementation of measures to assist sufferers, caregivers, and families.

Nursing Practices Standards by State board

Effectiveness of Standards and Role of Nurses in Policy Making

Nurses are required to remain aware of policy changes. In order to improve quality of care, nurses should develop skills in proposing and developing new healthcare implementations and policies. Nurses’ roles are changing continuously. Initially, nurses are trained to focus solely on the well-being of patients. Nurses now play a role in finding evidenced base research to implementing new protocols to enhance affected person results, stop illnesses, and lower readmissions. In a stepwise approach, nurses are able to advocate for their patients using a professional ladder approach to proposition changes to care.

Effects of Federal, State and Local Policies on Nursing practice

American’s have been experiencing complexities surrounding dementia, especially in healthcare. The federal, nation, and neighborhood governments have embraced specific measures to address healthcare issue. The federal authorities applied the National Alzheimer’s Project Act alongside different rules for identical purposes. This act turned into an excellent basis in addressing the problem of restricted assets. Additionally, public coverage statements recognize enhancing communication, awareness, useful resource coordination, and setting up linkages in any respect authority’s levels.

Leadership Strategies

Effectiveness of Leadership Strategies

Effective leadership is vital and is what facilitates and emphasizes the effective continuation of safe, high quality, and compassionate care. This is important for patients with Alzheimer’s disease as they progress their dependability on their caregivers increase. Safe, High quality evidenced based and empathetic care are accordingly vital for them. Effective management will consequently steer and provide guidance on tackling healthcare hurdles.

Communication and Collaboration Strategies

Effective communication and collaboration are essential for transparency, problem solving and providing colleagues with respect. The collaboration includes assuming cooperative and complementary roles while sharing accountability for making decisions and problem-solving methods to evaluate and continue patient care plans. Teamwork and communication skills are important for delivering quality healthcare, and staff can improve patient outcomes and improve efficacy and patient satisfaction.

Changes Management Strategies

Various change management policies anticipate the need to address the health problem. The strategies include recognizing and organizing stakeholders, organization, developing change impact evaluation, and changing communication plan. Using the change management, culture change movement to help provide support the patients need to make their time in hospitals or nursing homes feel more like home to diminish confusion while maintaining safety in place.

Conclusion

Nurses play an effective role in promoting the best care and interventions for the patients by improving healthcare procedures and methods with evidence-based practice. There are various positions within the healthcare system for nurses to be change agents. Alzheimer’s disease and dementia affect about one third of all people over the age of 85 years of age. In this specific problem, the patient’s disease is progressing, and the caregiver is burnout. The caregiver needs additional support and resources to provide care.

References

Coffey, A. H. (2021). Implementation of Evidence-based Guidance for Dementia Palliative Care using Participatory Action. Dementia Palliative Care using Participatory Action Research: Examining Implementation Through the Consolidated Framework for Implementation Research (CFIR). Retrieved from https://www.researchsquare.com/article/rs-559312/latest

Conroy, T. F. (2021). Building nursing practice: The fundamentals of care framework. In Potter & Perry’s Fundamentals of Nursing: Australia and New Zealand 6th Edition. Elsevier Australia, 19-33. Retrieved from https://researchnow.flinders.edu.au/en/publications/building-nursing-practice-the-fundamentals-of-care-framework-2

Dudley, N. M. (2021). The impact of nurse delegation regulations on home care services: A four-state case study. Medical Care Research and Review, 47S-56S. Retrieved from

https://journals.sagepub.com/doi/abs/10.1177/1077558720960902

Gaugler, J. E., Yu, F., Davila, H. W., & Shippee, T. (2014). Alzheimer’s disease and nursing homes. Health affairs (Project Hope), 33(4), 650–657. https://doi.org/10.1377/hlthaff.2013.1268

Kumar A, Sidhu J, Goyal A, et al. Alzheimer Disease (Nursing) [Updated 2021 Aug 11].

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568805/

National Institue on Aging (2019). Alzheimer’s disease

https://www.nia.nih.gov/health/what-causes-alzheimers-disease#:~:text=Older%20age%20does%20not%20cause,older%20may%20have%20Alzheimer’s%20disease

.

Tebbs, O. H. (2021). Evaluation of a blended learning approach to developing specialty-nursing practice. An exploratory, descriptive qualitative study. Nurse education today, 104663. Retrieved from https://www.sciencedirect.com/science/article/pii/S0260691720315136

Theofanidis, D. F. (2021). Nursing Interventions in Alzheimer’s Disease: A Concise Practical Guide for Everyday Use. International Journal of Caring Sciences, 106. Retrieved from http://www.internationaljournalofcaringsciences.org/docs/12_theofanidis_original_%2014_1

Practicum Focus Sheet Assessment 2

Note: Expect to spend at least 2 hours with the patient, family, or group you’ll be working with during this portion of your practicum, exploring issues of patient safety, quality, and costs associated with the health problem you’ve defined. This includes time spent in consultation with subject matter or industry experts. You’ll report on the results of this work as part of your next assessment.

