Benchmark- Capstone Change Project Objectives
Background (140 words)
The United States has one of the highest prevalence of type 2 diabetes in the world. A 2020 report by the United States Center for Disease Control (CDC) noted that at least 34.2 million people in the country have diabetes. The current report does explicitly state the component of diabetes that is type 2 diabetes. However, the prevalence rate of type 2 diabetes is expected to be the same as the current report does not indicate a significant change in the reduction of the disease. Nonetheless, the report shows there has been a substantial rise in the incidence rate of the scourge among minority groups – Blacks and Latinos – compared to Whites. Retrospectively, the report indicates that Whites account for 7.5% of diagnosed cases of diabetes whereas Asians, Latinos, Blacks, and Native Americans account for 9.2%, 12.5%, 11.7%, and 14.7% of the cases respectively. The analysis of these statistics shows that minority groups bear the burden of the scourge; they have the worst patient outcomes – high morbidity and mortality. The burden of type 2 diabetes in Illinois, more so the city of Chicago, parallels the national statistics. The prevalence rate of the disease in the state varies with demography – age, ethnicity, and race. Adult populations – people with 45 years and above- account for 31.2 % of type 2 diabetes cases in the state. On the other hand, at least 29.5% of the minority population – Blacks, Asians, Latinos, and Native Americans – have diagnosed type diabetes. It is estimated that only 7% of the White population is affected by the disease. The percentage of people from minority group struggling with the illness is thought to be significantly higher than the confirmed figure considering the community has one of the highest diabetes screening disparities in the state. The black community in Harvey, Chicago – the community of focus for the capstone change project – experiences one of the highest HbA1c disparities in the states. In tandem with national statistics, HbA1c levels above 9% in the community are quite high. The predisposition of the community to type 2 diabetes has a significant implication on patients’ health-related quality of life, productivity, and socioeconomic status. The effectiveness of diabetes management in the community is limited by the interplay of several factors including exposure to risk factors – obesity, tobacco smoking, poor diet, and sedentary lifestyle – health care disparities, and social determinants of health. Conventional strategies for diabetes management are hardly effective in taming the incidence of the disease or regulating its effects on minority groups. Diabetes self-management is one of the most popular interventions for managing the disease. However, the design of the intervention is hardly responsive to the culture, beliefs, values, and socioeconomic conditions of the minority communities. It is, therefore, imperative to formulate a diabetes self-management education that resonates with the individual and communal health care needs of the targeted community. Although diabetes self-management education is one of the best alternatives for managing the disease, making the intervention culturally competent promises to enhance the outcome of patients from minority groups.
Clinical Problem Statement (1o0 words)
The management of type 2 diabetes incorporates medical therapies and lifestyle modification to alleviate the deterioration of the disease and the occurrence of comorbidities. The most common type of medical therapies includes insulin therapy, metformin, sulfonylureas, and meglitinides, among others. Lifestyle modifications relevant to the management of type diabetes include close monitoring of blood glucose, healthy lifestyle, and regular exercises. Patients play a valuable role in the management of type 2 diabetes. Providing them with adequate and competent diabetes education empowers them to take charge of their recovery process. However, the effectiveness of diabetes educations depends on the level of its responsiveness to the values, beliefs, religion, ethics, and standards of the patient population. The conventional diabetes self-management education is not aligned to meet the needs of patients from a diverse cultural background. As such, it is imperative to make diabetes self-management education culturally competent to meet the health care needs of minorities adequately.
Purpose of Change Proposal (100 words)
The burden of the type 2 diabetes predisposes minorities to a myriad of challenges that include the risk of contracting comorbidities, deterioration of HbA1c, and socioeconomic issues. Disparities in diabetes screening, diagnosis, and patient self-management education deny these communities the opportunity to alleviate exposure to the scourge or arrest it when it is most amenable to medication and other therapies. The high prevalence of type 2 diabetes in Harvey’s black community is partially attributed to low levels diabetes of literacy and critical determinants of health such as low socioeconomic status, lack of access to healthy food, and inadequate recreational facilities. Making diabetes self-management education culturally competent is expected to raise awareness of the risks of unmitigated type 2 diabetes and enhance self-management. The PICOT question below provides an overview of the overall purpose of the proposed intervention.
PICOT Question
Will disparities in HbA1c in Harvey’s black community reduce with the implementation of culturally competent diabetes self-management education compared to typical diabetes self-management education from levels greater than 9% to below 5.7% in three months?
