LOU-POSTER PRESENTATION
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MSN Project Manuscript Section IV-V
Student’s name: Lourdes Cano
Chamberlain University
Advanced Nursing Role Synthesis
Date: May 29, 2024
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Poor Glycemic Control in Diabetes Mellitus Type II
Executive Summary
Purpose
The purpose of this project is to ascertain the efficacy of a community-based diabetes self-
management education program for people with type II diabetes among geriatric adults in rural
Miami, Florida. The aim is to improve glycemic control, reduce complications, utilize fewer
health resources, and enhance the quality of life over one year.
Project Location
This program was conducted in rural community centers in Miami, chosen for their accessibility
to the elderly and suitability for educational activities.
Synthesis of Literature and Evidence
Literature reviews indicate that diabetes self-management education significantly improves
health outcomes among the elderly by enhancing their ability to manage the disease. This
informed the adoption of a program tailored to the needs of a rural elderly population (Ha &
Park, 2020).
Implementation
The program was conducted in three phases: preparation, implementation, and evaluation. It
provided educational workshops on important self-care topics and individualized support through
biweekly follow-ups and coaching (Allison, 2023).
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Dissemination
The project's findings will be published in scientific journals, highlighted at conferences,
presented at community meetings, and disseminated on a website aiming to influence public
health policy and foster the creation of similar programs in other rural settings
Section I: Introduction and Problem Identification
Problem Statement
Diabetic elderly patients in rural Miami face numerous challenges in type 2 diabetes
management, leading to common poor glycemic control and rising complications. The traditional
approach to health is limited by accessibility, tailored education, and patient engagement
(Suganth et al., 2020). This study proposes an organized intervention to address these
inadequacies and improve the health status of this frail population.
Problem Background
Diabetes management in the elderly is comprehensive and involves standard medical treatment.
Educational interventions emphasizing self-management could be effectively utilized with this
population. However, there is a lack of targeted programs in rural Miami that address the unique
needs and challenges faced by the elderly diabetic population (Wiese et al., 2023).
Stakeholders
The program's stakeholders include the geriatric population with type 2 diabetes, healthcare
professionals in rural Miami, local health departments, community centers, elderly caregivers,
and policymakers interested in reducing healthcare costs related to diabetes.
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PICOT Question
In adults aged 65 and above with type 2 diabetes in a rural community in Miami, Florida (P),
does implementing a community-based diabetes self-management education program (I)
compared to standard care (C) result in improved glycemic control, reduced diabetes-related
complications, decreased healthcare utilization, and enhanced quality of life (O) over 12 months
(T)?
Section II: Literature Support
Review of Literature
A comprehensive review of existing literature and evidence highlighted the benefits of
diabetes self-management education programs. Numerous studies demonstrate that such
programs significantly improve glycemic control, reduce the incidence of diabetes-related
complications, and enhance overall quality of life. For instance, Trento et al. (2021) found that
diabetes self-management education is associated with clinically significant improvements in
glycemic control. Davidson et al. (2022) emphasized the long-term benefits, noting reductions in
HbA1c levels, improved self-efficacy, and better diabetes-related knowledge among participants.
Van Truong et al. (2021) reported that older adults in self-management programs showed better
medication adherence, improved dietary habits, and increased physical activity.
Section III: Intervention Description
Proposed Intervention
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This organized program for community-based education includes regular health
monitoring, individualized coaching sessions, and biweekly seminars led by community health
professionals (Yin et al., 2020). The program aims to raise awareness of diabetes management
techniques, promote lifestyle modifications, and enhance medication compliance.
Setting
The program will take place in community centers across rural Miami, Florida, where most
elderly residents have limited access to health facilities.
Barriers
Possible barriers include the need to attend sessions, resistance to change after habituation to
long-standing behaviors, and limited access to technology for remote consultations (Jain et al.,
2020). Strategies to overcome these barriers include transport services, education in
collaboration with family members, and user-friendly technology.
Outcomes
Expected outcomes include improved HbA1c levels, a decrease in ER visits, and fewer diabetes-
related hospital admissions. Other outcomes are self-reported measures of the patient's quality of
life. Outcome measures will be derived from pre- and post-intervention surveys, medical records,
and continuous glucose monitoring systems.
Action Plan
The action plan includes participant recruitment, educator training, development of
educational materials, workshop schedules, and follow-up appointments. Key milestones are the
initial enrollment of participants, the mid-point evaluation, and the end-of-study assessment.
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Section IV: John Hopkins Nursing Evidence-Based Practice Model
Introduction
Model The Johns Hopkins Nursing Evidence-Based Practice The model is essential in
guiding this practicum project toward the realization of the goal of enhancing glycemic control
among the aged diabetic population in rural Miami. A 19-step complex process divides the model
into three major stages: practice question, evidence, and translation (PET (Newhouse et al.,
2007)). The stage is used to identify issues in orderly steps, acquire and appraise relevant proof,
and lay down sustainable, practical strategies.
The questioning phase of practice helps one to know the present clinical problem at hand,
the question and answer, or the result required. This step is, therefore, very crucial because it
makes the project focus on the correct and specific issues, hence more impactful output
Appraising evidence allows one to critically look at the gathered proof. The procedures
involve the review of existing literature, research studies, and clinical guidelines that could
provide the best available outcome in supporting the intervention (Dong et al., 2020). This phase
ensures that an intervention can have some good science behind it and, in turn, will hopefully
increase the chances of working.
