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Type 2 Diabetes Patients’ Lack of Proper Education

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Lack of proper education on patient with type 2 diabetes

Locating the Best Evidence

Often, type 2 diabetes patients lack proper education mainly because of the different barriers that they face as well as the receiving education that lacks a proper algorithm. Therefore, there is a great need for these measures to be acted upon so that the patients can realize more positive outcomes. Mshunqane, Stewart and Rothberg (2012) indicated that diabetes type 2 is associated with numerous complications, many of which can cause death if not managed appropriately.

In addition to this, at the worldwide level, the disease is acknowledge as a main challenge that nags the policymakers each day. There is presently some staggering statistics of the increasing prevalence as well as the linked economic and health impact.

Further, the World Economic Forum, World Health Organization, as well as the United Nations recognize the challenge. All these bodies suggest for collective dedication to improve the life quality of the patients as well as prevent the disease. They are clear that the challenge is universal, urgent, and critical. There is also the acknowledgment that the disease is serious for two main reasons (Stults-Kolehmainen & Sinha, 2014).

First is the health impacts linked to it which are more critical including increased likelihood for lower limb amputations, blindness, heart attacks, kidney failure, as well as stroke. Second, there are indirect and direct costs which are a major drain on the healthcare budgets as well as productivity.

The issue is very urgent considering that its prevalence is rising. Moreover, managing the complications associated with the disease is very costly, same as incorporating appropriate measures to ensure that the patients lead a high quality and independent life. The mentioned bodies also agree that proper education is one of the strategies through which the disease can be prevented and managed efficiently.

However, there are a number of barriers that prevent this and the education algorithm normally used is inappropriate. Therefore, this systematic review will aim at finding information suggesting the appropriate algorithm as well as the common barriers as well as how they can be addressed.

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Methods

Search strategy

Peer-reviewed academic journals will be sought from different databases, and these will be used to conduct the systematic review (Lee et al., 2013). The intention will be creating a proper algorithm on diabetes type 2 education, as well as identify some of the barriers to proper education and how they can be addressed. The databases to be used for the systematic review are CENTRAL, Social Science Citation Index, Science Citation Index, PSYCLinfo, Medline, ERIC, and CINAHL.

The references to the articles that were selected were also evaluated for leads. Reading the reviews was necessary as it helped identify if the article was appropriate. In relation to the inclusion criteria, there was selection of articles that were not older than five years. Particularly, there was selection of those discussing the barriers to proper diabetes type 2 education and their solutions, and those discussing proper education standards (Kapoor & Kleinbart, 2012).

Critically Analyzing the Evidence and Synthesis

Proper education algorithm

Type 2 diabetes education preventive measures will be informed to all the people through local barazas. This would ensure that all people engage in appropriate lifestyles to prevent the disease. Cultural competent educators, and those with proper listening and communication skills will be used to offer the education so that no one can be left behind (Garber, Gross & Slonim, 2010).

It will be necessary to educate the patients on all aspects of the disease including the causes, risk factors, predisposing factors, preventive strategies, available treatments, and management. In addition, awareness on how a patient can ensure self-care should be offered, same as the complications and the direct and indirect costs that a family can suffer because of the disease.

Moreover, the educator should go into details when elaborating on the preventive measures including the diet and physical activity. The more the patients and all people know about the disease and how it is connected to other chronic conditions, the more efficiently they can engage in self-care (Green, 2014).

Barriers and addressing them
for patients to be able to receive the recommended type 2 diabetes education, they should really be concerned about their healthcare and ready to access or seek quality medical education. However, because of the ignorance some patient have, they prefer using over-the-counter medications or seeking traditional medicine men. They never seek the quality healthcare services because of their ignorance and low socioeconomic backgrounds.

Therefore, even the use of preventive services among these patients is very minimal. To address this, the local authorities will be given a chance to mobilize people from their living areas, so that education can start at the grassroots level before even being offered at the healthcare institution (Zoepke & Green, 2012).

In addition, there are many elderly people suffering from type 2 diabetes and with hearing, memory, and vision challenges. These will be offered the education in the presence of caregivers who can assist them around (Chijioke, Adamu &Makusidi, 2010).

Feasibility, Benefits, and Risks

Feasibility

The project of delivering proper education to the type 2 diabetes, patients is feasible, especially if the most appropriate education is being delivered, with a consideration of the personal factors, and if the barriers that might hinder the education have been considered and measures to address these put in place. Healthcare providers would only need to offer patients attending the institution for medical care services the pamphlets containing all the necessary information.

However, when dealing with type 2 diabetes patients, it would be necessary to find out first what they already know and later creating awareness while dispelling the misconceptions. This would be relatively cheap. It would also be necessary to explore other factors that affect individual patients so that advice can be offered (Rosenstock & Owens, 2008).

Barriers

After proper education is offered and the barriers to it addressed, some patients might still lack the funds to purchase even the affordable local foods. Considering that some patients might be elderly, there might be issues such as improper vision, hearing loss, and memory loss, which might influence practice of the education.

Benefits

Ensuring that the patients are receiving proper education and implementing it is essential in that it can go a long way in reducing the high prevalence of the disease, preventing complications, reducing the high costs needed to treat and manage the condition, as well as the losses related to loss of productivity and need for a higher quality of life (Ruffin, 2016).

Risks

Some of the anticipated risks include limited resources to ensure that adequate and proper education on type 2 diabetes is being delivered to the patients (Valencia &Florez, 2014). In addition, there might be absence of cultural competence professionals to deal with patients from different backgrounds. In addition, tracking the patients at their homes to ensure that they are implementing the proper education appropriately can be difficult and costly.

References

Chijioke, A., Adamu, A. N., &Makusidi, A. M. (2010). Mortality patterns among type 2 diabetes mellitus patients in Ilorin, Nigeria : original research. Journal of Endocrinology, Metabolism and Diabetes in South Africa, 15, 2, 79-82.

Garber, J. S., Gross, M., & Slonim, A. D. (2010). Avoiding common nursing errors. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Green, B. (June 06, 2014). Diabetes and diabetic foot ulcers : an often hidden problem : review. Sa Pharmacist’s Assistant, 14, 3, 23-26.

Kapoor, B., & Kleinbart, M. (2012). Building an Integrated Patient Information System for a Healthcare Network. Journal of Cases on Information Technology (jcit), 14, 2, 27-41.

Lee YK, Ng CJ, Lee PY, Khoo EM, Abdullah KL, Low WY, Samad AA, Chen WS, & Lee, Yew Kong. (2013). What are the barriers faced by patients using insulin? A qualitative study of Malaysian health care professionals’ views. Dove Press.

Mshunqane, N., Stewart, A. V., & Rothberg, A. D. (January 01, 2012). Type 2 diabetes management : patient knowledge and health care team perceptions, South Africa : original research. African Primary Health Care and Family Medicine, 4, 1, 1-7.

Rosenstock, J., & Owens, D. (January 01, 2008). Treatment of Type 2 Using Insulin: When to Introduce?.

Ruffin, T. R. (January 01, 2016). Health Information Technology and Change.

Stults-Kolehmainen, M. A., & Sinha, R. (January 01, 2014). The Effects of Stress on Physical Activity and Exercise. Sports Medicine, 44, 1, 81-121.

Valencia, W. M., &Florez, H. (January 01, 2014). Pharmacological treatment of diabetes in older people. Diabetes, Obesity & Metabolism, 16, 12, 1192-203.

Zoepke, A., & Green, B. (January 01, 2012). Diabetes and diabetic foot ulcers : an often hidden problem : general review. Wound Healing Southern Africa, 5, 1, 19-22.