Literature Search (100 words)
The proposed intervention is an evidence-based solution for enhancing diabetes self-management among the underserved patient population from minority groups. The scientific evidence used to support the proposed intervention was gathered from varies literature located in the University library and the Internet. The supporting scientific evidence was collected from systematic reviews, cohort studies, and studies that used randomized and non-randomized trials. The elements of the PICO question were converted into search terms and used together with Boolean operators to optimize the literature search. For instance, the main search terms – culturally competent, diabetes self-management education, efficiency, HbA1c disparities, blacks, and African Americans- were joined together using the Boolean operator OR and with operator AND to retrieve citations that matched only with the PICOT elements.
Evaluation of Literature (100 words)
The disproportionate prevalence of type 2 diabetes in minority groups is attributed to a combination of several
factors. Some of the most common factors include family history, health inequalities, socioeconomic factors, genetics, sex, improper diet, and limited access to recreational facilities. The predisposition of minority groups to diabetes is also contributed by their cultures, values, and perspectives. Cultural norms in these societies are shaped by social – social support and relations – and physical – walking trails, access to outlets providing healthy foods, and safety of neighborhoods- environments. The acquired or inherited collective and individual perspectives and values shape the daily lives of the minority communities, which subsequently influences the meaning and management of type 2 diabetes and other diseases. The alignment of diabetes self-management education with established cultural norms provides an opportunity for increasing the level of diabetes literacy in minority communities. Pena-Purcell et al. (2015), in their prospective quasi-experimental study on rural African American communities in Texas, observed that culturally appropriate diabetes education promises to reduce diabetes disparities in minority groups. They specifically noted that culturally competent education has the potential to enhance diabetes knowledge, self-efficacy, self-care behavior, healthy outcome while decreasing the level of distress. In a similar study, Spruill et al. (2015) noted that the high level of religiosity among blacks might be exploited to deliver culturally sensitive diabetes education and care. Hempler and Ewers (2015) observed that matching diabetes education with the cultural norms of the targeted population increases the level of awareness and adherence to therapies and medications. In retrospective, culturally sensitive diabetes education is crucial in limiting the deterioration of HbA1c levels and the development of comorbidities which complicates the management of type 2 diabetes.
Change or Nursing Theory (100 words)
The primary objective of the capstone change project is to enhance the management of type 2 diabetes in Harvey’s black community. The project intends to achieve its objective by increasing the cultural sensitivity of the diabetes education offered to the patient population. Madeleine Leininger’s cultural care theory was crucial in formulating the proposed intervention. The theory postulates that cultural knowledge enables nurses to understand the variations needed in patients care to improve their outcomes and health-related quality of life.
Implementation Plan and Outcome Measures (100 words)
The implementation of the proposed intervention requires the input of various stakeholders. As such, a team of experts drawn from the internal and external stakeholders will be formed to spearhead the implementation process. The team will be essential in designing education curriculum, teaching materials, and strategies for rolling the teaching program. The implementation process will be done within the confines of set goals and the scope of the intervention. The key outcome measures of the intervention include the prevalence rate of the disease, HbA1c levels, and morbidity and mortality rates.
Use of Evidence-Based Practice in Intervention Plan (100 words)
The formulation of the proposed intervention relied on scientific evidence and global best practices for managing diabetes and other diseases among culturally diverse groups. The evidence was gathered from a variety of peer-reviewed journals. Greater emphasis was placed on the hierarchy of evidence. As such, most of the evidence was gathered from systematic reviews, meta-analysis, randomized controlled trials, quasi-experiments, and meta-syntheses.
Plan for Evaluating Proposed Nursing Intervention (100 words)
The success of the proposed intervention will be evaluated using the process, the impact, and the outcome methods. The process evaluation method will be used to assess the inter-relationship between activities – teaching processes, inputs – material and financial resources, and outputs- the level of HBA1c and diabetes knowledge – of the implementation process. On the other, the impact method will assess the clinical and statistical significance of the intervention, whereas the outcome evaluation will be critical in measuring the efficiency of the implementation process.
Potential Barriers and Plan to Overcome Barriers (100 words)
Several barriers are expected to limit the smooth implementation of the proposed intervention. Low literacy levels among all demographics and the limited number of health care facilities in the community will have a negative impact on the roll-out of diabetes education. The limitations posed by high levels of illiteracy in the community will be addressed by using pictures, diagrams, demonstrations, videos, music, and a simple language to educate patients on various aspects of diabetes. Critical technologies – telehealth, text messages, and website, among others – will be used to disseminate diabetes knowledge in parts of the community that have limited access to quality health care facilities.