NURS FPX 4900 Assessment 1 Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations

NURS FPX 4900 Assessment 1 Assessing the Problem

Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations

Alzheimer’s disease is a critical public health issue that requires skilled leadership, collaboration across sectors, clear communication, and thoughtful change management and policy considerations. Assessing this problem through these lenses is crucial to developing comprehensive solutions that reduce risk, improve timely diagnosis, expand care access, support caregivers, advance research, and reduce stigma. Effective leaders must bring together healthcare, research, government, community, and advocacy groups to tackle this complex disease. Clear communication strategies are needed to convey the latest evidence, reduce misconceptions, and guide patients and families. Implementing change and new policies requires understanding organizational dynamics and how to motivate stakeholders. A thorough assessment of Alzheimer’s through these perspectives will inform strategies to significantly improve prevention, care, research, and support for those impacted (Macklin, 2021).

Definition of Patient Health Problem

Clay is a 72-year-old male diagnosed with early-onset Alzheimer’s disease two years ago. He has a family history of dementia, as his mother also had Alzheimer’s. Clay is married and has two grown children who are supportive but struggling to cope with their father’s cognitive decline. He worked as an accountant prior to retiring last year after his diagnosis. Clay’s condition has progressed rapidly, increasing memory loss, confusion, and agitation. He requires constant supervision for safety. His wife provides most of his caregiving, which has affected her health and their family. Clay has Medicare coverage, but his long-term care needs are not adequately covered, placing financial strain on the family. As his nurse, I have evaluated (during a two-hour practicum session) that Clay requires resources for in-home assistance, adult day programs, and, eventually, residential care. Connecting his family to social services, planning for future care needs, providing education, and coordinating optimal medical management are priorities in my role as Clay’s nurse.

Relevance of Problem

Alzheimer’s disease represents an escalating public health crisis, as over 6 million Americans are currently afflicted with this progressive neurodegenerative disorder. Epidemiological data indicates that prevalence will nearly double by 2050, with estimates projecting close to 13 million individuals with Alzheimer’s (Alzheimer’s Association, 2023). It constitutes the sixth leading cause of death in the United States. It disproportionately impacts seniors, with research showing that 1 in 3 adults over 65 will die with Alzheimer’s or another type of dementia. The aggregate costs of care pose economic concerns as well, with current expenditures reaching $345 billion annually and projected to rise to nearly $1 trillion by 2050 if trends continue (Alzheimer’s Association, 2023). Given the mounting social, economic, and public health burdens associated with Alzheimer’s, evidence-based policies and interventions must be prioritized that promote prevention, early detection, advanced care planning, family support structures, and clinical best practices. A multi-layered, collaborative approach across public and private stakeholders is imperative to mitigate the epidemic of Alzheimer’s disease (Alzheimer’s Association, 2023).

Analysis of Evidence

Current peer-reviewed literature underscores the value of a multifaceted care approach for patients with Alzheimer’s disease that integrates both pharmacological and non-pharmacological interventions. Evidence-based clinical practice guidelines emphasize the importance of prescribing acetylcholinesterase inhibitors or memantine for cognitive and functional decline while closely monitoring potential adverse effects (Chin et al., 2022). However, medication therapy alone is insufficient; integrating psychosocial support, education, caregiver training, home safety assessments, routine monitoring, and care coordination significantly improves the quality of life outcomes. For Clay specifically, referrals to counseling services could help his family better cope with the stresses of caregiving and grief over his deterioration (Cheng, 2021). Enrolling Clay in community-based social engagement programs tailored to dementia patients promotes social connection and reduces isolation. Given Clay’s increasing disorientation, collaborating with a physical therapist to optimize fall prevention is also indicated. Evidence strongly confirms that individualizing collaborative care plans with input from the patient, family caregivers, and an interdisciplinary team produces optimal results (Cheng, 2021).

For population health approaches, addressing Alzheimer’s disease requires policy and system-level changes to expand care access, support caregivers, advance research, and reduce stigma. Public health interventions underscore education starting at earlier ages about risk factor modification through diet, exercise, and cognitive engagement (Barnard et al., 2014). Broadening insurance coverage for long-term care costs is also a policy priority (Sanjna Vinze et al., 2023). Healthcare systems must focus on integrating care models like PACE (Program of All-Inclusiev Care for the Elderly) that deliver comprehensive medical and social services tailored to dementia patients in community settings. Through multilayered individual, family, community, and policy approaches, nurses play integral roles in improving care across the disease trajectory for patients like Clay and their loved ones (Vellani et al., 2021).