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Weight Management for Overweight/Obese Children: Parents Take Charge (PTC)

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Weight Management for Overweight/Obese Children: Parents Take Charge (PTC)

Abstract

This proposal is designed to halt the increasing rate of childhood obesity. Modifications in nutrition, behavior and physical activity are well documented to produce successful outcomes for obesity with the main change agent being the individual. Due to the complexities of childhood obesity, an intervention that includes proven elements that prevent obesity and addresses the special factors that affect children is needed.

Parents Take Charge (PTC) is a multi-component family-based childhood obesity intervention that includes modification in nutrition, behavior and physical activity, but focuses on the parent(s) being the primary change agent for the child, age 10-13 years. Addressed in this evidenced-based proposal are the assessment of need, an analysis of best evidence, design aspects, implementation, evaluation, integration and maintenance of the practice change in a primary care setting.

The focus of the intervention is to teach healthy lifestyle behaviors to the child through parental involvement instead of focusing on weight reduction as the primary outcome.

Weight Management For Overweight/Obese Children: Parents Take Charge (PTC)

Quality care can be defined as appropriately identifying, evaluating, diagnosing and treating patients. The term quality in healthcare is correlated to professional knowledge and desired health outcomes (Institute of Medicine, 2012). It is also defined as being closely associated with patient safety (Mitchell, 2008). Clinical excellence is the goal of providing quality care. The process for achieving clinical excellence includes patient-centered care.

The patient is the focus and includes their concerns regarding their illness, values, beliefs and support network. Making the patient an active participant in their health care results in informed decision-making by the patient. Autonomy, nonmalfeasance, beneficence, justice and fidelity are ethical principles that are addressed as definitions of providing quality care and achieving excellence in primary care.

America Nurses Association, American League of Nursing, and Center for Applied and Professional Ethics are organizations that set guidelines for excellence (Stanley, 2011). Quality and excellence in a clinical site is achieved through appropriate, comprehensive and timely care.

Examples of methods of providing clinical excellence include providing evidence-based treatment, the timely manner in which patients are seen from when they sign in, the offer of generics versus brand-name medications, patient education, open dialogue with patients and referrals to specialist as needed. Ethical considerations taken in account are the patient’s autonomy. The patient is provided information for full understanding of their illness, evaluation, treatment and alternative treatments so that the capability for informed decision-making is established.

Guidelines for the prevention, identification, assessment and management of overweight and obesity in adults and children include how to assess whether people are overweight or obese; what should be done to help people lose weight; how to care for people who are at risk due to their weight and how to help people improve their diets and increase their physical activity (The National Institute for Health and Clinical Excellence NHS, 2012).

The intention of this paper is to present an evidence-based project (EBP) proposal for childhood obesity. Included in this paper is assessing the need for change in practice, appropriate theoretical models and frameworks, statement of problem, intervention, goals, systematic review of current research and design. Assessing the need for change in practice consists of identifying stakeholders, collecting internal data about current practice, comparing external data with internal data, identifying the problem and linking the problem with interventions and outcomes (Larrabee, 2012).

Step 1: Assessing the Need for Change in Practice

Stakeholders

The first step for the model of evidenced-base change is assessing the need for change in practice. To facilitate this, identification of stakeholders is needed. The target population is children, age 10-13 years and their families. Final decisions to change behaviors lies with the children, but parents have great influences over the young child’s meals, snacks and physical activities.

Participating parents therefore, will be the change agent, adding them to the list of stakeholders. Parents make informed decisions regarding the health of their children with the help of a primary healthcare provider (Burns, Dunn, Brady, Starr, & Blosser, 2013). Primary healthcare providers or nurse practitioners (NPs) are stakeholders that will assist in facilitating and implementing change.

Barriers to Change

Barriers for children’s outcomes include their maturity level; ability to understand or commit to the program and their parents, if they are reluctant to participate. The primary barrier to change is participation of the parents. Physical activity and dietary behaviors will need modification in and out of the home. Without the participation of the parents the goal for long lasting results will not occur.

Barriers for the parents include health literacy level; language, if the primary language is not English and attitudes towards modifying foods and physical activity. Another barrier is the participant’s adherences to the nutritional guidelines provided because diet plans do not include the cultural foods that the family consumes.

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Facilitators to Change

Facilitators to change include support from their primary care provider or NP that the participants know and trust, educational classes that will be designed to meet their family’s cultural and specific needs and physical activities that can be done as a family that includes utilizing the workout facilities and pool in the local gym.

Internal Data

Internal data (date retrieved within Porterville Valley PromptCare Medical Center) provides overweight/obesity information that is defined by height, weight, body mass index (BMI), frequency of physical activity and anthropometric measurements of children in rural Tulare County, California.

External Data

External data (data retrieved outside of Porterville Valley PromptCare Medical Center) include the following (Ogden, Carroll, Kit & Flegal, 2012; California Center for Research on Women & Families, 2011):

a). Approximately 31.8 percent of children and adolescents aged 2—19 years are obese in the United States

b). Approximately 1 in 3 (33.2 percent) of children and adolescents age 6 to 19 years are considered to be overweight or obese in the United States

c). An estimated 30.5% of children and adolescents aged 10-17 years are presently overweight or obese in California

d). The total percentage of overweight and obesity from 1999 to 2009 rose from 34.0% to 37.6% for 9-11 year olds in California

e). For teens ages 12-17 years in California, African American youth had the highest percentage of overweight/obesity (39.9%), followed by Latinos (29.4%), Asian/other (18.0%) and white youth (12.0%)

Internal data presents an estimated 30% of the children seen in Porterville Valley PromptCare Medical Center are overweight or obese. When comparing Internal data and External data a change in practice is needed to prevent the incidence of childhood obesity from continuing to grow at an alarming rate.

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Theoretical Model and Framework

Since this EBP proposal involves changes in physical activity and dietary behaviors understanding the effects of behavioral and social aspect of the child is necessary. With this in mind, the Transtheoretical Model will be discussed as an integral element in the design of PTC, an overweight/obese child intervention proposal.

Transtheoretical Model (TM)

The TM integrates clinical psychology and concepts to support a framework to understand the behavior and motivate behavioral change. The concepts of TM are decisional balance, processes of change, self-efficacy and temptation. The five stages of the transtheoretical model are the following: precontemplation (not intending to change), contemplation (considering a change), planning or preparation (actively planning change), action (actively engaging in a new behavior) and maintenance (taking steps to sustain change and resist temptation to relapse) (Kadowki, 2012).

Decisional balance occurs in each stage and involves the weighing of advantages and disadvantages towards changing behavior. The processes of change are the steps that facilitate understanding and behavioral change. Self-efficacy is essential and will vary depending on the TM stage. Temptation to revert back to previous stages will exist throughout the model. Support from the individual’s social network will provide the encouragement to continue within the program’s parameters.

Problem

A correlation between obesity and chronic diseases such as cardiovascular disease, diabetes mellitus and hypertension has been documented. Life expectancy for those who are obese is lower than those that maintain a normal Body Mass Index (BMI) (Centers for Disease Control and Prevention, 2011). Earlier death rates in adulthood have been linked to excess weight in the younger ages (American Heart Association, 2013).

The prevalence of obesity has increased three-fold over the past few decades and is reported as a public health problem within the United States (Singh & Kogan, 2010). The cost of health care for obesity-related diseases (diabetes mellitus, hypertension, cardiovascular disease, etc) has skyrocketed and is predicted to continue to grow.

