Abstract The underdiagnosis and the undertreatment of comorbidities of chronic obstructive pulmonary disorder (COPD) such as anxiety and depression are key issues in pulmonary care. Typically, primary care involves addressing physical health issues, such as COPD, which have a significant impact on patients. However, this does not adequately account for the overall well-being of patients. Anxiety and depression may have negative impact on patients’ quality of life and are likely to impede their ability to recover (Pooler & Beech, 2014). To address this, it is necessary to provide patients with access to mental health facilities. The change strategy proposed in this presentation is to provide cognitive behavior therapy (CBT) to patients by mental health professionals. Organizations could also train their nurses in CBT or hire nurses who are trained in CBT. The Deming Cycle, or the Plan-Do-Check-Act (PDCA) cycle, could be used to evaluate the efficacy of the strategy. The PDCA cycle would ensure that the change strategy is adequately evaluated in terms of whether it improves patients’ quality of life and their ability to cope both mentally and physically with COPD, anxiety, and depression. Quality Improvement Presentation Poster Learner’s Name Capella University Biopsychosocial Concepts for Advanced Nursing Practice I Quality Improvement Presentation Poster April, 2019 Interprofessional Team Benefits Quality Improvement Methods • • • • • • • Quality improvement is the betterment of the desired outcomes of any existing process. Typically, this would require prior understanding of the process and aspects of it that require improvement. The PDCA cycle is one of the tools used in quality improvement (Pietrzak & Paliszkiewicz, 2015). Once an area of improvement is identified, it is necessary to provide a plan of action to enhance the outcomes in that area. Primary care largely focuses on the physical health of patients. In pulmonary care, physicians and nurses typically focus on the physical symptoms that patients experience. However, COPD patients are often underdiagnosed and are undertreated for anxiety and depression (Pooler & Beech, 2014). These issues tend to impede patient recovery and deteriorate quality of life and health care outcomes. After an area of improvement is identified, the plan of action would address the issue of insufficient care by providing COPD patients with adequate access to mental health facilities. Once the plan of action is set, the next step is implementation. This is the “do” stage of the Deming Cycle. During this stage, it is necessary to execute the plan on a small scale to record its results and evaluate its efficacy. The effects of the change implemented are then evaluated during the “check” stage of the PDCA cycle (Pietrzak & Paliszkiewicz, 2015). The key question to be asked at this stage is whether the change does what it purports to do. If it does, would the change positively affect patients’ recovery and capacity to self-manage their condition? Based on the evaluation during the “check” stage, the quality improvement method is modified, and the cycle is repeated if the implemented change does not match the expected outcome. If the change proves to be effective, the quality improvement method is standardized and documented (Pietrzak & Paliszkiewicz, 2015). Limitations of the PDCA Cycle • • • • The PDCA cycle itself cannot guarantee quality improvement. The process of achieving a solution is slow and may not be linear. The cycle focuses on learning and taking informed actions. Adapting the cycle to different problems may not be simple and may require extensive skills and knowledge (Reed & Card, 2015). Insufficient planning may lead to failure in achieving desired results (Reed & Card, 2015). Strategies of the PDCA cycle also require scenarios that are not necessarily realistic (Pietrzak & Paliszkiewicz, 2015). When applied to realistic scenarios, these strategies could lead to failure, thereby creating more problems or adding to existing ones. To arrive at a solution to a problem, the four-step process has to be repeated several times. An iterative process could result in slow progress (Kliem, 2015). Therefore, the cycle may be ineffective at achieving swift results in emergencies (Reed & Card, 2015). • • Overall Project Benefits • • • • • • In health care, quality improvement comprises continuous, combined efforts by patients, professionals, researchers, and institutes to improve processes toward better patient care, health care outcomes, systems of care, and professional development (Carvalho, Jun, & Mitchell, 2017). The Deming Cycle, or the PDCA cycle, is a useful tool for quality improvement as it focuses on the creation of a plan followed by its execution and the evaluation of its results. By following this process, organizations can identify the shortcomings of the assumptions that their change strategies are based on and rectify those shortcomings. The PDCA cycle also provides a structure for teams to initiate change from within the system. The framework of the PDCA cycle ensures that the objective of any change process is within sight at all times and that the improvement that a process achieves is visible (Donnelly & Kirk, 2015). The evidence from the studies cited here indicates that an interprofessional approach that caters to COPD patients’ physical and psychological needs would improve their quality