POOR GLYCEMIC CONTROL IN DIABETES MELLITUS TYPE II
This assignment is a part 2 of a previous one completed. I have uploaded my assignment PART 1completed, the assignment was reviewed by my instructor and she add some comments that must be added or fixed for this PART 2. THE BLUE BOX must be double click to read what she wrote there to update.
I need update that according to her comment and wide a little more SECTION 4 AND SECTION 5.
ALSO I NEED TO WIDE MY REFERENCES it is required at least 20 scholarly resources, NO OLDER THAN 5 YEARS AND CHECK THAT PROFESSOR AS WELL REQUIRE APPENDIX.
1
MSN Project Manuscript Section I-III
POOR GLYCEMIC CONTROL IN DIABETES MELLITUS TYPE II
Executive Summary
Purpose
2
To ascertain the efficacy of a community-based diabetes self-management education
program for people with type II diabetes among geriatric adults in rural Miami, Florida, in a way
that improves glycemic control, reduces complications, expends fewer health resources, and
enhances quality of life for one year.
Project Location
This program was conducted in rural community centers in Miami because they are
easily accessible to the elderly and are suitable for educational activities.
Synthesis of Literature and Evidence
Literature reviews have indicated that diabetes self-management education can
significantly improve health outcomes among the elderly due to the enhancement of their ability
to handle the disease by themselves. This informed the adoption of the program, which was
tailored to the needs of a rural elderly population.
Implementation
The program was conducted in three phases: preparation, implementation, and
evaluation. It provided educational workshops on important self-care topics and individualized
support through biweekly follow-ups and coaching.
Dissemination
The project's findings will be published in scientific journals, highlighted at conferences,
presented at community meetings, and disseminated on a website that aims to influence public
health policy and foster the creation of such programs in other rural settings.
SECTION 1: INTRODUCTION AND PROBLEM IDENTIFICATION
3
Diabetes Mellitus Type II is, therefore, a severe public health problem, especially when it
comes to the elderly. Aging increases susceptibility to complications of the condition, which may
be compounded further by co-morbidities. Such is the case in rural Miami, Florida, where
healthcare resources remain less than optimal, among other things. The following paper
highlights how effective community-based diabetes self-management education was for seniors
over 65 with type 2 diabetes regarding glycemic control, health care utilization, and quality of
life.
Problem Statement
Diabetic elderly patients in rural Miami have numerous challenges in type 2 diabetes
management, whereby poor glycemic control is common, and complications are on the rise. Poor
glycemic control is common, and complications are on the rise. The traditional approach to
health is limited by accessibility, tailored education, and patient engagement; as such, this study
will propose an organized intervention to cater to these inadequacies in care and improve the
health status of this frail population.
Problem Background
Diabetes management in the elderly is comprehensive and involves standard medical
treatment. Therefore, these educational interventions, emphasizing self-management, could be
used with this population. However, there is a lack of targeted programs in rural Miami that
address the unique needs and challenges faced by the elderly diabetic population.
Stakeholders
The program's stakeholders would include the geriatric population with type 2 diabetes,
healthcare professionals working in rural Miami, local health departments, community centers
4
where the programs could be conducted, and elderly caregivers. It would also interest
policymakers who seek to reduce the cost of health care connected with diabetes.
PICOT Question
In adults aged 65 and above with type 2 diabetes in a rural community in Miami, Florida
(P), implementing a community-based diabetes self-management education program (I)
compared to standard care (C) results in improved glycemic control, reduced diabetes-related
complications, decreased healthcare utilization, and enhanced quality of life (O) over 12 months
(T)?
SECTION 2: LITERATURE SUPPORT
Review of Literature
A comprehensive review of existing literature and evidence highlighted the benefits of
diabetes self-management education programs. Numerous studies have demonstrated that such
programs can significantly improve glycemic control, reduce the incidence of diabetes-related
complications, and enhance participants' overall quality of life. For instance, a study by Trento et
al. (2021) found that diabetes self-management education is associated with clinically significant
improvements in glycemic control. The Davidson et al. (2022) study also emphasized the long-
term benefits of self-management education, noting reductions in HbA1c levels, improved self-
efficacy, and better diabetes-related knowledge among participants.
