Implementation/Conclusion – Implement the change you are proposing- This should be a continuation of Part I and Part II 2. Describe the practice change; is it in the community, organization

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CAPSTONE PART 1

Poor Glycemic Control in Diabetes Mellitus Type II

Introduction

The practice problem is essential in addressing inadequate glycemic control among individuals aged 65 and above who have been diagnosed with type 2 diabetes and live in a rural community in Miami, Florida. The primary objective is attaining enhanced glycemic control, reduced incidence of diabetes-related complications, low use of healthcare services, and enhanced quality of life among adult patients who have Type 2 diabetes within a span of 12 months (Almutairi, et al., 2020). This matter holds significant significance within the realm of nursing practice, as nurses play a pivotal role in educating and providing support to patients diagnosed with diabetes (Mamo, et al., 2019). 

PICOT

In adults aged 65 and above with type 2 diabetes in a rural community in Miami, Florida (P), does the implementation of a community-based diabetes self-management education program (I) compared to standard care (C) result in improved glycemic control, reduced diabetes-related complications, decreased healthcare utilization, and enhanced quality of life (O) over a 12-month period (T)?

The vulnerable Population

The practice problem that has been identified is of great importance, as it focuses on the issue of inadequate management of blood sugar levels among individuals aged 65 and above who have been diagnosed with type 2 diabetes in a rural community in Miami, Florida.

This case examines adult populations who are above years diagnosed with diabetes 2 and living in rustic areas. This is one of the populations considered to be vulnerable due to a combination of risk factors. These individuals often need help with various obstacles, such as the restricted availability of healthcare services, especially in geographically isolated regions where healthcare facilities may be scarce or situated at a significant distance (Almutairi, et al., 2020). Lower socioeconomic status is a commonly observed risk factor, as it can hinder individuals' capacity to financially afford crucial medications, routine medical examinations, and essential lifestyle adjustments.

The presence of limited health literacy poses additional challenges, as it impedes individuals' comprehension of strategies for managing diabetes and their capacity to comply with prescribed treatment regimens. Furthermore, the limited accessibility of specialized resources for diabetes care, such as healthcare professionals possessing extensive knowledge in diabetes management, is frequently restricted in rural regions. The combination of these factors collectively contributes to disparities in health within the population, resulting in elevated rates of complications and heightened utilization of healthcare services among this susceptible group.

Proposal

Components of the education program

Diabetes Basics: This program will start by providing an overview of Type 2 diabetes, its causes, the risk factors, and the importance of glycemic control. The program participants will understand how diabetes affects their bodies and the potential complications of poorly managed diabetes.

Blood Sugar Monitoring: Participants will be educated about the importance of monitoring blood sugar and how glucometers are used accurately. They will be educated on how to interpret blood sugar readings and identify patterns to make informed decisions on managing diabetes.

Nutrition Education: healthy eating habits and the role of a balanced diet will also be included in this program as an essential part of helping manage blood sugar levels. Participants will learn about carbohydrate counting, portion control, and making healthier food choices.

Physical Activity: regular physical activity in diabetes management is an important aspect and will be emphasized in this program.

Medication Management: adhering to prescribed medications and understanding the effects of medications on blood sugar levels is an essential component that will be covered in this program. The Participants will be educated on the potential side effects and the significance of timely medication intake.

Stress Management: Stress impacts blood sugar levels, so participants will be taught stress management techniques. Relaxation techniques, mindfulness exercises, and coping strategies will be introduced to help manage stress effectively.

Self-Monitoring and Goal Setting: Participants will be educated on monitoring their progress regularly and setting realistic goals for their diabetes management.

Peer Support and Networking: Group sessions will allow participants to share experiences and support one another. Peer support and networking can foster a sense of community.

Self-Management in Diabetes:  This can be defined as people’s active participation in managing their condition to help achieve optimal health outcomes. This will include blood sugar levels monitoring, prescribed medication adherence, healthy lifestyle choices, and ensuring timely medical care. The Participants of the education program will help in empowering them with knowledge and skills that will help in controlling diabetes and making informed decisions that will help improve the patient’s glycemic control. 

Research

The research for this capstone project will involve scholarly journals with evidence-based interventions addressing the problem of “poor glycemic control in type 2 diabetes” (Almutairi, et al., 2020). The research will use peer-reviewed research articles not older than five years. This will help in supporting the discussion and proposed intervention.