of life and aid their ability to self-manage and thereby recover from both issues. Using the Deming Cycle, physicians, nurses, and mental health professionals could evaluate the outcomes of implementing a CBT program for COPD patients. After the evaluation, if the quality improvement method suggested is found to result in optimal outcomes, the process could be standardized. If the outcomes are found to be suboptimal, then the process could be amended, and the Deming Cycle would begin again to ensure that quality improvement is an ongoing process. By ensuring that quality improvement is an ongoing process, patients will receive care that is continuous and of high quality, and teams will be able to develop better communication and cooperation among themselves. Further, through a collaborative approach, physicians, nurses, and mental health professionals could identify gaps in patient safety during the implementation of change strategies. Knowledge Gaps and Unknowns References • Amalakuhan, B., & Adams, S. G. (2015). Improving outcomes in chronic obstructive pulmonary disease: The role of the interprofessional approach. International Journal of Chronic Obstructive Pulmonary Disease, 10(1). 1225–1232. Carvalho, F., Jun, G. T., & Mitchell, V. (2017). Participatory design for behaviour change: An integrative approach to healthcare quality improvement. Paper presented at IASDR 2017 Proceedings, 7th International Congress of the International Association of Societies of Design Research, Cincinnati, OH. Coury, J., Schneider, J. L., Rivelli, J. S., Petrik, A. F., Seibel, E., D’Agostini, B., . . . Coronado, G. D. (2017). Applying the Plan-Do-Study-Act (PDSA) approach to a large pragmatic study involving safety net clinics. BMC Health Services Research, 17(411). Donnelly, P., & Kirk, P. (2015). Use the PDSA model for effective change management. Education for Primary Care, 26(4), 279–281. 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. Kliem, R. L. (2015). Managing Lean Projects. Boca Raton, FL: CRC Press. Pietrzak, M., & Paliszkiewicz, J. (2015). Framework of strategic learning: The PDCA cycle. Management, 10(2), 149–161. 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. Reed, J. E., & Card, A. J. (2015). The problem with Plan-Do-Study-Act cycles. BMJ Quality & Safety, 25(3), 147–52. • • • If the data received from the check phase is misinterpreted, people may arrive at inaccurate conclusions, leading to incorrect actions (Reed & Card, 2015). In research conducted by Coury et al. (2017), it was found that when the PDCA Cycle is applied before a clinical intervention is fully implemented, the focus of the improvement process is likely to shift. In the same research by Coury et al. (2017), it was observed that several clinicians commonly found it challenging to measure the success of the PDCA cycle using the electronic medical record tools available. The cycle also focuses on observing and rectifying errors. It does not predict errors. Change Strategy Foundation • Evidence Supporting QI Methods The change strategy proposed here would involve teams of physicians, nurses, and mental health professionals. These three teams would work together to coordinate the patient’s treatment. This would require consistent communication and cooperation between the teams. Through an interprofessional collaboration, the teams would identify gaps in patient safety and improve coordination in implementing change strategies (Amalakuhan & Adams, 2015). • • Patients who suffer from COPD are often comorbid with anxiety and depression. These conditions are likely to impede their recovery (Pooler & Beech, 2014). For instance, shortness of breath is a symptom that is common to both COPD and anxiety and can be distressing for the patient. A COPD patient who also presents with anxiety might interpret shortness of breath in an exaggerated manner, associating it with an inability to breathe or imminent death (Heslop et al., 2013). If a COPD patient’s anxiety or depression is left untreated, it can significantly impact his or her compliance with COPD treatment. Anxiety and depression can affect a patient’s cognitive functioning and his or her ability to self-manage the condition (Pooler & Beech, 2014). According to research conducted by Howard and Dupont (2014), COPD patients who received treatment for anxiety and depression coped with physical and mental conditions much better than patients who do not receive treatment. Potential Challenges • • COPD patients require access to therapists trained in CBT. It might be difficult to conduct one-on-one sessions for every patient; therefore, organizations could train their nurses in CBT or hire nurses who are trained in CBT. Helping COPD patients achieve sustainable improvement in quality of life, functioning, and general physical condition can be challenging. Group therapy sessions can help patients talk about and cope with both physical and psychological issues. Providing COPD patients with access to CBT along with their regular treatments is likely to improve their quality of life and capacity to self-manage their condition (Pietrzak & Paliszkiewicz, 2015; Pooler & Beech, 2014). NURS-FPX6021 Assessment 3 Guiding Questions: Quality Improvement Presentation Poster This document is designed to give you questions to consider and additional guidance to help you successfully complete the Quality Improvement Presentation Poster