In the year 2000 an estimated $117 billion and $61 billion was spent both directly (medical costs) and indirectly (lost work time, disability, premature death and subsequent loss of income, etc) on overweight and obese individuals in the United States (Ward Smith, 2010). Chronic diseases linked to obesity were once seen mainly in adults, but are now becoming more and more prevalent in children.

The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Adolescent and School Health (2010) reported “the prevalence of obesity among children aged 6 to 11 years increased from 6.5% in 1980 to 19.6% in 2008…and among adolescents aged 12 to 19 years increased from 5.0% to 18.1%” (NCCDPHP, Division of Adolescent and School Health, 2010). Health concerns for obese children are a reality that must be addressed since the effects of early obesity will impact their health for the rest of their lives.

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Problem Statement

The problem addressed in this EBP proposal is the growing rate of childhood obesity and the negative effects on the child, parents, family and community.

Possible Interventions

Intervention of childhood obesity includes early identification and participating in health promotion activities such as eating healthier and becoming more physically active, as early as possible, to reduce the likelihood of chronic diseases and increase the health in those at risk. Wojcicki and Heyman (2010) stated “studies have shown that early interventions can potentially prevent the development of obesity in school-age children, along with associated health conditions” (Wojcicki & Heyman, 2010, p. 1457).

Interventions of childhood obesity include promoting a balanced diet and increased frequency of physical activity. But, with the complexity behind childhood obesity, it requires other interventions as well. Vos, Wit, Pikl, Kruff and Houdijk (2011) stated their family-based cognitive behavioral multidisciplinary lifestyle treatment “aims to establish long-term weight reduction and stabilization, reduction of obesity related health consequences and improvement of self-image by change of lifestyle and learning cognitive behavioral techniques” (Vos et al., 2011).

Education and physical activity should be provided to the whole family in order to ensure successful lifestyle change to occur for the child. It is hoped that by encouraging whole family participation that a lasting positive outcome would result.

Pender, Murdaugh and Parsons (2011) stated “the significant role the family plays in the development of both health-promotion and health-damaging behaviors, beginning at a very early age is well documented” (p. 243). Golley, Magarey, Baur, Steinbeck and Daniels (2007) stated “parenting-skills training combined with promoting a health family lifestyle may be an effective approach to weigh management in prepurbertal children, particularly boys” (p. 517).

Critical Outcome Indicators

Outcome indicators aim to achieve results that matter to the patient (Larrabee, 2012). Critical outcome indicators include improved BMI, improved laboratory measurements, improved health behavior, improved dietary patterns and increased frequency of physical activity.

Goals and Purpose

The health goal is to improve outcomes of obese children living in rural Tulare County, California. Quality goals are to improve access to diagnostics, early treatment and continuity of care with the use of evidence-based practices that include family participation. Quality measures include the participant’s understanding of the nature of obesity, treatment, the negative impact of obesity on lifestyle and overall health. These aspects will be measured through documentation of BMI status, weight classification, percent of physical activity and nutritional counseling.

Purpose Statement

The purpose of the EBP proposal is to promote health and well being in overweight/obese children and their whole family through participation in a nine-week multi-component, family-based community intervention program.

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Designing a Practice Change: Evidence Based Practice

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Designing a Practice Change

Introduction

Trends have indicated an increase in prevalence in diabetes with 42% of the patients with diabetes aged over 65 years (Chen et al., 2012). Projections have been conducted and proved that this ratio will increase to over 60% by 2050. This increase in diabetes prevalence has also impacted related health care costs.

For instance, the average acute hospital cost for managing diabetic patient with a diabetic foot was estimated to be $9,900 in the USA (Dabelea et al, 2014). According to Wong et al, this rise in the prevalence of diabetes has made it imperious to offer training and practice care for clinicians to manage diabetes (Wong et al., 2015).

This paper is going to focus on the design of Evidence Based Practice training program for practice change that will be aimed at training healthcare practitioners on diabetes and improving the outcomes of patients with diabetes.

Timeline

The training module will involve one basic 50-minute presentation which will be conducted by a well-trained diabetes educator and a physician. The presentation will be conducted on Monday, Wednesday and from 0800hrs to 0850hrs for a period of two months. The presentation will be divided into two parts.

The first part will concentrate on enlightening the trainees on diabetes for practice change, that is, the causes, risk factors, onset, types, signs and symptoms, treatment, and management of this disease. This part will also highlight the complications associated with diabetes. The second part of the presentation will concentrate more on patient education which is an integral component of comprehensive patient care.

Several long term care facilities will be contacted as potential recruitment sites. Comprehensive training modules and assessment measures will also be developed to aid in the evaluation of immediate and long term impact of the training project.

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Key Personnel

To achieve the educational needs of the clinicians the program will focus on training licensed practical nurses (LPNs), registered nurses (RNs), and physical therapists. The module will conduct a follow-up of learning outcomes in one group (RNs). The training will be designed for a small group of between 20-30 trainees in each session. This will ensure that close interaction is maintained between the participants and the instructors, with time set aside for participant comments and questions.

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Supplies Needed

Some of the material that will be required include; PowerPoint presentation, videos, and handouts.

PowerPoint Presentation: Will consist of 40 slides. These slides will entail a brief overview of diabetes, and the associated complications such as foot problems, risk of amputation, blurred vision, and kidney problems. It will also offer information on appropriate history taking, keeping of records, conducting physical examination, and appropriate specialist referral.
Video: This will demonstrate the proper techniques of carrying out patient examination such as conducting a monofilament examination with the aid of a tuning fork.
Handout: Will be issued to the participants for daily patient explaining and for explaining how to conduct physical examination on a patient with diabetes.
An official website that will contain all that will have been taught during this period.

Cost

For successful completion of this module, funds will be used in paying two diabetes instructors, paying the IT technicians who will compile the PowerPoint presentation, the video, creation of website and typing of the handout. Funds will also be used in buying enough training materials such as tuning forks for the monofilament examination and glucometers. All this will be allocated a total of $ 2,000.

How do these items tie up to project goals?

These items will help in achieving the set goal of 10-15% increase in diabetes practice change two month post training. Such training promotes clinical judgment and advance patient care quality. The clinicians will understand how to acquire, interpret, and incorporate the best available research evidence with clinical observations and patient data which are important aspects in clinical practice (Wong et al., 2015).

References

Chen, L., Magliano, D. J., & Zimmet, P. Z. (2012). The worldwide epidemiology of type 2 diabetes mellitus—present and future perspectives. Nature Reviews Endocrinology, 8(4), 228-236.

Dabelea, D., Mayer-Davis, E. J., Saydah, S., Imperatore, G., Linder, B., Divers, J., … & Liese, A. D. (2014). Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. Jama, 311(17), 1778-1786.

Wong, C. K. H., Wong, W. C. W., Wan, Y. F., Chan, A. K. C., Chan, F. W. K., & Lam, C. L. K. (2015). Effect of a Structured Diabetes Education Programme in Primary Care on Hospitalizations and Emergency Department visits among people with type 2 diabetes mellitus: results from the Patient Empowerment Programme. Diabetic Medicine.

Wong, C. K., Wong, W. C., Wan, Y. F., Chan, A. K., Chan, F. W., & Lam, C. L. (2015). Patient Empowerment Programme (PEP) and Risk of Microvascular Diseases Among Patients With Type 2 Diabetes in Primary Care: A Population-Based Propensity-Matched Cohort Study. Diabetes care, 38(8), e116-e117

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Feasibility, Benefits, and Risks: Type 2 Diabetes

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Feasibility, Benefits, and Risks

Feasibility of the implementation of change in practice

Undeniably, several studies have reported on the dramatic increase of Diabetes type 2, especially among people below 30 years. This dramatic increase and complications associated with the disease are important public health issues that feasibility must be addressed amicably. Recent surveys have recommended that the application of education strategies facilitates changes in lifestyle among patients diagnosed with diabetes Type 2.

