EBP: A Literature Review

Managing diabetes needs continuum of care to improve the health of the population, reduce per capita costs of care and improve the experience of care. Continuum of care is defined as a care system that guides and tracks the clients through a myriad of health services at all levels, stages and intensity of care (HIMSS.com, 2015). The provisions of Title II-Subtitle E provide new options for long-term services and support. The provision of community first choice allows the lower income diabetes patients to have access to long-term healthcare at an affordable cost (Obamacarefacts.com, 2013). Empowered by HIT, nurses can find community resources, develop patient

The goal is to increase the percentage of understanding of diabetes and how to live empowered with diabetes. I will conduct outreach programs in various methods to reach the people to participate in the health program. My objective is done by specific, measurable, achievable, results-focused, and time-bound (SMART) goals. By May 31, 2018, an increase of 40% establishes one-on-one follow up education session with each individual and families through home visits or phone calls to monitor them to improve their lifestyles. By February 30, 2018, an increase of 80% distribution of brochures and with door to door interactions with the individuals in the community. By September 2018, increase 90% of people to engage in community health fair, classes, and exercise activities on diabetes and cardiovascular classes. This will introduce the individuals in social support that allow interactions with teaching and

Patient-centered care refers to the view that patients and their family members are partners in developing a care plan. This stems from the belief that the patient is in control and that the care provided is rooted in respect that addresses the patient’s personal needs and values (Barnsteiner & Sherwood, 2012). Creating a partnership with a patient that allows them to grasp the goals and methods of their plan of care and includes them in the decision-making process can prevent errors from occurring. This gives the patient the opportunity to correct any

Diabetes is a serious medical condition that can also be a risk factor for the development of many different diseases and conditions including dementia, heart disease, and CVA. Thus, effective management of diabetes is very important. Patient compliance can be difficult to achieve if the person affected with diabetes is not educated about the illness or treatment, has not fully accepted the diagnosis or its severity, will not change habits or believes that the prescribed treatment regime is too difficult or ineffective, has cultural beliefs conflicting with the treatment regime, experiences stressful events, lacks social support, or suffers from psychiatric issues unrelated to diabetes (Gerard, Griffin, & Fitzpatrick, 2010). As one may expect, adequate education programs are essential tools when dealing with diabetics. Solid education will provide the patient with information as well as teaching the necessary skills to manage the disorder. The primary focus of any diabetes education program must be to empower patients as a part of the multidisciplinary team. This team should be focused at integrating diabetes into the lives of the patients and this focus should be based on the decisions made by the patient, otherwise the treatment plan can be looked on as forced (Gerald et al., 2010). Every patient stricken with diabetes has the right to benefit from an education program of this type. First, basic education and facts should be administered directly following the diagnosis of

According to Rural Health Information Hub (2017), the fundamental purpose of disease prevention is to keep individuals healthy. One implements health promotion interventions in an effort to promote healthy behaviors and to decrease the risks of developing chronic illnesses (RHIH, 2017). According to the ADA (2016) individuals that participate in health promotion behaviors are more likely to have better health outcomes compared to those who do not. The EBP change project has shown that educating patients with prediabetes can increase diabetes knowledge and promote an increase in health promotion behaviors. The EBP change project outcome has indicated that participants who completed the 6-week diabetes education program were able to increase their knowledge regarding type 2 diabetes. Therefore, with the positive outcome of the EBP change project, the EBP change project site can incorporate certain aspects of the diabetes education program into their patient education to increase diabetes knowledge, picking healthier food options and participants in activities that would increase physical fitness.

Individuals that have been diagnosed with type 2 diabetes are cared for by a variety of people like podiatrist, district nurses, DSNs, GPs, and practice nurses. Good communication between these professionals and the person with type 2 diabetes can lead to better insight into the individual’s life, therefore helping to plan and provide the best care for that person. This can reduce repetition, improve quality of care for people with diabetes type 2 and

In some areas of population health, technology in enhanced patient information is utilized to perform risk stratification to identify the high risk patients. These patient’s often have uncontrolled BP, diabetes with an HgbA1c over 9, COPD, etc. Once identified as high risk or potential high risk, these patients receive additional care or patient outreach to help manage their condition. Some organizations employee RN Health Coaches and Care Coordination teams to help these patients and identify gaps in care. The primary care physician assumes care of the patient along with striving for the patient to become active in their overall health thereby keeping them out of the hospital (Sanford, 2013). One enhanced area of population management is the PCMH model. PCMH practices increase patient’s engagement in shared decision making while providing compensation for care coordination, care management and medical consultation outside of traditional face-to-face visits (Berryman, Palmer, Kohl &Parham, 2013). A patient centered approach pushes for changes not only in the delivery of medicine but in traditional encounters. In addition, PCMH encourages increased access to the patient’s primary care physicians and improved patient satisfaction scores. PCMH and population health encourages providers to increase after hours care to decrease emergency department visits and/or hospitalizations. Thereby reducing cost and improving the patient’s

The intended outcome of the EBP practice change project is that participants will exhibit an increase in diabetes knowledge at the end of the 6-week course. An increase in diabetes knowledge would be confirmed by participants exhibiting higher posttest intervention assessment scores.

