Patient Summary
Mrs. Emma Johnson is an 85-year-old female with type 2 diabetes, and she has a history of moderate tobacco use, alcohol use, and borderline obesity. Even though the patient quit those habits several years ago, they may have contributed to her existing conditions like high blood pressure and dementia. Due to her age and various conditions, Mrs. Johnson cannot manage her condition alone; hence her granddaughter Emily Johnson helps in her diabetic care. She has been under various oral medications like metformin, glipizide, and insulin; however, we have identified the need for lifestyle modifications to improve her overall health outcomes.
Mrs. Johnson was a patient of interest for my Capstone Project since I have known her for quite some time after becoming a friend to the family a few years ago. Her granddaughter is a close friend, and I have interacted with her as she cares for Mrs. Johnson. While oral medications and insulin therapy have helped with the patient’s condition, as I interacted with the family, I felt lifestyle modifications would better help the patient in diabetes management.
According to the Centers for Disease Control and Prevention (CDC), over 37 million Americans have diabetes, and over a third of U.S. adults have prediabetes. Type 2 diabetes accounts for about 90% to 95% of all diagnosed cases. As more Americans become obese and overweight and grow older, the number of diabetes cases has more than doubled in the last 20 years (CDC, 2023). Hence, if poorly managed or left untreated, diabetes can result in various complications, such as nerve damage (neuropathy), kidney damage, cardiovascular disease, and eye damage (retinopathy). However, with proper medical care, regular monitoring, and lifestyle changes, individuals with diabetes can lead healthy and fulfilling lives.
As a baccalaureate-prepared nurse, this subject is of interest due to the high prevalence of diabetes in the American adult population. Therefore, staying informed about diabetes causes, symptoms, and management approaches aids in effectively supporting and caring for individuals living with the condition. Besides, as a nurse, I have the knowledge and skills to educate patients and families regarding diabetes prevention and management and provide guidance to help patients better manage their conditions and improve their well-being.
Role of Leadership and Change Management in Addressing Diabetes
In developing the proposed intervention for the patient, leadership, and change management strategies played an integral role. Effective leadership is vital in supporting the development of the intervention. As a healthcare provider, my role as a leader is to provide guidance, direction, and support. Leaders acknowledge the need for addressing lifestyle factors in managing diabetes and advocating for various solutions focused on lifestyle modifications. Leaders also mobilize resources, promote a culture of innovation and collaboration within the healthcare team, and engage various stakeholders like patients and their families in developing the intervention.
In developing the intervention, change management strategies were employed, particularly the Kurt Lewin change model. The Kurt Lewin model of change management was essential in developing the intervention. According to Harrison et al. (2021), this model entails unfreezing, which prepares the patient for the change by breaking down behaviors and mindsets that may hinder the change process. The change would involve introducing the intervention to the patient and training or educating the patient about the change. While implementing the change to the patient, effective communication and collaboration will be essential. The final step is refreezing, which entails reinforcing and stabilizing the intervention and making it the new norm for the patient. The outcomes of the intervention would be evaluated, and ongoing support would be provided to ensure long-term benefits to the patient.
In developing the intervention, nursing ethics emphasized nursing principles like beneficence which highlights the importance of promoting the patient’s overall well-being. The primary intervention for the patient is lifestyle modifications in diabetes management. Hence the intervention aims to improve patient outcomes by prioritizing patient health and well-being. The proposed intervention recognized the autonomy of the patient in making decisions regarding lifestyle choices. The intervention aims to empower the patient by providing her with support, tools, and knowledge to make informed decisions about their lifestyle modifications. The intervention also prioritized the non-maleficence principle by considering potential adverse effects and risks of the intervention and ensuring the interventions were safe and suitable for the patient (Varkey, 2021). Furthermore, nursing ethics also integrate fairness and equity, and the proposed intervention focused on fostering equitable access to lifestyle modification resources, irrespective of ethnicity, race, age, or socioeconomic status. Integrating nursing ethics in the proposed intervention ensured ethical considerations were central to the decision-making process.
Strategies for Communicating and Collaborating with the Patient
Communicating with the patient is essential in nursing. When I met Mrs. Emma Johnson, who is diagnosed with diabetes, we discussed her condition and how she has been managing her diabetes through pharmacological support. She also has hypertension and dementia, conditions which have presented challenges in her care. However, she has also been able to manage her blood pressure through medications. Certain factors, including the loss of her husband, have also affected her diabetes management. In our collaborative activity, I enquired about what she wanted to achieve in her care. By asking open-ended questions and her input, I was able to acquire information on her feelings towards the condition and the goals she wanted to achieve in diabetes management. Therefore, her input and feedback helped in developing the intervention.
