Complex Disease: Diabetes, Capstone Project Example

Introduction

Diabetes is a complex disease that leads to many complications for patients that may have a widespread impact on organs and systems. However, patients do not often receive adequate education and guidance regarding the disease, thereby contributing to complications associated with treatment and management over time. Furthermore, their self-care skills may be limited due to lack of knowledge and understanding of the importance of diabetes self-care. Pregnant women who have never had diabetes before but  still demonstrate signs of having who high blood glucose, or sugar, levels throughout their pregnancy are diagnosed with gestational diabetes. Recent diagnostic criteria for gestational diabetes finds that it affects 18% of all pregnancies (“American Diabetes Association”, 2014).  Nurses must recognize the weaknesses that exist and expand their education to patients to increase knowledge and awareness of diabetes and related symptoms so that self-care objectives are met and lead to successful outcomes. It is anticipated that patients will favorably respond to an education intervention and will demonstrate their expanded knowledge of diabetes to facilitate improved quality of life. In particular, patients with gestational diabetes should be considered as part of an intervention to ensure that they possess the proper education and knowledge to ensure that their self-care is comprehensive and effective in treating the disease at all stages.

Step 1: Identification of the Problem

Many patients who are diagnosed with diabetes do not fully understand the scope of this problem and its impact on organs and systems. Therefore, they are either poorly educated to begin with or do not understand the severity of the disease as expressed by nurses and other healthcare providers. As a result, a diabetes education intervention is necessary in order to ensure that medications are self-administered in a timely manner to minimize symptoms and prevent further degradation of organs and systems. There appears to be a significant gap between the knowledge that patients are expected to have in regards to diabetes management and the education that is provided to them. This gap must be explored in greater detail in order to establish an intervention strategy for nurses to educate patients regarding diabetes to minimize gaps in knowledge and expand self-care to prevent symptoms and promote greater wellbeing for this patient population.

Step 2: Problem/Intervention/Outcome

Patients who are diagnosed with diabetes often find it difficult to understand the scope of the disease and its impact on quality of life. For the average person, the physiological constructs of diabetes are not well known or well understood; therefore, they complicate health matters for many patients, perhaps none more than pregnant women with gestational diabetes (Perry, 2006). This population group faces a difficult battle with diabetes if it is left untreated or undiagnosed, as this could pose a greater risk to patients and their unborn children (Perry, 2006). It is important to recognize the symptoms and diagnose the condition as early as possible to prevent permanent or long-term complications for pregnant women (Perry, 2006).

The development of a successful strategy to educate women regarding gestational diabetes requires knowledgeable nurses with experience in this specialty area to promote improved understanding and self-care (Hernandez et.al, 2013). This includes nutritional guidance and support to ensure that patients are aware of the foods that they should consume throughout the pregnancy that will minimize their diabetic complications (Hernandez et.al, 2013). In addition, patients should obtain the necessary knowledge regarding self-care so that upon discharge, the appropriate steps will be taken to accommodate patient needs and promote greater health and wellbeing (Hernandez et.al, 2013).

It is expected that the intervention will provide an overview of gestational diabetes and enable patients to ask questions regarding the disease and its impact on pregnancy (Landon et.al, 2011). This approach is necessary because pregnant women who have been diagnosed with gestational diabetes require a level of knowledge and education that go above and beyond traditional prenatal care (Landon et.al, 2011). These efforts are important because they provide a basis for exploring new insights and enhancing knowledge for patients with gestational diabetes (Landon et.al, 2011). The proposed intervention must target the appropriate areas so that patients are able to perform self-care in the desired manner and improve their chances of achieving healthy pregnancies, which is the anticipated outcome of the intervention strategy and course of action (Landon et.al, 2011).

Step3: Best Evidence Change Evaluation

Gestational diabetes is a fairly common and complex condition that is exacerbated by the symptoms of pregnancy and the hormonal changes that occur throughout the body. Therefore, it is important to recognize these symptoms, their causes, and the possible best practice solutions that exist to combat this disease effectively (Lechner et.al, 2011). The chosen course of action must consider the issues that are critical to patients with gestational diabetes and expand knowledge to facilitate successful patient care outcomes (Lechner et.al, 2011). However, another area to consider is screening for gestational diabetes, which must be comprehensive and supportive of accurate diagnoses and subsequent treatment strategies (Perucchini et.al, 1999). These issues are significant and play an important role in shaping patient outcomes, particularly when screening tools are successful and an early diagnosis is made (Perucchini et.al, 1999). Similarly, gestational diabetes must be diagnosed as early as possible to enable nurses to facilitate effective knowledge regarding self-care and the appropriate alternatives to effectively treat the condition without delays (Ryan, 2011).

