LRDSHP PRACT Resp 2

ASSIGNMENT:

1. Provide a brief summary of what your DNP Project entails.

2. Describe the individuals you interviewed, including, relevance of qualifications to your DNP Project, and rationale for choosing.

3. Write a summary of how this expert consultation regarding nursing practice will affect your DNP Project.

4. Share your experience and summary in the discussion board with your peers.

5. Attach transcripts of each interview performed.

 

RUBRIC

20 pts

Exceptional

One post written in response to fellow learners’ post and each between 100-150 words. Response substantive insightful and contain at least one reference.

STUDENT’S PROJECT:

1. Provide a brief summary of what your DNP Project entails.

My DNP project will address Prediabetes in our Primary Care Clinic at NYCHHC/Queens Hospital.  The objective of this project is to determine if education on lifestyle interventions- physical activity and diet, and weight loss- will decrease Hemoglobin A1C and delay the onset of Type 2 Diabetes.

The quality measure variables

 The quality measure variables for this project will be as follow:

 

Quality measure 1 Variable- Hemoglobin A1C %

Quality measure 2 Variable – Weight in kg

Quality measure 3 Variable-Daily physical activity log- minutes per day.

 

The selected variables will indicate the average glucose levels, weight change in kilograms and daily activity log in minutes per day and will show the progress in diabetes prevention in accordance with ADA (2021) Guidelines on Diabetes Prevention.

2.Describe the individuals you interviewed, including, relevance of qualifications to your DNP Project, and rationale for choosing.

For this project I interviewed a clinical pharmacist, a medical doctor, a nutritionist, a registered nurse, and a certified diabetes educator. I chose these providers because the ADA guidelines requires that a pharmacist, a healthcare provider- MD, NP, PA; and Registered Nurse or CDE provide education on lifestyle modifications to patients with prediabetes (ADA, 2021). In addition, in our clinic these providers regularly follow up with patients with Prediabetes.

Write a summary of how this expert consultation regarding nursing practice will affect your DNP Project. This expert consultation helped me:

1. Understand the gaps in Prediabetes management in Primary care clinic- we are not providing educational sessions to our patients on lifestyle modifications.

2. This expert consultation helped me plan my intervention – educational session on lifestyle modifications

Current guidelines on Prediabetes strongly recommend lifestyle interventions – diet (level B evidence), exercise (level A evidence), weight loss (Level A evidence) and healthy lifestyle (level A evidence) to decrease the blood sugar levels and prevent Diabetes onset (ADA, 2014; ADA, 2021.) “The Diabetes Prevention Program demonstrated that an intensive lifestyle intervention could reduce the risk of incident type 2 diabetes by 58% over 3 years” (ADA, 2021). American Diabetes Association emphasizes that hemoglobin A1c measurements can assist with prediabetes management and guide the interventions (ADA, 2014; ADA, 2021).

Share your experience and summary in the discussion board with your peers/ This expert consultation was very helpful and very professional. I was delighted to meet with such highly professional and knowledgeable experts. I liked that we tried to look into the issue in a holistic way and also through patient lenses. We tried to be sensitive to our patient population and discussed the specifics of our clients. We decided we will follow the ADA guideline and will address weight management, physical activity and dietary modifications in our educational sessions.  

Interview with Clinical Pharmacist, Nick Niceforo, Pharm.D., BCACP, BC-ADM, CDE

Mira: Hi Nick, I would like to ask you some questions in regards to prediabetes management in primary Care

Nick: Hi Mira, yes of course, I will be happy to respond to your questions.

Mira: What role does a pharmacist play in Prediabetes management?

Nick: I usually discuss weight loss/weight management in reference to Diabetes/Hyperlipidemia (HLD)/Hypertension (HTN) treatment through my collaborative practice agreement (CDTM).

· I try to discuss some therapeutic life-style changes initially with my patients such as diabetic plate method/portion control, DASH diet, Mediterranean diet, etc.

