Organizational Needs Assessment

Organizational needs assessment is a powerful tool for identifying a practice gap to implement an evidence-based intervention. Implementing evidence-based intervention can significantly improve the quality of care, enhance patient safety, and guarantee positive health outcomes (Najafipour et al., 2021). A lack of effective, efficient, and evidence-based guideline for controlling blood glucose can worsen diabetes type and lead to serious health complications including stroke, heart attack, kidney disease, nerve damage, and eye disease (Farjo et al., 2020). Against this backdrop, the paper focus on the problem of uncontrolled blood glucose in diabetes type 2 patients; explain how the problem was established at the practicum site; summarize evidence in literature related to the practice problem, identify the stakeholders who will support, resist, or have most influence to the problem and finally, analyze the gap in practice using the gap analysis table. Organizational needs assessment is the cornerstone of a change project.

Practice Problem or Need

Blood glucose originates from consuming carbohydrates. During digestion, carbohydrates are broken down into glucose and absorbed into the blood. Once absorbed, the glucose is oxidized in the presence of oxygen to produce energy used by the body (Galicia-Garcia et al., 2020). Insulin hormone produced by the pancreas stimulates the liver to convert excess glucose to convert glycogen. The glycogen is stored in the liver and broken down to glucose when blood glucose falls. The process is also facilitated by insulin. Insulin also facilitates the absorption of glucose into the cells (Galicia-Garcia et al., 2020). Diabetes type 2 is caused by high blood glucose due to the body’s inability to adequately produce or use insulin (National Institute of Diabetes and Digestive and Kidney Diseases, 2022). Excess glucose can significantly worsen the symptoms of type 2 diabetes, leading to health complications and high mortality. Consequently, the most efficient and effective way of managing diabetes type 2 is controlling blood glucose levels. Lack of evidence-based blood glucose control guidelines is a serious practice problem in most healthcare primary healthcare facilities. This potentially endangers the lives of diabetes type 2 patients and increases the cost of managing diabetes (Farjo et al., 2020).

The practicum site is a medium primary healthcare facility. It does not have an evidence-based guideline for managing diabetes type 2. The facility relies on health education to manage diabetes type 2. Consequently, there is a need for an evidence-based intervention to manage the problem. Lack of an evidence-based intervention to control blood glucose in diabetes type 2 patients was identified through stakeholder interviews, personal observation, and analysis of patient charts. Key stakeholders at the practicum site, among them the nurse manager, clinical director, and chief executive officer, reported that the current practice does not yield desirable results. They reported that they have witnessed many cases of uncontrolled blood glucose among diabetes type 2 patients receiving care at the facility. Concerned stakeholders who mainly include pharmacist, nurses, diabetes educators, dieticians, and physician have voiced concern over increased number of diabetes patients reporting uncontrolled blood glucose levels. The patients complained that the current practice was not helping them effectively manage their blood glucose hence need for another intervention.

According to Liu et al. (2020), there is a high prevalence of uncontrolled blood glucose in diabetes type 2 patients. The authors concluded that it is vital to effectively control fasting glucose levels (Liu et al., 2020). There is rising evidence of poor glycemic control among diabetes type 2 patients due to several factors including lack of physical activity, sedentary lifestyle, poor eating habits, and increasing obesity (Farjo et al., 2020). There is a significant positive correlation between controlling these factors and effective management of blood glucose. There is need for the development of a comprehensive evidence-based intervention that addresses the factors associated with high blood glucose in diabetes type 2 patients (Di Martino et al., 2021). Intensive glucose monitoring and control in diabetes type 2 patients is linked with decreased risk of health complications. However, in most clinical settings, achieving the target diabetes control is impossible (Farjo et al., 2020). A study carried out in Malaysia among type 2 diabetes patients being treated in primary health facilities showed that only 11% had controlled blood glucose. Overweight, smoking, lack of physical exercise, and obesity were identified as the most significant factors associated with poor blood glucose control (Riaz et al., 2021). Interventions to manage blood glucose must address overweight, smoking, lack of physical exercise, and obesity (Riaz et al., 2021).

Uncontrolled blood glucose increases the risk of uncontrolled diabetes (World Health Organization, 2023). Uncontrolled diabetes is a significant risk factor for major health complications and high mortality. Between 2000 and 2019, uncontrolled diabetes increased diabetes mortality by 3%. In 2019, kidney disease due to uncontrolled diabetes caused about 2 million deaths globally (World Health Organization, 2023). A study by Najafipour et al. (2021) established that the prevalence of uncontrolled diabetes among people being treated in primary healthcare settings in the U.S. in 2021 was 48.8%. The prevalence was highest among illiterate patients at 55% (Najafipour et al., 2021). Uncontrolled diabetes is a major cause of lower limb amputation, stroke, heart attacks, kidney failure, and blindness (World Health Organization, 2023).