Communicating and collaborating with the patient would involve establishing a respectful and trusting relationship. It also entails actively listening to the patient’s goals, fears, and concerns and developing a safe environment for open communication. Ensuring effective communication encourages the patient’s input which can enhance adherence and adoption of the proposed intervention. According to Ifrim et al. (2022), engaging the patient in decision-making empowers them to take ownership of their health, resulting in better health outcomes and better management of diabetes. Best practice strategies to ensure effective communication involve the use of such open-ended questions that encourage the patient to share their feelings and thoughts. The use of open-ended questions and active listening helped in understanding the needs and goals of the patients and strategies, including lifestyle modifications to better manage her condition.
Standards and/or Policies That Guided my Work
Organization and government policies guide the development of interventions by outlining various standards and guidelines. The Center for Disease Control and Prevention (CDC) and American Diabetes Association (ADA) provides guidelines for evidence-based recommendations in managing chronic diseases, including diabetes. ADA standards and guidelines emphasize timely treatment decisions, adherence to evidence-based guidelines, and collaboration with patients based on their preferences, comorbidities, prognoses, and informed financial considerations (American Diabetes Association, 2022). Diabetes management approaches should also be aligned with Chronic Care Model, which emphasizes person-centered team care, integrated long-term treatment approaches to diabetes, as well as ongoing collaborative communication and goal-setting between interdisciplinary teams. State boards such as the New Jersey Board of Nursing provide strict guidelines and practices to ensure nurses are unified in providing quality patient care and promoting safety. According to American Diabetes Association Professional Practice Committee (2022), implementing standardized diabetes care guidelines and protocols is linked to decreased complications, reduced hospital readmissions, and improved glycemic control. Policies fostering support programs and diabetes self-management education have demonstrated positive effects on self-care behaviors, patient knowledge, and glycemic control. In addition, policies focusing on care coordination and integration have shown reduced healthcare costs and improved health outcomes for patients (Ernawati et al., 2021; Teisberg et al., 2020). For example, the Affordable Care Act (ACA) policies prioritize care coordination in chronic disease management, which has led to increased patient satisfaction, decreased healthcare costs, and improved patient outcomes.
How the Proposed Intervention Will Improve the Quality of Care, Enhance Patient Safety, and Reduce Costs to the System and the patient
The proposed intervention of lifestyle modification, including regular physical activity, adopting a healthy diet, and weight management, results in improved glycemic control. According to Salama et al. (2023), lifestyle modifications aid in reducing the risk and severity of comorbidities linked to diabetes, such as dyslipidemia, high blood pressure, and cardiovascular diseases. Besides, the intervention provides support and education to the patient, empowering them with the skills and knowledge necessary for diabetes management. Lifestyle modifications, including maintaining optimal glucose levels and blood pressure, can considerably minimize the risk of complications associated with diabetes like diabetic retinopathy, nephropathy, and neuropathy, hence enhancing patient safety. According to Sheng et al. (2019), when patients focus on lifestyle modifications, the need for multiple medications or high doses in diabetes management may be minimized, potentially reducing the risk of medication errors and adverse drug reactions. Moreover, lifestyle modification interventions can result in a decrease in emergency room visits, hospitalizations, and outpatient visits associated with diabetes complications, leading to cost savings. According to Watson et al. (2021), by attaining better glycemic control through lifestyle modifications, patients may not need higher doses or medications, and this results in decreased medication costs for the patient and healthcare system.
Moreover, the CDC publishes the National Diabetes Statistics Report, which provides comprehensive data on diabetes prevalence, costs, and healthcare utilization, hence acting as a benchmark for care quality and costs. Organizations and agencies like the National Committee for Quality Assurance (NCQA) and Agency for Healthcare Research and Quality (AHRQ) provide benchmark data for patient safety and quality care measures, including those associated with diabetes management. Additionally, health insurance claims databases and administrative databases maintained by healthcare systems and government agencies can also provide valuable data regarding costs, healthcare utilization, as well as outcomes for individuals with diabetes.