For this portion of your practicum, discuss, in depth, how the problem will affect patient safety, quality of care, and costs. Consider the following questions to help guide your exploration of quality, safety, and costs and to make the most of your time:

• Has the patient, family or group experienced any serious safety events because of the problem? • How many times have they gone to the emergency department (ED)?

• How many times have they been hospitalized?

• What is the frequency of ED visits or hospitalizations?

• How many medications are needed to manage the problem?

• Does insurance pay for these medications?

• Have the medications caused any side effects?

• How often are doctors’ visits or other therapies needed?

• Does insurance pay for these visits or treatments?

Assessing the Problem: Quality, Safety, and Cost Considerations

Top of Form

Bottom of Form

·

PRINT

· In a 5 page written assessment, assess the effect of the patient, family, or population problem you’ve previously defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend approximately 2 direct practicum hours exploring these aspects of the problem with the patient, family, or group you’ve chosen to work with and, if desired, consulting with subject matter and industry experts

. Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form.

Report on your experiences during your first two practicum hours.

Introduction

Organizational data, such as readmission rates, hospital-acquired infections, falls, medication errors, staff satisfaction, serious safety events, and patient experience can be used to prioritize time, resources, and finances. Health care organizations and government agencies use benchmark data to compare the quality of organizational services and report the status of patient safety. Professional nurses are key to comprehensive data collection, reporting, and monitoring of metrics to improve quality and patient safety.

Preparation

In this assessment, you’ll assess the effect of the health problem you’ve defined on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 direct practicum hours working with the same patient, family, or group. During this time, you may also choose to consult with subject matter and industry experts.

To prepare for the assessment:

· Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete and how it will be assessed.

· Conduct research of the scholarly and professional literature to inform your assessment and meet scholarly expectations for supporting evidence.

· Review the 

Practicum Focus Sheet: Assessment 2 [PDF]

, which provides guidance for conducting this portion of your practicum.

Note: Remember that you can submit all, or a portion of, your draft assessment to 

Smarthinking

 for feedback, before you submit the final version. If you plan on using this free service, be mindful of the turnaround time of 24-48 hours for receiving feedback.

Instructions

Complete this assessment in two parts.

Part 1

Assess the effect of the patient, family, or population problem you defined in the previous assessment on the quality of care, patient safety, and costs to the system and individual. Plan to spend at least 2 practicum hours exploring these aspects of the problem with the patient, family, or group. During this time, you may also consult with subject matter and industry experts of your choice. Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form. Use the 
Practicum Focus Sheet: Assessment 2 [PDF]
 provided for this assessment to guide your work and interpersonal interactions.

Part 2

Report on your experiences during your first 2 practicum hours, including how you presented your ideas about the health problem to the patient, family, or group.

· Whom did you meet with?

4. What did you learn from them?

. Comment on the evidence-based practice (EBP) documents or websites you reviewed.

5. What did you learn from that review?

. Share the process and experience of exploring the influence of leadership, collaboration, communication, change management, and policy on the problem.

6. What barriers, if any, did you encounter when presenting the problem to the patient, family, or group?

1. Did the patient, family, or group agree with you about the presence of the problem and its significance and relevance?

1. What leadership, communication, collaboration, or change management skills did you employ during your interactions to overcome these barriers or change the patient’s, family’s, or group’s thinking about the problem (for example, creating a sense of urgency based on data or policy requirements)?

. What changes, if any, did you make to your definition of the problem, based on your discussions?

. What might you have done differently?

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.

· Explain how the patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.

. Cite evidence that supports the stated impact.

. Note whether the supporting evidence is consistent with what you see in your nursing practice.

· Explain how state board nursing practice standards and/or organizational or governmental policies can affect the problem’s impact on the quality of care, patient safety, and costs to the system and individual.

. Describe research that has tested the effectiveness of these standards and/or policies in addressing care quality, patient safety, and costs to the system and individual.

. Explain how these standards and/or policies will guide your actions in addressing care quality, patient safety, and costs to the system and individual.

. Describe the effects of local, state, and federal policies or legislation on your nursing scope of practice, within the context of care quality, patient safety, and cost to the system and individual.

· Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual.

. Discuss research on the effectiveness of these strategies in addressing care quality, patient safety, and costs to the system and individual.

. Identify relevant and available sources of benchmark data on care quality, patient safety, and costs to the system and individual.

. Document the time spent (your practicum hours) with these individuals or group in the Core Elms Volunteer Experience Form.

· Use paraphrasing and summarization to represent ideas from external sources.

· 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 pages in length, not including the reference page.

· Supporting evidence: Cite at least 5 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

By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

· Competency 3: Transform processes to improve quality, enhance patient safety, and reduce the cost of care.

. Explain how a patient, family, or population problem impacts the quality of care, patient safety, and costs to the system and individual.

. Propose strategies to improve the quality of care, enhance patient safety, and reduce costs to the system and individual and document the practicum hours spent with these individuals or group in the Core Elms Volunteer Experience Form.

