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NURS FPX 4900 Assessment 1 Leadership Collaboration Communication Change Management and Policy Considerations TS

NURS FPX 4900 Assessment 1 Leadership Collaboration Communication Change Management and Policy Considerations TS

Patient Identification

Amanda is a 56-year-old female, a longtime diabetic, and an obese person who has recently had chest discomfort and cardiovascular problems. The 2-hour practicum conversation at my health care facility revealed how her chronic illness background, lifestyle choices, social, emotional and personality decision influenced the advancement of her health problem into the present state. She went to hospital twice in the ongoing year for migraines and fainting. She was identified with type II diabetes during her two hospital stays based on HbA1C testing and a probable that most genetic background. The physician suggested β- blockers, insulin, and caloric restriction educational methods after analyzing the symptoms and background. The nurses in charge of the ward were ignorant of the patient’s varied needs Nurses would frequently overlook the insulin dosage amount and misjudge the dosage at the affected site. Nurses were also unaware of the healthy diet and physical behaviors that might produce a positive health consequence. Amanda could not be educated about diabetes monitoring and control by the inpatient nursing professionals. The nurses were not knowledgeable of the management approaches for worsening hyperglycemia. The nurses were unable to inform them about the nutritional adjustments, activity needs, and insulin dosing technique at home. During her stay in the hospital, the nurses frequently experienced difficulty with the computation of the insulin dosage as well as the timing of delivery.  The Body mass index (BMI) was elevated to 29.2 with a consistent 300+ glucose conc. in addition to 145/95 BP on daily basis was the factors for immediate symptoms remediations. 

My scope of Presentation will be on nursing education on how to care for a DM patient. As an RN in my practice, I’ve witnessed a significant rate of rehospitalization due to nurses’ negligence and their inefficient behavior with patients like in this case, nurse didn’t give the patient correct dosage of the insulin as well as they didn’t educate Amanda about diabetes self-management and monitoring and control by the inpatient nursing professionals. 

Role of Nurses and Organizations 

Nurses not only assist in the administration of medication, such as life-saving insulin, but also provide important health and psychological advice to help people cope with the daily challenges that a life-long chronic condition can bring (Pivari et al., 2019). When it comes to treating diabetic patients, all nursing staff members play a vital role and have distinct responsibilities. Nursing teams from all areas of nursing, especially workplace health nursing, are likely to come into touch with persons who have diabetes or are undergoing diabetic testing. Practice nurses play an especially important role since they are frequently the ones who do the yearly diabetes and foot exam. Practice nurses, in particular, perform a clinical role in diabetes screening, maintenance, and care.

NURS FPX 4900 Assessment 1 Leadership Collaboration Communication Change Management and Policy Considerations TS

Diabetes Specialist Nurses play an important role in both delivering high-quality patient care and supporting self-care. Diabetes Specialist nurses (DSNs) are diabetes specialists who may practice in a variety of settings. A DSN is typically the first point of contact for people, directing them to more specialized services. DSNs will also educate, teach, and assist non-specialist health care providers such as general practitioners, nurses, and others in primary, secondary, and community settings, as well as nursing homes (Goldberg et al., 2020). 

Evidence-Based Approach 

The American Diabetes Association’s (ADA) “Standards of Professional Management in Diabetic Patients” covers the ADA’s recent treatment practise benchmarks and is designed to give the elements of diabetes care, basic treatment objectives and procedures, and instruments to assess quality of healthcare (ADA, 2021).

For the optimal population results, the research revealed a significant demand for evidence-based practice abilities in health care facilities. Academic programmers and leadership development should include standards-based and evidence-based methods (Pivari et al., 2019). The proposed practice interventions are backed by highly referenced and renowned journal publications. Diabetic management is an excellent approach to prevent tiredness, bladder difficulties, and other diabetes symptoms. Furthermore, treating your diabetes can lower your risk of developing visual difficulties, dementia, and other major medical conditions (Goldberg et al., 2020). The latest thorough, evidence-based suggestions for the management and therapy of infants and older people alike with diabetes were given. These include strategies for the preventing disease or delay of diabetics.  Patient-centered diabetes treatment solutions boost patients’ shared decision-making abilities and self-diabetes care measures (Yakaryılmaz & Öztürk, 2017). These recommendations give information to patients and, in some situations, family members to assist them in making informed health decisions with the objective of diabetes self-management. The American Diabetes Association recommends that nurses get diabetes education (Goldberg et al., 2020).