Diabetes is a chronic illness that requires continuous medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications[ ].

To start my plan for implementation, I will first talk to my director of nursing, manager, and nurse educator for approval. I plan to implement increase evidence based practice use in my department (cardiac unit). I will obtain information from our quality assurance nurse to evaluate how our core measures like AMI, chf, and stroke bundle is being consistently followed by the nurses in my department. I plan to empower staff nurses to use EBP. I will schedule workshops for nurses interested in learning more about research and EBP, increase access to library resources and EBP information, interactive EBP skills and rounds, development of EBP mentors and champions. The change should be an ongoing support from the leaders and organization to

Saline County, Kansas population 55,606 ranks 48 out of 102 counties for health outcomes (County Health Rankings and Roadmaps, 2015) and has a diabetes diagnosis of 8.8% for the total population. Additional statistics of diabetes diagnosis reveals 24.4% for Medicare age and 12% of residents age 20-64 being diagnosed with diabetes (Robert Woods Johnson Foundation, 2016). Prior needs assessment identified a lack of outpatient diabetes education and self-management support (DSMES) for person with diabetes (PWD) for Saline County and surrounding counties. Additionally, a previous Logic Model identified resources, key stakeholders, essential activates, outputs and short and long term program goals of the DSMES program. Identification of

The healthcare industry has intensely advanced throughout the world, in turn changing the principles that incorporate the practice and culture of nursing practice. Altering the model of care to a patient-centered mode signifies an organizational culture shift and requires the participation of executives at the senior level (Cliff, 2012). To practice this care to provide the best care possible, it goes beyond the nurse to all healthcare professionals and senior leadership. The days of patients and nurses following a physician’s order without favor to care has now loaned themselves to more of an interdisciplinary approach to practice. Though, it is encouraged that the patient makes decisions for themselves, after receiving the proper education and information on their condition. Part of the patient-centered care is to be the patients’ advocate, by letting them know you are there for them when they are unable to speak and advocate for themselves and what is in their best interest. That goes in hand with educating them on “self-management of care, health literacy, patient, and family education through nurse-patient communication and interaction (Finkelman & Kenner, 2016, p. 271).”

After reflecting on my own nursing practice, I decided to search the literature on the need for better education associated with DMI. Certain ethnic and cultural groups have an increased risk for DMI and educating those at risk is a key component in the management process. If nurses use more individualized teaching processes and meet their patients’ teaching needs, then their patients will feel more comfortable in taking care of themselves at home and in schools. By reviewing the literature on the need for enhanced diabetes

outcomes and prevention must be developed and proposed as viable alternatives to current care systems to address some of the current problems. There is also the need to strengthen the primary care due to changing systems of health-care delivery and rapidly emerging advances in diabetes treatment. The patient-centered Medical Home Model has been proposed as a practical solution to access, and quality issues surrounding primary care. Another proposed intervention is that practice change is essential to provide the type of evidence based care recommended by these models, to effectively manage diabetes.

Diabetes is associated with wide range of complications such as chronic renal failure, blindness, amputations, heart disease, high blood pressure, stroke, and neuropathy (Alotabi, A., et al., 2016). There is no known cure for diabetes, but the disease can be controlled through health management that includes multiple perspectives of care such as medications, blood glucose monitoring, diet, nutrition, screening for long-term complications and regular physical activity (Alotabi, A., et al., 2016). Managing diabetes may be complicated and requires the knowledge and skills of both healthcare providers and the clients. Studies have shown that to prevent or delay diabetic complications due to diabetes, counseling and other lifestyle interventions are the effective therapy. Even with many policies set up for diabetes, 8.1 million Americans are undiagnosed with diabetes mellitus, and approximately 86 million Americans ages 20 and older have blood glucose levels that considerably increase their risk of developing Diabetes Mellitus in the next several years (CDC, 2015). For diabetes care to be successful there needs to be a good understanding of the disease and management by both patients and healthcare providers,