Evaluation of Evidence

Evaluating evidence on Alzheimer’s disease interventions necessitates clear criteria, including relevance to the clinical question, generalizability to target populations, the rigor of experimental study design, sample size and power, use of validated instruments, and recent publication in high-quality peer-reviewed journals. Additionally, the strength of clinical practice guideline recommendations, expert consensus statements, and meta-analyses support best practices. Sustained effects from large randomized controlled trials represent higher-quality evidence versus smaller case studies. By applying unambiguous critical appraisal criteria, clinicians discern the most substantial evidence to guide care for patients like Clay (Chen et al., 2021).

Potential Barriers

Implementing evidence-based Alzheimer’s care encounters barriers like inadequate time, resources, reimbursement, and support for interdisciplinary coordination. Organizational culture resistance to expanding dementia services and ageist stereotypes impede progress. Theoretical frameworks like the chronic care model emphasize multifactorial solutions across delivery system redesign, clinical information systems, care coordination, and community engagement. Nursing’s holistic patient-centered philosophy aligns with this approach. Overcoming barriers requires leadership commitment, provider education, telehealth integration, and person-centered, culturally appropriate interventions that elevate patients’ quality of life and dignity, like Clay (Kong et al., 2021).

State Board Nursing Practice and Policies

The American Nurses Association has outlined clear evidence-based standards and competencies to guide registered nurses in delivering optimal, ethical care for patients with Alzheimer’s and related dementias (American Nurses Association, 2023). These standards emphasize person-centered assessment, care planning, patient and caregiver education, palliative care, interdisciplinary collaboration, culturally sensitive approaches, and advocacy. For example, nurses must leverage validated tools like the Mini-Mental Status Exam during assessments and educate families on stage-specific behavioral and communication strategies. State boards of nursing also articulate standards for dementia continuing education, care coordination, use of restraints, and oversight of unlicensed personnel (Cato & Dickerson, 2021).

Various policies at the state and federal level affect access, quality, and reimbursement of Alzheimer’s care. The National Plan to Address Alzheimer’s Disease advanced policy priorities like expanding home and community-based services through Medicaid waivers, providing caregiver tax credits, increasing clinical trial participation, and integrating dementia training into healthcare curriculums (The Assistant Secretary for Planning and Evaluation, 2022). Synthesizing nurses’ professional standards with evolving federal and state policies guide nurses like me to assess problems, identify gaps, and advocate for evidence-based improvements that better serve patients like Clay and families impacted by Alzheimer’s disease.

Impact of Policy on Nursing Scope of Practice

State and federal policies shape registered nurses’ scope of practice related to Alzheimer’s care delivery. Some state policies limit nurses from diagnosing dementia independently or prescribing medications, requiring physician oversight. However, certain states permit advanced practice nurses with proper training to clinically diagnose Alzheimer’s and prescribe acetylcholinesterase inhibitors. The policy also enables nurses to lead dementia care coordination, provide case management, conduct cognitive assessments, deliver psychotherapy under supervision, and manage patients holistically in collaboration with the interdisciplinary team. Navigating evolving policy frameworks allows nurses to optimize their scope and level of dementia care responsibility (Bae-Shaaw et al., 2021).

Leadership Strategies

Implementing transformational leadership represents a promising strategy to improve Alzheimer’s disease care quality, outcomes, and patient experience. Transformational leaders exhibit strong values, establish a unified vision, empower team members, and help staff overcome barriers to providing evidence-based, patient-centered dementia care. For example, I could spearhead weekly interdisciplinary huddles focused on discussing complex Alzheimer’s cases, coordinating care delivery, and creating joint solutions. Recognizing and celebrating staff accomplishments related to dementia care is another transformational approach to motivating and inspiring frontline nurses and clinicians (Nieuwboer et al., 2022).

Adopting relationship-based care models also fosters leadership approaches centered on human connections, empowerment, and reducing patient and caregiver burdens. For example, care teams make weekly phone calls to check on patients like Clay and identify emerging needs or concerns. Leadership training on communication techniques and person-centered care cultivates compassionate mindsets and reduces burnout risk among dementia care providers. Through these relational leadership strategies, nurses enhance experiences for Alzheimer’s patients, provide support for overwhelmed caregivers, and improve access to services that allow more individuals to age with dignity (Ferreira et al., 2020).

Collaboration, Communication & Change Management

Leading change and fostering collaboration through clear communication represent a pivotal nursing role in transforming Alzheimer’s care. Nurses must collaborate with patients, families, administrators, providers, researchers, and community organizations to develop integrated, evidence-based dementia services. Change management requires educating stakeholders on the benefits of person-centered, team-based care models that improve outcomes. Ongoing communication through meetings, in-services, community engagement, and policy channels also helps catalyze systems-level improvements that better serve patients like Clay across settings (Hoek et al., 2020).

