Capella 6030 Assessment 3

Intervention Plan Design

Name:

Capella University

School of Nursing and Health Sciences, Capella University

NURS-FPX 6030: MSN Practicum and Capstone

Prof. Name:

Date

Intervention Plan Design

In order to address the rising prevalence of Alzheimer’s disease in the United States, my focus has been on devising an intervention plan that targets lifestyle modifications. To guide my search for the most relevant and up-to-date data, I formulated a PICOT question. As reported by the Alzheimer’s Association, the number of Americans affected by Alzheimer’s disease is rapidly increasing, currently impacting approximately six million individuals, with higher incidence rates among the elderly (Alzheimer’s Association, 2021). Given this alarming trend, finding effective ways to slow the development of Alzheimer’s disease has become an urgent priority.

Throughout my capstone project, I have diligently applied the knowledge gained from both classroom learning and 20 verified hours of practicum experience. The primary purpose of this paper is to delve into the key components of my intervention plan for Alzheimer’s disease patients in the United States. It will explore the influence of cultural needs and characteristics specific to the targeted population, the integration of theoretical nursing models, the roles of various stakeholders involved, as well as the ethical considerations that may arise during the implementation of this intervention plan.

Part 1-Intervention Plan Components

Major Components 

The main focus of my intervention strategy is to educate individuals with Alzheimer’s about the importance of modifying their lifestyle, particularly their diet, as a more effective approach to slowing the progression of the disease. Since Alzheimer’s currently has no cure, pharmaceuticals and lifestyle changes can only provide some slowing effects. Research indicates that lifestyle changes have shown greater success in reducing the course of Alzheimer’s compared to pharmaceuticals.

How will these components lead to Improved Health Outcomes? 

These components are expected to lead to improved health outcomes due to the growing evidence that certain cardiovascular risk factors play a significant role in predicting Alzheimer’s disease (Bhatti et al., 2020). Managing these primary risk factors, particularly around midlife, can potentially slow down the progression of the disease. Studies have shown that adopting a combination of lifestyle changes, such as regular physical exercise, mental and social engagement, meditation, spiritual practices, and dietary choices, can yield better cognitive outcomes (Bhatti et al., 2020).

Physical inactivity has been linked to around 21% of Alzheimer’s disease cases in the USA, and research on animals and humans has demonstrated the neuroprotective benefits of regular exercise (Arab & Sabbagh, 2010). Moreover, dietary habits have been associated with cognition, where increased consumption of calories and fat may elevate Alzheimer’s risk. A Western diet high in saturated fatty acids and simple carbohydrates has been shown to have a negative impact on memory and learning processes mediated by the hippocampus (Cao et al., 2018). Conversely, adopting a Mediterranean diet rich in fruits, vegetables, whole grains, olive oil, and fish, while low in red meat, has been linked to a decreased risk of Alzheimer’s disease (Cao et al., 2018).

Alzheimer’s patients often experience memory loss, behavioral issues, and mobility challenges, which may lead to institutionalization due to the complexities of care. In addressing this complex condition, a multidisciplinary team approach is recommended. The inter-professional team plays a crucial role in ensuring the safety and well-being of Alzheimer’s patients (Kumar et al., 2021). Nurses, in particular, have a vital role in educating patients and their families about medication management, making healthy dietary choices, and facilitating other activities of daily living (Kumar et al., 2021).

Why are these Components the Best Option to Address the Identified Need?

Medical experts have been recommending changes in food and lifestyle as a means to reduce the risk and progression of Alzheimer’s disease. Healthcare professionals, including nurses, have been assigned the responsibility of educating patients about the potential benefits of modifying their daily habits for improved health. As part of my intervention goal, I aim to provide guidance to patients on making lifestyle changes that can help delay the progression of Alzheimer’s disease.

Impact of Cultural Needs and Characteristics of a Target Population

Cultural Needs and Characteristics

The percentage of Americans aged 65 and over is increasing, along with the racial and cultural diversity within this group (Clark et al., 2018). While age remains the most significant risk factor for developing Alzheimer’s disease, it is crucial to acknowledge the diverse cultural perspectives on dementia and how they can impact treatment approaches. Notably, there is a disproportionately high rate of Alzheimer’s dementia among African Americans compared to other racial and ethnic groups (Clark et al., 2018).