This is specifically in subjects identified as high risk of developing diabetes type 2. Research indicates that integration of the proposed practice in the clinical setting will reduce approximately 60% risk of developing diabetes Type 2 within 3 years of intervention. Secondly, the effects of these interventions are long- term (Inzucchi, et al., 2012).

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Potential barriers for the implementation

One of the major barriers for the implementation of the practice is inadequate resources. This will make it difficult for the healthcare providers to balance between their workloads and the demand of practicing proposed intervention- integrative patient education. Other potential barriers are organizational cultural and policy barriers that could lead to staff resistance.

Due to the low level of research in the clinical setting, most of the healthcare providers would be sceptical regarding the evidence based research. Therefore, prior to the onset of the research, the healthcare providers will be trained to ensure they understand the concept and project outcomes (Inzucchi, et al., 2015).

Main Risks of the integration of the practice

The main risk involved in integration of the practice into the clinical setting is the concern that too much content about diabetes type 2 could result in confusion and reduce its utility. Additionally, communication barriers could reduce the opportunity for the patient-physician interaction, which would make it difficult to realize the project’s objectives (Steinsbekk, et al., 2012).

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Benefits for integration of the practice into the clinical setting

Integrative patient education is beneficial as it will increase the patient’s ability of understanding the disease pathophysiology, and in establishment of the relevant coping strategies. This is because it will facilitate the process of diagnosis and treatment alternatives, as well as the consequences of various patient activities. Additionally, it will help the patient to make appropriate decision, thereby reducing the readmission rates, length of hospitalization and slows the disease progression (Kayshap et al., 2013).

The intervention justifies the time as well as cost toward the improvement of the feasibility of clinical outcomes.

The proposed study is an expensive study as it involves a lot or resources such as educating material, employment of additional nurse assistants and time. However, the outcome of the ontervention justifies these costs as it increases patients satisfaction, improve the patient compliance to the regulatory standards and improve the efficiency of care. Lastly, better informed patients are more alert and attentive, which minimizes the risk of malpractice.

Ethical concerns

The researcher will seek permission from ethical review board committee at the institution. The work will require to be approved by the IRB as it involves interaction with human beings. This is to ensure that the study is safe and does not pose potential dangers to the participants. Each of the participants will be required to fill in a consent form.

References

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … & Matthews, D. R. (2012). Management of hyperglycemia in type 2 diabetes: a patient-centered approach position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes care, 35(6), 1364-1379.

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 38(1), 140-149.

Kashyap, S. R., Bhatt, D. L., Wolski, K., Watanabe, R. M., Abdul-Ghani, M., Abood, B., … & Kirwan, J. P. (2013). Metabolic Effects of Bariatric Surgery in Patients With Moderate Obesity and Type 2 Diabetes Analysis of a randomized control trial comparing surgery with intensive medical treatment. Diabetes care, 36(8), 2175-2182.

Steinsbekk, A., Rygg, L., Lisulo, M., Rise, M. B., & Fretheim, A. (2012). Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC health services research, 12(1), 213.

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Locate the Best Evidence: Clinical Practice Guidelines

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Locate the Best Evidence

Clinical Practice Guidelines used in the practice setting

Among the bodies in the US that are tasked with the responsibility of developing the clinical practice guidelines include the AADE (American Association of Diabetes Educators) that published the Standards of Practice, Scope of Practice, as well as the Standards of Professional Performance of Diabetes Educators. Based on these documents and evidence, pharmacists have a particular role of delivering diabetes education.

AADE also came up with a framework related to optimal practice for self management. During the process, there should be an assessment of the specific education needs in every patient (Garber, Gross & Slonim, 2010). Second is the identification of the particular diabetes self-management goals in every person. This can go a long way in ensuring effectiveness of the strategies used.

Third, the behavioral interaction as well as the education should aim at ensuring that the individual achieves the identified self-management goals (Kapoor & Kleinbart, 2012). In addition, following the education sessions, there should be evaluations aimed at determining the extent to which the individual is achieving the identified self-management goals.

The other body accountable for creating the clinical practice guidelines is ADA (American Diabetes Association). According to this body, the care standards or recommendations should not preclude clinical judgment but should be applied within an excellent clinical care context, with adjustments being made for comorbidities, individual preferences, as well as patient factors. The body also emphasizes on patient education that is patient-specific (Kapoor & Kleinbart, 2012).

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Information for conducting systematic reviews

One aspect that can guide the systematic review is evidence supporting self-management training’s effectiveness for diabetes type 2, especially on a short-term basis. Second is evidence showing that education programs that are based on the health belief model are effective in improving self-management (Chijioke, Adamu & Makusidi, 2010). Therefore, their implementation can promote effectiveness in preventing the disease’s complications.

Proper diabetes health education has short-term impacts such as knowledge of diabetes and glycemic control. Health policy makers should consider the need to train diabetes educators so that they can tailor fitting education interventions among the patients (Garber, Gross & Slonim, 2010).

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Published research sources- journals to be used

The use of peer-reviewed articles will be cardinal in helping locate credible information. Majorly, those articles are evidence-based and can ensure quality information. The journals will be obtained from authentic databases such as Proquest, GoogleScholar, and Elsevier. Research sources can also be obtained from nursing bodies’ sites as these also deliver quality information.

Experts in the US who provide sources of best evidence

Entities or bodies such as the ADA and AADE are among the experts who promote best evidence. Moreover, individuals, particularly those in the healthcare sector have a cardinal role in spreading best evidence. Moreover, agencies, particularly those focusing on research, help in generation and promoting the use of best evidence.

My personal expertise and how it fits with the EBP

Diabetes type 2 patients need to develop a wide array of competencies so that they can manage being in greater control of their disease. in connection to this, while education should promote health, it should respect the voluntary choices and self-perceived needs.

Although there is the possibility of educating patients towards greater autonomy, a good number of professionals are not ready to collaborate with them. moreover, clinical staff should acquire better comprehension on diabetes management and of the theoretical principles that underlie patient empowerment. These factors need to be considered for effective EBP (Mshunqane, Stewart & Rothberg, 2012).

References

Mshunqane, N., Stewart, A. V., & Rothberg, A. D. (2012). Type 2 diabetes management : patient knowledge and health care team perceptions, South Africa : original research. African Primary Health Care and Family Medicine, 4, 1, 1-7.

Kapoor, B., & Kleinbart, M. (2012). Building an Integrated Patient Information System for a Healthcare Network. Journal of Cases on Information Technology (jcit), 14, 2, 27-41.

Garber, J. S., Gross, M., & Slonim, A. D. (2010). Avoiding common nursing errors. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Chijioke, A., Adamu, A. N., & Makusidi, A. M. (2010). Mortality patterns among type 2 diabetes mellitus patients in Ilorin, Nigeria : original research. Journal of Endocrinology, Metabolism and Diabetes in South Africa, 15, 2, 79-82.

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Nurse Managers Career Planning

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Nurse Managers Career Planning

Nurse Managers have demanding and complex responsibilities that involve coordinating work of individuals with varying education, skills, and personalities of providing safe, high quality patient care. The Nurse managers are accountable for staff performance, resource utilization, financial management, and patient outcomes. The Nurse Managers also ensure that patient care is delivered in line with the standards of practice and organizational ethics and policies. According to Anonson et al., (2014), good nurse managers provide leadership and ensures that his/her department runs smoothly.

