NURS FPX 6021 Assessment 2 Change Strategy and Implementation

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

Patients often present with respiratory issues of varying severity; these can range from breathing difficulties to dry or wet coughs. Patients that do present with these issues are admitted to the pulmonary ward to treat the issue at hand. Chronic obstructive pulmonary disorder (COPD) is one of the primary issues among these. Each patient receives treatment based on the severity of his or her condition. The treatment can include prescribing antibiotics, non-invasive ventilation, and pulmonary rehabilitation. Pulmonary rehabilitation involves a program of exercise and education specifically designed to help individuals with pulmonary issues such as COPD (NHS, 2016a). The treatment for COPD is aimed at improving the physical health of patients admitted to the ward. However, it does not take into consideration the mental health of these individuals. There exists a strong positive correlation between COPD and anxiety and depression (Pooler & Beech, 2014), which means that patients who present with COPD are likely to be comorbid with anxiety, depression, or both.

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

Further, COPD patients who are comorbid with depression and anxiety are statistically more likely to be hospitalized; these patients are also likely to require longer periods of hospitalization and face a greater risk of mortality after they are discharged. Considering these factors, it is necessary to address mental health issues simultaneously with physical issues to ensure that these patients can manage their overall health more effectively. Left untreated, both anxiety and depression can lead to significant implications for compliance to medical treatment (Pooler & Beech, 2014).

Anxiety and COPD

Some of the symptoms associated with COPD overlap with those associated with anxiety. Dyspnea or shortness of breath is particularly distressing for patients and is common to both COPD and anxiety. A COPD patient with anxiety might interpret dyspnea in an exaggerated manner, often correlating this symptom with an inability to breathe or even an imminent death (Heslop, Newton, Baker, Burns, Carrick-Sen, & De Soyza, 2013). Anxiety might not be the cause of dyspnea in COPD patients, but it can be viewed as an indicator of acute exacerbation in such patients (Pooler & Beech, 2014).

Depression and COPD

As mentioned above, there exists a significant correlation between COPD and depression. The effect that depression has on COPD patients is different from the effect produced by anxiety. Depression has been significantly linked to a perceived decrease in quality of life as well as in physical activity. Pooler and Beech (2014) also note that depression is likely to be underdiagnosed and undertreated for individuals with COPD. Patients who suffer from COPD and depressive symptoms are less likely to follow through on their recommended physical therapy. Consequently, their COPD becomes aggravated, requiring them to receive further treatment.

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

For most patients, particularly in cases of acute exacerbation, further treatment would require                             hospitalization. However, this might cause patients to feel that they are unable to care for                                    themselves; they may experience inferiority or a diminished sense of autonomy As a result, patients are often stuck within this cycle of deteriorating health, leading to a decline in the state of their mental health The only effective method to treat patients in such a situation is to                 address both their physical and psychological issues (Dursunoğlu et al., 2016).

Change Strategies

Both depression and anxiety require attention from a mental health professional to adequately and effectively help patients. Cognitive behavioral therapy (CBT) has been proven to be an effective method of managing anxiety, depression, and a range of other mental health conditions. In a typical CBT session, a patient and a therapist work together to break down one of the patient’s problems into its separate parts. Some of these parts could be how the patient thinks about the problem, how he or she feels physically about it, and how he or she acts in response to it. The patient and the therapist then evaluate these parts and figure out what might be unhelpful or unrealistic as well as the effect that these parts have on each other and on the patient (NHS, 2016b).

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

By identifying these parts, the therapist can figure out a plan of action for the patient to change thoughts and behaviors that are counterproductive. The patient will then be asked to practice these changes in his or her life and report back on whether he or she was able to enact the changes and how effective they were. By using this method, the patient would eventually be able to apply the skills that he or she has learned in the sessions to his or her life. This would help the patient manage his or her issues even after the course of treatment is complete (NHS, 2016b). For example, individuals with COPD and anxiety might be able to better manage their anxiety by not associating shortness of breath with more catastrophic outcomes. However, CBT has certain drawbacks. It requires patients to be willing to confront their emotions and anxieties, which can be uncomfortable. Further, CBT requires patients’ commitment to the process and their cooperation to help themselves get better. The therapy can be guided, but ultimately the outcome of therapy is determined by the patients’ participation (NHS, 2016b). On a practical level, it can be difficult for hospitals to accommodate an adequate number of therapists for patients or to provide an efficient therapist-to-patient ratio.