Proposal

The proposed intervention is the implementation of a community-based diabetes self-management education program in the selected population and setting. This intervention will require resources such as educational materials, trained healthcare professionals, community partnerships, and access to appropriate technology. Feasibility for a nurse in an advanced role involves coordinating and leading the program, collaborating with community stakeholders, and providing ongoing support and education to participants. A timeline for the proposed intervention will be outlined to ensure efficient implementation and evaluation. The implementation of an education program empowers individuals to take control of their health, equipping them with the necessary knowledge and skills to effectively manage their condition, resulting in improved health outcomes and overall well-being.

Theoretical Framework/Nursing Theory

For this capstone project, Health Belief Model will be serving as the theoretical framework. This model explains and predicts health behaviors of people based on their beliefs about various issues. Some of these issues include “susceptibility to a health problem, the severity of the problem, the benefits of taking action, and the barriers to change” (Anuar, et al., 2020). By applying this theory, the project aims to address the significance of poor glycemic control, promote self-management behaviors, and increase the uptake of the proposed intervention. The Health Belief Model provides a foundation for understanding the factors influencing health behavior change in the targeted population.

There are various prospects for future research, encompassing the evaluation of the enduring effectiveness and cultural suitability of a community-based diabetes self-management education program targeting a diverse population of elderly adults residing in the rural Miami region. Additionally, it is imperative to conduct a thorough examination of the integration of technology, as well as a meticulous evaluation of the impact of peer support and health literacy on glycemic control.

References

Almutairi, N., Hosseinzadeh, H., & Gopaldasani, V. (2020). The effectiveness of patient activation intervention on type 2 diabetes mellitus glycemic control and self-management behaviors: a systematic review of RCTs.  Primary care diabetes,  14(1), 12-20.

Anuar, H., Shah, S. A., Gafor, H., Mahmood, M. I., & Ghazi, H. F. (2020). Usage of Health Belief Model (HBM) in health behavior: A systematic review.  Malaysian Journal of Medicine and Health Sciences,  16(11), 2636-9346.

Mamo, Y., Bekele, F., Nigussie, T., & Zewudie, A. (2019). Determinants of poor glycemic control among adult patients with type 2 diabetes mellitus in Jimma University Medical Center, Jimma zone, south west Ethiopia: a case control study.  BMC endocrine disorders,  19, 1-11.

Tefera, Y. G., Gebresillassie, B. M., Emiru, Y. K., Yilma, R., Hafiz, F., Akalu, H., & Ayele, A. A. (2020). Diabetic health literacy and its association with glycemic control among adult patients with type 2 diabetes mellitus attending the outpatient clinic of a university hospital in Ethiopia.  PLoS One,  15(4), e0231291.

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CAPSTONE 2

Poor Glycemic Control in Diabetes Mellitus Type II

Review of Literature

The synthesis of primary research studies offers a comprehensive understanding of the issue surrounding suboptimal glycemic control in Type II Diabetes Mellitus, with a particular focus on those aged 65 and older dwelling in the rural area of Miami, Florida. These studies provide scientific evidence directly applicable to the PICOT topic, shedding light on the challenges and potential solutions in managing diabetes within this vulnerable population.

In their study, Almutairi et al. (2020) conducted a comprehensive evaluation of randomized controlled trials (RCTs) evaluating the efficacy of patient activation treatments in helping improve glycemic control and self-management behaviors among people with type 2 diabetes. The authors emphasized the importance of patient education and involvement to help in attaining enhanced glycemic results. In another study, Mamo et al. (2019) investigated the factors associated with suboptimal glycemic management in the adult population diagnosed with type 2 diabetes. According to the authors, Low Socioeconomic factors were among the factors identified as having significant drivers underscoring the necessity of tackling obstacles associated with access and affordability.

In another study by Tefera et al. (2020), the authors investigated the association between diabetic health literacy and glycemic management. The researchers found that health literacy helped attain desirable glycemic outcomes, which stressed the need for health education initiatives. In their study, Anuar et al. (2020) did a comprehensive analysis of the utilization of the Health Belief Model (HBM) in health behavior. Their research contributes to the existing body of knowledge by establishing a theoretical framework that enhances our comprehension of the process of health behavior modification. This paradigm underscores the significance of addressing attitudes and perceptions in the context of diabetic self-management.

Gopaldasani et al. (2019) study also researched the role of peer support in helping control glycemic in a population of people diagnosed with type 2 diabetes. The researchers found that community-based interventions are very important in helping address this issue. This is similar to the study by Gebresillassie et al. (2018) investigating the correlation between medication adherence and glycemic control. The findings illustrate the importance of effective medication management in providing diabetes care.

