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Develop a data table that illustrates one or more underperforming clinical outcomes in a care environment of your choice. Write an assessment (3–5 pages) in which you set one or more quantitative goals for the outcomes and propose a change plan that is designed to help you achieve the goals.

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.


Knowing what is the best practice for our patients is very important in providing safe and effective care. Understanding best practices can help nurses identify areas of care that need to be improved. To identify areas of need, nurses must use evidence from various sources, such as the literature, clinical practice guidelines (CPG), professional organization practice alerts or position papers, and protocols. These sources of evidence can also be used to set goals for improvement and best practices with an eye toward improving the care experience or outcomes for patients.

The challenge facing many care environments and health care practitioners is how to plan for change and implement changes. For, if we cannot effectively implement changes in practice or procedure, than our goals of improving care will likely amount to nothing. This assessment focuses on allowing you to practice locating, assessing, analyzing, and implementing change strategies in order to improve patient outcomes related to one or more clinical goals.

This assessment will take the form of a data table to identify areas for improvement and to set one or more outcome goals, as well as a narrative describing a change plan that would help you to achieve the goals you have set.


Consider the current environment. This could be your current care setting, the care settings presented in the Vila Health: Using Evidence to Drive Improvement or Vila Health: Concept Maps as Diagnostic Tools media, or a care setting in which you are interested in working.For the setting that you choose you will need to have a data set that depicts sub-optimal outcomes related to a clinical issue. This data could be from existing sources in the course (Vila Health: Using Evidence to Drive Improvement), a relevant data set that already exists (a data set from the case study you used as a basis for your Concept Map assessment, or from your current place of practice), or an appropriate data set that you have created yourself. (Note: if you choose to create your own data set, check with your instructor first for approval and guidance.)After you have selected an appropriate data set, use your understanding of the data to create at least one realistic goal (though you may create more) that will be driven by a change strategy appropriate for the environment and goal.Potential topics for this assessment could be:

Consider ways to help minimize the rate of secondary infections related to the condition, disease, or disorder that you focused on for your Concept Map assessment. As a starting point you could ask yourself, “What could be changed to facilitate safety and minimize risks of infection?”

Consider how to help a patient experiencing traumatic stress or anxiety over hospitalization. As a starting point you could ask yourself, “How could the care environment be changed to enhance coping?”

Once you determine the change you would like to make, consider the following:

What data will you use to justify the change?

How can the team achieve this change with a reasonable cost?

What are the effects on the workplace?

What other implementation considerations do you need to consider to ensure that the change strategy is successful?

How does your change strategy address all aspects of the Quadruple Aim, especially the well-being of health care professionals?

Once the change strategy is implemented, how would you evaluate the efficiency and effectiveness of the care system if the desired outcomes are met?


Your assessment submission should include a data table that illustrates the current and desired states of the clinical issue you are attempting to improve through your application of change strategies. Additionally, you will need to explain the rationale for your decisions around your chosen change strategies, as well as how the change strategies will be successfully implemented. The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your change strategy addresses all of them. You may also want to read the Change Strategy and Implementation scoring guide and Guiding Questions: Change Strategy and Implementation to better understand how each grading criterion will be assessed.

Develop a data table that accurately reflects the current and desired states of one or more clinical outcomes.

Propose change strategies that will help to achieve the desired state of one or more clinical outcomes.

Justify the specific change strategies used to achieve desired outcomes.

Explain how change strategies will lead to quality improvement with regard to safety and equitable care.

Explain how change strategies will utilize interprofessional considerations to ensure successful implementation.

Communicate the change plan in a way that makes the data and rationale easily understood and compelling.

Change Strategy and Implementation
Learner’s Name
Capella University
Biopsychosocial Concepts for Advanced Nursing Practice I
Change Strategy and Implementation
April, 2019
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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. 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
Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.
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. 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 (DursunoÄŸlu 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
Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.
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).
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.
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
Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.
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 CO 2 .
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. 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
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Patients who suffer from
COPD do not have adequate
access to mental health
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
To ensure that patients
receive the care they need,
certain measures are
• Therapists should be
made available to COPD
• Nurses should be trained
in CBT, or nurses who are
trained in CBT should be
• 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,
b) Patients who are
comorbid with COPD and
depression will be better
prepared to manage both
their COPD and their
depressive symptoms
(DursunoÄŸlu et al., 2016).
Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.
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.
NHS. (2016a). Chronic obstructive pulmonary disorder (COPD). Retrieved from
NHS. (2016b). Cognitive behavioral therapy (CBT). Retrieved from
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.
Copyright ©2018 Capella University. Copy and distribution of this document are prohibited.

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