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Clinical Practice Guidelines used in the practice setting

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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, 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.

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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).

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).

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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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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.

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Information for conducting systematic reviews

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Published research sources- journals to be used

Experts in the US who provide sources of best evidence

My personal expertise and how it fits with the EBP

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

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.

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Diabetes Mellitus Patient Diagnosis

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Diabetes Mellitus

Being newly diagnosed with diabetes mellitus can be overwhelming and confusing due to the several things that a patient needs to learn and understand. However, for millions of diabetic patients learning about their diabetes is the first step towards living a longer and healthier life. According to Shaw (2014), Registered Nurses (RNs) play an important role of educating individuals that have just been diagnosed with diabetes mellitus encouraging them that they can live longer if they follow important guidelines for managing diabetes.

First, the RN should let the patient understand what type 1 diabetes is and how its symptoms present by highlighting the classic symptoms associated with diabetes mellitus such as excessive thirst and hunger, fatigue, unexplained weight loss, nausea, and vomiting. She should encourage the patient that he is not the only one suffering from type I diabetes.

Most youth with type 1 diabetes do not adhere to clinical guidelines (Wood et al, 2013). Therefore, the nurse can use examples of patients of almost similar age to the patient and are coping well with diabetes mellitus. The nurses should also explain to the patient that insulin injections are the central treatment for type I diabetes and for the patient to lead a quality life she should adhere to her medication.

For proper management of type I diabetes, some of the factors that the RN should focus on mainly includes control of blood glucose, insulin management, nutrition, exercise, and support (Atkinson, Eisenbarth & Michels, 2014). The nurse should advise the patient to measure his blood glucose levels regularly and administer insulin appropriately. Exercise on the other hand is a significant component of proper care for type I diabetes as it aids the body to respond with more stable levels of blood glucose (Haas et al., 2013).

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However, patients should be cautioned against extreme exercise which lowers their glucose levels considerably. Additionally, the nurse should aid the patient understand how various foods affect blood glucose and enlighten them on how to come up with solid meal plans (Chiang et al., 2014). She should also encourage the patient to seek help from other people with the same condition and be free to visit the medical center in case of any clarification.

The steps of the teaching learning process that were most likely not well employed are the implementation and the evaluation steps. In the implementation step, the nurse should have delivered content in a manner that is more organized with the aid of planned teaching strategies. The evaluation step could be improved if the nurse questioned the patient on some aspects such as why insulin is important in management of type I diabetes and more so the rationale of giving it as an injection instead of pills.

References

Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1 diabetes. The Lancet, 383(9911), 69-82.

Chiang, J. L., Kirkman, M. S., Laffel, L. M., & Peters, A. L. (2014). Type 1 diabetes through the life span: A position statement of the American Diabetes Association. Diabetes Care, 37(7), 2034-2054.

Haas, L., Maryniuk, M., Beck, J., Cox, C. E., Duker, P., Edwards, L., … & McLaughlin, S. (2013). National standards for diabetes self-management education and support. Diabetes care, 36(Supplement 1), S100-S108.

Shaw, R. J., McDuffie, J. R., Hendrix, C. C., Edie, A., Lindsey-Davis, L., Nagi, A., … & Williams, J. W. (2014). Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions: a systematic review and meta-analysis. Annals of internal medicine, 161(2), 113-121.

Wood, J. R., Miller, K. M., Maahs, D. M., Beck, R. W., DiMeglio, L. A., Libman, I. M., … & T1D Exchange Clinic Network. (2013). Most youth with type 1 diabetes in the T1D Exchange Clinic Registry do not meet American Diabetes Association or International Society for Pediatric and Adolescent Diabetes clinical guidelines. Diabetes care, 36(7), 2035-2037.

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