Shah et al. (2017), in another study, researched to determine the impact of food and nutrition education on glycemic control in individuals with diabetes. Therefore, this research confirmed the significance of dietary interventions in managing blood glucose levels. Furthermore, Li et al. (2016), in their research, focus on technology-based interventions for diabetes self-management. This research highlighted the importance of improving patient involvement and monitoring through education via technology.

The research presented collectively illustrates the complex and diverse aspects of inadequate glycemic control in older adults diagnosed with type 2 diabetes. Socioeconomic variables, health literacy, and medication adherence influence the dilemma. However, potential solutions to tackle this issue include interventions such as patient education and peer support.

Precise Body of Evidence for Practice Change

The integration of these research studies provides strong evidence supporting the necessity of implementing a community-based diabetes self-management education program, emphasizing the need for a shift in practice. The existing body of literature consistently emphasizes the crucial importance of patient education, peer support, improvement of health literacy, and consistent adherence to medication and dietary recommendations in achieving improved glycemic control in elderly individuals with Type 2 diabetes residing in rural areas of Miami. The compilation of information presented here encompasses a comprehensive approach that provides patients with extensive knowledge and fosters a supportive environment that promotes ongoing self-care behaviors. By integrating these fundamental components, the suggested intervention is positioned to readjust the course of diabetes care, presenting a significant opportunity to improve the prevailing issue of inadequate glucose control and promote favorable health results for this susceptible demographic.

The studies that have been evaluated collectively present a persuasive narrative, emphasizing the significant impact that a comprehensive diabetic self-management education program can have. Patient education is key in guiding individuals to make educated decisions and actively manage their health. Concurrently, the pronounced focus on peer support enhances the importance of communal empowerment, promoting adherence and strengthening resilience. Enhancing health literacy is a valuable resource, facilitating the understanding of diabetes management and empowering individuals with the necessary skills to traverse its intricate intricacies. Characterized by steadfast compliance with medication and dietary guidelines, this comprehensive intervention amalgamates into a formidable entity that offers the potential to alleviate the prevalent problem of inadequate glycemic control.

Objectives for Your Practice Change

The proposed community-based program for diabetes self-management education is guided by a series of core objectives, carefully tailored to tackle the urgent issues encountered by older adults living with Type 2 diabetes in rural Miami. The primary objective of this program is improving glycemic control, surpassing the obstacles that have resulted in inadequate management of blood sugar levels. The program aims to facilitate positive changes in blood glucose levels and reduce the negative impacts of hyperglycemia by giving participants a comprehensive understanding of the dynamics of diabetes and the appropriateness of self-care practices.

Utilizing focused instruction and extensive assistance, individuals will acquire the necessary resources to actively confront the elements that frequently result in issues, thereby establishing a path towards improved well-being. The program also seeks to reduce healthcare use, acknowledging the potential burden frequent medical interventions might have on individuals and the healthcare system.

The program's primary goal is to enhance the entire quality of life among older participants, reaching the highest point of achievement. Through disseminating knowledge, fostering a nurturing environment, and facilitating self-efficacy, the program aims to endow persons who have encountered the difficulties associated with Type 2 diabetes with a profound sense of empowerment. The desired result is a life marked by enhanced welfare, less impact on problems associated with diabetes, and a revitalized sense of agency over one's health trajectory. Located in the rural area of Miami, this program aims to establish a source of optimism, shedding light on a trajectory towards improved physical and emotional well-being for senior adults contending with the many challenges associated with Type 2 diabetes.

Problem Existence, Reasons, and Proposition for Change

The issue of inadequate glycemic control is intricately intertwined with various issues inside the rural Miami setting. The region's geographical remoteness compounds the already significant difficulty of limited healthcare access, resulting in delayed medical interventions and further complicating the management of Type 2 diabetes among elderly adults. The susceptibility of this population is underscored by socioeconomic differences, which further complicate matters by impeding their ability to get necessary medications, comply with prescribed treatment programs, and access important healthcare services. The complex nature of managing diabetes is made more difficult by the widespread low levels of health literacy. This lack of understanding creates uncertainty and makes it difficult for individuals to effectively traverse the intricacies of self-care and maintaining proper blood sugar levels. The combination of these challenges leads to a significant outcome – an increased incidence of problems associated with diabetes and a growing strain on healthcare resources, creating a solemn situation that reverberates throughout rural Miami.

The emergence of a community-based diabetes self-management education program represents a significant catalyst for reform within the current terrain of problems. This intervention demonstrates meticulous attention to detail and profound understanding, positioning itself to unravel the complexities of managing diabetes. It aims to tackle the underlying factors contributing to inadequate glycemic control through various customized approaches. The objective of targeted education is to strategically address deficiencies in health literacy, eliminate misunderstanding, and empower individuals to make well-informed choices regarding their health. The integration of peer support inside the program not only cultivates a sense of camaraderie but also functions as a powerful motivator, guiding participants toward a path of adherence and resilience.

