Improving quality of health

Defining the Problem

Diabetes Type 2 (DM2) is an worldwide disease that rates among the top 10 causes of deaths and a significant problem in the world today. According to the Centers for Disease Control and Prevention (CDC), (2023), About 38 million Americans have diabetes (about 1 in 10), and approximately 90-95% of them have type 2 diabetes. (DM2) is a long-term illness marked by the body's decreased sensitivity to insulin, which makes it more difficult for the body to control the necessary amounts of glucose in the blood. There are several causes of diabetes in humans, including obesity, genetic predisposition or mutation, chronic hypertension, hormonal imbalance (Cushing’ syndrome, acromegaly, and hyperthyroidism), some medications (niacin, diuretics, anti-seizure drugs, some HIV medications, pentamidine, glucocorticoids, and some anti-rejection drugs used to prevent rejection of organ transplants (Opara & Opara, 2022). Common physical symptoms displayed that are linked to DM2 include polyuria (regular urination), polydipsia (increased thirst). and polyphagia; appetite is increased. A further side effect of type 2 diabetes is hyperglycemia, which refers to high blood glucose levels. Type 2 diabetes is more prevalent in socioeconomically disadvantaged populations and certain racial and ethnic groups (Herman et al., 2023). A considerable proportion of the African American population are susceptible to diabetes due to poor dietary habits and insufficient engagement in physical activity. Further barriers that African Americans confront include financial deprivation, cultural affiliations and poverty. According to the DC Department of Health (Opara & Opara, 2022), the diabetes death rate among African Americans is five times the rate for Caucasians living in Colombia district.

The Patient

Leah, a 41-year-old Jamaican woman, was recently granted a green card to access employment in the United States. She was born and raised deep in the country of Trelawney, St. Elizabeth. After Leah was granted permission to enter the United States, she vowed to pursue her ambition of becoming a registered nurse. Given the ultimate goal of transferring to a school to pursue a registered nurse program, she decided to finish a one-year vocational nursing (LVN) program. The LVN program required her to undergo a comprehensive physical examination, which encompassed laboratory tests, X-rays, and an electrocardiogram, prior to beginning the program. The nurse observed that she had a few red labels on her labs after she had completed all of her tests; the doctor then requested to speak with her. She was measured at 5 feet 4 inches tall, weighing 210 pounds, with a BMI of 36, indicating severe obesity. The patient's vital signs and ECG were within normal ranges. The doctor expressed concern due to her elevated Hgb A1C level of 14, her fasting Complete metabolic Panel glucose was 320 and her weight. During her physical assessment, Leah informed the doctor that she has never undergone a physical examination due to living in a deprived neighborhood where the closest big hospital is three parishes away. Lack of resources, cultural and religious beliefs, and language barriers often hinder AAs from accessing the required medical care (Chen et al., 2019). She mentioned that her 52-year-old mother suddenly lost vision in both eyes and twice her size in weight, with big wounds that will not heal. She informed the doctor that she eats a diet high in carbohydrates because they keep her fuller longer. She felt like she was in good health aside from her obesity, always being thirsty and the frequent urination. The physician diagnosed her with type 2 diabetes based on laboratory confirmation, her body weight, and her potential family predisposition. According to the CDC, (2020 ), 89 percent of people with diabetes are obese, 68.4% are hypertensive, 50 percent have high Hemoglobin A1C levels, 43.5 percent are hypercholesterolemic, 37% are generally sedentary, 36.4 percent are past smokers, and 36.6 percent are present smokers (CDC, 2020).

Role of Leadership and Change Management

Effective management of the DM2 epidemic requires compassionate leadership and quality healthcare. HRRP is a Medicare value-based purchasing program that, for example, encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, reduce avoidable readmissions (Hosp. Readmission Reduction | CMS, n.d.). Diabetic patients require support from multiple organizations to collaborate effectively in order to manage their condition, avoid hospitalization and avoid readmissions. Due to self-management being the number one treatment for DM2, it’s important that staff are trained well and provide adequate teaching. Transformational leadership has been identified as to be extremely productive according to research and comparisons. The execution of a tailored strategy that prioritizes the patient's welfare is guaranteed via the combination of change management and patient-centered care. A fundamental aspect of nursing change management is patient-centered care, which is closely related to the assessment, planning, execution, and evaluation processes. Effective implementation of changes by healthcare organizations will ensures that management guarantees a favorable impact on patient safety and quality of care.

Analyzing Evidence that Describes and Guides Nursing Action

Nurses must be familiar with and follow their state's NPA since it specifies their clinical practice and makes them liable for delivering safe patient care by defining nursing practice guidelines from a professional, legal, and ethical standpoint (Lockhart, 2020). Nurses must complete 20 hours of ongoing nursing education to renew their state licensure. In addition to state regulations, most hospitals mandate that staff engage in ongoing education to ensure they remain current on evidence-based research and hospital policies. In order to deliver accurate education, it is critical that nurses maintain current knowledge on cultural sensitivity, as DM2 is determined by what is consumed. To ensure the delivery of high-quality care, nurses should use evidence-based practice (EBP) to guide their decision-making in the field of healthcare and patient education. Peer-reviewed papers are always recommended while conducting research, and they must also be within the last five years from the origin of scientific publications for the most up-to-date study. For this capstone assignment, The Capella University scholarly database , ‘‘CINAHL” Health Care Administration Database through Capella University was used to ensure the information being searched is valid. The search contained the phrases: Diabetes Mellitus Type 2, Hyperglycemia, Type 2 Prevention and Control, Diabetes Education In Adulthood and African Americans Psychosocial Factors. The knowledge found in Dorothea Orem's Self-Care theory (DOSC) will be utilized in this capstone project. The theory is based on the concept that self-care is a human regulatory function, and the person deliberately achieves defined elements to adjust his or her own functioning (Abd El Kader, Ibrahim, Mohamed, & Osman, 2023). The likelihood of a DM2 patient surpassing DM2 is increased when the patient is adequately educated by a healthcare provider addressing self-management nutrition, physical activity, blood sugar and medication management. According to Smith et al., (2030), hemoglobin A2C over 3 to 6 months via SCT-based strategies, including demos, establishing goals, individual and group counselling, cognitive reframatization, support network, and coping strategies (Smith et al., 2020).

