I need someone to do this cumulative project by Tomorrow. I will attach the essays that will be needed for this project.

Evidence - Based Practice proposal

Section - A

February 8, 2021

Section A

The place of employment is in an acute care hospital and usually dealing with the step-down patients. The facility is providing an intermediate level of care between the intensive care units and the general medical-surgical wards. The facility is handling different patients from different ethnic groups. The focus of the facility is to reduce the rate of common chronic illness such as type – 2 diabetes.

The healthcare providers promote healthy behaviors in the facility. For the patient with these chronic illnesses, the management is focused on supporting health behaviors approaches to reduce the risk of complications from these illnesses and reducing the risk of developing these illnesses. One of the strengths of the facility in relation to the promotion of healthy behaviors is that it focuses on patient education. At the healthcare facility of employment, even though the healthcare providers are focused on the promotion of healthy behaviors to help in the reduction of chronic illnesses like type 2 diabetes, there is a lack of the diabetic educator. There are no specialized exercise trainers in the facility to guide every patient on the type of exercise that they should be involved in to reduce the risk of developing the disease. Even though the facility does not have a diabetic educator, nurses play a significant role in educating the patient via written education, demonstration and verbal education. If it is not within the budget of the organization to have an onsite diabetic educator, nurses should be educated extensively and should be provided with tools necessary to educate diabetic patients effectively.

The facility is weaker when it comes to the follow-up especially when the patients are discharged from the facility. This is making it hard to ensure that patients are adhering to the practice guidelines and taking foods to ensure that they are free from exposure and complications associated with diabetes disease. The poor follow-up process is caused by the limited number of healthcare providers in the facility especially nurses and the increase in the number of patients seeking services in the facility. It will be recommended for the facility to follow up on the patients who are discharged from the facility to know if the community - based exercise program is working for them. Patients should be given a log to record daily blood sugar readings and information about the program so that effectiveness of the program can be understood. The nurse educator at the facility focuses on EBP and brings out EBP practices and explains to the nurse. For example, recently the educator started nurse driven protocols to remove foley catheters which is based on EBP. Nurses were given education in detail. Nurses and physicians provide patient care based on EBP. Only problem with the facility is that sometimes the administration doesn’t agree to some of the EBP and policies due to lack of resources and/or budget.

The organizational Culture & Readiness for System-Wide Integration of Evidence-based Practice Survey (Melnyk & Fineout-Overholt, 2014) was completed and showed that.

The health care providers working in the organization have a strong knowledge of EBP and provide patient care based on EBP. The healthcare workers work as a team to provide quality care to the patients. The culture of teamwork and the skills and knowledge of EBP among the health care workers, is one of the biggest strengths of the organization. The administration must include the staff during the decision making process on the units. The organization also lacks a library. A library in the organization can help the staff access EBP based journals and other useful information. This way the organization wouldn’t need to spend as many resources on education on EBP policies, repeatedly. Since most of the EBP related information can be accessed in the library.

Section B

One of the evidence-based practices that have been proposed is the community - based physical exercise program to help patients managing type 2 diabetes. The community follow-up process also requires an adequate number of healthcare workers. This implies that the implementation process of the community-based exercise is not effectively carried out thus affecting the overall goal that is aimed at ensuring that the chronic illnesses related to type 2 diabetes is dealt with accordingly. This therefore implies that the adoption or implementation of the community-based exercise program is not done as per the requirement in this facility to help in ensuring that there is a reduction in the weight and blood sugar levels.

Section B

PICOT

PICOT Question – Do the adult patients with type 2 diabetes (P) show improvement in their blood sugar levels and reduction in weight (O) with the help of community – based exercise program (I) as compare to patients who are unable to participate in the program (C) in an acute care facility, monitored over a 6 weeks period (T).

Literature Review

According to Akanni et al (2017), the dissemination of evidence-based programs is helpful in improving the health outcomes among the elderly population. It helps in understanding the factors that influence the community adoption of evidence-based programs. According to this study, Texercise Select is a community-based health promotion program that improves the functional health, the physical activity, nutritional habits, and the quality of life among adults. Such programs are cost-effective strategies that help in increasing the physical activities and improvement (Akanni et al. 2017).

