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NURS FPX 6021 Assessment 2 : Change Strategy and Implementation

Assessment 2: Change Strategy and Implementation


Capella University

NURS-FPX6021: Biopsychosocial Concepts for Advanced Nursing Practice 1

Professor Name

March, 2024

Change Strategy and Implementation

Renal failure is a severe health issue often caused by diabetes. Healthcare professionals need to be knowledgeable in effective management practices. Thirty-seven million Americans have chronic kidney disease, and 40% of cases are caused by diabetes, which is responsible for 60% of all end-stage renal disease cases. As a result, it is crucial for nursing professionals to determine the areas in patient care that require improvement and to employ evidence-based resources to establish and accomplish progressive care objectives. This is critical for safe and effective treatment (Cheng et al., 2021). Their role involves evaluating, identifying, and implementing strategies to enhance patient outcomes, especially in cases where renal failure is triggered by diabetes.

Nurses must develop skills in locating, evaluating, analyzing, and applying change strategies through a focused approach. This process is essential in advancing patient care and outcomes in healthcare, particularly in managing complex conditions such as renal failure secondary to diabetes. Continuous learning and adaptation are crucial in the ever-evolving field of healthcare. The landscape of diabetes management and its complications, including renal failure, continues to evolve with new insights and treatment approaches. The American Diabetes Association (ADA) has released updated Standards of Care in Diabetes. The guidelines offer evidence-based strategies for diagnosing and treating diabetes, preventing comorbidities, and providing personalized care. Notable updates include managing obesity, screening for heart failure and peripheral arterial disease, and using new medications. The ADA also emphasizes vaccination, bone health, and managing liver disease in diabetic patients (Gupta et al., 2023). 

CKD is a diabetes complication that affects public health. It can lead to ESRD, which requires dialysis or transplant. Risk factors are high blood pressure, diabetes, and a family history. Prevent it by regular screenings, managing hypertension and diabetes, healthy weight, and a low-sodium diet with fruits and veggies. The highest prevalence of diagnosed diabetes is observed among American Indian and Alaska Native adults, and prevalence rates are higher among adults living in nonmetropolitan areas compared to those in metropolitan areas (Wheeler et al., 2021). Healthcare professionals must stay informed of these updates to provide the best possible care to patients.

Data Table for Clinical Outcomes Analysis

When focusing on improving outcomes for diabetes patients and preventing renal failure, a clinical outcome assessment table for Vila Healthcare could be structured as shown below:

Clinical OutcomeCurrent StateDesired StateChange Strategy
Incidence of Renal Failure due to Uncontrolled DiabetesHighReduced IncidenceImplement a structured diabetes education program for patients with uncontrolled diabetes.
Monitoring of Kidney Function in Diabetes PatientsInadequateImproved MonitoringImplement regular kidney function tests, including GFR tests and urine protein tests.
Adherence to Medication Regimen in Diabetes PatientsPoorImproved AdherenceImplement a medication reconciliation program.
Access to Specialized Renal Care for Diabetes Patients with Renal FailureLimitedImproved AccessEstablish partnerships with renal specialists for timely referral and treatment.

Explanation of the Table:

Incidence of Renal Failure due to Uncontrolled Diabetes:

  • Current State: There’s a high incidence of renal failure in diabetic patients.
  • Desired State: The goal is to reduce this incidence.
  • Change Strategy: Introducing a structured diabetes education program could help patients better manage their diabetes.

Monitoring of Kidney Function in Diabetes Patients:

  • Current State: Currently, the monitoring of kidney function in these patients is inadequate.
  • Desired State: The aim is to enhance the monitoring process.
  • Change Strategy: Regularly conducting GFR and urine protein tests can help in early detection and management.

Adherence to Medication Regimen in Diabetes Patients:

  • Current State: There is poor adherence to medication regimens among these patients.
  • Desired State: To improve medication adherence.
  • Change Strategy: Implementing a medication reconciliation program can ensure patients take their medications correctly.

