NURS FPX 6011 Assessment 3 Implementing Evidence-Based Practice

Name

Capella university

NURS-FPX 6011 Evidence-Based Practice for Patient-Centered Care and Population Health

Prof. Name

Date

Implementing Evidence-Based Practice

Clinical Background

Diabetes Mellitus (DM) is a significant global health issue, marked by insulin resistance and a relative deficiency of insulin. This problem is also predominant in our healthcare organization, Saint Mary’s Medical Center in Huntington, West Virginia (WV). Poor management of DM has resulted in numerous complications, such as cardiovascular diseases, neuropathy, nephropathy, retinopathy, and an increased risk of infections. Despite the presence of evidence-based guidelines and various treatment options, effective DM management remains insufficient in our healthcare setting.

In WV, the American Diabetes Association (ADA) reports that approximately 227,400 adults, and 15.8% of the adult population, are affected by diabetes, with about 8,500 new cases each year. The state suffers about $1.67 billion annually in direct medical expenses related to diabetes (ADA, 2024). Several factors contribute to the inadequate management of DM, including insufficient patient education, limited access to healthcare services, medication non-adherence, and unhealthy lifestyle choices. Additionally, healthcare providers face challenges in implementing guideline-recommended care due to time constraints, opposing priorities, and limited resources (Al-Qerem et al., 2021).

PICOT Question

The challenges we face prompt us to focus on a pivotal question that will guide our future strategies and initiatives. The PICOT question is:

“In adult patients with DM (P), does telehealth educational session on dietary modifications and behavioral support (I), compared to standard care alone (C), regulate glycemic control (O) over six months (T)?”

This question aims to evaluate the effectiveness of telehealth-based lifestyle management training programs in managing diabetes compared to standard care, which primarily relies on medication. By evaluating the effects of adopting healthier lifestyle habits, such as increased physical activity and behavioral support, we can determine the efficacy of a non-pharmacological approach in managing DM. This will provide us with valuable insights into preventing complications associated with elevated glycemic levels in adults with DM (Gal et al., 2020).

Action Plan to Implement the Evidence-Based Project

To address the challenge of poorly managed diabetes cases in our organization, I have devised an evidence-based action plan to enhance diabetes management among adults. This action plan includes the following proposals for practice changes within our organization:

• Dietary Modifications: Facilitate personalized dietary counseling with a registered dietitian to educate patients on nutritious eating habits, portion control, and carbohydrate management. Provide resources like meal planning guides, recipe collections, and educational materials on nutrition for effective diabetes management (Dobrow et al., 2022).
• Increased Physical Activity: Develop customized exercise plans personalized to each patient’s fitness level, preferences, and medical history. Offer guidance on integrating aerobic exercises, strength training, and flexibility routines into daily activities (Cornely et al., 2022).
• Behavioral Support: Implement Cognitive-Behavioral Therapy (CBT) and Motivational Interviewing (MI) sessions to address psychological obstacles and encourage behavior change. Establish support groups and peer mentoring programs to build social support, accountability, and motivation. Utilize self-monitoring tools such as food diaries, activity trackers, and glucose records to enhance awareness (Cornely et al., 2022).

Proposed Timeline for Implementation

The proposed schedule for implementing recommended practice changes is as follows:

• Months 1-2: Develop telehealth-based educational resources and conduct training sessions for healthcare providers on comprehensive lifestyle interventions.
• Months 3-4: Identify adult patients diagnosed with DM and arrange initial evaluations for personalized dietary counseling, physical activity plans, and behavioral support.
• Months 5-6: Implement personalized lifestyle interventions for enrolled patients, ensuring regular follow-up appointments and adjustments to treatment plans as needed. 

Tools or Resources Required

• Dietitian Services: Provide telehealth-based educational sessions on dietary counseling and expert nutrition education (Gal et al., 2020).
• Educational Resources: Develop materials covering nutrition, physical activity, and behavioral strategies for patient learning (Werfalli et al., 2020).
• Exercise Facilities: Provide access to equipment and places for organized exercise sessions through telehealth-based training programs.
• Health Coaching Resources: Offer training and materials for healthcare providers to aid in behavior modification and goal-setting (Werfalli et al., 2020).
• Self-Tracking Instruments: Provide patients with resources for self-assessment, such as food journals, mobile applications like MySugr, activity monitors, and glucose meters. (Gal et al., 2020).
• Peer Support Programs: Support groups and mentoring programs are designed to provide social encouragement and motivation (Werfalli et al., 2020)

With a pivotal role in this action plan, every component is ensured to be achievable and practical to execute. Patients can receive on dietary adjustments and physical activity through the collaborative efforts of dietitians and fitness experts, utilizing telehealth devices such as the MySugr app. Furthermore, each aspect of this action plan is supported by significant evidence from research, making them valuable and realistic choices (Sherazi et al., 2022).

