NURS FPX 4900 Assessment 4 Patient Family or Population Health Problem Solution

Name

Capella university

NURS-FPX 4900 Capstone project for Nursing

Prof. Name

Date

Patient, Family, or Population Health Problem Solution

Mr. Paul is a patient (36-year-old) struggling with Alcohol Use Disorder (AUD), characterized by his excessive and uncontrolled alcohol consumption. It has led to notable physical, psychological, and social consequences for Mr. Paul. He has strained relations with his immediate (spouse and children) and extended family, has a high risk of chronic health conditions (liver and cardiovascular concerns), having a low quality of life. I chose this problem as the focus of my project because AUD is a prevalent and complex health issue (affecting 17.3 million men annually) with far-reaching impacts (NIAAA, 2023).

Addressing AUD requires a multifaceted approach involving medical, psychological, and social interventions, making it an ideal subject for a comprehensive project. This problem is highly relevant to my professional practice as a healthcare provider because AUD affects not only the individual but also their family and broader social network. Understanding and addressing AUD can improve the well-being of the patient, their family, and the community. 

Leadership and Change Management

Transformational leadership is prevalent in healthcare systems due to its positive impact and influential strategies for enhanced health outcomes. This leadership style is effective due to the complex nature of current healthcare conditions and the requirement for sustainable evidence-based practices to manage multifaceted health issues like AUD. This leadership style utilizes elements of influence and motivation, inspiring and empowering its employees through intellectual stimulation (Chu et al., 2021). In the healthcare system, this leadership style has positively impacted team members at different levels and disciplines to achieve one goal: to improve Mr. Paul’s quality of life cost-effectively through individualized intervention. It motivated nurses, psychiatrists, counselors, and pharmacists to bring positive and sustainable change in Mr. Paul’s life. It allowed us to integrate a multifaceted approach through pharmacological and social support to address AUD.  

Change management is a way to identify loopholes, address gaps, and sustain effective practices. In this capstone project, Kotter’s 8-Steps addresses AUD for Mr. Paul. With transformational leadership, Kotter’s model positively impacted Mr. Paul’s life quality and healthcare system (Miles et al., 2023). Firstly, leadership created a sense of urgency (Step one) by raising awareness about the prevalence and impact of AUD, highlighting the need for a proactive intervention strategy for Mr. Paul. This step involves educating patient (Mr. Paul) and his family members, about addressing AUD promptly and effectively. Then, transformational leadership assembled a coalition of key stakeholders, such as caregivers, specialists like psychiatrists, social workers, and patient advocates (nurses). This coalition (Step two) collaboratively develops strategies and interventions for AUD management, leveraging diverse perspectives to ensure comprehensive care for Mr. Paul.

NURS FPX 4900 Assessment 4 Patient Family or Population Health Problem Solution

In Steps three and four, leaders articulate a compelling vision for AUD management (Gradual and complete abstinence from alcohol), emphasizing patient-centered, evidence-based, and continuous care. They build a plan that outlines objectives and resource allocation for Mr. Paul’s AUD management (Miles et al., 2023). Effective communication is essential at this point (Step five). I clearly and consistently communicate the vision for management to all stakeholders (nurses, healthcare team, and social workers), ensuring understanding, buy-in, and alignment across the healthcare team and organization. Then, leaders empower team members to take action (Step six) by providing them with the necessary resources, training, and support. They encourage innovation and collaboration in developing and implementing interventions tailored to the patient’s (Mr. Paul’s) needs and preferences.

AUD is a complex healthcare issue, requiring time and a multifaceted approach. Mr. Paul cannot quit alcohol consumption all of a sudden and expects to not relapse on available opportunities or triggers. Leaders celebrate early success in AUD management, such as reduced intake of alcohol, reduced relapse, and enhanced patient satisfaction (Step seven). Lastly, the positive change in AUD management becomes ingrained in organizational culture and practices. They monitor progress, evaluate outcomes, and adjust to sustain improvements and drive future change. The last step (Step eight) is sustained by observing the patient’s health progress and tests and by taking feedback from healthcare providers, patients, and their family members regarding behavior and treatment adherence (Miles et al., 2023).  