Technology, Care Coordination, and the Utilization of Community Resources
From previous assessment, I outlined how technology, care coordination, and the utilization of community resources can be applied in the patient’s diabetes management. One of the technologies widely adopted by patients is Continuous Glucose Monitoring (CGM), which is a system that provides real-time measurement of glucose levels, enabling diabetes patients to monitor their blood sugar levels more accurately and frequently. CGM devices help in the identification of trends and patterns in glucose levels, hence aiding in reducing risks of complications and better diabetes management. According to Kluemper et al. (2022), technological advancements like CGM have increased patient and healthcare providers’ access to glucose data and trends. Real-time CGM has shown a decline in HbA1c, whereas the cases of severe hypoglycemia have declined.
According to Lee et al. (2018), telemedicine can be useful in diabetes management as remote monitoring of glucose levels improves A1C levels in individuals with poor glucose control. Telemedicine technologies enable health professionals to monitor and communicate with patients remotely. In diabetes management, telemedicine allows for virtual diabetes education, remote data review, and virtual consultations. Remote monitoring technologies like web-based platforms or digital applications can transmit data from CGM systems, insulin pumps, blood pressure cuff, or glucose meters to healthcare professionals, hence facilitating timely interventions and remote management. Studies reveal that patients with more regular and frequent participation in remote monitoring and telehealth interventions had lower HbA1c levels ((Lee et al., 2018; Su et al., 2019). Hence, for patients with type 2 diabetes, current evidence demonstrates the effectiveness of telehealth in controlling HbA1c and attaining better glycemic control.
Furthermore, there are various digital tools and mobile applications designed for diabetes self-management. Such tools integrate features such as medication reminders, meal planning, glucose tracking, and educational resources. Veazie et al. (2018) conducted research on 11 applications for diabetes self-management, which encompassed features like tracking blood glucose and HbA1c and setting reminders for physical activity and medication use. Results from the study revealed that the use of mobile applications with support from health professionals led to improved outcomes on HbA1c. Various applications suitable for the patient include Apple Health App and BlueStar app for type 2 diabetes patients, which allows patients to enter their blood glucose levels and receive real-time coaching. According to Doupis et al. (2020), patients can organize their medication plans and get advice on their diet and lifestyle. BlueStar also integrates various variables like body weight and blood pressure, and patients further receive automated coaching messages and personalized education. As a result, mobile applications and digital tools facilitate self-care practices, enhance patient engagement, and provide real-time feedback on diabetes management.
Care coordination and the use of community resources are integral in addressing the needs of can be applied in addressing diabetes. By fostering collaboration among health professionals, support networks, and community organizations, care coordination can improve the quality of care and overall well-being of diabetes patients. Effective care coordination ensures effective communication and collaboration among healthcare providers involved in managing diabetes, including dieticians, nurses, endocrinologists, and primary care physicians. Northwood et al. (2023) point out that effective communication and collaboration encourage a unified approach to care, hence optimizing patient outcomes and preventing gaps in treatment. Moreover, care coordination entails providing education and support to empower patients in self-management. This includes education on healthy lifestyle behaviors, blood glucose monitoring, medication adherence, and recognizing signs of complications. In my practice, support has been provided by connecting patients with peer support groups and self-management programs.
Community resources, including diabetes education programs, help with support groups and offer classes and workshops that educate diabetes patients and their families about the condition and foster self-management skills. Such programs also provide valuable information regarding coping strategies, medication management, exercise, and diet. Community resources like nutritional assistance programs, food banks, or subsidized meal programs help patients manage their dietary needs and access healthy food options. Community-based exercise programs, recreational centers, fitness facilities, or walking groups encourage physical activity, which is vital in managing diabetes. Most older patients in the community have walking groups that aim for at least 30 minutes of regular exercise to improve their overall health. Additionally, community organizations like non-profit organizations, social service agencies, and faith-based organizations provide support services for individuals with diabetes, like counseling for mental health issues, financial guidance, and transportation assistance (CDC, 2023). One such support service in my practice is a transportation service operated by the city, which transports elderly individuals with diabetes to healthcare facilities for appointments, consultations, and treatment. Besides, various local churches have developed counseling programs to help patients with mental health issues like stress.
Conclusion
While diabetes management can be challenging for some patients, particularly the elderly, developing a coordinated care plan, adopting necessary technology, implementing effective interventions, and fostering the utilization of community resources can considerably alleviate the challenges, barriers, and stressors associated with diabetes management. The proposed intervention in this Capstone Project will provide better solutions for the patient and their families, ultimately resulting in improved health outcomes. The invaluable experience and knowledge gained throughout this project with regard to patient care, patient safety, technology and informatics, health promotion, ethics, and care coordination will contribute to my personal and professional growth as a registered nurse.
References
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