In another study, Van Truong et al. (2021) found that older adults participating in self-
management programs reported better adherence to medication, improved dietary habits, and
increased physical activity levels. Section II: Intervention Description
SECTION III: INTERVENTION DESCRIPTION
5
Proposed Intervention
This organized program for community-based education includes regular health
monitoring, individualized coaching sessions, and biweekly seminars led by community health
professionals. The program aims to raise awareness of diabetes management techniques, promote
lifestyle modifications, and enhance medication compliance.
Setting
The program will take place in community centers across rural Miami, Florida, where
most elderly residents have limited access to health facilities.
Barriers
Possible barriers will be the need to attend sessions, resistance to change after habituation
to long-standing behaviors, and limited access to technology for remote consultations. Strategies
to overcome them will be transport services, education in collaboration with family members,
and easy and accessible technology use.
Outcomes
The expected outcomes include improved HbA1c levels, a decrease in the frequency of
ER visits, and a decline in the quantity of diabetes-related hospital admissions. Other expected
outcomes are in the form of self-reported measures relating to the patient's quality of life.
Outcome measures in this study will be derived from pre- and post-intervention surveys, medical
records, and continuous glucose monitoring systems.
Action Plan
The action plan includes specifics on how participants will be recruited, training for the
educators, the development of educational material, workshop schedules, and follow-up
6
appointments. The baseline for critical milestones is the initial enrollment of participants, the
mid-point evaluation, and the end-of-study assessment.
SECTION IV: JOHN HOPKINS NURSING EVIDENCE-BASED PRACTICE MODEL
Introduction to Model
Using the Johns Hopkins Nursing Evidence-Based Practice Model in this paper becomes
pivotal in directing the practicum project to improve glycemic control in the elderly diabetic
population living in rural Miami. It is an elaborate 19-step model grouped under three primary
phases: practice question, evidence, and translation (PET). The model is designed to identify
issues stepwise and systematically, acquire and appraise relevant evidence, and layout
practicable and sustainable strategies.
Applying the model to the project, the practice question phase entails formulating a
specific question to solve poor glycemic control. In the evidence phase, a systematic literature
review and data collection are conducted to confirm the necessity of the project, which is a
community-based diabetes self-management education program, and to gauge the effectiveness
of similar interventions conducted in studies by Trento et al. (2021) and Davidson et al. (2022).
SECTION VI: TRANSLATION TO PRACTICE AND EVALUATION
Evaluation
Intervention effectiveness will be measured by comparing pre-and post-intervention data.
Dissemination
7
The findings will be shared with the broader community through public meetings,
professional health forums, and publication in peer-reviewed medical journals to inform policy
and practice further.
Conclusion and Contribution to the Nursing Profession
This result is expected to provide valuable insight into community-based educational
interventions for managing type 2 diabetes among the elderly. Therefore, the study should be
applicable across a wide implementation based on the proven effectiveness of community-based
educational interventions and, consequently, prove useful in diabetes management strategies in
response to the needs of the elderly in similar rural settings.
References
8
Davidson, P., Dickinson, J. K., Hyer, S., LaManna, J., Davis, J., Ojeda, M. M., & Kavookjian, J.
(2022). A comprehensive analysis of randomized controlled trials examined for people
with type 1 diabetes. 48(2), 111–135, The Science of Diabetes Self-Management and
Care.
Mastrian, K., and D. McGonigle (2024). Nursing informatics and the knowledge base. Learning
by Jones & Bartlett.
.
Tsai, P. S., Van Truong, P., Lin, M. Y., Chiu, H. Y., & Wulan Apriliyasari, R. (2021). Effects of
self-management programs on medication adherence, blood pressure, self-efficacy, and
body mass index in older individuals with hypertension: a meta-analysis of randomized
controlled trials. 27(2) of the International Journal of Nursing Practice, e12920.
Salassa, M., Barutta, F., Gruden, G., Trento, M., Fornengo, P., Amione, C., & Porta, M. (2020).