· Competency 5: Analyze the impact of health policy on quality and cost of care.

. Explain how state board nursing practice standards and/or organizational or governmental policies can affect a patient, family, or population problem’s impact on the quality of care, patient safety, and costs to the system and individual.

· Competency 8: Integrate professional standards and values into practice.

. Use paraphrasing and summarization to represent ideas from external sources.

. Apply APA style and formatting to scholarly writing.

2/8/22, 8:05 PM

Assessing the Problem: Quality, Safety, and Cost Considerations Scoring Guide

https://courserooma.capella.edu/bbcswebdav/institution/NURS-FPX/NURS-FPX4900/220100/Scoring_Guides/a02_scoring_guide.html 1/2

Assessing the Problem: Quality, Safety, and Cost Considerations Scoring Guide

CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED

Explain how a
patient, family, or
population problem
impacts the quality
of care, patient
safety, and costs to
the system and
individual.

Does not describe
the impact of a
patient, family, or
population
problem on the
quality of care,
patient safety, and
costs to the
system and
individual.

Attempts to
describe the
impact of a patient,
family, or
population
problem on the
quality of care,
patient safety, and
costs to the
system and
individual.

Explains how a
patient, family, or
population
problem impacts
the quality of
care, patient
safety, and costs
to the system and
individual.

Provides a convincing explanation
of how a patient, family, or
population problem impacts the
quality of care, patient safety, and
costs to the system and individual
by providing specific individual,
family, or population examples of
such impacts.

Explain how state
board nursing
practice standards
and/or
organizational or
governmental
policies can affect a
patient, family, or
population
problem’s impact on
the quality of care,
patient safety, and
costs to the system
and individual.

Does not identify
state board
nursing practice
standards and/or
organizational or
governmental
policies that could
affect a patient,
family, or
population
problem’s impact
on the quality of
care, patient
safety, and costs
to the system and
individual.

Attempts to
explain state board
nursing practice
standards and/or
organizational or
governmental
policies that could
affect a patient,
family, or
population
problem’s impact
on the quality of
care, patient
safety, and costs
to the system and
individual.

Explains how
state board
nursing practice
standards and/or
organizational or
governmental
policies can affect
a patient, family,
or population
problem’s impact
on the quality of
care, patient
safety, and costs
to the system and
individual.

Provides an explanation—based
on a perceptive and coherent
synthesis of current literature—of
how state board nursing practice
standards and/or organizational or
governmental policies can affect a
patient, family, or population
problem’s impact on the quality of
care, patient safety, and costs to
the system and individual.
Provides clear insight into how
policy affects nursing scope of
practice and will inform and guide
an intervention.

Propose strategies
to improve the
quality of care,
enhance patient
safety, and reduce
costs to the system
and individual and
document the
practicum hours
spent with these
individuals or group
in the CORE ELMS
Volunteer
Experience Form.

Does not propose
strategies to
improve the
quality of care,
enhance patient
safety, and
reduce costs to
the system and
individual, and
does not
document
practicum hours
in the CORE
ELMS Volunteer
Experience Form.

Proposes
leadership
strategies that are
not clearly related
to care quality,
patient safety, or
cost reduction, or
which are unlikely
to significantly
improve outcomes,
and/or does not
document
practicum hours in
the CORE ELMS
Volunteer
Experience Form.

Proposes
strategies to
improve the
quality of care,
enhance patient
safety, and
reduce costs to
the system and
individual and
documents the
practicum hours
spent with these
individuals or
group in the
CORE ELMS
Volunteer
Experience Form.

Proposes strategies, supported by
examples, to improve the quality
of care, enhance patient safety,
and reduce costs to the system
and individual. Exhibits clear
insight into the effectiveness of
the strategies and available
sources of relevant benchmark
data. Documents the practicum
hours spent with these individuals
or group in the CORE ELMS
Volunteer Experience Form

Use paraphrasing
and summarization
to represent ideas
from external
sources.

Incorporates
plagiarized
information.

Paraphrasing or
summarization is
awkward,
inaccurate, or
borders on
plagiarism.

Uses
paraphrasing and
summarization to
represent ideas
from external
sources.

Uses concise paraphrasing or
summarization to accurately
represent ideas from external
sources. Exhibits an insightful
interpretation and synthesis of
credible sources.

2/8/22, 8:05 PM Assessing the Problem: Quality, Safety, and Cost Considerations Scoring Guide

https://courserooma.capella.edu/bbcswebdav/institution/NURS-FPX/NURS-FPX4900/220100/Scoring_Guides/a02_scoring_guide.html 2/2

CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED

Apply APA style and
formatting to
scholarly writing.

Does not apply
APA style and
formatting to
scholarly writing.

Applies APA style
and formatting to
scholarly writing
incorrectly and/or
inconsistently,
detracting
noticeably from
good scholarship.

Applies APA style
and formatting to
scholarly writing.

Applies APA style and formatting
to scholarly writing. Exhibits strict
and nearly flawless adherence to
stylistic conventions, document
structure, and source attributions.