NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Student Name

Capella University

NURS-FPX 6021 Biopsychosocial Concepts for Advanced Nursing Practice 1

Prof. Name

Date

Change Strategy and Implementation

Renal failure refers to a pathological state in which the kidneys are unable to effectively eliminate metabolic waste or maintain fluid and electrolyte balance, leading to widespread physiological disruption (Nagendra et al., 2023). In this context, the present plan outlines a patient-focused intervention for Mrs. Smith, a 52-year-old diagnosed with Type II Diabetes Mellitus and Acute Renal Failure (Capella University, 2024).

The strategy integrates evidence-based clinical interventions with coordinated interprofessional collaboration to improve safety, accessibility, and health outcomes. It aligns with established clinical standards from organizations such as the American Diabetes Association (ADA) and NANDA, ensuring that care delivery is both standardized and individualized. The approach prioritizes patient engagement, clinical monitoring, and equitable access to healthcare resources.

Data Table

The following table presents Mrs. Smith’s current clinical status, expected outcomes, and measurable improvement targets based on clinical benchmarks and best-practice guidelines. Confidentiality considerations are maintained in accordance with HIPAA principles.

Table 1: Clinical Outcomes Assessment

Clinical Outcome	Current Status	Expected Outcome	Target Improvement
Blood Glucose Levels	Fasting: 125 mg/dL; Postprandial: 140 mg/dL; frequent spikes (200–350 mg/dL); ~60% variability	Fasting: 80–130 mg/dL; Postprandial: <180 mg/dL	50% reduction in glucose fluctuations (Lin et al., 2021)
Renal Function	Mild edema; early signs of kidney impairment; ~30% prevalence	No edema; stable renal markers; normal urine output	20% improvement in renal function (ADA, 2022)
Self-Care & Social Support	Poor dietary adherence; dependence on family; limited engagement; ~40% deficit	Consistent self-care; improved independence; active social participation	95% improvement in self-management (Martens et al., 2021)
Medication Adherence	Financial barriers; ~70% affected	Consistent adherence; reduced financial burden	90% access to support programs (Laursen et al., 2021)

Areas of Ambiguity and Uncertainty

What information is missing that may affect the care plan?
Several uncertainties remain that could influence intervention effectiveness. A more detailed understanding of Mrs. Smith’s dietary patterns, physical activity routine, and medication-taking behavior is required to identify the root causes of glycemic instability.

Why is socioeconomic context important in this case?
Socioeconomic constraints may directly affect treatment adherence, access to medications, and lifestyle modifications. Evaluating her financial limitations and support systems will allow for more tailored and feasible interventions (Lin et al., 2021).

Addressing these gaps is essential to refine clinical decision-making and ensure that interventions are both realistic and sustainable.

Change Strategies for Desired Outcomes

What interventions can stabilize blood glucose levels?
The introduction of Continuous Glucose Monitoring (CGM) is a key strategy. This technology enables real-time glucose tracking, allowing prompt therapeutic adjustments. When combined with structured diabetes education focusing on nutrition and lifestyle, CGM has been shown to significantly reduce glycemic variability (Martens et al., 2021).

How can renal complications be managed effectively?
Renal function can be supported through:

• Prescribed diuretic therapy
• Routine monitoring of renal biomarkers
• Early referral to nephrology specialists

These measures facilitate early detection of deterioration and improve long-term kidney outcomes (ADA, 2022).

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

What approaches improve self-care capacity?
A multidimensional strategy is required, including:

• Nutritional counseling by registered dietitians
• Participation in community-based support groups
• Structured self-management education programs

These interventions enhance patient autonomy and encourage sustained behavioral changes (Do et al., 2020).

How can financial barriers to treatment be reduced?
Financial challenges can be addressed through:

• Enrollment in medication assistance programs
• Cost-effective treatment planning
• Collaboration with community organizations

These approaches improve medication adherence and access to care (Laursen et al., 2021).

A multidisciplinary team—including endocrinologists, nurses, dietitians, nephrologists, and social workers—will coordinate care delivery. Barriers such as resistance to lifestyle changes and financial limitations can be mitigated through family engagement and community resource utilization (Sugandh et al., 2023).

Justification of the Change Strategies

Why is CGM considered an effective intervention?
Clinical evidence supports CGM as a reliable method for improving glycemic control by providing continuous feedback and enabling timely interventions, thereby reducing acute complications (ADA, 2022).

Why is dietary education critical?
Structured nutritional education improves metabolic outcomes and supports long-term diabetes management (Martens et al., 2021).

What is the role of diuretics in renal care?
Diuretics help manage fluid overload and reduce the progression of renal dysfunction, making them essential in patients with kidney impairment (Afify et al., 2023).

How do financial interventions influence adherence?
Reducing economic barriers has a direct positive effect on medication adherence and treatment success (Kvarnström et al., 2021).

Additional supportive interventions include:

• Renal-specific dietary modifications
• Integration of mental health support

These strategies address both clinical and psychosocial determinants of health, ensuring a comprehensive care model (Karakuş et al., 2021; Bingham et al., 2020).

