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Running head: SELF-MANAGEMENT EDUCATION Diabetes Self-Management Education Intervention Jorge Lopez Capella University 1 SELF-MANAGEMENT EDUCATION 2 Diabetes Self-Management Education Intervention Care and health outcomes can be implemented through interventions aimed at enhancing care management and producing better health outcomes. The target population for this capstone has been patients with diabetes. As identified in previous assessments, patients with chronic conditions require the relevant skills, knowledge, and resources to ensure independence and reduce the utilization of healthcare services. The intervention developed for the target population was an educative brochure for the patients and their families to learn how to manage diabetes better and reduce the risk of complications. The brochure provides an intervention aimed at enhancing self-management of the chronic condition and reducing dependence on and utilization of healthcare services. This report is an analysis of the brochure and its effectiveness in improving health and health maintenance in the target health population. Defining the Role of Leadership and Change Management The development of the intervention was influenced by both leadership and change management strategies. The main leadership strategy used in the development of the intervention is evidence-based leadership approaches. According to Greenhalgh (2017), evidence-based leadership seeks to align project goals with current data on health needs. This leadership strategy aims to develop goals and define interventions meant to improve the current state as evidenced by credible evidence. Therefore, for the intervention, evidence-based leadership was achieved through an analysis of the patient needs and presenting information that handles those needs. Education on Diabetes Self Management Reflection Video
For instance, the patient in this case lacked knowledge on relevant lifestyle changes and hence the brochure captured this information to fill the gap. Moreover, change management is also crucial in designing and implementing healthcare interventions. Organizational change management is necessary when implementing an evidence- SELF-MANAGEMENT EDUCATION 3 based practice (EBP) intervention. In this case, change management was achieved by pointing out some of the gaps in practice and health maintenance for patients. This strategy allows staff to understand the need for change to be implemented. The intervention was thus developed by first informing other nurses of the changes that needed to be implemented. Another aspect of change management is acquiring the relevant resources and time to implement the change. Discussions with the preceptor about time and required resources support for the intervention were held. These discussions were important in gaining support from the management and preparing the EBP change process to be successful. Additionally, the development of the intervention was also supported by nursing ethics which the nurse observed. An important aspect of ethics in patient education is postponing judgment and establishing the education needs of the patient (Bastable, 2016). When preparing the brochure, the patient’s education needs were not assumed but rather, the patient was interviewed to determine their level of knowledge and areas where more education could help. Additionally, it is necessary for health professionals to advocate for patient health enhancement without necessarily changing the patient’s identity. Therefore, the educational brochure presents general health knowledge applicable to all patients and based on medical and clinical evidence. Overall, the nurse worked to reduce any harm that could be caused by the information provided in the intervention. Strategies for Communicating and Collaborating with the Patient The intervention developed is aimed for patients with diabetes and aims to improve selfmanagement and care to reduce the impact and risk of diabetes complications. Gathering patient perspectives in diabetes care and management is paramount for this intervention due to the need to personalize care and interventions and tackle the most crucial aspects of their care SELF-MANAGEMENT EDUCATION 4 management. Patient feedback and input into care activities help in identifying and targeting gaps in practice. This input also enhances patient engagement with the healthcare processes and issues. Education on Diabetes Self Management Reflection Video
For diabetic patients, their input revolves around the challenges they experience in selfmanagement and also adjusting to the new health condition. This input is then used in designing interventions to assist them to manage their condition better and improve their health outcomes. Communicating and collaborating with patients during the development of the intervention and delivery are thus essential. Effective communication and collaboration are necessary for improving health outcomes. When designing and delivering the educational health brochure, one of the communication strategies was to design a brochure that is language and literacy appropriate. According to Sim et al. (2016), instructions to patients should focus on critical information and be brief. Also, the author assessed the language literacy of the patient before designing the brochure. This communication strategy is important because it ensures that communication to the patient is effective. Other strategies used included using plain rather than clinical language, a teach-back method, and include key learners such as family members who offer care to the patients. To ensure effective collaboration, communication with the patient will be implemented face to face as well as on phone. This collaboration will ensure that the patient and the nurse are accessible when need be and can assist in care management. Therefore, communication and collaboration are essential for effective patient education to enhance diabetes self-management. Standards and Policies that Guided Intervention Design The standards and policies used for the design of the intervention were largely based on current practice in diabetes care and self-management. The Association of Diabetes Care and Education Specialists (ADCES) developed standards for operating self-management education SELF-MANAGEMENT EDUCATION 5 programs. These standards include, among others, the need to integrate diabetes education services in the healthcare organization and also review the community for diabetes management (Beck et al., 2017). Based on these strategies, the developed intervention was aligned to organizational strategic plan and was also supported by the healthcare organization. Secondly, the intervention was only developed after interviewing patients to learn patient needs for diabetes education. Adherence to the standards was crucial in ensuring the delivery of care that aligns with patient needs and the best practices in healthcare. Education on Diabetes Self Management Reflection Video