After evaluating myself with the skills inventory, I found that I have the various strengths and weakness in the following areas;

Personal and Professional Accountability

First, I noted that I am competent enough when it comes to personal growth and development. This is because I hold a Bachelors OF Science Nursing (BSN) degree which has equipped me to meet the demands weighed on today’s nurse. With this degree, I have acquired skills in critical thinking, case management, and health promotion in order to practice across various inpatient and outpatient settings. I also possess leadership skills that are crucial for anyone that would like to serve as a nurse manager. In my practice, I adhere to the expected nursing codes of ethics.

However, I am a novice when am required to make appropriate decisions surrounding the several ethical dilemmas in my practice. For instance, a teen who had been diagnosed with syphilis due to unprotected sex asked me to lie to her mum about her condition. Moreover, I am also an active member of several nursing associations such as the American Nursing Association (ANA); an important institution that safeguards our welfare as nurses.

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Career Planning

I am an expert in this area because I understand my role as a BSN nurse and what is expected of me. I also intend to pursue a master’s degree in Nursing. However, I have not yet decided on the program I need to pursue.

Personal Journey Disciplines

I noted that I am an expert in this area. I have vital management skills that can aid me in educating and supervising staff without micromanaging. I can use conflict resolution and negotiation skills to enhance collaboration between physician, staff, and clinical leaders. I can also mentor and coach stuff at all levels. Moreover, I am flexible hence I can adapt quickly in the field of healthcare as patients usually develop problems. However, I find it a bit challenging to make agent decisions of care on my own in accordance to the changing needs. I prefer consulting someone else before I can implement a decision.

Reflective practice reference behaviors/tenets

After rating myself on this area, I found that I uphold integrity and transparency in all my dealings. I also have the desire of developing my potential. For instance, I usually challenge myself to attain the standards that some of my predecessors in the field of nursing have set. This aids me to discover my potential, know my weaknesses and strengths whenever I want to attain certain goals.

However, I do not know how to create and maintain a balance that renews and regenerates my spirit and body so that I can grow continually. This is because I usually find myself being caught up in the profession, squeezing some personal time relax and rejuvenate has always been a challenge to me risking work burn out.

Reflective practice is one of the most important pillars in my career. It aids my making sense of human frailties such as mental and physical health and the dynamics between the relationship between human beings and the system in which they function.

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Often, leaders are charged with the responsibility of creating change processes in an organization (Schaffer et al., 2013). Change processes that involve upgrade of tools and techniques, human resources, and basic rules and controls within a hospital are the mandate of managers within the organization. With my leadership set, I will be able to make the change initiatives real and tangible rather than abstract.

I will also ensure that I awaken the enthusiasm and ownership of the proposed change within the organization. My leadership set also helps me to be accountable for filling the gap between strategic decisions and the certainty of executing the change within the workforce and structure of the institution. I will use my communication skills to ensure that the staff is updated on all change activities that are taking place and what we expect to achieve.

Thinking strategically is one of the goals for my leadership growth. I intend to improve my ability of seeing the big picture and learn to step back from daily tactical details of my practice and concentrate not only on the “how” and “what” but also on the “why.”By being a critical thinker, I will hold all my views and reasoning to intellectual reasoning standards. This will aid in reducing ambiguity and confusion in the understanding of ideas and thoughts. Achievement of this goal will place me at a suitable position thinking deeply and broadly. My thinking will be driven towards being adequate, precise, and logical for my intended purpose.

References

Anonson, J., Walker, M. E., Arries, E., Maposa, S., Telford, P., & Berry, L. (2014). Qualities of exemplary nurse leaders: perspectives of frontline nurses. Journal of nursing management, 22(1), 127-136.

Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence‐based practice models for organizational change: overview and practical applications. Journal of advanced nursing, 69(5), 1197-1209.

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McGregor’s Theory X and Theory Y of Motivation

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McGregor’s Theory X and Theory Y of Motivation

Introduction

According to this theory, the managers view employees in different human nature concepts which he labels as Theory X and Theory Y. This theory demands the managers to reflect about their employees including issues such as how do you treat the employees? How does the manager talk to them? This is important to know because it enables the management learn where they are in the Theory X-Theory Y continuum.

In Theory X, managers assume that employees generally heat work and that the average employee is lazy, lacks ambitions and is generally lazy. This theory assumes that employee motivation is money. This type of manager is sharp contrast to Theory Y. Theory Y managers assume that employees and highly satisfied by their work and exhibit high level of creativity. According to this theory, employees seek recognition and self-fulfilment than money (Korzynski, 2013).

How I Identify and Differ With This Style

I identify with this management theory because I believe that it is very important to understand the various ways to treat human nature, as most of the employee behaviour observed in their work place is a reaction to management style. For instance, the management that believes employees avoids responsibility and must be coerced to achieve organizational goals are likely to set strict measures to the employees dictating what they want the employees to do, ways they want it done and closely monitor them.

This communicates lack of trust to the employees In this regards, the employees reaction towards work is negative, which convinces the managers that their assumptions is actually correct. On the other hand, Theory Y managers have entirely different assumptions. In this type of management, they make their decisions by consensus. This enhances the employee’s sense of belonging. By empowering the employee, the employee’s authority increases and tends to be responsible. This management encourages the employee creativity as well as teamwork and are more likely to reward them. As a result, the employee’s reaction is positive because they are treated with respect and support (Mikkelsen, Jacobsen, & Andersen, 2015).

Despite the fact that the theory explanations of management and employees performance are feasible- I highly doubt that there are managers who are purely X or Y. The theories are designed to help the management understand their natural instincts and help them appreciate their attitudes such that they can adjust to certain situations within specific environment and organizational culture.

In this regards, it’s not a question if one is a Theory X or Theory manager. Irrespective of the type of management, the work must be done. Therefore, the key to success is evaluating your organization to identify the styles that are more consistent with bringing out the highest motivation levels and improve employee’s productivity (Reed & Bogardus, 2012).

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An Example of Business That Has Applied Theory Management Style

An example of business that has applied Theory Management style in their organization is Google Company. The Google Company gives their students much freedom to ensure that they enjoy working at this company. The management looks at the employees tend to believe that they are self-actualizing as well as self-fulfilling. In Google Company, there is no micromanagement of the employees because they want them to be creative and improve their sense of belonging by making them take ownership of their work.

This company does not motivate the employees with fear of getting fired if they do not deliver quality work, but rather it encourages and empower employees to ensure that they take initiative to pursue their life goals. When the employee’s psychological needs are improved, they become motivated and are ultimately more likely to accomplish their company’s goals. The organizations push their workers to ensure that they understand their self-actualisation alongside the company’s goals set. The employees are given flexibility and ensure that the work place is comfortable. This motivates the employees to remain productive (Korzynski, 2013).

Case study

During the unstable economic times, many companies management are expected to make tough decisions regarding the organization work force structure and size. The director of Tri-County Home Health Agency is expected to implement a reduction in force (RIF) program also commonly known as lay-off. This requires a lot of interaction with the top management officials and human resource manager to evaluate the jobs that need to be eliminated and ways the employees needs to be notified about the decisions. In this case, Theory X will work effectively (Gandolfi, & Hansson, 2010).

Before implementing RIF, the management should explore all the alternatives available. This is because RIF could be a quick answer, but may not make sense in the long-term. Other alternatives such as reducing work schedules, salary reduction, freeze of hiring, reduction of employee’s contribution and natural attrition. After reviewing these options and RIF still remains the best step for the company it is important for the management to explore ways to go about it.