NURS FPX 4900 Assessment 1 Leadership Collaboration Communication Change Management and Policy Considerations TS

. According to research from the United Kingdom, Germany, and Denmark (Pivari et al., 2019), integrating nurses in diabetes care is related with increased diabetes management quality with no negative consequences. When members of a practice team do not have enough time to plan, analyses, and evaluate care together, there is a danger of service duplication or omission, poor care coordination, and the synergies from team members’ pooled expertise and views not being effectively used.

Barriers In Evidence-Based Practices

The most often mentioned hurdles in the use of evidence-based diabetic health care services are instructional provisions, diabetes distress, and the use of technology (Goldberg et al., 2020). In hospital care settings, efficient diabetes treatment is hampered by inadequate nurse training, education, and resources (Nikitina et al., 2019). Discrepancies in the work situations of diabetes care facilities, as well as the availability of the DSNs, diminish patient care and result in poor health safety results (Nikitina et al., 2019). Hospitals have reported dealing with a high physician workload and a limited number of nurses. The heavy burden on physicians inhibits nurses’ communication and coordination. It disregards patient education sessions for diabetes treatment, resulting in rehospitalization and the development of macrovascular problems (Yakaryılmaz & Öztürk, 2017). Manpower, resources, and financial resources are all in limited supply.

NURS FPX 4900 Assessment 1 Leadership Collaboration Communication Change Management and Policy Considerations TS

Individual nurse reluctance to participate in continuing education programmers, obtain new information, adequate clinical practice, and a lack of priority all impede good diabetes care education training (Yakaryılmaz & Öztürk, 2017). Nurses’ professional practice is also hampered by various patient-centered hurdles that impede their well-known diabetes care practice. The patient’s low literacy, mental health state, cultural mores, earlier than normal illness identification, and generally inadequate management procedures are a problem for the patient, and they influence the patient’s quality of life as well as the course of diabetes and its consequences (Koivunen & Saranto, 2018).

Contextual variables, according to health experts, are more critical impediments to appropriate diabetes management than physician perceptions and awareness. Challenges persist on several dimensions and are intricately interconnected. Examples include: time restrictions and practise economic principles in private practise; a need to preserve referral connections and specialist disparities in the context; lack of public awareness as well as economic factors among patients; and an inaccessibility for poor patient populations, limited remuneration, and an inadequate prevention strategy in the U.s Healthcare framework (Goldberg et al., 2020).

National Standards/ Organization Based Guidelines for Diabetes Care

The American Diabetes Association (ADA) has established glycemic objectives, improvement measures, behavioral modifications, and the risk of developing comorbidities that contribute to diabetes in the Standards of Medical Care in Diabetes (ADA,2021). It also offers multifactorial guidelines for risk reduction and improves diabetes management for children, women, and adults (ADA, 2021)). These goals criteria will offer nurses with a more accurate comparative examination of patient health. Such guidelines also can help diabetics determine healthy and pathological glycemic control. The behavioral treatment strategies will assist patients in overcoming the challenges resulting from chronic illness’s repercussions. 

The ADA’s dietary and activity guidelines can help diabetics choose the proper type and number of meals while also reducing frequent glycemic spikes. Stakeholders evaluate regulations and general standards of guidelines to offer a full grasp of the problem and its potential solutions. These policies can help nurses educate themselves and their patients about diabetes care management (Yakaryılmaz & Öztürk, 2017). The Diabetes Care in Hospitals guideline enables nurses to include multifactorial diabetes care practices into diabetes medication, dietary treatment, and self-management approaches (ADA, 2021).