Several studies have shown that a significant number of African Americans believe their health is entirely determined by God’s Will if they develop AD; however, those who hold this belief are just as likely to believe they can influence their health outcomes as anyone else (Rovner et al., 2018). Many African Americans view their health as ultimately determined by God, but they also believe that taking care of their health aligns with God’s Will. Despite having a higher risk for AD compared to whites, many African Americans are unaware that lifestyle changes can reduce this risk (Rovner et al., 2018). This knowledge gap likely contributes to the under-diagnosis and under-treatment of cognitive problems in African American seniors. Many healthcare providers struggle to strike a balance between respecting their patients’ autonomy and encouraging them to become as independent as possible, often due to common misconceptions about Alzheimer’s disease (Rovner et al., 2018).

Impact on my Intervention Plan Components

My intervention strategy may face challenges while treating US residents, particularly African American patients, as indicated by research. The belief in the specific “will of God” can be a barrier, leading patients to resist following healthcare professionals’ advice, adopt the recommended diet and lifestyle modifications known to slow the progression of Alzheimer’s disease, and instead continue with their current routines.

Part 2-Theoretical Nursing Models, Strategies from Other Disciplines, and Healthcare Technologies

Theoretical Nursing Model

The Health Belief Model has proven beneficial in health promotion and illness prevention initiatives, shedding light on and predicting individuals’ health-related behaviors over time. It is one of the most widely used frameworks for analyzing health-related actions (Kissal & Kartal, 2019). Central to the Health Belief Model are individuals’ beliefs about their health problems, which subsequently influence their health-related behaviors (Kissal & Kartal, 2019).

Orem’s Self-Care Nursing Theory offers valuable guidance for practitioners. Nurses can support their patients by representing them, providing instruction, offering guidance, giving support, and fostering a growth-conducive environment (Khademian et al., 2020).

Both the Health Belief Model and Orem’s Self-Care Nursing Theory will be employed effectively in this intervention strategy. The Health Belief Model will aid in understanding the diverse beliefs of US citizens regarding Alzheimer’s disease care, while Orem’s self-care theory will help analyze patients’ strengths and limitations in self-care. Both models will assist in identifying and mitigating elements that may pose challenges to the intervention plan.

Weaknesses

The Health Belief Model does not account for established routines that may influence a person’s decision to follow a doctor’s orders. Additionally, behaviors motivated by factors other than health, such as social acceptance, are overlooked. Orem’s self-care deficit theory may not fully encompass the care and needs of certain clients. Some patients with varying care requirements have reported that this health concept does not align with their reality. Moreover, Orem’s theory has been critiqued for its inadequate acknowledgment of the emotional needs of individuals, presenting a notable flaw by prioritizing physiological maintenance over mental health maintenance.

Strategies from other Disciplines

Epidemiological studies have highlighted the potential role of diet in preventing or slowing the onset of Alzheimer’s disease. Nutritional supplements rich in antioxidants, vitamins, trace minerals, flavonoids, and lipids have shown promising effects on cellular health and regeneration, aging processes, and pathogenic pathways in the progression of AD. Dietary changes offer advantages as they rarely cause serious side effects, are easy to implement, and are generally well-accepted by society (Bello-Corral et al., 2021).

The MIND diet has been recommended by nutritionists as a means of delaying the onset of Alzheimer’s disease. This diet, comprising ten brain-healthy foods such as leafy greens, vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and wine, excludes five unhealthy foods (red meats, butter and stick margarine, cheese, pastries and sweets, and fried or fast food) that may contribute to Alzheimer’s dementia prevention (Cremonini et al., 2019).

Weakness

The evidence supporting the benefits of the MIND diet is limited.

Healthcare Technology

Telehealth has proven to be a valuable tool for diagnosing and treating Alzheimer’s disease. Several aspects of patient care for Alzheimer’s are now accessible through telehealth, allowing for monitoring of adherence to nutritional and exercise recommendations, as well as educating patients about the advantages of lifestyle changes (National Institute of Aging, 2019).