Access to Specialized Renal Care for Diabetes Patients with Renal Failure:

  • Current State: Access to specialized renal care is limited.
  • Desired State: To improve this access.
  • Change Strategy: Establishing partnerships with renal specialists can facilitate timely referrals and treatment.

This table outlines targeted strategies for improving diabetes care and renal failure management at Vila Healthcare based on recent research and best practices.

Areas of Ambiguity or Uncertainty

Further research is necessary to understand better the impact of diabetes education and medication reconciliation programs in reducing renal failure in diabetic patients. Clinical trials, observational studies, and other research methodologies could provide more definitive insights. In addition, it is crucial to determine the most effective approaches for monitoring kidney function. With this data, healthcare professionals can make informed decisions to improve outcomes for diabetic patients who are at risk of renal failure (Shlipak et al., 2021).

Strategic Interventions and Overcoming Challenges for Optimal Clinical Outcomes 

The proposed strategies in Table 1 are designed to enhance clinical outcomes in patients with diabetes-related renal failure. These strategies include:

  • Structured Diabetes Education Program: To reduce the incidence of renal failure, a comprehensive educational program focusing on diabetes management is suggested. This would involve teaching patients about diet, exercise, blood sugar monitoring, and medication adherence.
  • Regular Kidney Function Tests: Implementing routine tests like GFR and urine protein tests can improve the monitoring of kidney function in diabetic patients.
  • Medication Reconciliation Program: To ensure that patients with diabetes adhere to their medication regimen, a program that reviews and manages patients’ medication schedules is proposed.
  • Access to Specialized Renal Care: Establishing networks with renal specialists to provide timely referral and treatment for diabetic patients with renal failure.

Acknowledging Challenges and Solutions:

  • Patient Engagement: The success of educational programs depends on patient participation. Engaging patients through individualized care plans and interactive educational tools can help overcome this.
  • Resource Allocation: Regular testing and specialized care require resources. Effective resource allocation and possibly seeking additional funding are critical.
  • System Integration: Ensuring that medication reconciliation programs are seamlessly integrated into the existing healthcare system can be challenging. Effectively utilizing digital tools and EHR systems can help.
  • Cross-Disciplinary Collaboration: Coordination with renal specialists might face logistical hurdles. Establishing clear communication channels and protocols can mitigate these challenges.

These strategies, grounded in evidence and best practices, are geared towards significantly enhancing the care and outcomes for patients with diabetes, potentially reducing the incidence and impact of renal failure (Sindhu et al., 2023). Continuous evaluation and adjustment based on feedback and outcomes are crucial for the success of these interventions.

Justification of Strategies for Enhancing Clinical Outcomes in Diabetes-Renal Failure

The strategies proposed to manage renal failure in diabetes patients are based on evidence-based practices. They aim to address specific aspects of care that can directly affect patient outcomes. Firstly, a structured diabetes education program is recommended due to the strong evidence supporting the effectiveness of patient education in managing chronic conditions such as diabetes. Digital programs can improve self-management skills and glycemic control, reducing the risk of renal failure. However, their effectiveness can vary, so tailored approaches are needed to address individual health literacy and engagement levels (Kaur et al., 2023). Early detection and management of renal impairment in diabetic patients are crucial for their health. Managing patient adherence to regular testing and medication non-adherence can be challenging for healthcare providers. 

A medication reconciliation program can help address non-adherence and improve overall treatment effectiveness. However, healthcare providers and patients may resist due to increased workload and complex treatment regimens (Calli & Kartal, 2021). Establishing a network with renal specialists can lead to more effective interventions for diabetes-related renal failure. Digital health offers opportunities for telehealth and mobile health applications that complement traditional care models. However, these technologies may not be accessible or suitable for all patients. Strategies for change are justified by their alignment with best practices and potential to address diabetes and renal failure management (Sindhu et al., 2023). Balancing these approaches with patient needs and evolving healthcare technology is crucial for optimal outcomes.

