Nursing Tiff assignment

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Identifying a Practice Problem in Nursing

Tiffany Williams

Herzing University

NU700

3/28/2025

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Identifying a Practice Problem in Nursing

Nurses are directly responsible for identifying and addressing practice problems

impacting patient outcomes. As frontline healthcare professionals, they apply clinical expertise,

evidence-based practice, and patient-focused care to eliminate holes in healthcare provision.

Among such red-hot issues is ineffective self-management of diabetes in Cuban Americans,

driven by cultural, linguistic, and socioeconomic factors. Diabetes mellitus and type 2 diabetes,

in this case, disproportionately affect minority populations due to systemic inequalities in

healthcare access, education, and social determinants of health. Yedjou et al. (2024) show that

Hispanic/Latino populations, such as Cuban Americans, have higher rates of incidence for

diabetes complications compared to non-Hispanic whites. Contributing to this are minimal

exposure to culturally sensitive care, linguistic imbalances, and socio-economic constraints.

Practice Problem

Cuevas and Brown's (2018) “Self-Management Decision Making of Cuban Americans

with Type 2 Diabetes” addresses Cuban American diabetes self-care predictors. The study is

based on qualitative design, in which data is gathered from Cuban American adults who have

type 2 diabetes and were interviewed. Outcomes identify several obstacles to effective self-

management that consist of cultural beliefs, language proficiency, and inadequate individualized

education.

Key Challenges Identified

One of the main challenges is cultural influences, as the typical Cuban diets that are

primarily carbohydrate-based necessarily contradict medical dietary recommendations. It is hard

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for people to modify entrenched eating habits, and thus it is hard to adhere to diabetes treatment

plans.

Another barrier, linguistic variation, makes it more challenging to self-care as limited

English skills limit exposure to educational resources and communication with healthcare

providers. Without explicit and understandable directions, patients are destined to become

bewildered by the medication or dietary counseling instructions.

In addition, suspicion of the health system is another barrier since some Cuban

Americans distrust Western medicine. This distrust normally leads to excessive reliance on home

remedies or unnecessary delay in coming forward to professional medical services, which results

in more complications like neuropathy and retinopathy.

Literature Review

Research conducted among Haitian immigrants, African Americans, and Vietnamese

Americans shows that there are equivalent barriers to health diabetes self-management, focusing

on the importance of culturally competent nursing intervention. Magny-Normilus et al. (2023)

documented Haitian immigrant diabetes self-care and listed socioeconomic barriers, cultural

incongruence, and lack of confidence in health care. All Haitian immigrants lack economic

resources for the acquisition of medicine and materials and promote negative health outcomes.

Cultural beliefs about illness and treatment are likely to conflict with clinical guidelines and lead

to non-adherence. Past marginalization also causes deeply ingrained distrust of the health system,

and patients are not as likely to access medical treatment. Ajuwon and Insel (2022) discussed

diabetes care for African Americans and determined that poor health literacy, mental illness, and

structural disparities were the biggest barriers.

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African Americans who have not mastered the fundamentals of diabetes care experience

most of them and make incorrect drug doses or have dietary blunders. Secondary complications

resulting from mental illness in the form of depression and anxiety also interfere with self-care

practice, with persons suffering from such psychological disturbances showing lower levels of

adherence to follow prescribed treatment pathways. Structural disadvantage in terms of food

deserts and absence of diabetes specialists deepens inequality. Sheen et al. (2023) also explored

diabetes management among Vietnamese Americans, and in their discussion mentioned language

difficulties, family responsibilities, and dietary struggles. Lack of translated papers restricts

access for many Vietnamese-speaking individuals to even understand their treatment plans fully,

risking mismanagement. Informal translators become members of their family as well, but that

creates the potential for miscommunication and errors in the management of diabetes. In

addition, typical Vietnamese diets that are rich in rice and sodium are challenging to gain

glycemic control.

Synthesis of Evidence

The reviews of the studies overall present systemic diabetes self-management obstacles

within minority populations such as cultural mismatch, language and literacy problems, and

structural inequality. Cultural ideas about food and health and cultural practices frequently

conflict with medical guidance, making adherence more difficult. Low health literacy and

language issues hinder people from comprehensively grasping their diabetes care plans, which

may result in poor disease management. In addition, socioeconomic factors such as poverty,

underinsurance, and food insecurity contribute to differences in diabetes outcomes. These may

be addressed with nurse-led care through the implementation of bilingual diabetes education, i.e.,

so that patients acquire knowledge in their native language but culturally appropriate nutrition

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accommodations are accommodated. Also, the involvement of community health workers

(CHWs)—unreliable neighbors who can provide culturally sensitive education and support—is

likely to maximize adherence and involvement. Lastly, implementing care models that are

integrated to address not only medical needs but also mental health and social determinants of

health can facilitate more sustainable diabetes management improvement among Cuban

Americans.

Conclusion

The issue of poor diabetes self-care among Cuban Americans is representative of broader

healthcare disparities in minority populations. The study highlights the need for culturally

competent, language-translatable, and structurally sensitive interventions to improve diabetes

outcomes. Nurses must demand policy changes, including increased funding for community-

based diabetes education programs and more sophisticated training in culturally competent care.

Subsequent studies ought to focus on measuring the effectiveness of focused interventions

through the utilization of frameworks such as the Knowledge-to-Action (KTA) Framework to

ensure long-term health equity and enhanced diabetes care.

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References

Cuevas, H. E., & Brown, S. A. (2018). Self-management decision making of Cuban Americans

with type 2 diabetes. Journal of Transcultural Nursing, 29(3), 222-228.

https://cuevaslab.com/wp-content/uploads/2021/01/1043659617696977.pdf

DeForest, N., & Majithia, A. R. (2022). Genetics of type 2 diabetes: implications from large-

scale studies. Current diabetes reports, 22(5), 227-235.

https://link.springer.com/content/pdf/10.1007/s11892-022-01462-3.pdf

Magny-Normilus, C., Whittemore, R., Nunez-Smith, M., Lee, C. S., Schnipper, J., Wexler, D., ...

& Grey, M. (2023). Self-Management and Glycemic Targets in Adult Haitian Immigrants

With Type 2 Diabetes: Research Protocol. Nursing research, 72(3), 211-217.

https://journals.lww.com/nursingresearchonline/_layouts/15/oaks.journals/downloadpdf.a

spx?an=00006199-202305000-00007

Nguyen, A. T., Jones, E. J., O’Neal, K. S., Netter, M. K., & Dwyer, K. A. (2022). An academic-

community engagement: a roadmap for developing a culturally relevant diabetes self-

management program among Vietnamese Americans. Collaborations: A Journal of

Community-Based Research and Practice, 5(1).

https://collaborations.miami.edu/articles/10.33596/coll.104?_rsc=er9ci

Yedjou, C. G., Sims, J. N., Njiki, S., Chitoh, A. M., Joseph, M., Cherkos, A. S., & Tchounwou, P.

B. (2024). Health and Racial Disparities in Diabetes Mellitus Prevalence, Management,

Policies, and Outcomes in the United States. Journal of community medicine & public

health, 8(3), 460. https://pmc.ncbi.nlm.nih.gov/articles/PMC11654833/