Education on self-management has the potential to lower blood pressure in type 2
diabetics. a controlled, randomized clinical experiment. 30(11), 1973–1979; Nutrition,
Metabolism, and Cardiovascular Diseases.
,
1
MSN Project Manuscript Section I-III
Student’s name: Lourdes Cano
Chamberlain University
Advanced Nursing Role Synthesis
Date: May 15, 2024
POOR GLYCEMIC CONTROL IN DIABETES MELLITUS TYPE II
Executive Summary
2
Purpose
To ascertain the efficacy of a community-based diabetes self-management education
program for people with type II diabetes among geriatric adults in rural Miami, Florida, in a way
that improves glycemic control, reduces complications, expends fewer health resources, and
enhances quality of life for one year.
Project Location
This program was conducted in rural community centers in Miami because they are
easily accessible to the elderly and are suitable for educational activities.
Synthesis of Literature and Evidence
Literature reviews have indicated that diabetes self-management education can
significantly improve health outcomes among the elderly due to the enhancement of their ability
to handle the disease by themselves. This informed the adoption of the program, which was
tailored to the needs of a rural elderly population.
Implementation
The program was conducted in three phases: preparation, implementation, and
evaluation. It provided educational workshops on important self-care topics and individualized
support through biweekly follow-ups and coaching.
Dissemination
The project's findings will be published in scientific journals, highlighted at conferences,
presented at community meetings, and disseminated on a website that aims to influence public
health policy and foster the creation of such programs in other rural settings.
SECTION 1: INTRODUCTION AND PROBLEM IDENTIFICATION
3
Diabetes Mellitus Type II is, therefore, a severe public health problem, especially when it
comes to the elderly. Aging increases susceptibility to complications of the condition, which may
be compounded further by co-morbidities. Such is the case in rural Miami, Florida, where
healthcare resources remain less than optimal, among other things. The following paper
highlights how effective community-based diabetes self-management education was for seniors
over 65 with type 2 diabetes regarding glycemic control, health care utilization, and quality of
life.
Problem Statement
Diabetic elderly patients in rural Miami have numerous challenges in type 2 diabetes
management, whereby poor glycemic control is common, and complications are on the rise. Poor
glycemic control is common, and complications are on the rise. The traditional approach to
health is limited by accessibility, tailored education, and patient engagement; as such, this study
will propose an organized intervention to cater to these inadequacies in care and improve the
health status of this frail population.
Problem Background
Diabetes management in the elderly is comprehensive and involves standard medical
treatment. Therefore, these educational interventions, emphasizing self-management, could be
used with this population. However, there is a lack of targeted programs in rural Miami that
address the unique needs and challenges faced by the elderly diabetic population.
Stakeholders
The program's stakeholders would include the geriatric population with type 2 diabetes,
healthcare professionals working in rural Miami, local health departments, community centers
4
where the programs could be conducted, and elderly caregivers. It would also interest
policymakers who seek to reduce the cost of health care connected with diabetes.
PICOT Question
In adults aged 65 and above with type 2 diabetes in a rural community in Miami, Florida
(P), implementing a community-based diabetes self-management education program (I)
compared to standard care (C) results in improved glycemic control, reduced diabetes-related
complications, decreased healthcare utilization, and enhanced quality of life (O) over 12 months
(T)?
SECTION 2: LITERATURE SUPPORT
Review of Literature
A comprehensive review of existing literature and evidence highlighted the benefits of
diabetes self-management education programs. Numerous studies have demonstrated that such
programs can significantly improve glycemic control, reduce the incidence of diabetes-related
complications, and enhance participants' overall quality of life. For instance, a study by Trento et
al. (2021) found that diabetes self-management education is associated with clinically significant
improvements in glycemic control. The Davidson et al. (2022) study also emphasized the long-
term benefits of self-management education, noting reductions in HbA1c levels, improved self-
efficacy, and better diabetes-related knowledge among participants.