Quality Improvement in Safety and Equitable Care through Change Strategies

How do these strategies enhance patient safety?
The use of CGM allows early identification of hyperglycemia and hypoglycemia, reducing the risk of severe complications such as diabetic ketoacidosis (Martens et al., 2021). Additionally, diuretics assist in maintaining fluid balance and protecting renal function (Afify et al., 2023).

How is equitable care achieved?
Equity is improved by ensuring access to essential medications through financial assistance programs, thereby reducing disparities associated with socioeconomic status (Kvarnström et al., 2021).

These interventions support the Quadruple Aim framework by:

• Improving patient experience
• Enhancing population health
• Lowering healthcare costs
• Supporting healthcare providers (Clark et al., 2022)

How Change Strategies Will Utilize Interprofessional Considerations

How does interprofessional collaboration improve outcomes?
Effective care implementation relies on coordinated teamwork among healthcare professionals. Each discipline contributes specialized expertise:

• Endocrinologists manage glycemic control
• Nurses provide monitoring and patient education
• Dietitians guide nutritional planning
• Social workers address psychosocial and financial barriers

This collaboration ensures continuity of care, timely clinical decisions, and comprehensive patient support (Martens et al., 2021; Ernawati et al., 2021).

What are the system-level benefits of this approach?
Distributing responsibilities across the care team reduces workload and prevents provider burnout, contributing to a more sustainable healthcare system (Ernawati et al., 2021). Successful implementation depends on access to trained professionals and appropriate technologies such as CGM systems (Nurchis et al., 2022).

Conclusion

The integration of advanced glucose monitoring, patient education, and financial support mechanisms offers a structured and evidence-based approach to improving Mrs. Smith’s health outcomes. These strategies enhance patient safety, promote equitable access to care, and strengthen interprofessional collaboration. Ultimately, this comprehensive model supports long-term disease management, reduces complication risks, and improves both patient and provider well-being.

References

ADA. (2022). American Diabetes Association. https://diabetes.org/

Afify, H., Morales, U. G., Asmar, A., Alvarez, C. A., & Mansi, I. A. (2023). Association of thiazide diuretics with diabetes progression, kidney disease progression, cardiovascular outcomes, and death among patients with diabetes who initiate statins. The American Journal of Cardiology, 203, 274–284. https://doi.org/10.1016/j.amjcard.2023.07.057

Bingham, J. M., Black, M., Anderson, E. J., Li, Y., Toselli, N., Fox, S., Martin, J. R., Axon, D. R., & Silva-Almodóvar, A. (2020). Impact of telehealth interventions on medication adherence for patients with type 2 diabetes, hypertension, and/or dyslipidemia: A systematic review. Annals of Pharmacotherapy, 55(5), 637–649. https://doi.org/10.1177/1060028020950726

Capella University. (2024). Capella University: Online accredited degree programs. https://www.capella.edu/

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Clark, A., Jung, E., Prusky, C., Shah, B. R., & Halperin, I. J. (2022). Evaluation of virtual care for gestational diabetes using the quadruple aim framework. Canadian Journal of Diabetes, 47(3), 236–242. https://doi.org/10.1016/j.jcjd.2022.12.002

Do, J. Y., Kim, S. W., Park, J. W., Cho, K. H., & Kang, S. H. (2020). Association between metformin use and clinical outcomes in diabetes patients. Diabetes & Metabolism, 47(4). https://doi.org/10.1016/j.diabet.2020.10.006

Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of diabetes self-management education in T2DM patients. Journal of Public Health Research, 10(2), 198–202. https://doi.org/10.4081/jphr.2021.2240

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Karakuş, K. E., et al. (2021). Benefits and drawbacks of continuous glucose monitoring. Journal of Patient Experience, 8(1). https://doi.org/10.1177/23743735211056523

Kvarnström, K., Westerholm, A., Airaksinen, M., & Liira, H. (2021). Factors contributing to medication adherence. Pharmaceutics, 13(7). https://doi.org/10.3390/pharmaceutics13071100

Laursen, J., et al. (2021). Effects of dapagliflozin on renal outcomes. EClinicalMedicine, 37. https://doi.org/10.1016/j.eclinm.2021.100895

Lin, R., Brown, F., James, S., Jones, J., & Ekinci, E. (2021). Continuous glucose monitoring in diabetes. Diabetic Medicine, 38(5). https://doi.org/10.1111/dme.14528

Martens, T., et al. (2021). Effect of CGM on glycemic control. JAMA, 325(22). https://doi.org/10.1001/jama.2021.744

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Nagendra, L., Fernandez, C. J., & Pappachan, J. M. (2023). Kidney transplantation perspectives. World Journal of Transplantation, 13(5), 208–220. https://doi.org/10.5500/wjt.v13.i5.208

NANDA. (2020). NANDA International Nursing Diagnoses. https://nanda.org/

Nurchis, M. C., et al. (2022). Interprofessional collaboration in diabetes care. Journal of Personalized Medicine, 12(4). https://doi.org/10.3390/jpm12040643

Sugandh, F. N. U., et al. (2023). Advances in diabetes management. Cureus, 15(8), 1–13. https://doi.org/10.7759/cureus.43697