Weaknesses

The major drawback of telehealth is its inability to fully replace face-to-face visits with healthcare providers. In some cases, physical presence is necessary, and virtual visits are insufficient. Moreover, telehealth effectiveness heavily relies on internet connectivity, presenting challenges for individuals without access to this facility.

Major Components of an Intervention

Theoretical Nursing Model 

According to Yip (2021), Orem’s self-care theory guides nurses in deciding what areas of patient care to prioritize, and it emphasizes the significance of patients keeping control over their self-care (Yip, 2021). The theory of self-care deficiencies proposed by Orem elucidates the ways in which nurses may and should act to enable patients to retain their sense of agency. By using this theory nurses can analyze the weaknesses of patients that can hinder their way of self-management (Yip, 2021). 

According to Tsai et al. (2021), nurses can use the health belief model to better understand their patients’ risk perceptions and motivations for engaging in potentially harmful behaviors. This in turn improves their ability to implement interventions that encourage patients to adopt more healthful lifestyles (Tsai et al., 2021).

Strategies from other Disciplines

 According to Cremonini et al. (2019) adhering to the MIND diet, which includes ten brain-healthy foods and excludes five unhealthy ones (red meats, butter and stick margarine, cheese, pastries and sweets, and fried or fast food), has been shown to have a significant impact on reducing the risk of developing Alzheimer’s disease and other forms of dementia (Cremonini et al., 2019).

Health Care Technologies

Telehealth has been shown to be an effective method for both diagnosing and treating Alzheimer’s disease. Physicians may now provide better treatment for their patients with Alzheimer’s disease by addressing a wider range of needs through telemedicine (De Marchi et al., 2021). Doctors may utilize telehealth to monitor their patients’ compliance with dietary and exercise advice and to educate them on the benefits of adopting healthier lifestyles (De Marchi et al., 2021).

Conflicting Evidence 

The Health Belief Model doesn’t take into account how a person’s regular habits may affect their decision to comply with a doctor’s advice. In the same vein, it disregards actions taken for reasons other than health, such as conformity. Also, Orem’s self-care deficit theory may not be enough to address the client’s needs. One of the most obvious problems with Orem’s theory is that it fails to adequately acknowledge the emotional needs of its subjects. Physical health is given more importance than mental health (Yip, 2021).

The MIND diet has no apparent flaws, however, according to different research studies, along with MIND diet, good night sleep, and regular physical activity are also important in slowing down the progression of Alzheimer’s disease (Timlin et al., 2021). 

The use of telehealth technology may encounter a number of challenges, including those pertaining to its technology, patients’ acceptance of it, their doctors’ capacity to engage with them, their level of privacy, the secrecy of their medical data, and their ability to pay for it. The restricted availability of computers, together with the accompanying poor internet connections, was one example of a technical barrier that needed to be overcome (Blandford et al., 2020).

Part 3-Impact of Stakeholder Needs, Health Care Policy, Regulations, and Governing Bodies

Relevant Stakeholders

The key stakeholders for this intervention plan include U.S. citizens, nurses, healthcare practitioners, and an information technologist team. Fulfilling the needs of each stakeholder can be a challenge but for the successful execution of my plan, I had to consider the specific needs of each stakeholder in this intervention plan. I had to make sure that I am providing culturally competent care to my patients, as well as, I need to respect the point of view of other healthcare staff members as well as the staff members of the IT team. 

Relevant Health Care Policies and Regulations

Founded in 1980 and headquartered in New York City, the Alzheimer’s Foundation of America (AFA) is a national, non-profit organization committed to improving the lives of all Americans by advancing research into the causes, prevention, treatment, and eventual cure for Alzheimer’s disease and other forms of dementia, as well as providing support, services, and education to those affected by the disease and their loved ones (Alzheimer’s Foundation of America, 2018).

I may follow the criteria and recommendations established by the Alzheimer’s Association, and Alzheimer’s Foundation of America for lifestyle modification intervention, and I can educate my patients on these standards and guidelines.