The translational phase involves the actual implementation of the intervention in reality,
based on evidence in the practice setting. It is conducted with programming, implementation, and
monitoring in order to foresee potential barriers and mechanisms that enhance the intervention
(Akbari & Hopkins, 2022). Implementation has to occur so that the interventional process can be
activated and tested for its efficacy in overcoming the clinical problem.
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Applying the Model
As such, the PICO formulated for this practice question stage is: "In adults who are 65
years old and above, have a diagnosis of type 2 diabetes, and are living in a rural community in
Miami, Florida, is a diabetes self-management education intervention in the community
compared with usual care effective in achieving optimal glycemic control, diminishing diabetes
follow-up complications, and reducing health-care utilization and improving quality of life
within 12 months (Xing et al., 2020). There is a need to clarify this because the population,
intervention, comparison, outcomes, and time are well stated (Dang et al., 2022). At the evidence
stage, the review of literature must be systematized, and the data collection process must be able
to establish the need for the proposed project. It reviews the literature to identify similar projects
in studies that demonstrate the effectiveness of diabetes self-management education in improving
glycemic control among the elderly. Established from the evidence adduced is that the use of the
identified programs is supported to ensure positive roles in the control of glycemia and overall
proper diabetes management by Trento et al. (2021) and Davidson et al. (2022).
Important translation phase steps are
It is the entire work schedule for study design, planned for participant recruitment and training of
educators in developing educational materials, workshops, and the follow-up meeting schedule
for changing behaviors to address better the needs and barriers identified in the rural Miami
elderly population.
Execution
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The program will be executed within the community centers. All the health education
sessions and the program follow-ups were carried out with continuous health monitoring.
Coaching was also done one-to-one with fortnightly seminars to be held by the community
health specialists for program execution (Pahuja et al., 2020).
It will continuously monitor the data on pre- and post-intervention in glycemic control,
the frequency of emergency room visits, and hospital admissions in measuring the program's
effectiveness, along with self-quality of life measures. It may further analyze the data for the
derivation of program impact and identifying areas for enhancement (Sseproni et al., 2020).
Barrier mitigation Discuss overcoming identified potential barriers to implementation, such as
transportation, stubbornness to change, or lack of technology, including providing the ability to
reach and return from the appointment, including family members in the education processes,
and ability to have available, simple enough technology to allow for remote consultation (Saiyad
et al., 2021). This project will be systematically executed by following the Johns Hopkins
Nursing Evidence-Based Practice Model to resolve the problem of poor glycemic control among
elderly diabetic patients in rural Miami (Hopkin & Bardoel, 2023). The process will guarantee
that the proposed intervention is evidence-based, appropriately implemented, and its impact is
evaluated.
Section V: Translation to Practice and Evaluation
Evaluation
A comparison of the collected pre- and post-intervention data measures effectiveness. The
following precise measures are used in assessing this outcome:
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Glycemic control: Baseline, midpoint (6 months), and endpoint (12 months) HbA1c levels to
obtain changes in glycemic control.
Healthcare Utilization: The rate of emergency room visits and inpatient admissions for diabetes
is compared pre-and post-intervention.
Quality of Life: The standardized questionnaires on the measures of change in the quality of life
perception by the subject must be measured in the same intervals using validated questionnaires,
such as the Diabetic Quality of Life (DQOL) (Alqarem et al., 2022).
Self-management activities: According to Schreiner et al., (2020) Change in self-management
activities were measured and confirmed by self-reported data from the subjects about a number
of medications taken, adherence to diet and exercise, and a number of health monitoring records
presented.
The appropriateness of the data from the statistical point of view, as well as the data's clinical
relevance to the pronounced changes, will be considered upon scrutiny (Grigorescu et al., 2022).
Feedback will also be taken into consideration from the participants and educators on what is
going well with the program and what could be rethought.
Dissemination
The results of this project will be disseminated to the public so that it will reach and benefit
the maximum number of people:
• Public Meetings: Community meetings in local and rural communities in Miami to
disseminate the results of the work to the participants, their families, and community
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members. Share findings in regional, national, and regional nursing and public health
conferences to help shape practitioners' and policymakers' ideas in light of the program's
results and replicability (Allen & Urmanche, 2024). Publish in top-quality journals
dealing with medical or nursing subjects; in this way, you will be conducting your
contribution to the scientific literature relevant to diabetes self-management education.
• Online Platforms: Provision for a dedicated website to display results and resources and
make further use of social media to disseminate and popularize results and resources to
have more people contribute and also get broad community support for the replication of
such programs (Zinovieve et al., 2021).
Conclusion and Contribution to the Status of the Nursing Profession
It will be of utmost importance in providing information about the effectiveness of
community-based educational interventions for older people in a rural setup. The results will
further shed light on how effective these programs might be in improving glycemic control
reducing the use of healthcare resources, and leading to a better quality of life for old diabetic
patients living in a rural setup. As stated in the methods section, the study should be practical
because the intervention would also apply to other implementations and offer a model for this
population of similar rural, underserved communities. Therefore, there is an application to
developing evidence-based nursing practice and policy benefiting from the advantages of
diabetes self-management education, which this study will aid in implementing diabetes care
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enhancement among the elderly. Also, it emphasizes that interdisciplinary collaborations and
involvements of the community and patients are essential in treating the patient. It is a witness to
the reality that such implementation by the nurse plays an instrument in handling community
health initiatives that solve public health problems and change patient results to the positive.
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