L-MANUSCRIPT SECTION VI

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MSN Project Manuscript Section IV-V

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-

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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).

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

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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.

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)?

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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

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.

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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.

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.,

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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.

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

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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

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

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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:

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.

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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

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.

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• 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

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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