Relevant Governing Bodies

Anyone who is interested in enrolling in a health insurance program will have a number of obstacles to overcome if they do so in the United States. As a result, the welfare of the American people places a high premium on the stability and continuity of government assistance programs such as Medicare and Medicaid (Subhan, 2021). There are an increasing number of health insurance and government programs that will pay for treatments provided by telemedicine providers (Subhan, 2021).

Protecting patients’ health records is a top priority for the United States government, which is why it enacted the Health Insurance Portability and Accountability Act (HIPAA) (Cohen & Mello, 2018). With the set rules by HIPAA, I can make sure that patients’ health information is protected on telehealth. 

Part 4-Ethical and Legal Implications

Ethical Implications 

However, in the United States, people with chronic diseases are seldom adequately prepared for the degree to which they would be expected to self-manage their illness. The patient’s well-being may be jeopardized, and their capacity to make the most of their life’s possibilities may be sapped. In light of the centrality of patient education to the nursing philosophy and practice, nurses should take the lead in eliminating systemic impediments to self-management education and ensuring that it is provided effectively (Salemonsen et al., 2020). In addition, I am powerless to insist that my patients make positive lifestyle changes like eating healthier and doing more exercise. I can only provide information, and from there, it is ultimately up to the patient to determine whether or not to implement any suggested lifestyle adjustments.

Legal Implications 

The limits of technology add to the concerns over the patient’s right to privacy, as well as the security and confidentiality of their data (Blandford et al., 2020). This leads me to believe that I should not put all of my eggs in the telemedicine basket, but rather I should use these solutions in combination with other, more conventional approaches. If medical professionals are truly interested in making a difference in the lives of those affected by Alzheimer’s disease, they will make telehealth visits an essential part of the treatment they provide and take extra precautions to ensure that the counseling session that takes place between the patient and the attending physician is not disrupted in any way.

Points of Uncertainties and Knowledge Gaps  

The fact that a person with Alzheimer’s disease may pick between pharmaceutical therapies or behavioral modifications to delay the course of the condition may be the root cause of the ambiguity. It is possible that the timing will be impacted by the absence of knowledge on how people in the United States would react to advancements in medical technology. In the event that all goes according to plan, the implementation of the intervention strategy will take around six months.

Conclusion 

It is essential to make it clear to patients that leading a healthy lifestyle is the most important factor in delaying the onset of Alzheimer’s disease or avoiding it altogether. This involves the management of cardiovascular risk factors as well as a combination of staying physically active, mentally active, socially active, and spiritually active. In addition, the research has made clear that adhering to a healthy diet such as the Mediterranean diet is also helpful in slowing the progression of Alzheimer’s disease. 

References

Alzheimer’s Association. (2021). Facts and Figures. Alzheimer’s disease and Dementia. https://www.alz.org/alzheimers-dementia/facts-figures#:~:text=More%20than%206%20million%20Americans%20of%20all%20ages%20have%20Alzheimer

Alzheimer’s Foundation of America. (2018). Alzheimer’s Foundation of America. Alzheimer’s Foundation of America. https://alzfdn.org/

Arab, L., & Sabbagh, M. N. (2010). Are certain lifestyle habits associated with lower Alzheimer’s disease risk? Journal of Alzheimer’s Disease: JAD, 20(3), 785–794. https://doi.org/10.3233/JAD-2010-091573

Bello-Corral, L., Sánchez-Valdeón, L., Casado-Verdejo, I., Seco-Calvo, J. Á., Antonio Fernández-Fernández, J., & Nélida Fernández-Martínez, M. (2021). The influence of nutrition in Alzheimer’s disease: Neuroinflammation and the microbiome vs. transmissible prion. Frontiers in Neuroscience, 15. https://doi.org/10.3389/fnins.2021.677777

Bhatti, G. K., Reddy, A. P., Reddy, P. H., & Bhatti, J. S. (2020). Lifestyle modifications and nutritional interventions in aging-associated cognitive decline and Alzheimer’s disease. Frontiers in Aging Neuroscience, 11. https://doi.org/10.3389/fnagi.2019.00369

Blandford, A., Wesson, J., Amalberti, R., AlHazme, R., & Allwihan, R. (2020). Opportunities and challenges for telehealth within, and beyond, a pandemic. The Lancet Global Health, 8(11). https://doi.org/10.1016/S2214-109X(20)30362-4