assessment. You may find it useful to use this document as a pre-writing exercise, as an outlining tool, or as a final check to ensure that you have sufficiently addressed all the grading criteria for this assessment. This document is a resource to help you complete the assessment. Do not turn in this document as your assessment submission. Propose quality improvement methods to promote continuous improvement related to a specific biopsychosocial consideration. • Have you proposed specific quality improvement (QI) methods? o • Have you explained the key aspects of the QI methods? How will the QI methods help promote continuous improvement? o What challenges or difficulties might you encounter in promoting continuous improvement? ▪ • How could you work to mitigate these challenges or difficulties? How are the proposed QI methods related to your specific biopsychosocial consideration? o What challenges or difficulties might you encounter in adapting the QI methods to ensure they effectively address your specific biopsychosocial consideration? ▪ How could you work to mitigate these challenges or difficulties? Evaluate specific evidence that supports the quality improvement methods proposed. • What evidence suggests the quality improvement methods proposed will be appropriate and effective for the project? • Which pieces of evidence that you cited will be most valuable and relevant for your project? o How does the evidence support and inform the specific QI approach and application? Explain how the project is grounded in successful change strategies. • What change strategies informed the development or identification of the proposed quality improvement methods? o What are the key aspects of these change strategies? o How have these change strategies been implemented successfully in other projects, especially QI projects with characteristics similar to yours? o How are these change strategies appropriate, relevant, and built into this QI project? Analyze the way in which interprofessional teamwork will improve the effectiveness or efficiency of the quality improvement project. 1 NURS-FPX6021 Assessment 3 • Which teams or role groups will be working interprofessionally on your QI project? • How will interprofessional teamwork improve the effectiveness of your QI project? o • Why is interprofessional teamwork likely to lead to the effectiveness improvements that you described? How will interprofessional teamwork improve the efficiency of your QI project? o Why is interprofessional teamwork likely to lead to the efficiency improvements that you described? Communicate quality improvement considerations to relevant stakeholders in a way that is clear, concise, and compelling for the audience. • Is your poster clearly presented? • Does your poster include all the sections described in the assessment instructions? • o Quality Improvement Methods. o Evidence Supporting QI Methods. o Change Strategy Foundation. o Interprofessional Team Benefits. o Overall Project Benefits. Is the writing for your abstract clear and professional? o Is your writing free from errors? o Is your abstract 100–250 words? Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style. • Did you use 5–7 sources in your assessment? o • Are the sources you used no more than five years old? Are your sources cited in APA format? 2 Quality Improvement Presentation Poster Scoring Guide CRITERIA NONPERFORMANCE BASIC PROFICIENT DISTINGUISHED Propose quality improvement methods to promote continuous improvement related to a specific biopsychosocial consideration. Does not explain quality improvement methods. Explains quality improvement methods, but does not fully address if they will promote continuous improvement, or it is unclear how the methods are related to a specific biopsychosocial consideration. Proposes quality improvement methods to promote continuous improvement related to a specific biopsychosocial consideration. Proposes quality improvement methods to promote continuous improvement related to a specific biopsychosocial consideration. Acknowledges potential difficulties and discusses how those challenges will be met. Evaluate specific evidence that supports the quality improvement methods proposed. Does not describe specific evidence that supports the quality improvement methods proposed. Describes specific evidence related to the quality improvement methods proposed, but does not attempt to evaluate the evidence or how it supports the methods proposed. Evaluates specific evidence that supports the quality improvement methods proposed. Evaluates specific evidence that supports the quality improvement methods proposed. Identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the analysis). Explain how the Does not project is grounded describe a in successful change change strategy. strategies. Describes a change strategy, but does not explain it related to the project. Explains how the project is grounded in successful change strategies. Explains how the project is grounded in successful change strategies. Acknowledges potential difficulties and discusses how those challenges will be met. Analyze the way in which interprofessional teamwork will improve the effectiveness or efficiency of the quality improvement project. Does not analyze interprofessional teamwork strategies. Analyzes interprofessional teamwork strategies, but either does not address how those strategies will improve