The Proposed Intervention

The intervention for Mr. Paul’s AUD involves implementing education regarding  Medication-Assisted Treatment (MAT) alongside comprehensive counseling and support services. MAT utilized medications such as naltrexone or acamprosate to reduce alcohol cravings and withdrawal symptoms, besides Cognitive Behavioral Therapy (CBT) (Magill et al., 2023; U.S.FDA, 2023). The treatment will be conducted through telehealth services, like video conferencing, and allow Mr. Paul to understand the treatment plan, its impact, and expected effects. We will integrate telemedicine for medication reminders and alerts for physiological dangers like destructive sleep cycles or unstable gait.

Nursing Ethics in Developing the Proposed Intervention

Nursing ethics played an important role in the proposed intervention by prioritizing the principles of beneficence, non-maleficence, autonomy, and justice. Beneficence guide me to act in Mr. Paul’s best interest by providing evidence-based care like MAT and CBT that enhances his chances of recovery. Non-maleficence ensures that alcohol consumption and withdrawal journey would not harm the patient or immediate family through CBT, which ensures his emotional and mental health concerns are catered to through positive behavior modification. Autonomy respects Mr. Paul’s right to make informed decisions about his treatment, including the option of MAT. Justice ensures I provide equitable access to quality care, considering factors like cost-effectiveness to provide sustainable and inclusive interventions for Mr. Paul and other patients with AUD (Ogbonna & Lembke, 2019).  

Strategies for Communicating and Collaborating with Patients

Several communication strategies are beneficial for effective outcomes in AUD management. For instance, active listening is important to engage patients to understand their concerns, preferences, and goals. Mr. Paul requires active listening in terms of his mental and emotional state with immediate and extended family and regarding gradual alcohol quitting, which allowed me to develop a personalized plan for himself. Involving patients enables shared decision-making through treatment options, risks, and benefits clearly and understandably (Wu & Baker, 2021).

This approach help me in guiding Mr. Paul and his family to cooperate in the most effective way possible. Educating family members about the health problem, treatment options, self-management strategies, and available resources has positive outcomes. This promotes health literacy, enhances self-efficacy, and improves adherence to treatment plans with family support, improving health outcomes (Mar & Kunins, 2020). 

Patient satisfaction is an important factor in the medical care system and a significant approach to patient-centered care. Obtaining patient input has several benefits, as tailored interventions improve patient satisfaction, compliance, and health outcomes. Cultural sensitivity plays a role through suitable and preferable language and values. It increases treatment adherence through mutual decision-making and empowered commitment to plan, reducing barriers (Wu & Baker, 2021). A collaborative approach builds trust and therapeutic alliance, which is essential in AUD management and patients like Mr. Paul facing psychosocial issues. Input from patients or family helps identify social factors affecting the treatment plan and improving well-being. For example, communication and collaboration enabled the role of the immediate family (spouse and children) in abstinence and medication adherence through emotional support (Kools et al., 2022).   

Standards of Nursing Practice and Government Policies

Standard guidelines and policies play a pivotal role during intervention planning and intervention for AUD management. The American Nurse Association (ANA) instructs me and fellow nurses to follow evidence-based solutions to manage diseases, including AUD. Its nursing Code of Ethics, guided for intervention for Mr. Paul, is supported by ethical principles. This ensured that the intervention (MAT and CBT) for AUD management prioritized patient (Mr. Paul) wellbeing, respect for autonomy, and equitable access to quality care (Mercer et al., 2023).

Health Insurance Portability and Accountability Act (HIPAA) also plays a crucial role in building trust relations and utilizing innovative means, such as telehealth for counseling, therapies, and community resource accessibility. It guided patient confidentiality and privacy in all aspects of care delivery. This included Mr. Paul’s health information, obtaining consent for treatment, and securely sharing information among authorized care providers such as therapists, counselors, nurses, and social workers (Edemekong et al., 2022). 

Affordable Care Act (ACA) focuses on value-based care and cost-effectiveness, and it influences the intervention for AUD management plans (Ercia, 2021). Evidence-based practices, including MAT and CBT through telehealth and telemedicine, were considered cost-effective. It guided me AUD management by reducing hospitalizations, emergency visits, and healthcare costs in terms of traveling. Lastly, the Food and Drug Administration (FDA) provided approved medication effective for abstinence and relapses. These medications include naltrexone and acamprosate to help individuals like Mr. Paul recover (U.S. FDA, 2023).  