The following should be put into consideration, including what departments or divisions are likely to be affected or will RIF affect the entire organization. In this case, what employees are essential to keep the company running, what set of skills are very vital in the organization for future (McConnell, 2010).

One of the challenges during this process is selection of employees who will undergo lay-offs. This is complex due to the impact of disparate analysis. In this regards, the selection criteria should be based on employee’s level of experience, versatility and proficiency. The unnecessary jobs categories and classifications should be eliminated. The employee’s performance can be evaluated using data from job appraisal. To decide on whom to let go or stay, the management should strive an objective comparison of its employees. Strict compliance with the requirements must be maintained, failure to which employee’s claim of discrimination can be enforced (Gandolfi, & Hansson, 2010).

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Conclusion

To communicate to the employees, a note of warning must be given to organizations. This facilitates quick action which is important for people who are staying and those who are leaving. All information about severance should be clear to ensure that every person understands it. The management should predict the questions anticipated and address the issue from the start.

Additionally it is important to the employees sign a release to avoid the employees taking action against the organization. It is also important to communicate with the survivors as they are equally affected. Additionally, the survivors are expected to match the same output level or even higher, which calls for motivation, giving the employees sense of hope and belief (McConnell, 2010).

References

Gandolfi, F., & Hansson, M. (2010). Reduction-in-force (RIF) – New developments and a brief historical analysis of a business strategy. Journal of Management & Organization, 16(5), 727-743. http://dx.doi.org/10.5172/jmo.2010.16.5.727

Korzynski, P. (2013). Employee motivation in new working environment. International Journal of Academic Research, 5(5), 184-188. http://dx.doi.org/10.7813/2075-4124.2013/5-5/b.28

McConnell, C. (2010). Umiker’s management skills for the new health care supervisor. Sudbury, Mass.: Jones and Bartlett Publishers.

Mikkelsen, M., Jacobsen, C., & Andersen, L. (2015). Managing Employee Motivation: Exploring the Connections Between Managersâ€™ Enforcement Actions, Employee Perceptions, and Employee Intrinsic Motivation. International Public Management Journal, 1-23. http://dx.doi.org/10.1080/10967494.2015.1043166

Reed, S., & Bogardus, A. (2012). PHR. Hoboken: John Wiley & Sons

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Dementia and Psychosis PICO Analysis

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Dementia and Psychosis PICO Analysis

Part I: PICO analysis of research topic

Step 1: Frame clinical question using PICO method

P: the patients include people with dementia and psychosis

I: the anticipated intervention is to utilize typical antipsychotic drugs

C: the current standard or comparison group is atypical antipsychotics

O: the desired outcome is to have less mortality rates for elderly people with dementia and psychosis

The PICO question basically stands for patient, intervention, comparison and outcome (Elkins, 2014).

Part II: Search strategy

The PICO question is as follows: In elderly patients who have dementia and psychosis (P), does treatment with typical antipsychotics (I) or atypical antipsychotics (C) result in less mortality (O).

Step 1: Resources utilized to find articles

A number of scholarly articles relating to the identified issue are identified. The resources that were used in finding the articles that relate to the topic include the following: handbooks, electronic databases research, encyclopaedias, relevant books, and reputable journals.

Step 2: Search terms and criteria

With regard to search terms and criteria that were utilized, the search terms include the following: dementia, mortality, psychosis, atypical antipsychotics, and typical psychotics. The inclusion criteria was as follows: scholarly peer-reviewed journal articles only, articles not older than 5 years, articles that are published in the English language, articles that focus on dementia and psychosis among the elderly population, and article that reports on primary research.

Step 3: Boolean search strings

With regard to the exclusion criteria, the articles that would be excluded are as follows: articles that are older than 5 years, articles not published in English, and articles that do not focus on the elderly patients with dementia. Using different Boolean search strings, keywords would be combined with operators like OR, NOT as well as AND in order to generate additional results that are relevant. For this research, the Boolean search strings that would be utilized include the following: atypical antipsychotics and psychosis, atypical antipsychotics and dementia, typical antipsychotics and dementia, typical antipsychotics and psychosis. Therefore, the search results would be limited only to the two keywords.

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Part III: Analysis of literature

Step 1: Summary of five articles

The following 5 articles in the table below were selected from the research effort.

Table 1: Summary of analyzed articles

Citation	Conceptual framework / theory	Main finding	Research Method	Strengths of study	Weaknesses of study	Level of evidence
Ballard, C., Creese, B., Corbett, A., & Aarsland, D. (2011). Atypical antipsychotics for the treatment of behavioural and psychological symptoms in dementia, with a particular focus on longer term outcomes and mortality. Expert Opinion on Drug Safety, 10(1): 35-43	Not specified	Atypical antipsychotics medications provide modest benefits up to twelve weeks /short term treatment of psychosis and dementia. Nonetheless, these benefits should be balanced against the risk of major adverse events such as increased death. With longer term prescribing, there are clear benefits, but the risk of death also increase.	Review of existing studies. The authors provide a summary of the evidence that pertain to safety and efficacy from short-term randomized controlled trials, as well as main findings from case register studies	Study is thorough. Presents both benefits and shortcomings of atypical antipsychotic drugs. The review provides an up-to-date and balanced overview of the safety concerns and effectiveness that relate to atypical antipsychotics in elderly patients with dementia, giving a full overview of mortality risk	The study only focuses on atypical antipsychotic drugs and does not also look into the safety concerns and efficacy of typical antipsychotics.	High level
Haddad, P. M., & Sharma, S. G. (2012). Adverse effects of atypical antipsychotics: Differential risk and clinical implications. CNS Drugs, 21(11): 911-936	Not specified	Broad statements that compare the comparative risk of specific adverse effects between conventional and atypical antipsychotics are mainly insignificant. Instead, comparisons need to be made between particular typical and particular atypical antipsychotic drugs.	The authors reviewed various studies including post marketing, surveillance studies, and observational studies and randomized controlled trials.	The study is comprehensive, thorough and up-to-date	A small number of studies were reviewed	High level
Piersanti, M., Capannolo, M., Turchetti, M., Serroni, N., De Berardis, D., Evangelista, P., Costantini, P., Orsini, A., Rossi, A., & Maggio, R. (2014). Increase in mortality rate in patients with dementia treated with atypical antipsychotics: A cohort study in outpatients in Central Italy. Riv Psichiatr, 49(1): 34-40	Not specified	Using atypical antipsychotics to treat dementia amongst older adults is linked to a higher rate of mortality.	A cohort study was conducted that comprised 696 elderly patients with Alzheimer	The study recommends new approaches for managing dementia to replace the use of atypical antipsychotic drugs which have potential risks of mortality	A small sample size was used and the study was carried out within a single hospital. This affects the generalizability of the findings	Medium level
Rochon, P. A., Gruneir, A., Gill, S. S., Wu, W., Fischer, H. D., Bronskill, S. E., & … Gurwitz, J. H. (2013). Older Men with Dementia Are at Greater Risk than Women of Serious Events After Initiating Antipsychotic Therapy. Journal Of The American Geriatrics Society, 61(1), 55-61. doi:10.1111/jgs.12061	Not specified	Shortly after initiating oral atypical antipsychotic drug, the likelihood of developing a major event in elderly people with dementia was high.	This was a population-based, retrospective cohort study.	A large sample size was used that comprised 21,526 elderly men and women with dementia	The study had more women that. Women were 13,760 while the number of men was 7,766.	High level
Schneider, L. S., Dagerman, K. S., & Insel, P. (2012). Risk of death with atypical antipsychotic drug treatment for dementia – Meta-analysis of randomized placebo-controlled trials, JAMA, Journal of the American Medical Association, 294(15): 1934-1943		Atypical antipsychotic medicines might be linked to a slight increased likelihood for death in comparison to placebo where typical antipsychotic drugs were used.	The authors assessed the evidence for high death rates from atypical antipsychotic medications for patients who have dementia. The data sources were obtained from Cochrane Controlled Trials Register, MEDLINE, and meetings and presentations.	A large sample size is used hence the findings could be generalized. There a total of 5,101 participants	Some very old data materials from the 1960s were used which may not be relevant for use today	High level