Strategies Ensuring Safe, Equitable Healthcare Quality Improvement

The proposed change strategies aim to improve safety and equitable care for patients with diabetes-related renal failure. A structured diabetes education program will help patients manage their condition more effectively and reduce the risk of complications like renal failure. Additionally, the program will cater to a diverse patient population, providing critical information regardless of their background or education level (Bonner et al., 2020). Regular kidney function tests and accessible medication reconciliation programs can enhance patient safety and promote equitable care by detecting and treating health issues early and reducing the risk of medication errors and adverse effects.

Partnerships with renal specialists will improve access to specialized renal care for patients with diabetes-related renal conditions. This will ensure timely and necessary care, regardless of location or economic status, and enhance patient safety and equitable distribution of high-quality care (Chaudhuri et al., 2022). Effective education, regular monitoring, accurate medication management, and specialized care are crucial for improving patient outcomes, with equitable access essential for all patients. The proposed changes aim to create a more patient-centered, safe, and equitable healthcare environment for those with diabetes-related renal conditions.


The assumptions underlying the proposed change strategies include:

  1. Effective education enhances diabetes self-management and reduces complications.
  2. Regular monitoring leads to early detection and management of renal issues.
  3. Accurate medication management reduces the risk of errors and adverse effects.
  4. Equitable access to care services is vital for all patients, regardless of background.
  5. Specialized renal care provided in a timely manner improves patient outcomes.
  6. Patient understanding and adherence are key factors in successful treatment outcomes.

Interprofessional Strategies for Effective Implementation

Interprofessional strategies are crucial for patients with diabetes-related renal failure. A structured diabetes education program involving healthcare professionals like diabetes educators, dietitians, nurses, and primary care physicians is essential. This program covers vital areas such as diet, exercise, blood sugar monitoring, and medication adherence, offering patients tailored support and information. Regular kidney function testing and medication reconciliation programs are key strategies in the care of diabetic patients. Primary care providers, laboratory technicians, and nephrologists collaborate to ensure early detection and management of renal issues. Pharmacists, nurses, and physicians work together to reduce medication errors and improve treatment adherence, enhancing patient safety and effectiveness (Lv et al., 2023).

Interprofessional collaboration is crucial for providing specialized renal care to patients. This involves establishing networks with renal specialists that comprise primary care providers, nephrologists, and care coordinators working closely together. These healthcare providers work collaboratively to ensure patients have timely access to specialized renal care. Primary care providers identify patients who require specialist care, nephrologists provide the required treatment, and care coordinators manage the logistics of referrals and appointments (Nordheim et al., 2021). Such collaboration is believed to lead to more comprehensive and effective patient care. Furthermore, it is assumed that seamless communication and shared responsibility among healthcare providers result in better health outcomes for patients with chronic conditions like diabetes.


The assumptions underlying this interprofessional approach include the following:

  1. Each healthcare professional brings unique and complementary expertise to patient care.
  2. Effective communication and collaboration among healthcare providers lead to better patient outcomes.
  3. Integrated care approaches are more effective in managing chronic diseases like diabetes.
  4. Patient care is optimized when responsibilities are shared among a diverse healthcare team.

By leveraging the strengths of various healthcare professionals and ensuring effective communication and collaboration among them, these change strategies aim to provide comprehensive, patient-centered care that addresses the multifaceted needs of patients with diabetes-related renal failure (Bandiera et al., 2022).

NURS FPX 6021 Assessment 2 Change Strategy and Implementation Conclusion :

Collaboration among healthcare professionals is crucial for managing renal failure in diabetic patients. Strategies like structured diabetes education, regular kidney function tests, access to specialized renal care, and medication reconciliation can significantly enhance patient outcomes (Sindhu et al., 2023). These approaches rely on diverse expertise to manage complex chronic conditions. These strategies aim to improve clinical management and set a standard for treating similar conditions by fostering collaboration and communication among healthcare providers. This model can be an example of healthcare systems aiming to improve patient care through integrated and collaborative efforts.

