State of the Science Quality Improvement Paper 2
Abstract
Diabetes mellitus is the major cause of morbidity and mortality worldwide. People from ethnic minority groups living in upper-middle-income or high-income nations have a higher prevalence of diabetes compared to the majority population. In most cases, their issues are compounded by the migrant status, low socioeconomic status, relative deprivation, cultural and communication barriers. Many people learn about the facts of diabetes in piecemeal from various sources of different credibility. Hence, these populations have gaps in their knowledge of diabetes. This paper seeks to introduce a State of the Science Quality Improvement project. The project used the following question: How does the use culturally congruent interprofessional education for newly diagnosed diabetic patients age 40-70 impact A1C levels and weight? The various stakeholders impacted by this project involve primary care providers, clinic staff, and high-risk patients. The supporting theory for the project is culture care theory, which will be used to help the medical practitioners to provide culturally congruent education to the newly diagnosed patients aged 40-70 to improve their AIC levels and weight.
Providing culturally congruent interprofessional education is the intervention given to reduce the level of glycated haemoglobin and improve body weigh in newly diagnosed patients between the ages of 40 to 70. The primary goal of the study is to improve the conditions of the individuals who have been diagnosed with diabetes while preventing complications that are associated with the condition.
Review of Literature
The concept of developing culturally congruent interprofessional education for newly diagnosed diabetic patients combine concepts from various studies. In the tribal clinics, diabetes education as well as community, input content and design have been considered vital concepts to guide the development of interventions. It is important to acknowledge the fact that diabetes-related mortality is higher among the minority groups than in the majority groups. For instance, the mortality rate related to diabetes is higher among Native Americans compared to non-Hispanic whites (Hamilton, 2016). Research into Caucasian versus America Indians and Alaska Natives (IA /ANs) revealed that diabetes is a major cause of death or co-morbidity among the American Indians and Alaska Natives.
According to research conducted by Burrows et al., (2017), diabetes is the major cause of the end-stage renal disease (ESRD) as it accounts for approximately 45% of the new cases. Additionally, dialysis and diabetes disproportionately affect minority populations. In the United States, half of the ESRD patients attributed to diabetes die within 3 years of starting dialysis (Burrows, Hora, Geiss, Gregg, & Albright, 2017). This is mainly attributed to increased comorbidities, more specifically cardiovascular diseases. Fundamentally, cardiovascular disease (CVD) is major comorbidity that is highly connected with diabetes. CVD is cited as a major cause of mortality and morbidity among minority diabetic patients. Being a major cause of the death among all diabetic adults there is a great need for intensive management of risk factors associated with CVD (Hamilton, 2016). It is also believed that there are CVD risks that are connected with constricted glycemic control. According to Haghighatpanah et al., (2018) hypoglycemia can lead to poor outcomes among diabetic patients. For instance, hypoglycemia is associated with altered cardiac contractility, increased heart rates, and harmful effects of endothelial function (Haghighatpanah, Nejad, Haghighatpanah, Thunga, & Mallayasamy, 2018).
Over the years, the morbidity rates have significantly declined possibly because of improved healthcare. While the rates are declining among the general population, the number of new diabetic cases among the minority groups continue to rise (Nagelkerk et al. 2018). The rising numbers of diabetic people among the minority population is likely to add a significant burden to the healthcare sector as well as the tribal healthcare systems. For instance, in a study conducted for the Indian Health Service System, the costs of catering for Native American diabetic patients accounted for approximately 37 per cent of the total medical costs (Hamilton, 2016). The current trend demonstrates the increased need to break the spiral of this condition. Reducing the discrepancies in mortality connected to diabetes will call for the development of effective techniques to prevent and control diabetes among the minority populations.
Different authors have conducted studies to investigate the interventions that would be most suitable for these populations. According to a study by Hamilton (2016), a one-on-one session with minority patients is effective and has a better attendance rate than group sessions. As cited by the authors, newly diagnosed diabetic patients, especially from the minority groups, need more directions in the effective navigation of impediments and healthy lifestyle in form of customized education and supportive care for the patients and their families. In a study involving the Native American, it was evident that family support, as well as education, was needed along with the sharing of medical histories within families, nutritional education, and nutritious school lunches. As cited by Hamilton( 2016), diagnoses of diabetes hold a certain perception for the certain ethnic and racial groups including fear of change, need for a social support system, lack of awareness of diabetes, and challenges of modifying behaviours while maintaining integrity. Additionally, many people tend to believe that interventions should be culturally congruent with their traditions and beliefs.
In another study conducted by Navodia et al (2019), the authors argued that self-management is one of the effective methods of managing diabetes mellitus type 2. Even though empirical evidence considered these interventions effective, little is known about the cultural congruency of these techniques for individuals of diverse cultural backgrounds. As cited by Navodia et al. (2019) cultural beliefs can significantly influence people’s perception of health issues, management, and engagement in behavioural change, and adherence to change. According to the findings of the study, the authors reported that most of the diabetes self –management interventions were not effective in lowering A1C levels among the South Asian population (Navodia, et al., 2019). However, adopting culturally tailored intervention self-management interventions could have helped to reduce the A1C levels. Abdulrehman et al. (2016), in their study exploring cultural influences of self-management of diabetes in coastal Kenya, discovered that limited understanding about diabetes, beliefs, medical pluralism in diabetes, and fast and feasting during certain ritual affect self-management of diabetes.