The standards by ADCES are credited as effective in the literature. They are also recognized by the American Diabetes Association and the Centers for Disease Control and Prevention (CDC) as evidence-based and useful in enhancing the quality of diabetes management (CDC, 2020). Therefore, these standards which were the basis of the intervention are effective in enhancing diabetes education and generally improving diabetes management as well. Quality, Safety, and Cost Improvement by Proposed Intervention Diabetes self-management education improves quality of care by enhancing patients’ knowledge and skills for self-management. One of the goals of healthcare is to reduce care utilization in the population by equipping them with the skills and knowledge for selfmanagement and health maintenance. Patient education interventions such as the one designed for diabetes have been proved to improve care outcomes by enhancing health maintenance, especially among patients with chronic conditions (Menrath et al., 2019). Quality of care will be improved by reducing readmissions and unscheduled repeat hospital visits. Patients will enjoy a healthier lifestyle by effectively controlling their glycemic levels and reducing the need to visit the hospital. Lower healthcare utilization is an indicator of high quality of care leading to better health outcomes. SELF-MANAGEMENT EDUCATION 6 Additionally, patients’ safety will be improves through the process by reducing emergency department visits and diabetes-related complications. Education on Diabetes Self Management Reflection Video
Diabetic patients face many safety challenges such as the occurrence of diabetic coma when the glucose levels are extremely low or high (Wu et al., 2018). A diabetic coma can lead to further exacerbation of the patient’s health condition and also increase the risk of injury. Using the developed intervention, patient self-management will be enhanced. Enhancing self-management will significantly reduce risks to patients’ safety such as diabetic coma. Lower healthcare engagement also reduces the risk of medical errors and keeps the patient safer. Lastly, diabetes self-management education will reduce costs for the patient and the healthcare system. Starting with the patient, fewer visits to the hospital will produce lower spending on diabetes care. Self-management will reduce dependence on the healthcare system hence save cost for the patient. Similarly, depending on the nature of hospital visit, fewer visits could save the hospital money. Readmissions within 30 days are monitored by the Centers for Medicare & Medicaid Services (CMS) under the Hospital Readmission Reduction Program (HRRP) and penalized through deductions in payments made (Desai et al., 2016). Therefore, patient education will reduce readmissions hence reducing the cost that the hospital undergoes in delivering care. Technology, Care Coordination, and the Utilization of Community Various technologies may be used in delivering the intervention and supporting the patient in diabetes self-management. One such technology is the use of mobile apps for diabetes self-management. Mobile apps are useful in monitoring and storing information for use in diabetes management. The nurse could help the patient in downloading and familiarizing with an application on their mobile device useful in not only monitoring but also creating alerts SELF-MANAGEMENT EDUCATION 7 necessary for the patient to perform care and maintenance activities. Another technology is the insulin pen which the patient could learn about and use it for insulin delivery. Evidence shows that insulin pens are preferable for comfort and ease of measuring insulin (Kesavadev et al., 2020). Therefore, providing patients with this technology will support the proposed intervention and improve outcomes. Lastly, care coordination and community resources are useful in this intervention. Primarily, the nurse will coordinate care with the patient and their immediately family caregivers. The caregiver is important because they affect the environment and conditions which the diabetic patient lives in. Community utilization will be through provision of social worker services which enhance the patient’s social needs. Also, links to important educational resources will be provided to the patient to aid them in maintaining access to relevant information. Conclusion Diabetes self-management education intervention will be delivered to the patient to enhance their self-efficacy in diabetes management. Education on Diabetes Self Management Reflection Video
Diabetes is a chronic condition whose outcomes largely depend on how effective the patient can manage their condition. The proposed intervention will enhance the patient’s self-management and improve their quality of life. The cost of care will be reduced and safety increased proactively. This intervention should be carried out with the patient to enhance their independence in self-management and reduce dependence on healthcare providers. Education on Diabetes Self Management Reflection Video
SELF-MANAGEMENT EDUCATION 8 References Bastable, S. B. (2016). Essentials of patient education. Jones & Bartlett Learning. Beck, J., Greenwood, D. A., Blanton, L., Bollinger, S. T., Butcher, M. K., Condon, J. E., … & Kolb, L. E. (2018). 2017 National standards for diabetes self-management education and support. The Diabetes Educator, 44(1), 35-50. https://doi.org/10.1177/0145721717722968 Centers for Disease Control and Prevention (CDC). (2020). National Standards for DSMES. Education on Diabetes Self Management Reflection Video
https://www.cdc.gov/diabetes/dsmes-toolkit/standards/index.html Desai, N. R., Ross, J. S., Kwon, J. Y., Herrin, J., Dharmarajan, K., Bernheim, S. M., … & Horwitz, L. I. (2016). Association between hospital penalty status under the hospital readmission reduction program and readmission rates for target and nontarget conditions. Jama, 316(24), 2647-2656. https://doi.org/10.1001/jama.2016.18533 Greenhalgh, T. (2017). How to implement evidence-based healthcare. John Wiley & Sons. Kesavadev, J., Saboo, B., Krishna, M. B., & Krishnan, G. (2020). Evolution of Insulin Delivery Devices: From Syringes, Pens, and Pumps to DIY Artificial Pancreas. Diabetes Therapy, 11(6), 1251. https://doi.org/10.1007/s13300-020-00831-z Menrath, I., Ernst, G., Lange, K., Eisemann, N., Szczepanski, R., Staab, D., … & Thyen, U. (2019). Evaluation of a generic patient education program in children with different chronic conditions. Health Education Research, 34(1), 50-61. https://doi.org/10.1093/her/cyy045 Sim, D., Yuan, S., & Yun, J. (2016). Health literacy and physician-patient communication: a review of the literature. Int J Commun Health, 10, 101-114. SELF-MANAGEMENT EDUCATION 9 Wu, H., Eggleston, K. N., Zhong, J., Hu, R., Wang, C., Xie, K., … & Yu, M. (2018). How do type 2 diabetes mellitus (T2DM)-related complications and socioeconomic factors impact direct medical costs? A cross-sectional study in rural Southeast China. BMJ Open, 8(11), e020647. http://dx.doi.org/10.1136/bmjopen-2017- 020647 … Education on Diabetes Self Management Reflection Video