effectiveness or efficiency, or does not relate the strategies to the project. Analyzes the way in which interprofessional teamwork will improve the effectiveness or efficiency of the quality improvement project. Analyzes the way in which interprofessional teamwork will improve the effectiveness or efficiency of the quality improvement project. Identifies assumptions upon which the analysis is based. Communicate quality improvement considerations to relevant stakeholders in a way that is clear, concise, and compelling for the audience. Does not communicate quality improvement considerations to relevant stakeholders in a way that is clear, concise, and compelling for the audience. Communicates quality considerations in a way that is not consistently clear and concise, or in a way that is not relevant or compelling for the audience. Communicates quality improvement considerations to relevant stakeholders in a way that is clear, concise, and compelling for the audience. Communicates quality improvement considerations to relevant stakeholders in a way that is clear, concise, and compelling for the audience. The structure of the communication enables the audience to grasp complex concepts and encourages buyin. Integrate relevant sources to support assertions, correctly Does not integrate relevant sources to Sources lack relevance Integrates or are poorly integrated, relevant sources or citations or references to support Integrates relevant sources to support assertions, correctly formatting citations and formatting citations and references using current APA style. support are incorrectly formatted. assertions; does not correctly format citations and references using current APA style. assertions, correctly formatting citations and references using current APA style. references using current APA style. Citations are free from all errors. Assessment 3 Instructions: Quality Improvement Presentation Poster Create a poster for a presentation about a quality improvement (QI) project or plan that builds on the work you completed in the first two assessments. Include an abstract of 100-250 words about the QI plan and key information in your poster. Introduction Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, it is recommended that you complete the assessments in this course in the order in which they are presented. As a master’s-level nurse you will be responsible for promoting equitable quality of care. In the biopsychosocial model of care, there are a number of areas where you can have an impact on improving the quality, safety, and equitability of care. One example area where equitable quality of care is an issue is with medications, especially considering the cost of various medications to treat the same condition versus the effectiveness and potential side-effects of the medications. A further pharmacological concern for safe and quality care is medication errors. This could include considerations like a patient getting the wrong medication or a dangerous interaction due to other aspects of a patient’s health and treatment situation. An example could be vitamin or herbal supplements the patient has not disclosed as part of the medication reconciliation process. The ability to propose and promote quality improvements in care is a vital skill for a master’s-prepared nurse. One aspect of this is understanding strategies for implementing best practice changes in a team, department, or care setting. Another is understanding how best practices can help lead to a continuous quality improvement cycle. Additionally, it is important to grasp how successful change strategies can be leveraged to help in the creation or implementation of clinical best practices. Part of this is considering the audience when proposing quality improvement projects or new best practices. Another part of this is being able to effectively communicate the goals, rationale, and benefits of a project. One way to communicate the need for quality improvements, and your plans for achieving specific improvements, is through a presentation poster. This type of communication tool is used both in the work place and at professional and academic conferences. Being able to convey the essence and value of a project in a compelling and succinct way is a valuable skill, and it is vital within the constraints of a single poster. Preparation As you prepare to complete this assessment, you may want to think about other related issues to deepen your understanding or broaden your viewpoint. You are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community. Note that these questions are for your own development and exploration and do not need to be completed or submitted as part of your assessment. The assessment will be built around creating a professional and compelling poster to present a quality improvement project that may have grown out of your change initiative in the second assessment. • • • Guiding Questions: Quality Improvement Presentation Poster [DOC]. This document is designed to give you questions to consider and additional guidance to help you successfully complete the Quality Improvement Presentation Poster assessment Who will be the primary audience of your poster? Who might be the wider, or outreach, audience that will be relevant to consider when creating your poster? o What details or information will be most important and compelling to your audiences? o How might you craft