Stakeholders, Innovation Opportunities, and Potential Barrier

Stakeholders Impacted

Implementing the diabetes health improvement action plan in our hospital will impact various stakeholders. Adults diagnosed with diabetes will participate in the intervention and adopt lifestyle changes aimed at improving their health outcomes. They are expected to benefit from improved glycemic control and reduced complications associated with diabetes, such as infections, retinopathy, and peripheral neuropathy (Adhikari et al., 2021).

 Healthcare providers include physicians, nurses, dietitians, and exercise physiologists who are responsible for delivering lifestyle interventions. They utilize telehealth-based training sessions, employing platforms such as MySugr to provide education on dietary adjustments and physical activity (Sherazi et al., 2022). Administrations in the local community collaborate with the hospital to support behavioral treatment, patient education, access to healthy foods, and opportunities for physical activity (Adhikari et al., 2021).

Areas Ripe for Innovation

The project planned for adults in WV with diabetes in our hospital setting presents several opportunities for innovation. Firstly, integrating technology into the intervention improves patient engagement and monitoring. This includes utilizing mobile apps and patient portals to track dietary intake, physical activity, and glucose levels, offering real-time feedback and personalized guidance (Sharma et al., 2022). Additionally, leveraging telehealth platforms broadens access to counseling and support services.

This is feasible for patients with limited mobility and living in remote areas, aiming to prevent diabetes complications and ensure consistent management (Sharma et al., 2022). Lastly, collaborating with community partners like the ADA and integrating community resources extend the intervention’s impact outside hospital boundaries. Ultimately, this approach promotes a comprehensive strategy for managing diabetes that addresses broader health determinants. Embracing innovation in these domains has the potential to significantly improve patient outcomes of WV and revolutionize diabetes care delivery within our hospital setting (ADA, 2024). 

Potential Barrier

Several potential barriers affect the implementation of the outlined project for adults with diabetes in a hospital setting. A significant issue involves the need for enhanced knowledge and awareness among healthcare providers regarding educational sessions, lifestyle interventions, and their evidence-based components. By receiving adequate training and education in nutrition counseling, exercise prescription, and behavioral support techniques, healthcare providers can deliver interventions to patients through telehealth platforms (Shi et al., 2020).

Additionally, time constraints within the hospital environment present obstacles to fully implementing the intervention. Furthermore, technology barriers can impede the successful implementation of telehealth interventions. These barriers include limited access to reliable internet connections, a need for familiarity with telehealth tools among both patients and providers and potential resistance to adopting new technologies. Healthcare providers face challenges in allocating sufficient time for patient education, counseling sessions, and follow-up visits due to their demanding schedules (Shi et al., 2020). 

Limited proficiency in areas such as health coaching and behavior change techniques delay providers’ ability to engage and motivate patients. Furthermore, challenges related to motivation and support from healthcare providers and hospital administrators impede project implementation. With adequate support and commitment from key stakeholders, including leadership, frontline staff prioritize and sustain the intervention. Lastly, constraints on resources, such as budgetary limitations and a lack of access to necessary equipment and materials, could pose significant barriers to delivering the intervention effectively (van Zyl et al., 2021).

Specific Actions to be Taken 

To overcome these potential obstacles, proactive measures are essential. It includes training and education, efficient workflow integration, planned engagement of stakeholders, and resource allocation to ensure project implementation. Comprehensive training programs for healthcare providers in nutrition counseling, exercise prescription, and behavior change techniques will equip them with the necessary knowledge and skills to deliver interventions (van Zyl et al., 2021). Optimizing workflows within the hospital setting will maximize efficiency in utilizing time and resources and integrating the intervention into existing clinical practices without disrupting patient care.

Engaging key stakeholders such as healthcare providers, hospital administrators, patients, and community partners throughout the planning and implementation phases will build support, address concerns, and foster collaboration. Adequate allocation of resources, including personnel, equipment, and materials, is crucial to support the implementation and long-term sustainability of the intervention. This ensures that healthcare providers have the necessary tools to deliver exceptional care to patients with diabetes (Adhikari et al., 2021).

Outcome Criteria and Measurement for the Evidence-Based Practice Project

Measuring Outcome Criteria

Healthcare providers can measure and evaluate specific outcome criteria to measure the effectiveness of a diabetes health improvement action plan. Screening tests are used to monitor HbA1c levels initially and regularly throughout the intervention. A significant decrease from baseline signifies enhanced glycemic control and better diabetes management (Sim & Lee, 2021). Assessing patient-reported adherence to dietary changes and physical activity recommendations through validated surveys. Increased adherence to nutritional guidelines and suggested physical activity levels, reflecting improved self-reported behaviors (Sim & Lee, 2021).