Governmental and Organizational Policies

Diverse and governmental policies are in place throughout the globe in an effort to reduce type 2 diabetes. To prevent and manage type 2 diabetes, the government provided a wide bunch of programs such as raising knowledge about the condition, developing treatment strategies, and assisting communities in adopting healthier lifestyles. The legislation that established the NCCC specified that it include 12 private-sector members with expertise in medicine, nursing, pharmacy, patient advocacy, and public health and 11 individuals representing federal agencies including the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS), the Department of Defense, the Department of Veterans Affairs, the Food and Drug Administration (FDA), the Health Resources and Services Administration, the Indian Health Service, the National Institutes of Health (NIH), the Office of Minority Health, and the U.S. Department of Agriculture (USDA) (Herman et al., 2023). While each government sector operates differently, they all share the common objective of combating, preventing, and controlling the DM2 epidemic. The USDA Supplemental Nutritional Assistance Program (SNAP) addresses food insecurity and access to foods and beverages for approximately 42 million lower-income Americans each year (Herman et al., 2023). It aims to improve access to food, fruits and vegetables for individuals with lower income to enhance diet quality and reduce diabetes risk. CDC’s Division of Diabetes Translation (DDT) funds state and local health departments to support programs and activities to prevent or delay the onset of type 2 diabetes and to improve health outcomes for people diagnosed with diabetes (“DP18-1815 | Diabetes | CDC,” n.d.). These programs provide funding to the public with assistance in Diabetes education, medication management, testing, and resource referrals. Diabetes requires complex medical treatment and is a widespread issue in society that requires a comprehensive strategy that involves enabling government support at all levels.

Conclusion

Diabetes mellitus may appear intimidating to someone who has just been diagnosed, since it calls for extensive expertise, great commitment and cautious decision making (Smith et al., 2020). Receiving a fresh diagnosis of diabetes will not bring happiness to anyone. Leah was unaware of her health status due to a lack of education and access to healthcare. Leah requires comprehensive instruction on self-management and prevention training for DM2 in order to combat it effectively. Being in the United States of America will grant her access to government-funded services, improved healthcare, and medication. While she may not be advancing to the LVN program right now, she’s one step closer to improving her physical health and getting a better quality of life. .

Reference

Abd El Kader, A. I., Ibrahim, M. E., Mohamed, H. S., & Osman, B. M. (2023). Diabetes Distress and Self-Care Activities Among Patients With Diabetes Type II: A Correlation Study. SAGE Open Nursing, 9. https://doi.org/10.1177/23779608231189944

Centers for Disease Control and Prevention. (2020). National diabetes statistics report, 2020. Centers for Disease Control and Prevention; U.S. Dept of Health and Human Services. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

Type 2 Diabetes. (2023, April 18). Retrieved from https://www.cdc.gov/diabetes/basics/type2.html#:~:text=About%2038%20million%20Americans%20have,adults%20are%20also%20developing%20it.

Chen, V., Ning, H., Allen, N. B., Kershaw, K. N., Khan, S. S., Lloyd‐Jones, D. M., & Wilkins, J. T. (2019, May 1). Lifetime Risks for Hypertension by Contemporary Guidelines in African American and White Men and Women. https://doi.org/10.1001/jamacardio.2019.0529

DP18-1815 | Diabetes | CDC. (n.d.). Retrieved from https://www.cdc.gov/diabetes/programs/stateandlocal/funded-programs/dp18-1815.html

Herman, W. H., Schillinger, D., Bolen, S., Boltri, J. M., Bullock, A., Chong, W. P., . . . Wu, S. S. (2023, January 26). The National Clinical Care Commission Report to Congress: Recommendations to Better Leverage Federal Policies and Programs to Prevent and Control Diabetes. https://doi.org/10.2337/dc22-1587

Hosp. Readmission Reduction | CMS. (n.d.). https://www.cms.gov/medicare/quality/value-based-programs/hospital-readmissions

Lockhart, L. (2020). Nurse practice acts and the provision of safe, competent care. Nursing Made Incredibly Easy!, 18(3), 56–56. https://doi.org/10.1097/01.nme.0000658204.89628.2a

Opara, N. U., & Opara, E. U. (2022). Applying the principles of Evidence-Based Public Health in addressing the diabetes mellitus epidemic among African-American communities living in the district of Colombia: A literature review. Journal of Public Health Research, 11(3), 227990362211157. https://doi.org/10.1177/22799036221115772

Smith, Y., Garcia-Torres, R., Coughlin, S. S., Ling, J., Marin, T., Su, S., & Young, L. (2020). Effectiveness of social cognitive theory–based interventions for glycemic control in adults with type 2 diabetes mellitus: Protocol for a systematic review and meta-analysis. JMIR Research Protocols, 9(9), e17148. https://doi.org/10.2196/17148

What is Diabetes? (2023, September 5). Retrieved from https://www.cdc.gov/diabetes/basics/diabetes.html