the design of your poster so that it better speaks to your audiences? What steps might a nurse take to implement best practice changes in a care setting while respecting the multidisciplinary team? o What does each member bring to the care of the client or community? o How might recognizing the contributions of the multidisciplinary team help build buy-in or collaboration? ▪ Why is buy-in important to the success of a quality improvement project? Scenario For this assessment, you may take one of two approaches: • • The first is to build upon the clinical issue that was the focus of your Change Strategy and Implementation assessment, and turn it into a full, organization- or community-wide quality improvement initiative. The second is to identify a new issue related to a biopsychosocial (BPS) clinical issue, or a clinical issue related to one of the items from the list of conditions, diseases, and disorders presented in the Concept Map assessment. The focus should be on a community rather than on a specific patient or health care setting. As a master’s level nurse, your specific focus is on reviewing the implications of the data relevant to the clinical issue you are trying to address. Once you research this, review the aggregate data, and understand the BPS considerations relevant to the clinical issue, you can suggest strategies for improving the quality, equitability, and safety of care around the issue. You should act as an advocate for the value and need to pursue quality improvements to leadership and executives, as well as be able to present potential projects to a wide range of colleagues and community stakeholders. Instructions Create an abstract and a poster for a presentation to executive-level leadership of the organization, to the community, or to your colleagues that will sell them on your quality improvement plan. Abstract Requirements • • • Your abstract should be 100-250 words. It should summarize the key information in your poster. Do not put your abstract on your poster itself; submit it as a separate document. Or, if you are using PowerPoint to help create your poster, create a new slide that is clearly labeled as your abstract. Poster Requirements • Your poster should include the following sections: o Quality Improvement Methods. o Evidence Supporting QI Methods. o Change Strategy Foundation. o Interprofessional Team Benefits. o Overall Project Benefits. • There are templates in PowerPoint or on the Internet that can help you get a start designing your poster. The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your presentation addresses all of them. You may also want to read the Quality Improvement Presentation Poster scoring guide and the Guiding Questions: Quality Improvement Presentation Poster [DOCX] document to better understand how each grading criterion will be assessed. • • • • • • Propose quality improvement methods to promote continuous improvement related to a specific biopsychosocial consideration. Evaluate specific evidence that supports the quality improvement methods proposed. Explain how the project is grounded in successful change strategies. Analyze the way in which interprofessional teamwork will improve the effectiveness or efficiency of the quality improvement project. Communicate quality improvement considerations to relevant stakeholders in a way that is clear, concise, and compelling for the audience. Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style. Example Assessment: You may use the following to give you an idea of what a Proficient or higher rating on the scoring guide would look like: • Assessment 3 Example [PPTX]. Additional Requirements • • • Length of submission: o Abstract: 100-250 words. Your abstract should be succinct and precise. o Poster: Make sure your poster fits entirely onto a single poster template page (or slide) and contains all of the sections described in the assessment instructions. Number of references: Cite a minimum of 5-7 sources of scholarly or professional evidence that support your considerations and plans. Resources should be no more than five years old. APA formatting: Resources and citations are formatted according to current APA style. Competencies Measured By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria: • • • • • Competency 1: Design patient-centered, evidence-based, advanced nursing care for achieving high-quality patient outcomes. o Evaluate specific evidence that supports the quality improvement methods proposed. Competency 2: Develop change strategies for improving the care environment. o Explain how the project is grounded in successful change strategies. Competency 3: Apply quality improvement methods to practice that promote safe, equitable quality of care. o Propose quality improvement methods to promote continuous improvement related to a specific biopsychosocial consideration. Competency 4: Evaluate the efficiency and effectiveness of interprofessional care systems in achieving desired healthcare improvement outcomes. o Analyze the way in which interprofessional teamwork will improve the effectiveness or efficiency of the quality improvement project. Competency 5: Communicate effectively with diverse audiences, in an appropriate form and style, consistent with organizational, professional, and scholarly standards. o Communicate quality improvement considerations to relevant stakeholders in a way that is clear, concise, and compelling for the audience. o Integrate relevant sources to support assertions, correctly formatting citations and references using current APA style. Use the scoring guide to understand how your assessment will be evaluated. 