Following hospital admissions related to diabetes complications through electronic health records and administrative databases. A decrease in admissions for diabetes-related issues indicates improved disease management and prevention of acute exacerbations. Evaluate patient perceptions of the intervention’s effectiveness and relevance through satisfaction surveys and feedback forms. Positive responses on satisfaction surveys indicate high levels of patient satisfaction engagement and insight into the intervention (Dobrow et al., 2022).

Outcomes Alignment with the Quadruple Aim

The Quadruple Aim framework aligns with the proposed PICOT question, emphasizing cost reduction, healthcare provider well-being, and improved patient outcomes. The PICOT question focuses on telehealth educational sessions on dietary modifications and behavioral support that can regulate glycemic control over six months compared to standard care alone in adult patients with DM in a primary care setting of WV (Haverfield et al., 2020). The intervention aims to enhance patient health outcomes and satisfaction by improving glycemic control, leading to better health and reduced complications.

By incorporating telehealth, the intervention promotes accessible and continuous patient education and support, optimizing healthcare delivery by allowing providers to reach more patients without the constraints of physical appointments. This method addresses cost reduction by preventing complications and reducing hospital readmissions, lowering healthcare costs (Sherazi et al., 2022). Additionally, telehealth alleviates time constraints faced by healthcare providers, allowing them to manage their time more, reducing burnout, and improving their well-being. The effectiveness of this evidence-based practice project demonstrates that these outcomes can guide the development of evidence-based guidelines and policies in diabetes management (Sherazi et al., 2022).

Search Strategies and Databases

Evidence-based approaches were employed to develop our hospital’s project on managing DM, involving a precise search strategy to gather relevant literature and information. This strategy covered accessing various electronic databases such as PubMed, MEDLINE, CINAHL, and the Cochrane Library. These databases facilitated the retrieval of peer-reviewed articles, systematic reviews, meta-analyses, and clinical practice guidelines relevant to interventions in diabetes management. Key search terms like “diabetes mellitus,” “diabetes management,” “lifestyle interventions,” “glycemic control,” and “hospital setting” were utilized to refine the search results effectively. Additionally, we manually examined the reference lists of identified articles and pertinent journals to ensure comprehensive coverage of the literature.

The search strategy adhered to predefined inclusion and exclusion criteria, focusing specifically on studies conducted in hospital settings involving adult patients with diabetes mellitus and assessing lifestyle interventions aimed at enhancing glycemic control and associated outcomes (Al-Qerem et al., 2021). The evidence-based resources used to develop the improvement plan project are pertinent and valuable to experience critical appraisal during research. Each resource’s relevance and utility were assessed using the CRAAP criteria, which evaluate Currency, Relevance, Accuracy, Authority, and Purpose (Ali et al., 2023). For instance, resources from the ADA are current and endorsed by medical experts, and they provide relevant insights into DM in WV (ADA, 2024).

NURS FPX 6011 Assessment 3 Implementing Evidence-Based Practice

Similarly, journal articles selected for their relevance to the PICOT question focused on interventions such as nutritional strategies, increased physical activity, and behavioral support for adults with DM. These articles emphasize the importance of collaboration among interprofessional teams, including nutritionists, physical therapists, and support groups, to offer a comprehensive approach to diabetes care (Pasquel et al., 2021). The findings advocate for integrating non-pharmacological methods like lifestyle adjustments and self-management to prevent diabetes complications. This evidence forms a robust foundation for our proposed health improvement action plan for adults with DM at our hospital, ensuring a practical approach to enhancing patient care and outcomes (Pasquel et al., 2021).

Summary of Findings

According to the study by Dobrow et al. (2022), telehealth dietary counseling significantly improved glycemic control by providing regular interactions with dietitians, which helped patients adhere to their dietary plans more effectively. Cornely et al. (2022), showed that structured exercise plans enhanced physical activity and diabetic health outcomes by motivating patients to stay active and manage their blood sugar levels. The effectiveness of telehealth behavioral support, including CBT and MI sessions, in overcoming psychological barriers and promoting behavior change, leading to better diabetes management (Sherazi et al., 2022).