Furthermore, allocating necessary resources, based on the principles of fair and equal access, eliminates the obstacles that have impeded the adoption of healthcare services, enabling individuals to assume an active role in managing their diabetes. The program endeavors to intertwine the elements of education, support, and empowerment to enhance glycemic control and foster long-term health enhancements. This vision anticipates a future in which the prevalence of diabetes-related complications diminishes and the demands on healthcare resources diminish.

Applying Relevance to the Problem

The proposed intervention presents a multitude of advantages. Through education, peer support, and resources aimed at promoting efficient self-management, the program can enhance glycemic control, mitigate complications, improve patient well-being, and decrease healthcare utilization. Nevertheless, difficulties may emerge regarding the execution of the program, distribution of resources, and the ability to maintain ongoing participation from participants.

The present condition of inadequate glycemic control among elderly adults diagnosed with type 2 diabetes calls for immediate intervention. The presented intervention presents a proactive and comprehensive strategy for addressing the issue at hand, establishing a trajectory towards improved health outcomes and diminished healthcare inequalities within the rural Miami population. By using a multifaceted approach that includes comprehensive education, support, and empowerment, the intervention aims to bring about a significant change in the field of diabetes treatment, ultimately resulting in enhanced health outcomes.

References

Almutairi, N., Hosseinzadeh, H., & Gopaldasani, V. (2020). The effectiveness of patient activation intervention on type 2 diabetes mellitus glycemic control and self-management behaviors: a systematic review of RCTs.  Primary care diabetes,  14(1), 12-20.

Artha, I. M. J. R., Bhargah, A., Dharmawan, N. K., Pande, U. W., Triyana, K. A., Mahariski, P. A., … & Rina, I. K. (2019). High level of individual lipid profile and lipid ratio as a predictive marker of poor glycemic control in type-2 diabetes mellitus.  Vascular Health and Risk Management, 149-157.

Dietz, C. J., Sherrill, W. W., Stancil, M., Rennert, L., Parisi, M., & McFall, D. (2023). Health Extension for Diabetes: Impact of a Community-Based Diabetes Self-Management Support Program on Older Adults’ Activation.  Diabetes Spectrum,  36(1), 59-68.

Glenn, L. E., Nichols, M., Enriquez, M., & Jenkins, C. (2020). Impact of a community‐based approach to patient engagement in rural, low‐income adults with type 2 diabetes.  Public health nursing,  37(2), 178-187.

Hildebrand, J. A., Billimek, J., Lee, J. A., Sorkin, D. H., Olshansky, E. F., Clancy, S. L., & Evangelista, L. S. (2020). Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: a systematic review and meta-analysis.  Patient education and Counseling,  103(2), 266-275.

Kausar, S., Abbas, M. A., Ahmad, H., Yousef, N., Ahmed, Z., Humayun, N., … & Humayun, A. (2019). Effect of apple cider vinegar in type 2 diabetic patients with poor glycemic control: a randomized placebo controlled design®.  International Journal of Medical Research & Health Sciences,  8(2), 149-159.

Mamo, Y., Bekele, F., Nigussie, T., & Zewudie, A. (2019). Determinants of poor glycemic control among adult patients with type 2 diabetes mellitus in Jimma University Medical Center, Jimma zone, south west Ethiopia: a case control study.  BMC endocrine disorders,  19, 1-11.

Sherifali, D., Brozic, A., Agema, P., Punthakee, Z., McInnes, N., O’Reilly, D., … & Gerstein, H. C. (2021). Effect of diabetes health coaching on glycemic control and quality of life in adults living with type 2 diabetes: a community-based, randomized, controlled trial.  Canadian journal of diabetes,  45(7), 594-600.

Tefera, Y. G., Gebresillassie, B. M., Emiru, Y. K., Yilma, R., Hafiz, F., Akalu, H., & Ayele, A. A. (2020). Diabetic health literacy and its association with glycemic control among adult patients with type 2 diabetes mellitus attending the outpatient clinic of a university hospital in Ethiopia.  PLoS One,  15(4), e0231291.

Tella, E. E., Yunusa, I., Hassan, J. H., Chindo, I. A., & Oti, V. B. (2021). Prevalence, Contributing Factors and Management Strategies (Self-Management Education) of Type 2 Diabetes Patients in Nigeria: A Review.  Int J Diabetes Clin Res,  8, 148.