1 Care Integration and Coordination for Quality Improvement Lizeth Gonzalez Vargas Capella University Biopsychosocial Concepts for Advanced Nursing Practice 1 Martha Snider February 18, 2022 2 Care Integration and Coordination for Quality Improvement Holistic care provision is beneficial in that it address all patient needs and provides an opportunity for quality improvement. Addressing patients’ needs using the biopsychosocial approach is superior to simply offering treatment for the main medical need of the patient. The Vila Health case study presents the case of Carrie Alves, a female patient diagnosed with polycystic ovary syndrome (PCOS) and having several nursing diagnoses including risk of infertility, sleep deprivation, and risk of obesity. The case study highlights some gaps in the healthcare organization and the need to implement more effective healthcare services. Vila Health should integrate nutritional and mental health support services to improve the quality and accessibility of holistic care for their patients. Data Table and Gap The treatment of PCOS is mainly aimed at reducing the risk of infertility and regaining hormonal control to minimize the impact of associated symptoms. Vila Health focuses mostly on treating the condition and less on the patient’s psychosocial wellbeing. The data table below shows that there is a gap in the availability of healthcare services supporting patient recovery. Current Performance Proposed Changes Expected Performance • • • • Majority of PCOS patients Integrate nutritional health Fewer patients will be become overweight and are services to the clinic for overweight or obese on unable to return to healthy improved meal planning to follow-up weight even after treatment reduce risk of weight gain Patients presenting with (Roberts et al., 2020) reproductive health conditions often present anxiety and • • Patients will verbalize Coordinate care with better well-being and counselors to address quality of care 3 depressive symptoms; more mental health symptoms and than 50% have clinically- reduce risk of illness (Reiter diagnosable anxiety symptoms. et al., 2018) Change Strategies Vila Health should integrate nutritional services to its healthcare system to meet the needs of patients at risk of being overweight or obese. The expected change is that patients with such conditions will readily access nutritional services to guide them in health management. The aim of this strategy is to make available integrated health services for holistic care and better quality (Vladimirova et al., 2018). The anticipated challenge is the need for financial commitment and stakeholder buy-in. Hospital management will collaborate with independent providers to reduce costs. The outcomes can be evaluated by an overview of weight outcomes during follow-up in patients at high risk of obesity. Secondly, care coordination with a counselor is proposed as a means of addressing anxiety and depressive symptoms. This strategy, similar to integrating nutritional services, makes available additional health services for patients to access holistic care. It will essentially involve a dedicated mental health expert collaborating with nurses and providers to assess the psychological impact of diagnoses and health condition on patients and addressing them. The main implementation consideration to consider is the location of the mental health expert. A choice has to be made on whether the counselor will be recruited by Vila Health or will be an external collaboration with established providers. Nevertheless, the rates of anxiety and depressive disorders among patients on follow-up will be the means of assessing effectiveness of the change strategies. 4 Justification Current evidence supports care integration and coordination, especially for nutritional and mental health services. According to Arnett et al. (2019), nutritional services support lifestyle changes and are part of primary prevention which is essential to healthcare. Integration of nutritional services in a study by Roberts et al. (2020) also made a significant improvement in patient outcomes and care quality. Similarly, providing mental health services as appropriate is important in reducing trauma and enhancing patients’ wellbeing (Reiter et al., 2018). Patients with PCOS have been reported as presenting generally high rates of anxiety and counseling is an evidence-based approach (Wang et al., 2021). In general, the proposed strategies present the need for care integration and collaboration in addressing the diverse health needs of patients. Quality Improvement The two change strategies will lead to quality improvement in patient safety as well as equitable care. Providing nutritional and mental health services affects safety by reducing patients’ risk of complications due to the primary medical condition. Readily available mental health services, for instance, will reduce the risk of anxiety and depressive disorders developing from the primary medical diagnosis. Similarly, nutritional services present the first line of prevention against obesity and cardiovascular conditions. The result is that patients will be safer from healthcare complications when