Shirinzadeh et al (2019) performed a systematic review on the effects of community - based programs on diabetes prevention among the low and middle income nations. According to the authors, the community-based program that addresses physical activities is significantly beneficial in the prevention and management of type 2 diabetes mellitus especially in the high income nations. The study further indicates that community-based exercise program is positively impacting on the anthropometric indices and the HbA1C (Shirinzadeh et al., 2019).

Study by Mendes et al (2017) is focused on looking at how the implementation of the cheaper and community based exercise programs for the middle-aged and older patients with type 2 diabetes is beneficial to the control and management of diabetes and cardiovascular risk. The authors reveal that having a long-term, community-base, combined exercise program that is developed in a low-cost exercise approaches are effective in bringing about the control of the glycemic (Mendes et al., 2017).

According to Tan et al (2017), metabolic syndrome (MetS) together with its subclinical illnesses are becoming major public health concerns. The authors aimed at determining the impacts of the physical activity and the nutritional program for the reduction of MetS percentages. The outcome of the study revealed that community based physical activity is helping in the reduction of MetS percentage. It helps in the improvement of several metabolic and anthropometric parameters (Tran , et al., 2017).

Vanugopal et al (2017) aimed at evaluating the impacts of short term yoga-based lifestyle intervention in the management of diabetes and pre-diabetes within a pilot community-based research work. Based on the outcome of the study, it is evident that short-term yoga lifestyle intervention when implemented in the community is helping in the effective process of reducing the levels of fasting plasma glucose in type 2 diabetes and pre-diabetes (Venugopal et al., 2017).

Physical activity is one of the most important factors in reducing the risk of developing diabetes and reducing the complications related to diabetes. Research shows that when community - based programs are followed by type - 2 diabetic patients, there is a significant reduction in overall blood sugar levels and HbA1c. There are a lot of community - based programs available to the diabetic patients like Texercise, yoga or some other workout programs to suit a patient's need and interest. But, the health care professionals have to make sure that the program is covered by insurance or has a minimal charge. At the same time, discussion with the patients is crucial before a patient is discharged from the hospital so that any barriers that patient might have, can be taken care of.

References

Melnyk, B. M; Fineout-Overholt, E. (2014, July). Grand Canyon university - digital resources. Retrieved February 04, 2021, from http://gcumedia.com/digital-resources/wolters-kluwer/2014/evidence-based-practice-in-nursing-and-healthcare_a-guide-to-best-practice_ebook_3e.php

Akanni, O., Smith, M., & Ory, M. (2017, May 20). Cost-effectiveness of a community exercise and nutrition program for older adults: Texercise select. Retrieved February 03, 2021, from

Mendes, R., Sousa, N., & Reis, V. M. (2017). Implementing Low-Cost, Community-Based Exercise Programs for Middle-Aged and Older Patients with Type 2 Diabetes: What Are the Benefits for Glycemic Control and Cardiovascular Risk? International Journal of Environment Research and Public Health, 14(9), 1057.

Shirinzadeh, M., Afshin-Pour, B., Angeles, R., Gaber, J., & Agarwal, G. (2019). The effect of community-based programs on diabetes prevention in low- and middle-income countries: a systematic review and meta-analysis. Global Health, 15(1), 10. doi:10.1186/s12992-019-0451-4

Tran , V. D., James , A. P., Lee , A. H., Jancey, J., Howat , P. A., & Mal, L. M. (2017). Effectiveness of a Community-Based Physical Activity and Nutrition Behavior Intervention on Features of the Metabolic Syndrome: A Cluster-Randomized Controlled Trial. Metabolic Syndrome and Related Disorders, 15(2).

Venugopal, V., Rathi, A., & Raghuram, N. (2017). Effect of short-term yoga-based lifestyle intervention on plasma glucose levels in individuals with diabetes and pre-diabetes in the community. Diabetes & Metabolic Syndrome: Clinical Research and Reviews, 11(2), S597-S599.