Evidence-Based Practice Strategic Improvement Project

Introduction

Problem Statement

The wide spread of diabetes is noted worldwide, especially in the United States. The Hispanic population living in Miami-Dade County is twice more prone to developing diabetes compared to other ethnicities (Kenya et al., 2015). Since the symptoms and consequences of the mentioned disease are rather critical to the overall health of the population, it is of great importance for nurses to address this problem. The deficit in the current circumstances is associated with a lack of the population awareness of its own health needs and ways to enhance it. In particular, Hispanics may be characterized as practicing poor eating habits, low physical activity, and rare visits to hospitals. The magnitude of the problem is considerable – 8 percent of the given population have diabetes, and approximately 10 percent are diagnosed with pre-diabetes (“Adults with diabetes,” 2017). In this regard, it becomes evident that the problem of diabetes in Hispanics needs urgent actions.

Significance

The identified problem’s significance is closely aligned with the future of the community. Since the Hispanic population tends to grow, it is critical to assist them in overcoming diabetes. The main challenge is associated with the fact that people lack basic knowledge of proper nutrition and self-care, while these knowledge and skills are likely to considerably facilitate their treatment and management of the existing health conditions. In addition, diabetes causes many other concomitant diseases and may even lead to death. Therefore, the potential solution to the problem refers to increasing self-efficacy and health literacy of the population, which should learn how to prevent and manage diabetes based on evidence-based recommendations.

PICOT Question

In Hispanic patients, does the development of new guideline to address contributing factors in developing diabetes compared with the traditional approach of treating sick people increase their awareness of prevention and knowledge of their ethnicity group health needs over the period of one year?

Supporting Internal / External Data

Literature Review

The recent literature presents the evidence that reveals physiology, socio-demographic, and behavioral features that contribute to the development of diabetes in Hispanics. As noted by Kenya et al. (2015), the majority of the Hispanic population representatives have poor self-efficacy with regard to their own health. The authors discovered that 83 percent of the studied sample does not follow their medication prescriptions, and 80 percent were characterized as having depression (Kenya et al., 2015, p. 5). These findings show that nurses should employ patient education strategies to increases awareness of the target population and improve their health outcomes.

At the same time, it seems important to mention some wider researchers conducted to examine diabetes control in the given population in the US. Schneiderman et al. (2014) explored the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and found that diabetes prevalence in this community is the highest in Mexicans (18.3 percent) and Dominicans and Puerto Ricans (18 percent) (p. 2236). More to the point, the condition of prediabetes, a condition in which the blood glucose level is constantly elevated, but not enough for the diagnosis of diabetes, was also regarded as high. The low rates of diabetes control and awareness were identified as the key factors that cause the target problem, which is aggravated by low insurance levels.

Diabetes is harmful not only per se but also because it significantly increases the risk of many other diseases, especially cardiovascular issues, kidney disease, cancer, senile dementia, et cetera. According to the Centers for Disease Control and Prevention, diabetes is the most common cause of non-traumatic amputation of the legs and complete loss of vision among adults (Schneiderman et al., 2014). The overall risk of death for diabetics is increased in relation to people of the same age but without diabetes at least twice. The boost in the incidence of diabetes is also a serious economic problem – in the US, the presence of diabetes increases the cost of medical care by an average of 2-3 times.

Agency Internal Data

Leon Medical Centers organization was selected to conduct the proposed project. It one of Miami’s leading healthcare facilities that consists of seven centers, which provides the opportunity to visit it for many people. This organization provides educational sessions to the population and focuses on controlling diabetes in Miami-Dade County. For example, monitoring of glucose levels and taking immediate actions in case of complications are among the critical issues taught by Leon Medical Centers (“How to reduce your diabetes symptom,” 2018). In the view of the above information, the choice of this organization seems to be appropriate.

Proposed Intervention and Methods

Purpose

The paramount purpose of the proposed project is to provide patient education to the target population and measure its outcomes that are expected to be positive in terms of health improvement. In particular, it is anticipated to use the resources of Leon Medical Centers to increase awareness of Hispanics. The scope of the project will focus on the provision of both online and offline education based on diabetes self-management education (DSME). Nutrition, physical activity, lifestyles, and emotional health will be at the core of the proposed project. Nurses will be instructed to gather small groups of the population to translate evidence-based knowledge and help them to master important skills.