Cao, J., Hou, J., Ping, J., & Cai, D. (2018). Advances in developing novel therapeutic strategies for Alzheimer’s disease. Molecular Neurodegeneration, 13(1). https://doi.org/10.1186/s13024-018-0299-8

Clark, J. L., Phoenix, S., Bilbrey, A. C., McManis, T., Escal, K. A., Arulanantham, R., Sisay, T., & Ghatak, R. (2018). Cultural competency in dementia care: An African American case study. Clinical Gerontologist, 41(3), 255–260. https://doi.org/10.1080/07317115.2017.1420725

Cohen, G., & Mello, M. M. (2018). HIPAA and protecting health information in the 21st century. JAMA, 320(3), 231–232. https://doi.org/10.1001/jama.2018.5630

Cremonini, A. L., Caffa, I., Cea, M., Nencioni, A., Odetti, P., & Monacelli, F. (2019). Nutrients in the prevention of Alzheimer’s disease. Oxidative Medicine and Cellular Longevity, 2019(9874159), 1–20. https://doi.org/10.1155/2019/9874159

De Marchi, F., Contaldi, E., Magistrelli, L., Cantello, R., Comi, C., & Mazzini, L. (2021). Telehealth in neurodegenerative diseases: Opportunities and challenges for patients and physicians. Brain Sciences, 11(2), 237. https://doi.org/10.3390/brainsci11020237

Khademian, Z., Ara, F. K., & Gholamzadeh, S. (2020). The Effect of self care education based on Orem’s nursing theory on quality of life and self-efficacy in patients with hypertension: A quasi-experimental study. International Journal of Community Based Nursing & Midwifery, 8(2), 140–149. https://doi.org/10.30476/IJCBNM.2020.81690.0

Kissal, A., & Kartal, B. (2019). Effects of Health Belief Model-based education on health beliefs and breast self-examination in nursing students. Asia-Pacific Journal of Oncology Nursing, 6(4), 403. https://doi.org/10.4103/apjon.apjon_17_19

Kumar, A., Sidhu, J., Goyal, A., Tsao, J. W., & Svercauski, J. (2021). Alzheimer Disease (Nursing). PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568805/

National Institute of Aging. (2019). Telehealth: Improving Dementia Care | NIA. National Institute on Aging. https://www.nia.nih.gov/news/telehealth-improving-dementia-care

Rovner, B. W., Casten, R. J., & Harris, L. F. (2018). Cultural diversity and views on Alzheimer’s disease in older African Americans. Alzheimer Disease & Associated Disorders, 27(2), 133–137. https://doi.org/10.1097/wad.0b018e3182654794

Salemonsen, E., Førland, G., Hansen, B. S., & Holm, A. L. (2020). Understanding beneficial self-management support and the meaning of user involvement in lifestyle interventions: a qualitative study from the perspective of healthcare professionals. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-020-4951-y

Subhan, A. (2021). Centers for Medicare & Medicaid services. Journal of Clinical Engineering, 46(4), 152–153. https://doi.org/10.1097/jce.0000000000000483

Timlin, D., Giannantoni, B., McCormack, J. M., Polito, A., Ciarapica, D., Azzini, E., Giles, M., & Simpson, E. E. A. (2021). Comparison of barriers and facilitators of MIND diet uptake among adults from Northern Ireland and Italy. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-10307-9

Tsai, F.-J., Hu, Y.-J., Chen, C.-Y., Tseng, C.-C., Yeh, G.-L., & Cheng, J.-F. (2021). Using the health belief model to explore nursing students’ relationships between COVID-19 knowledge, health beliefs, cues to action, self-efficacy, and behavioral intention: A cross-sectional survey study. Medicine, 100(11), e25210. https://doi.org/10.1097/MD.0000000000025210

Yip, J. Y. C. (2021). Theory-based advanced nursing practice: A practice update on the application of Orem’s Self-Care Deficit Nursing Theory. SAGE Open Nursing, 7(1-7), 237796082110119. https://doi.org/10.1177/23779608211011993