Conclusion NURS FPX 4900 Assessment 1 Assessing the Problem: Leadership, Collaboration, Communication, Change Management, and Policy Considerations

In conclusion, Alzheimer’s disease represents a critical public health issue that requires a multifaceted approach to leadership, collaboration, communication, change management, and policy advocacy. Assessing this problem through these critical lenses provides insight into evidence-based solutions nurses can implement across individual, organizational, community, and political levels. Caring for patients like Clay and families impacted by Alzheimer’s and dementia necessitates applying current standards of practice, synthesizing literature, overcoming barriers, improving access to services, supporting caregivers, reducing stigma, and redesigning systems that foster safe, compassionate, and person-centered care. Through skilled nursing leadership, collaboration, communication, and policy engagement, we can make meaningful progress in confronting the growing epidemic of Alzheimer’s disease.

References

Alzheimer’s Association. (2023). Facts and figures. Alzheimer’s disease and dementia; Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/facts-figures 

American Nurses Association. (2023). American Nurses Association. ANA Enterprise. https://www.nursingworld.org/ 

Bae-Shaaw, Y., Lekovitch, C., Chew, F., Leland, N., Sood, N., & Shier, V. (2021). The Impact of state dementia training requirements for nursing homes on resident outcomes. Innovation in Aging5(1), 550–550. https://doi.org/10.1093/geroni/igab046.2098 

Cato, D., & Dickerson, P. (2021). Advocating for change in board of nursing continuing education rules. The Journal of Continuing Education in Nursing52(5), 208–210. https://doi.org/10.3928/00220124-20210414-02 

Chen, W.-Q., Wu, F.-F., Lv, H.-B., Xing, W.-T., Liu, Q., Liu, J.-P., Ge, Y.-G., & Lu, Y.-Q. (2021). Whether cognitive behavioral therapy is effective for Alzheimer’s disease. Medicine100(1). https://doi.org/10.1097/MD.0000000000023945 

Cheng, S.-T. (2021). Do caregiver interventions improve outcomes in relatives with dementia? A meta-analysis. Innovation in Aging5(1), 1029-1030. https://doi.org/10.1093/geroni/igab046.3683 

Chin, E., Jaqua, E., Safaeipour, M., & Ladue, T. (2022). Conventional versus new treatment: Comparing the effects of acetylcholinesterase inhibitors and N-methyl-D-aspartate receptor antagonist with Aducanumab. Cureus14(11). https://doi.org/10.7759/cureus.31065 

Ferreira, V. B., Amestoy, S. C., Silva, G. T. R. da, Trindade, L. de L., Santos, I. A. R. dos, & Varanda, P. A. G. (2020). Transformational leadership in nursing practice: Challenges and strategies. Revista Brasileira de Enfermagem73(6), 1–7. https://doi.org/10.1590/0034-7167-2019-0364 

Hoek, L. J., van Haastregt, J. C., de Vries, E., Backhaus, R., Hamers, J. P., & Verbeek, H. (2020). Partnerships in nursing homes: How do family caregivers of residents with dementia perceive collaboration with staff? Dementia20(5). https://doi.org/10.1177/1471301220962235 

Kong, E., Kim, H., & Kim, H. (2021). Nursing home staff’s perceptions of barriers and needs in implementing person‐centred care for people living with dementia: A qualitative study. Journal of Clinical Nursing31(13-14). https://doi.org/10.1111/jocn.15729 

Macklin, K. (2021). On the frontlines of the Alzheimer’s crisis: Advocacy organizations in Delaware and nationwide urge public health intervention to curb staggering disease trends. Delaware Journal of Public Healthhttps://doi.org/10.32481/djph.2021.09.005 

Nieuwboer, M., Sande, R. V. der, Rikkert, M. O., Marck, M. V. der, & Perry, M. (2022). Clinical leadership training in integrated primary care networks: A qualitative evaluation. Integrated Healthcare Journal4(1). https://doi.org/10.1136/ihj-2021-000086 

Sanjna Vinze, Chodosh, J., Lee, M., Wright, J., & Borson, S. (2023). The national public health response to Alzheimer’s disease and related dementias: Origins, evolution, and recommendations to improve early detection. Alzheimer’s & Dementia19(9), 4276-4286. https://doi.org/10.1002/alz.13376 

The Assistant Secretary for Planning and Evaluation. (2022). National plan to address Alzheimer’s disease and other NAPA documents. ASPE. https://aspe.hhs.gov/collaborations-committees-advisory-groups/napa/napa-documents 

Vellani, S., Puts, M., Iaboni, A., Degan, C., & McGilton, K. S. (2021). Integration of a palliative approach in the care of older adults with dementia in primary care settings: A scoping review. Canadian Journal on Aging / La Revue Canadienne Du Vieillissement41(3), 404–420. https://doi.org/10.1017/s0714980821000349 

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