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

To address this, it would be necessary for group therapy sessions to be conducted in conjunction with one-on-one sessions. This would enable a wider range of individuals to access the necessary treatment for their psychological condition, and it might be less intimidating for them if it is a group activity. Further, nurses could be trained in CBT, or those trained in CBT could be hired to facilitate more one-on-one sessions. Patients who are provided with access to these treatment options in addition to the treatment they receive for their COPD will have a higher quality of life and be able to manage both their physical and mental conditions more effectively than before (Howard & Dupont, 2014). Pharmacological interventions can also be used to treat anxiety and depression. Treatment doses vary based on the severity of the disorder and can have a variety of side effects. Most antidepressants are not contraindicated; however, caution is necessary while prescribing certain types such as tricyclic antidepressants. Benzodiazepines have the potential to cause respiratory depression and should not be administered to COPD patients who retain CO2. Standard antidepressants such as selective serotonin reuptake inhibitors can often have side effects such as headaches, tremors, gastrointestinal distress, and either psychomotor activation or sedation.

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

These side effects occur during the initial phase of treatment and can be problematic when coupled with the existing conditions of COPD patients. In contrast, CBT and group therapy are nonpharmacological interventions and would not result in contraindications. It is also difficult to implement the pharmacological treatment of depression and anxiety on the level of policy as the medication and doses required would be based on the needs of individual patients. Further, patients who suffer from COPD might be unwilling to take medication for depression or anxiety along with the medication that they might already be taking. This could possibly result from the stigma that surrounds mental illnesses or the reluctance of patients to accept their diagnosis (Tselebis et al., 2016).

Data Table

Current Outcomes Change Strategies Expected Outcomes Patients who suffer from COPD do not have adequate access to mental health facilities: a) Many COPD patients experience anxiety resulting from dyspnea. b) Patients with COPD are likely to experience depressive symptoms that have been positively correlated with the worsening of COPD symptoms. To ensure that patients receive the care they need, certain measures are necessary: • Therapists should be made available to COPD patients. • Nurses should be trained in CBT, or nurses who are trained in CBT should be hired. • Group therapy sessions should be conducted regularly for COPD patients who are comorbid with anxiety, depression, or both. Patients who suffer from COPD will have adequate access to mental health facilities and will be able to manage both their physical and mental conditions more effectively than before: a) Patients who are comorbid with COPD and anxiety will be able to distinguish between their anxiety and an aggravation of their COPD symptoms (Howard & Dupont, 2014). b) Patients who are comorbid with COPD and depression will be better prepared to manage both their COPD and their depressive symptoms (Dursunoğlu et al., 2016).

References

Dursunoğlu, N., Köktürk, N., Baha, A., Bilge, A. K., Börekçi, Ş., Çiftçi, F., . . . Turkish Thoracic Society-COPD Comorbidity Group. (2016). Comorbidities and their impact on chronic obstructive pulmonary disease. Tüberküloz ve Toraks, 64(4), 289–298. 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.

NURS FPX 6021 Assessment 2 Change Strategy and Implementation

NHS. (2016a). Chronic obstructive pulmonary disorder (COPD). https://nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/treatment/ NHS. (2016b). Cognitive behavioral therapy (CBT). https://nhs.uk/conditions/cognitive-behavioural-therapy-cbt/ 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. Tselebis, A., Pachi, A., Ilias, I., Kosmas, E., Bratis, D., Moussas, G., & Tzanakis, N. (2016). Strategies to improve anxiety and depression in patients with COPD: A mental health perspective. Neuropsychiatric Disease and Treatment, 12, 297–328.

ADDITIONAL INSTRUCTIONS FOR THE CLASS – NURS FPX 6021 Assessment 2 Change Strategy and Implementation

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. NURS FPX 6021 Assessment 2 Change Strategy and Implementation

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. NURS FPX 6021 Assessment 2 Change Strategy and Implementation

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