NURS FPX 6021 Assessment 2 Change Strategy and Implementation References

Bandiera, C., Lam, L., Locatelli, I., Dotta-Celio, J., Duarte, D., Wuerzner, G., Pruijm, M., Zanchi, A., & Schneider, M. P. (2022). Understanding reasons and factors for participation and non-participation to a medication adherence program for patients with diabetic kidney disease in Switzerland: a mixed methods study. Diabetology & Metabolic Syndrome, 14(1), 140. https://doi.org/10.1186/s13098-022-00898-7

Bonner, R., Albajrami, O., Hudspeth, J., & Upadhyay, A. (2020). Diabetic kidney disease. Primary Care, 47(4), 645–659. https://doi.org/10.1016/j.pop.2020.08.004

Calli, D., & Kartal, A. (2021). The relationship between self-efficacy of diabetes management and well-being in patients with type 2 diabetes. Nigerian Journal of Clinical Practice, 24(3), 393–399. https://doi.org/10.4103/njcp.njcp_280_18

Chaudhuri, A., Ghanim, H., & Arora, P. (2022). Improving the residual risk of renal and cardiovascular outcomes in diabetic kidney disease: A review of pathophysiology, mechanisms, and evidence from recent trials. Diabetes, Obesity & Metabolism, 24(3), 365–376. https://doi.org/10.1111/dom.14601

Cheng, H. T., Xu, X., Lim, P. S., & Hung, K. Y. (2021). Worldwide epidemiology of diabetes-related end-stage renal disease, 2000-2015. Diabetes Care, 44(1), 89–97. https://doi.org/10.2337/dc20-1913

Gupta, S., Dominguez, M., & Golestaneh, L. (2023). Diabetic kidney disease: An update. The Medical clinics of North America, 107(4), 689–705. https://doi.org/10.1016/j.mcna.2023.03.004

Kaur, A., Sharma, G. S., & Kumbala, D. R. (2023). Acute kidney injury in diabetic patients: A narrative review. Medicine, 102(21), e33888. https://doi.org/10.1097/MD.0000000000033888

Lv, R., Xu, L., Che, L., Liu, S., Wang, Y., & Dong, B. (2023). Cardiovascular-renal protective effect and molecular mechanism of finerenone in type 2 diabetic mellitus. Frontiers in Endocrinology, 14, 1125693. https://doi.org/10.3389/fendo.2023.1125693

Nordheim, E., & Geir Jenssen, T. (2021). Chronic kidney disease in patients with diabetes mellitus. Endocrine Connections, 10(5), R151–R159. https://doi.org/10.1530/EC-21-0097

Sindhu, D., Sharma, G. S., & Kumbala, D. (2023). Management of diabetic kidney disease: where do we stand?: A narrative review. Medicine, 102(13), e33366. https://doi.org/10.1097/MD.0000000000033366

Shlipak, M. G., Tummalapalli, S. L., Boulware, L. E., Grams, M. E., Ix, J. H., Jha, V., Kengne, A. P., Madero, M., Mihaylova, B., Tangri, N., Cheung, M., Jadoul, M., Winkelmayer, W. C., Zoungas, S., (2021). The case for early identification and intervention of chronic kidney disease: conclusions from a kidney disease: Improving global outcomes (KDIGO) controversies conference. Kidney International, 99(1), 34–47. https://doi.org/10.1016/j.kint.2020.10.012

Wheeler, D. C., Stefánsson, B. V., Jongs, N., Chertow, G. M., Greene, T., Hou, F. F., McMurray, J. J. V., Correa-Rotter, R., Rossing, P., Toto, R. D., Sjöström, C. D., Langkilde, A. M., Heerspink, H. J. L. (2021). Effects of dapagliflozin on major adverse kidney and cardiovascular events in patients with diabetic and non-diabetic chronic kidney disease: a prespecified analysis from the DAPA-CKD trial. The Lancet. Diabetes & Endocrinology, 9(1), 22–31. https://doi.org/10.1016/S2213-8587(20)30369-7

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