Lagisetty et al (2017) argued that while the genetic difference may account for the difference in diabetes-associated complication among the minority groups, failure to consider social and cultural factors might also hinder the strategies to prevent diabetes among the minority groups. The author used cultural tailoring terms to include interventions that enhance the health or ethnic groups by considering their cultural beliefs, customs, and attitudes. The authors in these study reinforced the fact that cultural tailoring is an important way to adapt interventions to certain ethnic groups.
The studies examining the cultural influences on the self-management of diabetes provides an exploratory study of diabetes self-management among different minority groups. However, there have been inconsistencies regarding the overall effectiveness of the interventions in improving the outcome of newly diagnosed patients. Additionally, the impact of structured education on diabetes management on hypoglycemia has not been rigorously assessed. With these limitations, it was plausible to develop a quality improvement plan to improve the outcome of newly diagnosed diabetic patients.
Quality of Improvement Plan
A quality of improvement plan comprises of the continuous actions and systems that lead to measurable enhancement in the healthcare system. The Institute of Healthcare Improvement (IHI) emphasizes on rapid-cycle testing as a way of learning which interventions can produce improvements. Plan-Do –Study- Actions (PDSA) will be used to bridge the gap in the current evidence and bring sustainable interventions in managing A1C levels and weight in newly diagnosed diabetic patients who happen to be culturally sensitive. In this model, the “plan” phase, involves identification of change aimed at promoting the improvement. The “do” phase is aimed at testing changes while the study phase involves evaluating the success of the change. The final phase, which is “act”, involves the identification of adaption for the other plan for the new cycle. In this project, the PDSA model will be utilized to search for evidence and develop an interdisciplinary quality improvement plan in improving A1C levels and body weight of newly diagnosed patients of 40-70 years. The supporting theory, which is Leininger culture care theory, will help in interpreting the results from the literature review. While conducting the feasible plan of implementation, an interdisciplinary method will be applied with the involvement and determination of an interdisciplinary team. The interprofessional team needs to take the necessary steps to ensure that they understand the cultural beliefs and traditions of the patients. Further, the team should also ensure that the dignity of newly diagnosed patients is respected. The identified stakeholders will be primary care providers with different healthcare specialities, clinic staff in an outpatient healthcare setting, and patients who have been recently diagnosed with diabetes.
Purposeful sampling will be employed to identify the newly diagnosed patients to develop an effective intervention while applying more rigorous measures to reduce body weight and improve levels of A1C. This improvement plan aims to increase the performance of A1C by at least 10 per cent with the four weeks of implementation.
To facilitate the desired change, cultural congruent interprofessional education will be administered to all newly diagnosed diabetic patients who between the ages of 40 to 70. Specifically, the quality improvement plan will use culturally congruent interprofessional to educated newly diagnosed patients on ways of the importance of regular physical exercise and proper diet as a way of improving their outcomes. The patient –linked outcome to address the issue will be assessed at two periods: three months before the use of culturally congruent interprofessional education and three months after the use of culturally congruent education. The target is to reduce increase body weight and reduce the level of glycated haemoglobin (A1C) in at least 50 per cent of the newly diagnosed cases. The outcome measurements will be used to define the effectiveness of the quality enhancement project in terms of improving patient quality of care and reduction of mortality and morbidity.
The quality improvement project also needs to put into account ethical considerations. The quality improvement needs to respect the dignity of the patients by respecting the cultural beliefs and traditions. Before any information is communicated to the people involved in the project, it would be important to obtain a document indicating the patients’ consent in regards to the sharing of information. Due to the involvement of different stakeholders in the project, there is a high risk that the information may be seen by an unauthorized person. Therefore, it is imperative to put in measures that protect the confidentiality of patients’ information.
Data will be gathered using semi-structured interviews. The focus will be to explore the perception of patients on culturally congruent healthcare professionals. In the semi-structured interview, it will be possible to understand the cultural barriers that prevent patients from seeking medical attention and screening for diabetes. Through the semi-structured interviews, it will possible to identify the gaps that exist in the current health systems regarding the management of diabetes among the minority groups. The data from this project will be held confidential as it will only be shared with persons who are directly involved in the project. The results of this project will encourage healthcare professionals to be culturally competent as a way of helping the newly diagnosed diabetic patients.
In conclusion, the burden of diabetes inexplicably falls on the ethnic minority groups who repeatedly experience higher mortality and morbidity than majority populations due to linguistic, cultural, and physiological reasons. In most cases, these groups receive inadequate diabetes care due to limited educational backgrounds, language barrier, and health and illness beliefs. From the above literature review, it is evident that the provision of appropriate cultural competent healthcare professionals can bring important benefits, not only to individuals with diabetes and their families but also to the entire healthcare system. In this paper, various studies have been examined for consistency of evidence and relevance of the findings. Additionally, a quality improvement plan was developed with various interested parties to address the problem with ethical considerations. For quality improvement plan, the PDSA model was used to generate recommendations for clinical practice change. Leininger culture care theory was utilized as the theoretical framework to act as guidance for culturally competent care providers. This paper is crucial in helping nurses and other professional to different strengths and obstacles in overcoming the barriers that improve patient care.
References
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