In another study, Van Truong et al. (2021) found that older adults participating in self-
management programs reported better adherence to medication, improved dietary habits, and
increased physical activity levels. Section II: Intervention Description
SECTION III: INTERVENTION DESCRIPTION
Proposed Intervention
5
This organized program for community-based education includes regular health
monitoring, individualized coaching sessions, and biweekly seminars led by community health
professionals. The program aims to raise awareness of diabetes management techniques, promote
lifestyle modifications, and enhance medication compliance.
Setting
The program will take place in community centers across rural Miami, Florida, where
most elderly residents have limited access to health facilities.
Barriers
Possible barriers will be the need to attend sessions, resistance to change after habituation
to long-standing behaviors, and limited access to technology for remote consultations. Strategies
to overcome them will be transport services, education in collaboration with family members,
and easy and accessible technology use.
Outcomes
The expected outcomes include improved HbA1c levels, a decrease in the frequency of
ER visits, and a decline in the quantity of diabetes-related hospital admissions. Other expected
outcomes are in the form of self-reported measures relating to the patient's quality of life.
Outcome measures in this study will be derived from pre- and post-intervention surveys, medical
records, and continuous glucose monitoring systems.
Action Plan
The action plan includes specifics on how participants will be recruited, training for the
educators, the development of educational material, workshop schedules, and follow-up
appointments. The baseline for critical milestones is the initial enrollment of participants, the
mid-point evaluation, and the end-of-study assessment.
6
SECTION IV: JOHN HOPKINS NURSING EVIDENCE-BASED PRACTICE MODEL
Introduction to Model
Using the Johns Hopkins Nursing Evidence-Based Practice Model in this paper becomes
pivotal in directing the practicum project to improve glycemic control in the elderly diabetic
population living in rural Miami. It is an elaborate 19-step model grouped under three primary
phases: practice question, evidence, and translation (PET). The model is designed to identify
issues stepwise and systematically, acquire and appraise relevant evidence, and layout
practicable and sustainable strategies.
Applying the model to the project, the practice question phase entails formulating a
specific question to solve poor glycemic control. In the evidence phase, a systematic literature
review and data collection are conducted to confirm the necessity of the project, which is a
community-based diabetes self-management education program, and to gauge the effectiveness
of similar interventions conducted in studies by Trento et al. (2021) and Davidson et al. (2022).
SECTION VI: TRANSLATION TO PRACTICE AND EVALUATION
Evaluation
Intervention effectiveness will be measured by comparing pre-and post-intervention data.
Dissemination
The findings will be shared with the broader community through public meetings,
professional health forums, and publication in peer-reviewed medical journals to inform policy
and practice further.
Conclusion and Contribution to the Nursing Profession
7
This result is expected to provide valuable insight into community-based educational
interventions for managing type 2 diabetes among the elderly. Therefore, the study should be
applicable across a wide implementation based on the proven effectiveness of community-based
educational interventions and, consequently, prove useful in diabetes management strategies in
response to the needs of the elderly in similar rural settings.
References
Davidson, P., Dickinson, J. K., Hyer, S., LaManna, J., Davis, J., Ojeda, M. M., & Kavookjian, J.
(2022). A comprehensive analysis of randomized controlled trials examined for people
with type 1 diabetes. 48(2), 111–135, The Science of Diabetes Self-Management and
Care.
8
Mastrian, K., and D. McGonigle (2024). Nursing informatics and the knowledge base. Learning
by Jones & Bartlett.
.
Tsai, P. S., Van Truong, P., Lin, M. Y., Chiu, H. Y., & Wulan Apriliyasari, R. (2021). Effects of
self-management programs on medication adherence, blood pressure, self-efficacy, and
body mass index in older individuals with hypertension: a meta-analysis of randomized
controlled trials. 27(2) of the International Journal of Nursing Practice, e12920.
Salassa, M., Barutta, F., Gruden, G., Trento, M., Fornengo, P., Amione, C., & Porta, M. (2020).
Education on self-management has the potential to lower blood pressure in type 2
diabetics. a controlled, randomized clinical experiment. 30(11), 1973–1979; Nutrition,
Metabolism, and Cardiovascular Diseases.
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