Step 2: History and purpose of research question

Every antipsychotic drug has warnings of increased mortality for elderly patients (Schneider, Dagerman & Insel, 2012). Antipsychotic medications are broadly utilized in managing psychological and behavioural symptoms in dementia in spite of concerns as regards their safety (Ballard et al., 2011; Piersanti et al., 2014). Compared to typical or conventional antipsychotic drugs, atypical antipsychotic drugs are linked to a statistically significant rise in the likelihood of mortality for older men and women who have dementia (Haddad & Sharma, 2012).

The purpose of the research question is to find out whether the use of typical antipsychotic medication, which is the intervention, results in less mortality rates than atypical antipsychotic medication, which is the comparison group, in elderly patients who have dementia and psychosis.

Step 3: Strengths and weaknesses of existing literature

The strengths of the existing literature is that there are studies which focus mainly on the atypical antipsychotics and others that focus mainly in typical/conventional antipsychotics and their correlation with mortality. The weakness of the existing literature is that there are no studies that compare typical antipsychotics and atypical antipsychotics on the rates of mortality on elderly patients with dementia and psychosis (Rochon et al., 2013).

Step 4: Gap in current literature

At the moment, the gap in current literature is that there are no studies which have focused specifically on the association of atypical and typical antipsychotic medications on the rates of mortality among the older adults who have dementia.

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Conclusion

In conclusion, the PICO question for the research study is as follows: In elderly patients who have dementia and psychosis (P), does treatment with typical antipsychotics (I) or atypical antipsychotics (C) result in less mortality (O). The purpose of the research question is to find out whether the use of typical antipsychotic medication results in less mortality rates than atypical antipsychotic medication in elderly patients who have dementia and psychosis. The resources used to find articles included electronic databases research, relevant books, and reputable journals. The search terms that were utilized include dementia, mortality, psychosis, atypical antipsychotics, and typical psychotics.

References

Ballard, C., Creese, B., Corbett, A., & Aarsland, D. (2011). Atypical antipsychotics for the treatment of behavioural and psychological symptoms in dementia, with a particular focus on longer term outcomes and mortality. Expert Opinion on Drug Safety, 10(1): 35-43

Elkins, M. Y. (2010). Using PICO and the brief report to answer clinical questions. Nursing, 40(4), 59-60. Retrieved from the Walden Library databases.

Haddad, P. M., & Sharma, S. G. (2012). Adverse effects of atypical antipsychotics: Differential risk and clinical implications. CNS Drugs, 21(11): 911-936

Piersanti, M., Capannolo, M., Turchetti, M., Serroni, N., De Berardis, D., Evangelista, P., Costantini, P., Orsini, A., Rossi, A., & Maggio, R. (2014). Increase in mortality rate in patients with dementia treated with atypical antipsychotics: A cohort study in outpatients in Central Italy. Riv Psichiatr, 49(1): 34-40.

Rochon, P. A., Gruneir, A., Gill, S. S., Wu, W., Fischer, H. D., Bronskill, S. E., & … Gurwitz, J. H. (2013). Older Men with Dementia Are at Greater Risk than Women of Serious Events After Initiating Antipsychotic Therapy. Journal of the American Geriatrics Society, 61(1), 55-61. doi:10.1111/jgs.12061

Schneider, L. S., Dagerman, K. S., & Insel, P. (2012). Risk of death with atypical antipsychotic drug treatment for dementia – Meta-analysis of randomized placebo-controlled trials, JAMA, Journal of the American Medical Association, 294(15): 1934-1943

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Hospice Nurse Transition- Business Plan

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Hospice Nurse Transition

Business Plan

Executive Summary

Transitioning from a student into a professional practitioner is a difficult experience for most people. However, the transition experience is especially difficult for graduate nurses who are ushered into a demanding work environment. Most new nurses are shocked at the sheer contrast between student life and work. Just a few weeks after employment, Graduate nurses are expected to take up serious responsibilities including patient care and supervisory duties. This business plan sets out to bridge the gap in knowledge about self-care strategies that NGNs can use as they transition to hospice.

Business Plan-Transitioning Nurses into Hospice

1.0 Preliminary

1.1 Objectives

The business plan aims to educate the nurses that are transitioning into hospice on how to identify, explore, and improve our health and self-care practices. The plan will also help teams to evaluate risks for burnout and compassion fatigue, and learn more effective strategies for work and home-life balance. The self-management transition plan hopes to decrease attrition rates to zero in the next six months.

1.2 Philosophy Background

Hospice can be defined as a model of care formulated to afford comfy, and support to the patient as well as families especially when a life-limiting malady does not react to remedial prescriptions. The philosophywas startedin 1960 by Dr. Cicely Saunders, a British physician. The phrase “hospice” comes from the Latin word “hospital” that implies guesthouse. Today there are more than 4,100 hospice programs that offer this specialized care to patients.

1.3 Problem Statement

While the demands for hospice service are greater than the resources, it leads to nurses being put into the field to care for these patients too soon. However, experience demonstrates that nurses who transition into hospice are thoroughly orientated and trained on how to care for dying patients. In short, nurses tend to care deeply for others, at their peril. The underlying cause is that the nursing orientation and training lacks on self-care and time management, which ultimately results in compassion fatigue and high attrition for nurses in hospice. There is, however, there is a need to equip hospice transitioning NGNs’ with “Self-Management skills to decrease compassion fatigue and attrition rates.

2.0 Situation on the Ground

The Georgetown Hospice office is growing at a rapid rate in their patient census and so is the attrition rate with the nurses. This situation forces the current nurses to take on larger caseloads and more on call. Nurses are being hired, but most are new to the field of hospice, which requires some extra training. Often this training and orientation are not completed, due to the need of the new nurse in the field to help with patient coverage (Casey et al.2004).

The incomplete orientation can cause nurses to feel unsupported, inadequate and insecure. These feelings and emotions without the necessary skills or training on self-management lead to burnout, compassion fatigue and high attrition. Developing this self-management project will, in turn, help this office and company as a whole by saving the cost of new hires.

3.0 Critical Assumptions and Constraints

The Georgetown Hospice Leadership Team has all agreed that this self-management project will be essential to manage the growth of the office (Dyess & Sherman, 2009). The Leadership Team believes this project will build up the moral and confidence in the nurses. Decrease the amount of physical, psychological and emotional exhaustion felt by the nurses (Scott, Engelke & Swanson, 2008).

Predict the risk of compassion fatigue and give the tools to be successful in the field. This project will require collaboration and feedback between the Executive Director, Quality Manager, Manager of Clinical Practice and the RN Case managers. Some constraints are:

Conflicts in the nurses schedules- not all be able to meet at the same time
Inadequate nursing coverage- high patient to nurse ratio
Poor communication- limited feedback

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4.0 Key Success Factors

Educate the staff on coping strategies for facing death with assigned patients.
Encourage effective communication between managers and staff.
Schedule RN Case-mangers with sensible ratios that will allow the nurse to spend adequate time with patients to build rapport.
Incorporate burn-out prevention strategies in every monthly nursing meeting.
Team building to show the nurses a sense of belonging.
Teach Nurses to safeguard their boundaries.

