A DNP prepared nurse
Section 2: Background and Context
Introduction
DM2 refers to a chronic disease resulting in short- and long-term effects on the patient, affecting disease progression and quality of life. According to ADA (2015), chronic hyperglycemia in DM2 may result in organ damage, loss of function, and affect an individual’s quality of life. To help reduce chronic hyperglycemia, there is a need for nurses in primary care settings to have the right education to effectively and efficiently benefit the DM2 patients. This is through self-management methods to help their patients. The lack of understanding by patients leads to chronic hyperglycemia, and thus the DM2 patients need further teaching and consistent follow up about their disease management. Therefore, the practice question for the project is: To what extent an educational program will provide primary care staff with the knowledge and skills needed to help DM2 patients manage chronic hyperglycemia?
Concepts, Models, and Theories
According to Wayne (2020), theories provide a reasoning or logical justification for nursing interventions. Theories provide nurses with the understanding and support essential for performing and acting suitably in nursing care situations.
Diabetes Self-Care Management
According to Azami et al. (2018), the Nurse-led DSME program improved lifestyle, psychological and clinical results. The intervention group showed a remarkable improvement in efficacy expectations—body weight, self-management behavior, glycemic control, social support, result expectation, and glycemic control. According to Mogre et al. (2019), barriers prevent healthcare providers from providing self-care support to diabetes patients. He stated that healthcare providers’ attitudes were generally favorable towards supporting self-care, although focusing on information provision rather than behavior change. Johnson et al. (2016) stated that nurse follow-up and notification are a clinically efficient technique than usual care. Still, there is a need to invest more resources in collaborative care to yield a more cost-effective strategy.
Impact of DSME on Quality of Life
Assessment of DSME as a significant factor impacting the quality of life of people with T2D is vital. According to Mardanian & Abdoli (2017), it’s crucial to evaluate the effectiveness of DSME programs based on the experience of those taking part in the plans. The current technique for DSME does not meet the needs and expectations of patients with dementia in reference to an Iranian study on the DSME program. Thus, there is a need for DSME improvements in terms of interactive teaching techniques, needs evaluation, multidisciplinary model, physical space needs, and technology (Mardanian & Abdoli, 2017).
Tools for Primary Care Nurses
According to a systematic review by Pamungkas et al. (2017), there is a need for the family to take part in a nurse-led DM2 DSSME program to offer total support to the DM2 patients whenever they start portraying negative behaviors toward glycemic control. The review found that DSME techniques that involve family were identified as essential in enhancing self-care management.
The technology usage such as smartphone could serve as an effective goal setting and reminders for patients as a positive resource for DSME. MyNetDiary (2020) provides an easy and comprehensive blood glucose (BG) tracking. Multiple readings can be entered per day, specifying the time and optional notes. The app provides built-in BG reminders for patients through a sound and popup as a notification, which allows a quick jump to the BG entry mode. MyNetDiary Diabetes and Diet Tracker for Android has similar core set features as the iPhone app.
Social Determinants and DSME
The social determinants of health (SDH) consider the social, economic status, education, location, health inequalities, resources, and other factors of the individual. According to Cockerham et al. (2017), perceived discrimination is a prominent SDH for members of racial, ethnic, gender, or other minority groups. The article further claims that the debate over whether or not social factors are fundamental causes of health and disease is essentially over. Thus, individual patients are affected depending on their experience, circumstance, and unique social issues.
Chronic Care Model (Wagner)
The Chronic care model (CCM) was developed to provide chronic disease patients. Including those with DM2, with forms of self-care through collaborations and tracking systems. The CCM embodies a process for streamlining healthcare through collaborations between health systems and communities. Additionally, the model gathers essential information that can be used for enhancing treatment in health systems at the community, clinical practice, and patient levels. DM2 has no cure and can quickly become chronic when not correctly cared for.
Bandura Theory of Learning
According to Bandura, observation alone may not be sufficient to incur maximum learning; thus, an individual’s motivation and mental state also influence learning. Therefore, he asserts that observation plays a crucial role in education since it teaches learners and aids them in successfully understanding, retaining, and applying to their lives so that they can learn and accomplish more. This social theory applies to the Nursing teaching the patients self-management care through ensuring they observe and regularly imitate what they do while administering treatment in the primary care centers. This will help patients be able to carry out the same procedures on themselves hence enhancing self-care management.
Adult Learning Theory
According to Institutional Design (2020), Knowles’ theory of andragogy is an attempt to develop an approach specifically for adult learning. It emphasizes that adults are self-directed and expect to take responsibility for decisions. Andragogy makes assumptions that: adults need to know why they need to learn something; adults need to learn experientially, adults approach learning as problem-solving, and adults learn best when the topic is of immediate value. Thus, the clear implication of Knowles’s theory that learning to manage their disease and prevent the long-term complications of DM2 can be a very compelling reason with patients being able to appreciate the immediate value.
Relevance to Nursing Practice
The DNP is an educational project providing nursing staff with instructions on how they should teach patients about their disease and self-care management. This will reduce the prevalence of hyperglycemia and damage to various organs resulting from DM2 in adults. A DNP prepared nurse is relevant on the regular follow up basis to effect the necessary change. This will be done by educating the nursing staff how to teach patients to understand their disease and be part of their care. Nursing is responsible for preparing patients, follow up with them, and direct them to the resources they need to be at their optimum.
Local Background and Context
According to the DM2 Research Institute Foundation (DRIF) (2019), there are approximately 30.3 million people in the U.S with DM2 0r 9.4%, with new cases estimated at 1.5 million in adults older than 18 years of age. Patients with DM2 often develop a peripheral vascular disease that results in short- and long-term consequences. This DNP project will be done at a primary care center with 70% DM patients, 45% of whom are DM2. The nursing staff will receive the education that they would adopt when teaching patients with DM2.
Role of DNP Student
The DNP is responsible for developing the proposed teaching and education to the healthcare staff at the primary care center. To achieve a social change, the DNP will create a plan that will teach health care providers at this clinic how to educate DM2 patients to self-manage.
Role of Project Team
Education will be given to five staff members (two RNs, one LPN, one medical assistant (MA), and one nurse practitioner) at the primary care site to provide a role-specific educational process with coaching. The unique knowledge will be communicated with the nursing staff who will begin the teaching, and then the NP will reinforce this education and everything the patient needs to know about their disease.
Summary
According to Mogre et al. (2019), diabetes is one of the most occurring diseases worldwide, increasing from a prevalence of 366 million adults in 2011 to 425 million in 2017. Rochfort et al. (2018) shared that patient self-management help is established as a critical element of chronic care. Teaching and instruction for health experts have been shown in the literature to be correlated with better uptake, application, and success of self-management programs.
A DNP prepared nurse is relevant to come in at this time to impact he required change. This will be done by educating the nursing staff how to teach patients to recognize their disease as part of their care. The use of technology, such as smartphones, could be a useful goal setting reminder for patients as a positive resource for DSM.