Diabetes Capstone Project Change Project - Essay Sample

Introduction

Diabetes is a lifelong disease caused by insulin resistance and insufficient production of insulin or both. It is a complex health care problem that requires continuous medical attention. Self-management education about lifestyle changes is critical to preventing long-term complications. For patients with limited mobility, lifestyle behavioral changes are critical to achieving good metabolic control. Besides the pharmacological interventions, nurses should be familiar with evidence-based lifestyle changes that would help diabetes patients achieve optimal health. My change project this semester is the prevention and control of diabetes in patients with limited mobility. The paper aims to describe the components of my change proposal.

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Background

In the facility where the change is taking place, many diabetes patients have severe complications. The presence of obesity is a problem that causes diabetes patients to have limited mobility. Diet and physical exercises are the major components of energy balance. Evidence supports that nutritional interventions for patients with diabetes help in the reduction of HbA1c levels (Andrews et al., 2011). Furthermore, promoting light exercise like walking would help patients regain their mobility and improve their metabolic function. In his study, Herman (2016) found that lifestyle interventions reduced the incidences of diabetes by 58%. According to the author, a diabetes prevention program using lifestyle interventions reduces health care costs significantly. EBP implementation improves the quality of care (Giomuso, Chandler, & Pulphus, 2016). The change project applies EBP to get the best available evidence for lifestyle changes.

Clinical Problem Statement

Diabetes patients are prone to medical problems that can cause long-term complications, hospitalizations, and mortality. In their 2020 national statistics report, the Center for Disease Control and Prevention (2020) stated that 34.1 million adults were diagnosed with diabetes as of 2018. Some of the risk factors for diabetes include obesity, physical inactivity, high blood pressure, smoking, high cholesterol, and high A1C levels (CDC, 2020). Of the 34.1 million population, 89.0% were obese and overweight while 38.0 were physically inactive (CDC, 2020). Care for diabetes requires the collaboration of interdisciplinary teams such as dieticians, diabetes educators, eye- doctors, and foot specialists (CDC, 2020). Considering the figures provided by the CDC, diabetes is a clinical problem that requires clinical intervention.

Purpose of the Change Proposal

The purpose of this change proposal is to discuss the significance of evidence-based lifestyle changes in the management of diabetes for patients with limited mobility. The proposal aims to discuss the PICOT question, evaluation of evidence-based literature, the change theory, the implementation plan, and barriers, as well as the evaluation of the intervention. The target readership for the proposal are stakeholders such as the hospital’s administration, patients, health professionals at the facility, and financial organizations that would provide funding.

PICOT question

In adult patients (P), do lifestyle interventions such as diet and exercise (I) compared to patients with no lifestyle interventions (C) manage their diabetes condition (O) within twelve weeks (T)?

Literature Search Strategy Employed

The search involved looking for literature evidence, appraising it, then finding the ones best suited for the change project. Melnyk, Gallagher-Ford, Long, and Fineout-Overholt, (2014) stated that searching for the best evidence requires appraising it for reliability, validity, and applicability to clinical expertise and patient’s preferences. I searched through various nursing databases and Google search then used the phrase ‘evidence-based lifestyle changes for diabetes management” and selected the best literature. Through evidence-based practice, clinicians can manage to provide value-based healthcare (Spruce, 2015). My search strategy yielded credible results that proved lifestyle changes such as diet and exercise can prevent and manage diabetes.

Evaluation of the Literature

I evaluated the literature by focusing on the usefulness of the research and the reliability of the information. Melnyk et al. (2014) asserted that continuous evaluations in healthcare help to induce practice changes. I was keen on checking whether the literature correlated with the PICOT question for this project. I also evaluated the literature by checking whether the study findings were generalizable in clinical practice.

Applicable Change or Nursing Theory Utilized

The change theory applied is Kurt Lewin’s change theory. In the model, the first stage is unfreezing where the change agent making people forgo their old ways of doing activities, second is movement, which is the change process, and the third is refreezing where people adjust to the new change (Currentnursing.com, 2011). The reason for using the model is that its steps will help in evaluating whether the project implementation will be a success.

Proposed implementation plan with Outcome Measures

The strategy involves incorporating a culture of EBP among the staff. The implementation plan for the incorporation of an evidence-based culture includes the following,

Training and education of staff – Unlimited access to EBP resources such as nursing databases will be provided to the health professionals to enable them to make use of evidence-based solutions in finding lifestyle changes for the patients.

Education for patients – Patients will receive diabetes education on the types of nutritional recommendations and exercises using the best available scientific evidence.

Continued monitoring and feedback to staff – this will help to explore and address any challenges that may occur during the implementation of the EBP project.

How Evidence-based Practice was used in Creating the Intervention Plan

I came up with the intervention using EBP by searching literature that discussed the use of EBP in preventing and managing diabetes. Creating a norm of EBP use in healthcare helps to improve patients’ health outcomes (Stetler, Ritchie, Rycroft-Malone, & Charns (2014). With that in mind, finding the best evidence for the lifestyle interventions was a priority.

Plan for Evaluating the Proposed Nursing Intervention

The evaluation plan identifies the project’s focus, the needs of the stakeholders, and the education available to meet the change objective. The evaluation plan is as follows,

Step 1: evaluate participant data – it would help to assess the patients’ data, current health status, and their knowledge about lifestyle changes to improve their health outcomes.

Step 2: Evaluate process measures – the process would assess staff knowledge on evidence-based solutions on diabetes patients’ lifestyle changes. This measure will also include the number of educational materials available for the staff to help in the successful implementation of the program. Additionally, the step will consist of the types of resources provided by stakeholders and their contributions to the project.

Step 3: Evaluate community outcomes – this process will evaluate the healthy behaviors adopted by the patients, their perceived health status, and the healthcare costs.

Potential Barriers to Implementation Plan and ways to Overcome

The two barriers that may prevent my EBP project from achieving the desired results include changes in institutional infrastructure and inadequate support from nurse leaders. The facility’s infrastructures, such as policies and development units, do not adhere to EBP. Using the best available evidence helps to improve healthcare outcomes (Flodgren, Rojas-Reyes, Cole, & Foxcroft, 2012). Six months to one year after the project’s implementation, it is likely that the staff might forget the culture of inquiry and the application of EBP.

Nurse leaders at the facility seem unmotivated. It is a barrier because leaders do not support the staff. In the current fragmented healthcare system, nurse leaders should provide support to their staff to transform the system in areas like healthcare experience, population health, and value for money (Wheatley, Doyle, Evans, Gosse, & Smith, 2017). Support from the facility’s administration would help my EBP project to achieve the desired results.

To overcome the barrier of institutional infrastructure and inadequate support from leaders, ensuring that the administration is the key stakeholder for the project will be necessary. Also, there will be a need for mentors and trainers who are qualified in healthcare infrastructure to educate the administration leaders on ways they could support staff and provide resources.

Conclusion

An evidence-based change project about lifestyle interventions will help health professionals to acquire knowledge on the ways to improve diabetes patients’ health outcomes. Patients with diabetes and have limited mobility have decreased health outcomes. Furthermore, evaluations help to determine the impact and effectiveness of a project. For my project, the evaluation plan includes assessing patients’ data, the process measures, and the community outcomes. Focusing on those three areas will help in the project’s successful implementation.