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5.0 NGNs’ Experiences

Nurses experience difficulties when transitioning from student to practicing Registered Nurses. NGNs initially find the role of practicing nurse extremely stressing and challenging. However, role stress decrease as NGNs gain confidence, obtain clinical support and develop competence (Duchscher & Cowin, 2004).NGNs describe the transition as a difficult time filled with feeling or incompetence, fear of physicians, an overwhelming sense of responsibility, and difficulties in prioritizing, organizing or delegating tasks.

Approximately 30% of NGNs quit their first nursing jobs within the first year of employment. In just two years, 57% had moved from their first jobs (Duchscher & Cowin, 2004). The high nurse turnover hinders work productivity, quality patient outcomes and the morale of the staff. Moreover, high turnover means healthcare organization have to incur the cost of rehiring and retraining new nurses to take the roles of those who leave.

While training more nurses may solve the nurse shortage problem, the problem of deficient patient care and supportive work environment needs to be handled to smooth the nurse transition. However, NGNs are not satisfied with their working environment as they complain about the lack of a consistent preceptor, struggles with authority, a feeling of being undervalued, and workload issues (Delaney, 2003). There are high burnout rates among new nurses.

The nurse also complains about the lack of support, limited access to resources and opportunities as their main barrier to productivity at the transition phase. However, the job satisfaction outcomes of NGNs improve significantly after the first 18 months of practice. Nurses start to enjoy their work once they can organize their time, prioritize tasks, access resource, understand job expectation, and were made aware of the availability of professional development opportunities.

The transition is a stressing time for graduate nurses. NGNs’ confidence is initially low as they are unsure about the experience and knowledge; they also fear the interaction with patients as they feel they will not be able to understand their issues. NGNs are also worried about acting autonomously and deciding when it is necessary to call physicians (Twibell et al. 2012). Therefore, this business plan will demonstrate how to boost NGNs confidence and ability to make informed decisions about service delivery.

6.0 Management Summary

Key stakeholders for the project has been identified and interviewed to obtained and assess their requirements/needs, as well as input for successful implementation. Key stakeholders include Executive Director; Jackie Williams, Quality Manager; Anna Hamilton, Manager of Clinical Practice; Aneko Jackson and Manager of Clinical Practice Tracy Sudduth. All requirements were obtained, reviewed, prioritized, and approved by the project sponsor and team members(Bowles & Candela, 2005). Key Stakeholders, Executive Director; Jackie Williams, Quality Manager; Anna Hamilton, and Manager of Clinical Practice Tracy Sudduth, will be updated on a weekly basis in person or via telephone regarding the progress of the business plan.

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7.0 Strategy and Implementation

7.1 Strategies

7.1.2 Control

Many NGNs are concerned about the control or autonomy of their new roles as practicing nurses. In addition, they complain that being responsible and accountable to patients was stressing. Student nurse roles are inadequate in equipping NGNs for the responsibilities awaiting them in practice. Patient care decision and outcome responsibilities often overwhelm new nurses (Romyn et al.2009).

However, the reactions of the NGNs vary as some embrace the new responsibilities, but most report a feeling of being overwhelmed. Control is a double-edged sword in the transition period. For nurses who embrace responsibility and accountability easily, it is exhilarating and exciting. In contrast, control brings about a feeling of anxiety for nurses who are unprepared for the new responsibilities.

NGNs may also suffer disorientation and poor sense of control as a result of unfamiliarity with the practice environment. NGNs are surprised when they realize that the practice environment is significantly different from the school context (Chang & Hancock, 2003). NGNs can experience as a result of the uncertain expectation of the new role which gives rise to role ambiguity.

7.1.3 Support

Support by supervisors or coworkers plays a significant role in easing the NGN transition process. Often NGNs expend much effort in trying to familiarize themselves with existing workers in their healthcare setting. Moreover, NGNs are in need the support of other members of the multidisciplinary team. The majority of NGNs report that there are adequately supported by preceptors and colleagues, which makes them part of the team (Cho, Laschinger & Wong, 2006).

However, the new nurse cannot challenge established ways of doing things as they lack the necessary support. Nurses also need support from family and friends outside the workplace. In fact, nurse reports that they perform better when they receive external support.

Some of the interventions to support NGNs include teaching nurses to self-manage the transition by performing recommended self-care practices. The use of internship programs and preceptor pairing to expose the nurse to the “real world” before commencing practice is also effective (Halfer & Graf, 2006). Nonetheless, NGN transition research lacks anadequate measure of interventions to support the process.

7.1.4 Self-efficacy

NGNs feel incompetent and inadequate as they begin practicing as nurses. Many new nurses report feeling as if they do not possess the necessary skills or knowledge to work as RNs. NGNs also greatly double their clinical competence as they lack the basis, unlike experienced healthcare workers. Furthermore, NGNs feel that their inadequate knowledge was a severe limitation (Edwards et al, 2015). However, NGNs have a higher self-efficacy and confidence scores as they continue to gain clinical experience.

7.2 Implementation

There are three options considered in the development of this Self- Management Project.

1. Weekend training carried out once a month that would only focus on the well-being of the RN Case Managers (other disciplinary team members would also be welcomed). This time, would allow the nurses to reflect on challenges and solutions as a team (Pellico, Brewer & Kovner, 2009).

2. Develop a month long structured orientation that includes a week of orientation that is dedicated to healthy coping mechanisms in the field of hospice.

3. Incorporate the self- management education in the monthly nursing meetings and encourage a brief self-evaluation on current feelings and emotions weekly during IDG meetings.

After discussing all three options with the sponsors, option 3 was the most feasible and would not change the budget since these meetings are already included in the budget during the nurses normal work hours. Option one sounds good, but it defeats the purpose which is self-management; we want our nurses happy, we want them to relax when they are off and enjoy with their families.

This also increases the budget for extra overtime (Waite, 2004). A month-longorientation forces our veteran nurses to work that much longer with the high patient to nurse ratios. High ratios are very stressful to these nurses. We want our nurses to enjoy their employment with the company and allow them the opportunity to give quality care to patients.

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8.0 Financial Plan

8.1 Budget Estimate and Financial Analysis

The cost of this project is no added cost to the budget since the sponsors have requested that execution of this project is incorporatedinto the standard meetings.

8.2 Schedule Estimate

The Georgetown office has determined this is a critical need, due to the rapid growth in the census; therefore, the projection is to be completed by May 1, 2016. A time estimate has been provided to the project sponsors, and will be the responsibility of the Project Champion, to ensure the expected completion date is obtained.

9.0 Conclusion

The nursing career has a plethora of challenges especially for NGNs, who complain of limited orientation, disorientation, feelings of confusion and loss, overwhelming responsibility as the primary barriers to successful transitions. The difficulties of the NGNs transition to practice are further complicated by other changes in their life. The truth is that the new nurse transition face is fraught with difficult, and there is a need for support and self-management strategies to handle the stresses of this phase of a nurse’s career.

This care plan hinted about training to help fix anomaly. Formal classes; evidence-based practice, and guidance and mentoring as crucial precepts of nursing practice. As such, all medical care should be involved in presenting, the presence of a designated preceptor and rewards for those who successfully carry out the preceptor’s role. Again, extended residencies and structured orientation to support the NGN transition may improve job satisfaction and reduce the high nurse turnover.

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10.0 References

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