additional healthcare services are integrated. The availability of services for every patient will also improve equitable care. The strategies will also contribute to the quadruple aim. The quadruple aim seeks to enhance clinician and patient experiences while promoting better outcomes and controlling costs (Bachynsky, 2020). Care coordination will improve patient experience and better outcomes. Patients’ needs will be addressed effectively through the collaborative process and they will also 5 achieve better health outcomes due to holistic care focusing on biopsychosocial issues. Therefore, the two strategies, based on care coordination, will enhance patient outcomes and promote their experiences as well. Interprofessional Collaboration Interprofessional collaboration is central to the proposed change strategies. The primary approach to care for patients at risk of obesity and mental health illness will be internal referrals to the respective providers. Primary care nurses and providers will make initial assessment of patients’ dietary and psychological needs and communicate with the dietitian and the counselor about the patient. There will be need for ongoing exchange of information among professionals. For instance, the primary provider to a patient with PCOS will need to communicate changes in hormonal imbalance with the dietician for nutritional changes to be adopted. This ongoing communication process will ensure interprofessional collaboration and healthcare professionals’ welfare. Conclusion The proposed quality improvement changes will promote a holistic care approach to patient needs, especially PCOS patients and others at risk of obesity and mental health issues. The improvement is anchored in care coordination and healthcare services integration. Patients will be safer and more satisfied with care due to the convenient and adequate access to patientcentered care. Interprofessional collaboration will also ensure care processes are effective and will increase care quality and provider wellbeing. The recommended changes are evidence-based and Vila Health should adopt them for better quality care. 6 References Arnett, D. K., Khera, A., & Blumenthal, R. S. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: Part 1, lifestyle and behavioral factors. JAMA Cardiology, 4(10), 1043-1044. https://doi.org/10.1001/jamacardio.2019.2604 Bachynsky, N. (2020, January). Implications for policy: The triple aim, quadruple aim, and interprofessional collaboration. In Nursing Forum (Vol. 55, No. 1, pp. 54-64). https://doi.org/10.1111/nuf.12382 Reiter, J. T., Dobmeyer, A. C., & Hunter, C. L. (2018). The primary care behavioral health (PCBH) model: An overview and operational definition. Journal of Clinical Psychology in Medical Settings, 25(2), 109-126. https://doi.org/10.1007/s10880-017-9531-x Roberts, S., Chaboyer, W., & Marshall, A. P. (2020). Hospital patients’ perceptions of using a technology-based intervention to participate in their nutrition care: A qualitative descriptive study. Clinical Nutrition ESPEN, 39, 79-86. https://doi.org/10.1016/j.clnesp.2020.07.014 Vladimirova, М., Danova, N., & Dimitrov, P. (2018, December). Integrated healthcare-reality and perspectives. In Varna Medical Forum (Vol. 7, pp. 205-209). http://dx.doi.org/10.14748/vmf.v7i0.6555 Wang, Y., Ni, Z., & Li, K. (2021). The prevalence of anxiety and depression of different severity in women with polycystic ovary syndrome: A meta-analysis. Gynecological Endocrinology, 37(12), 1072-1078. https://doi.org/10.1080/09513590.2021.1942452 1 Concept Map Narrative Lizeth Gonzalez Vargas Capella University Biopsychosocial Concepts for Advanced Nursing Practice 1 Martha Snider February 16, 2022 2 Concept Map Narrative The patient of focus in this concept map is a young woman presenting with polycystic ovarian syndrome (PCOS). The nursing diagnoses presented are the urgent diagnoses and are accompanied by evidence-based treatment and expected outcomes. The concept map presents an evidence-based nursing treatment plan for the patient and this narrative discusses the value and relevance of evidence and the interprofessional strategies used in the concept map. A new diagnosis of PCOS has many multidimensional impacts on the patient and presenting a biopsychosocial (BPS) evidence-based practice approach can help in holistically addressing important patient needs. Value and Relevance of Evidence The evidence used in the concept map is the best available evidence in connection to PCOS. Rezk et al. (2018) is a peer-reviewed journal article on pharmacological management of infertility in PCOS. Therefore, the evidence addresses the specific diagnosis of the risk of infertility and is a current and credible source of evidence. Similarly, Shahid et al. (2019) is a peer-reviewed and current journal article addressing nutrition and lifestyle changes. The article’s lead author is a professor of nutrition and dietary sciences and hence they are credible. Ee et al. (2021) and Bahman et al. (2018) are also peer-reviewed and discuss lifestyle changes and sleep hygiene respectively. Each of the articles used as evidence is appropriate to the specific diagnosis and is credible. Therefore, in addition to relevance, the value of the evidence to the scenario is also high. Moreover, the evidence used is also directly linked to PCOS. The presenting symptoms in the scenario are weight gain, hirsutism, and irregular