The Hospital Readmissions Reduction Program (HRRP) is a Medicaid valuation buying strategy that promotes institutions to enhance communications and care coordinating in order to better involve patients and staff in discharge plans, reducing needless re – admissions. HRRP hasn’t included the diabetes in its 30 days re admission policy yet but it has been trying to add it with other major disorders like cardiomyopathy, hypertension, heart failure etc (Pivari et al., 2019). Moreover, Individuals who believe they currently have adequate health insurance and believe that the Affordable Care Act (ACA) will raise their insurance rates or that the law exceeds the United States Government’s taxing jurisdiction often reject the ACA. The objective of this editorial is not to promote or oppose the ACA, but to highlight certain provisions that may be of special relevance to people who care for diabetic patients. This demographic was chosen because obtaining and utilizing healthcare is sometimes a big problem to their lifestyle and level of living (Levich, 2018).

NURS FPX 4900 Assessment 1 Leadership Collaboration Communication Change Management and Policy Considerations TS

Leadership and Diabetes Care

The National Health Services (NHS) is presently confronting unprecedented financial cuts, upheaval, and uncertainty. Furthermore, diabetes is growing increasingly frequent, with older individuals constituting the biggest age group in this population. With a rising number of individuals being diagnosed with diabetes, it is unavoidable that financial expenditures for treatment, education, and medicines, in addition to those associated with diabetes-related illnesses, will continue to climb. (Guerci et al., 2019). Amanda requires comprehensive diabetic control to avoid growing macrovascular problems. Diabetes progression prevention will necessitate dietary changes, reporting of glycemic load, pre-prandial and post-prandial, calculation of insulin dosage and delivery method, and medication adherence. Diabetes’ complex intervention nature necessitates multidisciplinary collaboration and communication among staff nurses. Communication between patients and nurses is also vital in achieving great health outcomes (Guerci et al., 2019). Change management in diabetes treatment in primary health care units necessitates changes in finances, education, recruitment, and level of practice.

Diabetes’ complex intervention nature necessitates multidisciplinary collaboration and communication among staff nurses. Communication between patients and nurses is also vital in achieving great health outcomes. he worrying absence of competent nursing education is “call to action” in healthcare settings (Guerci et al., 2019). Prior to developing changes in diabetes treatment, nurses may utilize Lewin’s Change Management theory to help them navigate transitions and identify areas of strength and resistance. Without a framework to guide them, new technology can lead to workarounds that endanger patient safety. Even though the Change model has still not been widely utilized to offer treatment for diabetes management, it has been used to guide strategies for change in diet and physical behaviour, which are both crucial in diabetes management (Pivari et al., 2019).

It is critical to remember that leaders are human, and as such, they will not always do things right, but will learn from their mistakes and failings. DSNs should spearhead the development of an integrated service for older individuals with diabetes, bridging the gap between health and social care. A DSN with a transformational leadership style can lead and build a motivated team to deliver high-quality, innovative services.


ADA| Diabetes Care: 43 (Supplement 1). (2020). Diabetes Care43(Supplement 1). https://care.diabetesjournals.org/content/43/Supplement_1

Goldberg, R. B., Stone, N. J., & Grundy, S. M. (2020). The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guidelines on the Management of Blood Cholesterol in Diabetes. Diabetes care43(8), 1673-1678.

Guerci, B., Chanan, N., Kaur, S., Jasso-Mosqueda, J. G., & Lew, E. (2019). Lack of treatment persistence and treatment nonadherence as barriers to glycaemic control in patients with type 2 diabetes. Diabetes Therapy10(2), 437-449.

Kim, M. K., Ko, S. H., Kim, B. Y., Kang, E. S., Noh, J., Kim, S. K., … & Park, K. S. (2019). 2019 Clinical practice guidelines for type 2 diabetes mellitus in Korea. Diabetes & metabolism journal43(4), 398-406.

Pivari, F., Mingione, A., Brasacchio, C., & Soldati, L. (2019). Curcumin and type 2 diabetes mellitus: prevention and treatment. Nutrients11(8), 1837.

Yakaryılmaz, F. D., & Öztürk, Z. A. (2017). Treatment of type 2 diabetes mellitus in the elderly. World journal of diabetes8(6), 278.

Levich, B. (2018). Diabetes management: optimizing roles for nurses in insulin initiation. Journal of Multidisciplinary Healthcare, 15. https://doi.org/10.2147/jmdh.s16451

Diabetes Care: 44 (Supplement 1). (2021). Diabetes Care44(Supplement 1). https://care.diabetesjournals.org/content/44/Supplement_1

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