Mira: Is there a particular practice model, guideline, policy, standard of care, or other scholarly product that guides this discipline on this problem?

Nick: the American Diabetes Association (ADA) offers guidelines on Prediabetes. Obesity management is a part of their prediabetes treatment recommendation.

Mira: How do clinical pharmacists work in conjunction with other members of the medical team to address prediabetes?

Nick: When I meet a patient with Hypertension who has Prediabetes, I discuss weight management, dietary and lifestyle modifications as well. I work through collaborative practice with providers; in my current role I focus on diabetes, HTN, HLD management. This allows me to practice as a mid-level practitioner and start/stop/adjust medications, place referrals, orders lab work as it pertains to these disease states.

· I often place nutrition referrals for my patients, as an integral part of disease management, are life-style modifications to maintain a “healthy” weight and activity level.

· At nearly every encounter, diet/activity is reviewed and 1-2 goals are set.

· In previous roles, I have also closely worked with mental health providers as some patient’s use food as a means to control their depression, anxiety, previous drug use history and various eating disorders.

Mira: Are there scheduled meeting times regularly? As needed?

Nick: I generally meet with patients every 2-12 weeks depending on the control of their other disease states as I do not specifically focus on prediabetes management in my current role.

· I discuss patients with their providers via chart notes and verbally as needed, generally prior to the patient’s next visit to better assess their progress.

Mira: What would be necessary to adequately address prediabetes management at hand?

Nick: More providers need to recognize prediabetes as a disease state and begin aggressive life-style therapies and education on lifestyle modifications early on. This would also include insurance companies offering coverage for the cost of prediabetes management, exercise programs and specific meal plan programs with proven long-term results such as Weight Watchers.

Mira: Thank you Nick.

Nick: You are welcome and good luck to you!

Interview with a Chronic Disease Management/ Collaborative Care RN, Parvin Begum

 

 Mira: Hi Parvin, I would like to ask you some questions in regards to Prediabetes management in Primary Care.

Parvin: Hello Mira, very nice – I will be happy to assist you.

Mira: Parvin, What role does your discipline play in addressing this issue?

Parvin: Registered nurses play a pivotal role in prediabetes management by assisting with lifestyle modifications such as diet, weight management, exercise.

Mira: Is there a particular practice model, guideline, policy, standard of care, or other scholarly product that guides this discipline on this problem?

Parvin: We follow ADA (2021) guidelines and Diabetes Prevention Program, which guides all Registered Nurses to uphold certain ethical and evidence-based guidelines in relation to lifestyle modifications, including diet and weight management.  Registered Nurses assess, diagnose and provide educational interventions, monitoring and evaluation for each patient. The RNs aim to assist the patient in healthy weight loss through education on dietary intake, physical activity, and psychological wellbeing. Monitoring and evaluation focuses on adherence to recommendations and any applicable biochemical or medical testing results.

Mira: How does this discipline work in conjunction with other members of the team to address this issue?

Parvin: Registered Nurses work closely with healthcare providers, nutritionists, nursing staff, and pharmacists in regards to referrals and patient centered care. A healthcare provider must place a referral for a patient in order to be seen by a Registered Nurse. RNs take into considerations current disease state(s), medication(s) and previous history as documented by the healthcare team. Consistent communication between other members of the healthcare team is integral to a patient's health. 

Mira: Are there scheduled meeting times regularly? As needed?

Parvin: Daily huddles occur with many of the healthcare team members in the Primary Care Clinic, this assists in consistent communication with other team members. Patients are seen throughout the day in person, via telephone or video call based on patient preferences. Follow up appointments are available every 1,3, 6, or 12 months dependent on the patient's needs and/or preferences.

Mira: What would be necessary to adequately address prediabetes management at hand?

Parvin: Patient education is crucial. I would suggest provide education not only in the clinic but also through televisits, or special Apps such as Blue Star for example.

Mira: Thank you Parvin, you have been very helpful.

Parvin: Anytime, it is my pleasure. Good luck to you!

Mira:  Thank you!