Enhancing Quality of Care, Promoting Safety, Minimizing Costs

The proposed intervention is a combination of MAT and CBT through telehealth and telemedicine for Mr. Paul to manage AUD. It aims to improve care quality, promote Mr. Paul’s safety, and minimize costs for the patient and the healthcare organization. To enhance the quality of care, I integrated MAT for physiological purposes, which, through evidence, is effective in reducing alcohol cravings and withdrawal symptoms (Leibowitz et al., 2020). Magill et al. (2023), state that CBT, delivered through telehealth platforms like video conferencing, is effective for the psychological aspect of a patient’s (Mr. Paul) health by developing coping strategies, managing triggers, and modifying unhealthy behavior patterns. 

The proposed intervention to manage AUD for Mr. Paul aimed to enhance his safety, for instance, through MAT and CBT implementation, collaboration among care providers, and guidance through HIPAA policy to ensure error reduction and confidentiality (Edemekong et al., 2022). I have set mobile alerts and reminders for medication adherence and therapy appointments to enhance patient safety by reducing the risk of missed doses or sessions. The combination of MAT, CBT via telehealth, and telemedicine approaches using mobile alerts and reminders optimize resource utilization and reduce healthcare system expenses by preventing relapses and transportation costs due to managing AUD. Snoswell et al. (2020), say telehealth saves $361 for individuals and $8566 for the healthcare system by saving service costs over six months. For Mr. Paul, reduced healthcare utilization and improved outcomes translate to potential cost savings guided through ACA policy. 

NURS FPX 4900 Assessment 4 Patient Family or Population Health Problem Solution

The reputable organizations have extensively researched AUD and provided benchmark data regarding prevalence, impact, and recovery plans. The notable benchmark data includes The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the World Health Organization (WHO). NIAAA provides patient safety guidelines in terms of medication safety, overdose prevention, and recovery outcome guidelines. For instance, NIAAA lays down remission and reduces heavy drinking benchmark by stating duration (Early: up to three months, Stable: more than five years) and drinking reduction to 14 drinks a week (for men) (Hagman et al., 2022). WHO also provides guidelines to reduce safety and quality life measures through risk reduction strategies, such as awareness programs, policy implementation, and accessible and cost-effective treatment for AUD (WHO, 2022). 

Role of Technology, Coordinated Care, and Community Resources

Technology plays a crucial role in healthcare, particularly in addressing AUD. Telehealth platforms can deliver evidence-based interventions like CBT to patients (like Mr. Paul), providing convenient access to therapy and support. Mobile applications are also practical, as studies have shown their effective use in medication adherence through reminders, tracking progress, and providing educational resources about AUD recovery strategies (Leibowitz et al., 2020). Effective care coordination involves collaborating with a multidisciplinary healthcare team, for example, nurses, psychologists, pharmacists, and community workers (Arnedt et al., 2022).

Patients like Mr. Paul receive comprehensive, integrated care addressing physical, mental, and social needs through coordinated efforts. Studies have shown that engaging community resources enhances the support network available to patients with AUD. This includes peer recovery programs like Alcoholics Anonymous (A.A.) and SMART Recovery. It also provides additional services like vocational training, which can benefit Mr. Paul in the future, contributing to sustained recovery and improved life quality (Wnuk, 2022). 

Conclusion

In conclusion, the intervention for Mr. Paul’s AUD integrates evidence-based practices such as MAT and CBT delivered through telehealth and telemedicine. This intervention enhances patient safety through coordinated care and a technology-enabled support system. Leveraging community resources and adhering to practice standards and policies ensure ethical, cost-effective, and individualized care. 

References

Arnedt, J. T., Cardoni, M. E., Conroy, D. A., Graham, M., Amin, S., Bohnert, K. M., Krystal, A. D., & Ilgen, M. A. (2022). Telemedicine-delivered cognitive-behavioral therapy for insomnia in alcohol use disorder (AUD): Study protocol for a randomized controlled trial. Trials, 23(1). https://doi.org/10.1186/s13063-021-05898-y 

Chu, H., Qiang, B., Zhou, J., Qiu, X., Yang, X., Qiao, Z., Song, X., Zhao, E., Cao, D., & Yang, Y. (2021). The impact of transformational leadership on physicians’ performance in China: A cross-level mediation model. Frontiers in Psychology, 12(1). Frontiersin. https://doi.org/10.3389/fpsyg.2021.586475 

Edemekong, P. F., Haydel, M. J., & Annamaraju, P. (2022, February 3). Health Insurance Portability and Accountability Act (HIPAA). Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK500019/ 

Ercia, A. (2021). The Affordable Care Act’s impact on patient coverage and access to care: Perspectives from FQHC administrators in Arizona, California, and Texas. BioMed Central (BMC) Health Services Research, 21(1), 1–9. https://doi.org/10.1186/s12913-021-06961-9 