menstrual cycle. These three main symptoms are for PCOS. Additionally, weight gain and sleep disruptions are also common 3 among PCOS patients and the evidence has addressed these specific symptoms. Overall, evidence-based practice was used through access to the best quality evidence that is relevant to the case scenario. Interprofessional Collaboration Interprofessional collaboration is expected in EBP and it was portrayed in the nursing management plan presented in this scenario. BPS approach requires collaboration with the professionals for each specific diagnosis and health need. The first collaboration captured in the concept map is with a sleep therapist. Anxiety associated with PCOS may be the major cause of sleep interruptions and vivid dreams. The main interprofessional strategy in this collaboration is effective communication between the professionals for holistic care management (oldsberry, 2019). This can help in addressing the causes of sleep first and then creating and effective sleeping intervention. The expected outcome is reduced sleep interruptions with at least 7 hours of sleep on most days. The second collaboration is with a dietician for meal planning for weight loss. The patient has the risk of obesity due to hormonal changes and this can adequately be addressed through weight loss. A dietician is important in providing personalized meal planning tips for not only weight loss but also hormonal management (Shahid et al., 2019). This collaboration will be based on giving and receiving feedback from each other. The collaborative effort will allow for healthy weight loss and potentially reduce the risk of obesity. Conclusion BPS interventions are important for patients with PCOS and they can help address the diverse patient needs. The current patient will be treated for infertility, weight loss, and sleep interruptions. The evidence used is high-quality peer-reviewed articles that are specific to each 4 patient need. This evidence also supports interprofessional collaboration in addressing different patient needs. The concept map presents an example of evidence-based practice for patients with PCOS. 5 References Bahman, M., Hajimehdipoor, H., Afrakhteh, M., Bioos, S., Hashem-Dabaghian, F., & Tansaz, M. (2018). The importance of sleep hygiene in polycystic ovary syndrome from the view of Iranian traditional medicine and modern medicine. International Journal of Preventive Medicine, 9. https://doi.org/10.4103/ijpvm.IJPVM_352_16 Ee, C., Pirotta, S., Mousa, A., Moran, L., & Lim, S. (2021). Providing lifestyle advice to women with PCOS: An overview of practical issues affecting success. BMC Endocrine Disorders, 21(1), 1-12. https://doi.org/10.1186/s12902-021-00890-8 Goldsberry, J. W. (2018). Advanced practice nurses leading the way: Interprofessional collaboration. Nurse Education Today, 65, 1-3. https://doi.org/10.1016/j.nedt.2018.02.024 Rezk, M., Shaheen, A. E., & Saif El-Nasr, I. (2018). Clomiphene citrate combined with metformin versus letrozole for induction of ovulation in clomiphene-resistant polycystic ovary syndrome: a randomized clinical trial. Gynecological Endocrinology, 34(4), 298300. https://doi.org/10.1080/09513590.2017.1395838 Shahid, M., Naveed, M., Khalid, S., Atif, M., Tufail, T., Shahid, M. Z., & Hussain, M. (2019). Nutritional and lifestyle modifications of polycystic ovary syndrome (pcos) in obesity. Int J Biosci, 5(6), 259-72. http://dx.doi.org/10.12692/ijb/15.6.259-272 MSN-FPX6021 Concept Map Patient Info: Most Urgent Nursing Diagnosis: Increased risk of infertility Subjective: Patient’s admission that she has been unable to become pregnant Objective: Signs of excess androgen as evidenced by hirsutism and acne Nursing Diagnosis 2: Name: Carrie Alves Risk of obesity Gender: Female Subjective: Patient has noticed weight gain Age: 31 Objective: 12 pounds weight gain Chief complaint: Irregularities in menstrual cycle lasting 6 months Medical History: History of birth control (discontinued) Treatment: Treatment: Nursing Diagnosis 3: Pharmacological: Metformin and clomiphene citrate to induce ovulation (Rezk et al., 2018). Nursing Intervention: Weight loss and increased exercise can restore normal ovulation and chances of getting pregnant (Shahid et al., 2019) Sleep deprivation Subjective: Patient reports night waking and vivid dreams that interrupt her sleep. Objective: Patient appears tired and sleepy Independent Intervention: Patient education on lifestyle changes and healthy weight loss and the etiology of obesity and infertility in PCOS Collaborative Intervention: Collaborate with a dietician to help the patient plan her meals for healthy weight loss and hormonal balance (Shahid et al., 2019) Treatment: Outcomes: Patient will manage at least 5% body weight loss Ovulation and normal menstrual cycle will be restored Independent Intervention: Educate patient on sleep hygiene such as setting the conditions and avoiding screens at bed time (Ee et al., 2021) Collaborative Intervention: Introduce patient to relaxation therapy targeting her sleep patterns and collaborate with a therapist to promote optimal relaxation and better sleep patterns (Bahman et al. 2018) Outcomes: The patient will sleep at least 7 hours for at least 5 days a week. Patient will appear well-rested and less fatigued Outcomes: Patient will manage at least 5% body weight loss Patient will adhere to lifestyle changes for at least 6 months