In the context of the project, the first goal is to provide education so that the Hispanic population would understand their current weaknesses and learn how to address them. The second goal is associated with collecting and analyzing data received from the participants, both Hispanics and nurses. Ultimately, the third goal is to compare the findings with the existing evidence and dissemination of the results in order to contribute to nursing practice (Moran, Burson, & Conrad, 2016). It is expected to learn how the population perceives education, what they find difficult or unnecessary, and how their attitudes towards diabetes changes in the course of the project implementation (Fineout-Overholt, Gallagher-Ford, Melnyk, & Stillwell, 2011). Among the measurable outcomes, there will be the level of awareness, blood glucose change, and self-efficacy rates.

Setting

Leon Medical Centers is a suitable place for conducting the proposed study as it specializes in diabetes management for several years. More to the point, it is located in seven different places, which allows involving people from different neighborhoods. It is especially important for those who have problems with transportation. It should also be emphasized that Leon Medical Centers has a reliable reputation as an organization that values and respects its patients, practicing respect and sensitivity to their needs and expectations.

Sample / Subject Population

Taking into account that the proposed study should determine the impact of patient education, it is necessary to include a sufficient number of participants. Namely, patients of the mentioned health organizations will receive the invitation to participate in the project. The inclusion criteria will be the age between 25 and 55, the ethnicity of Hispanics, and diabetes or prediabetes condition. Of those 200, 70 will be selected, and three groups will be organized. The first two groups will be experimental, while the latter will be a control one (Harris, Roussel, Thomas, & Dearman, 2015). In order to ensure that the project will be designed appropriately, it is expected to compare data from all groups. At the same time, the fourth groups will be composed of nurses participating in the study, including advanced practice nurse, managers, and unit administrators. They will be asked to share their perceptions and attitudes regarding the project and the effectiveness of the intervention.

Intervention

The main intervention will be the provision of patient education in such areas as healthy nutrition and physical activity roles. Since the Hispanic population tends to eat high-calorie foods, it is essential to explain the role it takes in terms of diabetes. The impact of adequate exercising should also be discussed as many people with diabetes lead sedentary lifestyles without even knowing that it may cause deteriorating of their health conditions. Furthermore, self-care and self-efficacy issues will be clearly presented to participants, paying attention to the positive impact of timely monitoring of the related symptoms and body systems.

A set of tools will be used to implement the project, among which Lippitt’s change theory and DSME will compose the theoretical framework. Both online and traditional education will be designed to meet the needs of the population. As for the blueprint, while some educational sessions will require the presence of patients in the selected centers, other information will be offered online either via the official website of Leon Medical Centers or email. Participants will be offered the opportunity to ask any questions related to diabetes, and receive relevant answers as well as assistance with self-care issues.

References

Adults with diabetes. (2017). Web.

Fineout-Overholt, E., Gallagher-Ford, L., Melnyk, B. M., & Stillwell, S. B. (2011). Evidence-based practice, step by step: Evaluating and disseminating the impact of an evidence-based intervention: Show and tell. The American Journal of Nursing, 111(7), 56-59.

Harris, J. L., Roussel, L., Thomas, P. L., & Dearman, C. (Eds.). (2015). Project planning & management: A guide for nurses and interprofessional teams (2nd ed.). Burlington, MA: Jones & Bartlett Publishers.

How to reduce your diabetes symptom. (2018). Web.

Kenya, S., Lebron, C. N., Chang, A. Y. H., Li, H., Alonzo, Y. A., & Carrasquillo, O. (2015). A profile of Latinos with poorly controlled diabetes in South Florida. Journal of Community Hospital Internal Medicine Perspectives, 5(2), 1-7.

Moran, K. J., Burson, R., & Conrad, D. (2016). The doctor of nursing practice scholarly project: A framework for success (2nd ed.). Burlington, MA: Jones & Bartlett Publishers.

Schneiderman, N., Llabre, M., Cowie, C. C., Barnhart, J., Carnethon, M., Gallo, L. C.,… Teng, Y. (2014). Prevalence of diabetes among Hispanics/Latinos from diverse backgrounds: The Hispanic community health study/study of Latinos (HCHS/SOL). Diabetes Care, 37(8), 2233-2239.