Guerrero, E. G., Frimpong, J., Kong, Y., Fenwick, K., & Aarons, G. A. (2020). Advancing theory on the multilevel role of leadership in the implementation of evidence-based health care practices. Health Care Management Review, 45(2), 1. https://doi.org/10.1097/hmr.0000000000000213 

NURS FPX 4900 Assessment 4 Patient Family or Population Health Problem Solution

Hagman, B. T., Falk, D., Litten, R., & Koob, G. F. (2022). Defining recovery from alcohol use disorder: Development of an NIAAA research definition. American Journal of Psychiatry, 179(11). https://doi.org/10.1176/appi.ajp.21090963 

Kools, N., Dekker, G. G., Kaijen, B. A. P., Meijboom, B. R., Bovens, R. H. L. M., & Rozema, A. D. (2022). Interdisciplinary collaboration in the treatment of alcohol use disorders in a general hospital department: A mixed-method study. Substance Abuse Treatment, Prevention, and Policy, 17(1). https://doi.org/10.1186/s13011-022-00486-y 

Leibowitz, A., Satre, D. D., Lu, W., Weisner, C., Corriveau, C., Gizzi, E., & Sterling, S. (2020). A telemedicine approach to increase treatment of alcohol use disorder in primary care: A pilot feasibility study. Journal of Addiction Medicine, 15(1), 27–33. https://doi.org/10.1097/adm.0000000000000666 

Magill, M., Kiluk, B. D., & Ray, L. A. (2023). Efficacy of cognitive behavioral therapy for alcohol and other drug use disorders: Is a one-size-fits-all approach appropriate? Substance Abuse and Rehabilitation, Volume 14(1), 1–11. https://doi.org/10.2147/sar.s362864 

Mar, Y., & Kunins, H. (2020). Treatment of alcohol use disorder. In PubMed. Johns Hopkins University. https://www.ncbi.nlm.nih.gov/books/NBK561234/ 

Mercer, M., Stimpfel, A. W., & Dickson, V. V. (2023). Psychosocial factors associated with alcohol use among nurses: An integrative review. Journal of Nursing Regulation, 13(4), 5–20. https://doi.org/10.1016/s2155-8256(23)00032-7 

NURS FPX 4900 Assessment 4 Patient Family or Population Health Problem Solution

Miles, M. C., Richardson, K. M., Wolfe, R., Hairston, K., Cleveland, M., Kelly, C., Lippert, J., Mastandrea, N., & Pruitt, Z. (2023). Using Kotter’s change management framework to redesign departmental GME recruitment. Journal of Graduate Medical Education, 15(1), 98–104. https://doi.org/10.4300/JGME-D-22-00191.1 

NIAAA. (2023). Alcohol Use Disorder (AUD) in the United States: Age groups and demographic characteristic. Www.niaaa.nih.gov. https://www.niaaa.nih.gov/alcohols-effects-health/alcohol-topics/alcohol-facts-and-statistics/alcohol-use-disorder-aud-united-states-age-groups-and-demographic-characteristics 

Ogbonna, C. I., & Lembke, A. (2019). Substance use among older adults: Ethical issues. FOCUS, 17(2), 143–147. https://doi.org/10.1176/appi.focus.20180041 

Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if telehealth can reduce health system costs: Scoping review. Journal of Medical Internet Research, 22(10), e17298. https://doi.org/10.2196/17298 

U.S.FDA. (2023, May 23). Information about Medication-Assisted Treatment. U.S. Food and Drug Administration. https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat 

WHO. (2022, May 9). Alcohol. Www.who.int. https://www.who.int//news-room/fact-sheets/detail/alcohol/?gad_source=1&gclid=CjwKCAjwrIixBhBbEiwACEqDJTqgsVkXDr4m0hi8TJiZuU7Q9TmXxu9sD2SmHhXBM_eX5GnadG3sqBoCX68QAvD_BwE 

NURS FPX 4900 Assessment 4 Patient Family or Population Health Problem Solution

Wnuk, M. (2022). The beneficial role of involvement in alcoholics anonymous for existential and subjective well-being of alcohol-dependent individuals? The model verification. International Journal of Environmental Research and Public Health, 19(9), 5173. https://doi.org/10.3390/ijerph19095173 

Wu, K., & Baker, J. (2021). Patient communication in substance abuse disorders. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK549858/