Review of patient charts from the facility’s electronic health record system showed that out of the 35 patients who were being treated for diabetes type between the months of November 2022 and January 2023, 23 (About six in every ten patients) had A1C of more than seven indicating high blood glucose. The patients reported frequent urination, increased thirst, dry skin, fatigue, blurred vision, and being sick. Patient interview showed that the patients were not satisfied with the current practice because they continuously experienced increased blood sugar levels. Interviews with the nurse manager, clinical director, and chief executive officer, pharmacist, nurse practitioner, diabetes educators, dieticians, and physician showed that the intervention was ineffective because all the stakeholders indicated that the intervention did not yield desired results of controlled blood glucose. The interviews were conducted at the clinic between the months of January and February 2023. It was also observed that the practicum site that the healthcare team lacked an evidence-based clinical guideline to use when caring for diabetes type 2 patients.

Stakeholders

Stakeholders are persons or entities who have an interest in a project or can influence its outcome (Heckert et al., 2020). Stakeholders can support, resist, or have a positive or negative influence on the project. It is important to identify all stakeholders and establish how they will react to the project to ensure success. Failure to address the interest of stakeholders can cause scope creep which can cause project failure (Heckert et al., 2020). The key stakeholders who will support the project include the facility’s management comprising of nurse manager, clinical director, and chief executive officer, the staff comprising of pharmacist, nurse practitioner, diabetes educators, dieticians, and physician, and the patients. The stakeholders will support the project because the interviews revealed that they yearn for change. They will also support the project because it is based on evidence. The staff and management will support the project because they have been involved since inception and educated about the intervention. The stakeholders who may resist the change are patient’s family members because they are yet to be involved in the project. Lack of information about the project may cause them to resist. The stakeholders who will have the most influence are the diabetes type 2 patients and staff who provide care to them. They will have the most influence because they will be directly involved in the project and the project will take a significant amount of their time. The staff will include pharmacist, nurse practitioner, diabetes educators, dieticians, and physician.

Gap Analysis

To conclude, organizational needs assessment is the cornerstone of a change project because it helps to identify and describe the practice problem. It also helps to identify the key stakeholders whose influence will determine the successful implementation of the change project. Through analysis of patient charts, interviewing key stakeholders, and personal observation, the problem of lack of an evidence-based intervention to control blood glucose levels among diabetes type 2 patients was established. Results of the analysis of patient charts and feedback from key stakeholders revealed a significant rise in blood glucose levels among diabetes type 2 patients receiving care at the practicum site. Controlling blood glucose is vital in preventing the adverse health effects of diabetes type 2.

References

Di Martino, G., Di Giovanni, P., Cedrone, F., D’Addezio, M., Meo, F., Scampoli, P., … & Staniscia, T. (2021). The Burden of Diabetes-Related Preventable Hospitalization: 11-Year Trend and Associated Factors in a Region of Southern Italy. In Healthcare (Vol. 9, No. 8, p. 997). MDPI.https://doi.org/10.3390/healthcare9080997

Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., … & Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International journal of molecular sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275

Heckert, A., Forsythe, L. P., Carman, K. L., Frank, L., Hemphill, R., Elstad, E. A., & Lesch, J. K. (2020). Researchers, patients, and other stakeholders’ perspectives on challenges to and strategies for engagement. Research Involvement and Engagement, 6(1), 1-18. https://doi.org/10.1186/s40900-020-00227-0

Farjo, P. D., Barghouthi, N., Chima, N., Desai, A., Fang, W., Giordano, J., & Bianco, C. M. (2020). Use of the burden of diabetes mellitus score for cardiovascular disease risk assessment. The American journal of cardiology, 125(12), 1829-1835. https://doi.org/10.1016/j.amjcard.2020.03.027

Liu, L., Wang, F., Gracely, E. J., Moore, K., Melly, S., Zhang, F., … & Eisen, H. J. (2020). Burden of uncontrolled hyperglycemia and its association with patients characteristics and socioeconomic status in Philadelphia, USA. Health Equity, 4(1), 525-532. https://doi.org/10.1089/heq.2020.0076

National Institute of Diabetes and Digestive and Kidney Diseases, (2022). Type 2 diabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes

Najafipour, H., Farjami, M., Sanjari, M., Amirzadeh, R., Shadkam Farokhi, M., & Mirzazadeh, A. (2021). Prevalence and incidence rate of diabetes, pre-diabetes, uncontrolled diabetes, and their predictors in the adult population in southeastern Iran: Findings from KERCADR study. Frontiers in public health, 1530. Doi: 10.3389/fpubh.2021.611652

Riaz, F., Al Shaikh, A., Anjum, Q., Mudawi Alqahtani, Y., & Shahid, S. (2021). Factors related to the uncontrolled fasting blood sugar among type 2 diabetic patients attending primary health care center, Abha city, Saudi Arabia. International Journal of Clinical Practice, 75(7), e14168. Doi: 10.1111/ijcp.14168

World Health Organization. (2023). Diabetes. https://www.who.int/news-room/fact-sheets/detail/diabetes#:~:text=Diabetes%20is%20a%20major%20cause,an%20estimated%202%20million%20deaths.