Step 4: Design Practice Change

Designing the practice change starts with the trigger problem of diabetes and the need to enhance educational resources for patients. . A roundtable discussion will be conducted, preferably at a related medical conference. This conference will be followed up with a select number of focused discussions about practice changes. During this process strategies are identified and the trigger topic will be explored to assess the best course of action towards implementing a new practice. Relevant clinicians in the field will be gathered to take part in this conference to establish a clear understanding of elements like early warning signs, prevention techniques and clinical instruction necessities for both staff and patients upon discharge. Standard nursing practices will also be reviewed as they relate to the issue and the new changes required for implementation. The design will be structured from these discussions with the goal of full implementation in mind. A blue print can be mapped out during this stage that will account for all resources required and milestones necessary for achievement of putting the design into practice.

Step 5: Implement and Evaluate the Change in Practice

DiCenso, Cullum, and Ciliska (1998) breakdown the implementation of evidence based nursing programs into five key steps, preparation, validation, comparative evaluation/ decision making, translation/application, and evaluation. Preparation entails the process of actually identifying the problem and designing the system which occurs in steps 1 and 4. Validation entails acquiring empirical evidence on the best path towards education and implementation. All non credible sources are eliminated during the validation process and if insufficient information is available for the change the change process will end. The comparative evaluation/ decision making process involves combining all cumulative findings of the design and allows for individual research to be incorporated if there is not enough information to continue. The Translation application of the evaluation process involves developing the proposal for the practice of the design. All strategies for formal dissemination of the design practice are prepared and mapped out during  this step and a pilot project will be considered.

Step 6: Integrate and Maintain the Change in Practice

Expanding an educational intervention for gestational diabetes is of critical importance in supporting a greater understanding of the nature and severity of the condition, as well as the challenges that are encountered in the form of symptoms and related complications. An intervention is also likely to be effective in providing a basis for evaluating nurses as educators because it will demonstrate their ability to screen patients and conduct outreach activities for those who are diagnosed with gestational diabetes. Once this strategy has been proven successful and sustainable, it must be explored for a larger population so that other patients with diabetes are screened properly and in a timely manner and are provided with a framework for exploring the different requirements of self-care through education. These elements will improve outcomes for diabetes patients and provide them with the resources that are necessary to perform excellent self-care to prevent symptoms and further complications.

Intervention mechanisms designed to supplement the patient population with tools and information for improved self-care activities in the home environment upon patient discharge will be incorporated in the change practice design at this time. This includes proper nutrition and medication administration instruction of both clinical professionals and patients.  Clinical instructors will be brought in as a part of the design change process to provide training and assist staff with the transition within the clinical setting. Since, in a clinical setting there are many unpredictable emergencies that can easily throw a care provider off a studied routine, clinical instructors must train their staff to be knowledgeable, skilled and adaptable. This can only be done through experience and experience can only be attained by the staff in practice. This means that the core role of a clinical instructor is to set the perfect environment for students to achieve the required level of experience specific to them to have the necessary confidence to apply classroom education in skill form in a real clinical setting. Support systems will also be established to maintenance the the design and maintenance its use.

Summary

Recognizing the challenges associated with diabetes for pregnant women, it is important to recognize the lack of cohesive education for women who are pregnant and who face a risk or diagnosis of gestational diabetes. Therefore, it is necessary to establish intervention mechanisms that will accommodate this patient population so that they are able to provide improved self-care activities in the home environment upon discharge, including but not limited to proper nutrition and medication administration. The proposed intervention must demonstrate the ability of nurse educators to have a positive influence on women with gestational diabetes and provide them with the tools and resources that are necessary to improve their quality of life. These issues are instrumental in providing a framework for these patients to provide self-care at home that is positive and favorable in expanding their health and wellbeing. The intervention must be evaluated in the context of its effectiveness in enhancing quality of care through stabilized blood sugar levels and other factors that will influence their behaviors to include improved medication administration and nutrition for mothers and their unborn children throughout the pregnancy.

References

“American Diabetes Association” (2014). <retrieved from> http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html

DiCenso, A., Cullum, N., & Ciliska, D. (1998). Implementing evidence-based nursing: some misconceptions. Evidence Based Nursing,1(2), 38-39.

Hernandez, T.L., Anderson, M.A., Chartier-Logan, C., Friedman, J.E., and Barbour, L.A. (2013). Strategies in the nutritional management of gestational diabetes. Clinical Obstetrics and Gynecology, 56(4), 803-815.

Landon, M.B., and Gabbe, S.G. (2011). Gestational diabetes mellitus. Obstetrics and Gynecology, 118(6), 1379-1393.

Lechner, A., Lohr, R., and Seissler, J. (2011). Gestational diabetes. Internist, 52(10), 1149-1157.

Perry, A. (2006). Gestational Diabetes. Journal of Midwifery & Women’s Health, 51(2), 135-136.

Perucchnini, D., Fischer, U., Spinas, G.A., Huch, R., Huch, A., and Lehmann, R. (1999). Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study. BMJ, 319(7213): 812-815.

Ryan, E.A. (2011). Diagnosing gestational diabetes. Diabetologia, 54(3), 480-486.