References

ADA. (2024). The burden of diabetes in West Virginia. diabetes.org. https://diabetes.org/sites/default/files/2024-03/adv_2024_state_fact_west_virginia.pdf

Adhikari, M., Devkota, H. R., & Cesuroglu, T. (2021). Barriers to and facilitators of diabetes self-management practices in Rupandehi, Nepal- multiple stakeholders’ perspective. BMC Public Health, 21(1). https://doi.org/10.1186/s12889-021-11308-4

Ali, S. M., Bakht, Jan, Alam, I., Almajwal, A., Osaili, T. M., Obaid, Faris, M. E., Ismail, L., Najah, F., Radwan, H., Hasan, H., Hashim, M., Sharifa AlBlooshi, Bismillah Sehar, & Zeb, F. (2023). An innovative state-of-the-art health storytelling technique for better management of type 2 diabetes. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1215166

NURS FPX 6011 Assessment 3 Implementing Evidence-Based Practice

Al-Qerem, W., Jarab, A. S., Badinjki, M., Hyassat, D., & Qarqaz, R. (2021). Exploring variables associated with medication non-adherence in patients with type 2 diabetes mellitus. PLOS ONE, 16(8). https://doi.org/10.1371/journal.pone.0256666

Cornely, R. M., Subramanya, V., Owen, A., McGee, R. E., & Kulshreshtha, A. (2022). A mixed-methods approach to understanding the perspectives, experiences, and attitudes of a culturally tailored cognitive behavioral therapy/motivational interviewing intervention for African American patients with type 2 diabetes: A randomized parallel design pilot study. Pilot and Feasibility Studies, 8(1). https://doi.org/10.1186/s40814-022-01066-4

Dobrow, L., Estrada, I., Cooley, N., & Miklavcic, J. (2022). Potential effectiveness of registered dietitian nutritionists in healthy behavior interventions for managing type 2 diabetes in older adults: A systematic review. Frontiers in nutrition, 8. https://doi.org/10.3389/fnut.2021.737410

Gal, R. L., Cohen, N. J., Kruger, D., Beck, R. W., Bergenstal, R. M., Calhoun, P., Cushman, T., Haban, A., Hood, K., Johnson, M. L., McArthur, T., Olson, B. A., Weinstock, R. S., Oser, S. M., Oser, T. K., Bugielski, B., Strayer, H., & Aleppo, G. (2020). Diabetes telehealth solutions: Improving self-management through remote initiation of continuous glucose monitoring. Journal of the Endocrine Society, 4(9). https://doi.org/10.1210/jendso/bvaa076

Haverfield, M. C., Tierney, A., Schwartz, R., Bass, M. B., Brown-Johnson, C., Zionts, D. L., Safaeinili, N., Fischer, M., Shaw, J. G., Thadaney, S., Piccininni, G., Lorenz, K. A., Asch, S. M., Verghese, A., & Zulman, D. M. (2020). Can patient–provider interpersonal interventions achieve the quadruple aim of healthcare? A systematic review. Journal of General Internal Medicine, 35(7), 2107–2117. https://doi.org/10.1007/s11606-019-05525-2 

NURS FPX 6011 Assessment 3 Implementing Evidence-Based Practice

Pasquel, F. J., Lansang, M. C., Dhatariya, K., & Umpierrez, G. E. (2021). Management of diabetes and hyperglycaemia in the hospital. The Lancet Diabetes & Endocrinology, 9(3), 174–188. https://doi.org/10.1016/s2213-8587(20)30381-8

Sharma, V., Feldman, M., & Sharma, R. (2022). Telehealth technologies in diabetes self-management and education. Journal of Diabetes Science and Technology, 18(1). https://doi.org/10.1177/19322968221093078

Sherazi, B., Laeer, S., Krutisch, S., Dabidian, A., Schlottau, S., & Obarcanin, E. (2022). Functions of mHealth diabetes apps that enable the provision of pharmaceutical care: Criteria development and evaluation of popular apps. International Journal of Environmental Research and Public Health, 20(1), 64. https://doi.org/10.3390/ijerph20010064

Shi, C., Zhu, H., Liu, J., Zhou, J., & Tang, W. (2020). Barriers to self-management of type 2 diabetes during COVID-19 medical isolation: A qualitative study. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Volume 13, 3713–3725. https://doi.org/10.2147/dmso.s268481

Sim, R., & Lee, H. (2021). Patient preference and satisfaction with the use of telemedicine for glycemic control in patients with type 2 diabetes: A review. Patient Preference and Adherence, 15, 283–298. https://doi.org/10.2147/ppa.s271449

van Zyl, C., Badenhorst, M., Hanekom, S., & Heine, M. (2021). Unravelling “low-resource settings”: A systematic scoping review with qualitative content analysis. BMJ Global Health, 6(6), e005190. https://doi.org/10.1136/bmjgh-2021-005190

Werfalli, M., Raubenheimer, P. J., Engel, M., Musekiwa, A., Bobrow, K., Peer, N., Hoegfeldt, C., Kalula, S., Kengne, A. P., & Levitt, N. S. (2020). The effectiveness of peer and community health worker-led self-management support programs for improving diabetes health-related outcomes in adults in low- and-middle-income countries: A systematic review. Systematic Reviews, 9(1). https://doi.org/10.1186/s13643-020-01377-8